2:10 PM Abstract No. 201 - Safety and efficacy of locoregional therapy for hepatocellular carcinoma in patients with indwelling TIPS

Abstract

<h3>Purpose</h3> Locoregional therapy has traditionally been considered contraindicated in patients with hepatocellular carcinoma (HCC) who had previously undergone TIPS. This study compared safety of and imaging response to ablation, arterial embolization, and radioembolization in patients with both TIPS and HCC. <h3>Materials and Methods</h3> The electronic medical record was reviewed to identify 47 patients who had both indwelling TIPS and a diagnosis of hepatocellular carcinoma over a 5-year period. 22/47 (47%) patients underwent locoregional therapy. 16/22 (73%) had Hepatitis C as etiology of their liver disease. 16/22 (73%) had undergone TIPS for variceal hemorrhage. 15/22 (68%) had Child B and 7/22 (32%) had Child C cirrhosis. 10/22 (45%) were ECOG 0. For ablations, median tumor number was 1 and median tumor size was 27 mm. For arterial embolizations, median tumor number was 2 and median tumor size was 24 mm. For radioembolization, median tumor number was 5 and median tumor size was 35 mm. Follow-up imaging response and toxicity were categorized for each procedure to account for multiple interventions. <h3>Results</h3> 27 ablations (14 RFA, 12 PEI, 1 irreversible electroporation) were performed in 13 patients; 16 arterial embolizations (10 chemo and 6 bland) were performed in 9 patients; 7 Y90 radioembolizations were performed in 5 patients. Post-embolization syndrome occurred more frequently in patients undergoing arterial embolization than radioembolization (44% vs. 14%). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the radioembolization group (38% vs. 14%). Classification of patients as having complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) at follow-up is summarized in the Table based on EASL imaging criteria. <h3>Conclusion</h3> Ablation appears to be safe and efficacious for HCC in patients with TIPS. Radioembolization is associated with decreased toxicity and superior imaging response compared to arterial embolization.