Korean J Radiol.  2007 Aug;8(4):320-327. 10.3348/kjr.2007.8.4.320.

Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation

• Ko HK
• Ko GY
• Yoon HK
• Sung KB

• KMID: 1110729
• DOI: http://doi.org/10.3348/kjr.2007.8.4.320

Abstract

OBJECTIVE
To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT). MATERIALS AND METHODS: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve. RESULTS: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE. CONCLUSION: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Keyword

Hepatocellular carcinoma; Liver transplantation; Chemoembolization

MeSH Terms

Adult
Aged
Antineoplastic Agents/administration & dosage
Carcinoma, Hepatocellular/blood supply/mortality/*therapy
*Chemoembolization, Therapeutic
Cisplatin/administration & dosage
Contrast Media/administration & dosage
Female
Follow-Up Studies
Humans
Iodized Oil/administration & dosage
Liver Neoplasms/blood supply/mortality/*therapy
Liver Transplantation
Living Donors
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local/mortality/*therapy
Survival Rate

Figure

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  Fig. 1 A.Contrast-enhanced arterial-phase axial CT image of the liver 17 months after living donor liver transplantation shows the single arterial enhancing mass (arrow) in the posterior portion of the transplanted liver. B.Arteriogram from the celiac trunk (late arterial phase) shows an area of tumor blush in the transplanted liver (arrow). C.Arteriogram from the celiac trunk immediately after embolization shows that the tumor blush has disappeared. D.Contrast-enhanced arterial-phase axial CT image of the liver one month after transcatheter arterial chemoembolization reveals complete iodized oil accumulation (arrow) in the tumor. We interpreted this patient as having CR. E.Contrast-enhanced arterial-phase axial CT image of the liver 22 months after transcatheter arterial chemoembolization shows a decrease in the size of the recurrent hepatocellular carcinoma with iodized oil accumulation.

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  Fig. 2 A.Contrast-enhanced delayed-phase axial CT image of a transplanted liver six months after living donor liver transplantation, with the left lobe showing multiple recurrent hepatocellular carcinomas in the entire transplanted liver; however, blood flow is preserved in the portal vein. B.Arteriogram from the celiac trunk (late arterial phase) shows multiple hypervascular tumors in the entire transplanted liver. C.Contrast-enhanced arterial-phase axial CT image of the transplanted liver one month after transcatheter arterial chemoembolization shows progression of the recurrent hepatocellular carcinomas in both size and number. Some nodules show partial accumulation of iodized oil. We interpreted this patient as having progressive disease.

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  Fig. 3 A.Contrast-enhanced delayed-phase axial CT image of the liver after living donor liver transplantation reveals a small nodule in the extrahepatic space of the transplanted liver (arrow). This patient had an elevated alpha fetoprotein level at that time. B.Digital image of the intercostal and right inferior phrenic arteries after transcatheter arterial chemoembolization shows subtle accumulation of iodized oil (arrow). C.Contrast-enhanced arterial-phase axial CT image of a transplanted liver one month after transcatheter arterial chemoembolization shows completed accumulation of iodized oil in the nodule (arrow). This patient's alpha fetoprotein level decreased after transcatheter arterial chemoembolization.

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  Fig. 4 Overall cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of living donor liver transplantation.

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  Fig. 5 Cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of recurrent hepatocellular carcinoma diagnosis.

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