Cancer Res Treat.  2015 Apr;47(2):251-258. 10.4143/crt.2014.011.

Changes in Arterioportal Shunts in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis Who Were Treated with Chemoembolization Followed by Radiotherapy

• Oh D
• Shin SW
• Park HC
• Cho SK
• Lim DH
• Paik SW

• KMID: 2132803
• DOI: http://doi.org/10.4143/crt.2014.011

Abstract

PURPOSE
In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and evaluated the changes in AP shunts after chemoembolization followed by external beam radiation therapy (EBRT).
MATERIALS AND METHODS
We analyzed 54 HCC patients with PVTT who were treated with chemoembolization followed by EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), with a daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and after radiation therapy (RT) were reviewed to investigate the AP shunt.
RESULTS
During the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and were evaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%) after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) rate for all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was 13 months. Patients with AP shunt showed poorer median OS than those without AP shunt, but there was no statistically significant difference (median, 12 months vs. 17 months).
CONCLUSION
The AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poor prognosis is associated with an AP shunt. Chemoembolization followed by RT may produce a decrease in AP shunts.

Keyword

Hepatocellular carcinoma; Arterioportal shunt; Radiotherapy; Chemoembolization; Therapeutic

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Portal Vein
Prevalence
Prognosis
Radiotherapy*
Retrospective Studies
Thrombosis
Venous Thrombosis*

Figure

• 

  Fig. 1. The grading system for arterioportal shunting flow. PVTT, portal vein tumor thrombosis; SMV, superior mesenteric vein; SV, splenic vein; RPV, right portal vein; LPV, left portal vein; arrow, shunt flow; red circle, tumor; orange line, hepatic artery; blue, portal vein.

• 

  Fig. 2. Change in arterioportal (AP) shunt after chemoembolization followed by radiation therapy. (A, B) A 76-year-old patient with left main portal vein tumor thrombus (PVTT) had angiography that showed a grade 2 AP shunt. (A) An AP shunt from the left portal vein (arrow) extends to the right portal vein (arrowhead). (B) After chemoembolization followed by RT, the angiography during the second session of chemoembolization showed minimal shunt flow around the left portal vein (arrow). (C, D) A 56-year-old patient had a S2/4 main tumor and segmental PVTT. (C) The angiography during the first session of chemoembolization showed AP shunt flow to the segmental portal vein (arrows). (D) After chemoembolization followed by RT, the AP shunt flow was completely obliterated.

• 

  Fig. 3. The overall survival rates by presence of arterioportal (AP) shunt. The median overall survival was 17 months in patients without AP shunt and 12 months in those with AP shunt (p=0.186).

Reference

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