Blood Flow Diversion Within Hepatocellular Carcinoma (HCC) after Selective Occlusion of Feeding Arteries (SOFA) and Feasibility of Utilizing the SOFA Technique in Transarterial Chemoembolization (SOFA-TACE).

Abstract

Arterial feeders supplying a hepatocellular carcinoma are known to be interconnected through the sinusoid-like tumor vasculature. It was observed angiographically that when one of the feeders is selectively catheterized for drug delivery in transarterial chemoembolization (TACE), the whole tumor vasculature will be filled up, if the arterial inflow from all the other feeders is temporarily arrested with selective occlusion of feeding arteries (SOFA) using an additional catheter (balloon catheter). The feasibility of using the SOFA technique in TACE (SOFA-TACE) is discussed. In this prospective, monocentric feasibility study, with informed consent obtained, 8 consecutive patients of median age 64.5years (60-68.8) and tumor dimension 4.7cm (3.2-6.1), having specific tumor features (solitary, hypervascularity, well-defined, ≤ 7cm, multiple tumor feeders), received SOFA-TACE using ethiodized oil-cisplatin suspension. Tumor response was assessed with 3-monthly CT using modified RECIST. A single tumor feeder was catheterized for drug delivery (8 cases). All other tumor feeders were successfully occluded with a balloon at one site (8 cases). Complete filling of the vasculature of the whole tumor was achieved in 7 of 8 cases with the SOFA technique as shown on arteriogram and CT, except in a case with an intratumoral septum. There was no complication. Surveillance CT (median 25months, range 22-28) showed complete response in all cases. SOFA-TACE is feasible with reasonable safety and favorable treatment outcome; it may be a valuable technical option that may facilitate the procedures of selective TACE in technically challenging cases.