TARE and PVE as pre-operative strategies in highly selected patients with primary and metastatic hepatic malignancies

Abstract

Introduction The treatment of hepatic malignancies (hepatocellular carcinoma [HCC], intrahepatic cholangiocarcinoma [ICC], metastatic neuroendocrine tumors [NET] and colorectal hepatic metastases [CRHM]) is challenging. Post-operative liver failure can be mitigated by pre-resection embolization techniques, such as portal vein embolization (PVE) and transarterial radioembolization (TARE). The purpose of this study was to understand the natural history of this treatment algorithm in disparate patient populations. Methods This was a retrospective case-control study from 2008-2018. Population consisted of non-transplant eligible patients who underwent TARE, PVE, or resection; patients were propensity matched based on co-morbidities, diagnosis, Child-Pugh Score, and ECOG score. Analyses were performed with chi-square. Results We identified 196 patients with an average age of 57.8±12.6 years, 119 of which were male (60.7%). 137 patients were Caucasian (CC, 70%) and 59 were African American (AA, 30%). HCC patients were more likely to undergo TARE (36.4%) than all other patients (P= 0.043). AA patients were more likely to undergo any embolization procedure (47% vs 31%, P=0.03), but less likely to undergo PVE (P=0.018). CRHM patients were more likely to undergo pre-resection PVE (80%, P=0.029). TARE was a bridge to resection for 9 patients. Conclusions In select cases, TARE is an option to bridge patients to resection. AA patients underwent more embolization procedures than CC patients.