Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: Experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center

Sarah Walcott-Sapp, Willscott (Scott) Naugler, Jeong Youn Lim, Jesse Wagner, Susan Orloff, Khashayar Farsad, Kenneth Kolbeck, John Kaufman, Erin Maynard, C. Kristian Enestvedt, Skye Mayo, Kevin Billingsley

Research output: Contribution to journalArticle

Abstract

Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI). Results: Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.

Original languageEnglish (US)
Pages (from-to)1074-1083
Number of pages10
JournalJournal of Gastrointestinal Oncology
Volume9
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Portal Vein
Hepatocellular Carcinoma
Liver
Neoplasms
Survival
Therapeutics
Brachytherapy
Kaplan-Meier Estimate
Group Psychotherapy
Alkaline Phosphatase
Liver Diseases
Multivariate Analysis
Databases
Guidelines
Safety
Drug Therapy

Keywords

  • Hepatocellular carcinoma (HCC)
  • Portal vein invasion (PVI)
  • Portal vein tumor thrombus
  • Transarterial chemoembolization (TACE)
  • Transarterial radioembolization

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

@article{c39b0767aa5344fda428dd78209b15a7,
title = "Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: Experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center",
abstract = "Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95{\%} CI). Results: Most patients (59{\%}) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100{\%} vs. 43{\%}, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.",
keywords = "Hepatocellular carcinoma (HCC), Portal vein invasion (PVI), Portal vein tumor thrombus, Transarterial chemoembolization (TACE), Transarterial radioembolization",
author = "Sarah Walcott-Sapp and Naugler, {Willscott (Scott)} and Lim, {Jeong Youn} and Jesse Wagner and Susan Orloff and Khashayar Farsad and Kenneth Kolbeck and John Kaufman and Erin Maynard and {Kristian Enestvedt}, C. and Skye Mayo and Kevin Billingsley",
year = "2018",
month = "12",
day = "1",
doi = "10.21037/jgo.2018.08.11",
language = "English (US)",
volume = "9",
pages = "1074--1083",
journal = "Journal of Gastrointestinal Oncology",
issn = "2078-6891",
publisher = "Pioneer Bioscience Publishing Company (PBPC)",
number = "6",

}

TY - JOUR

T1 - Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion

T2 - Experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center

AU - Walcott-Sapp, Sarah

AU - Naugler, Willscott (Scott)

AU - Lim, Jeong Youn

AU - Wagner, Jesse

AU - Orloff, Susan

AU - Farsad, Khashayar

AU - Kolbeck, Kenneth

AU - Kaufman, John

AU - Maynard, Erin

AU - Kristian Enestvedt, C.

AU - Mayo, Skye

AU - Billingsley, Kevin

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI). Results: Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.

AB - Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI). Results: Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.

KW - Hepatocellular carcinoma (HCC)

KW - Portal vein invasion (PVI)

KW - Portal vein tumor thrombus

KW - Transarterial chemoembolization (TACE)

KW - Transarterial radioembolization

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U2 - 10.21037/jgo.2018.08.11

DO - 10.21037/jgo.2018.08.11

M3 - Article

AN - SCOPUS:85058160395

VL - 9

SP - 1074

EP - 1083

JO - Journal of Gastrointestinal Oncology

JF - Journal of Gastrointestinal Oncology

SN - 2078-6891

IS - 6

ER -