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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study
Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Raffaele Fristachi, Luigi Cacace, Maria Talamo, Catello Accardo, Sara Bortone, Paolo Gallo, Paolo Tarantino, Riccardo Aurelio Nasto, Matteo Nicola Dario Di Minno, Pasquale Ambrosino
Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy
Giuseppina Busto, Department of Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy
Aurelio Nasto, Riccardo Aurelio Nasto, Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy
Raffaele Fristachi, Luigi Cacace, Department of Pathology, Andrea Tortora Hospital, 84016 Pagani, Italy
Maria Talamo, Catello Accardo, Sara Bortone, Department of Radiology, Andrea Tortora Hospital, 84016 Pagani, Italy
Matteo Nicola Dario Di Minno, Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80138 Naples, Italy
Matteo Nicola Dario Di Minno, Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
Pasquale Ambrosino, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
Author contributions: Tarantino L, Busto G and Nasto A designed the study; Tarantino L, Busto G and Nasto A performed the operations; Tarantino L, Talamo M, Accardo C, and Bortone S performed and evaluated imaging data; Fristachi R and Cacace L performed and analyzed pathology data; Tarantino L, Di Minno MND, and Ambrosino P wrote the manuscript; Gallo P, Tarantino P and Nasto RA collected clinical records and were also involved in editing the manuscript.
Institutional review board statement: This study was approved by the Institutional Board of the Umberto I, A.Tortora Hospital, Nocera inf., Pagani.
Informed consent statement: Written informed consent was obtained from all patients prior to enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: The original anonymous dataset is available on request from corresponding author at luciano_tarantino@fastwebnet.it. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luciano Tarantino, MD, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, Via A. De Gasperi 11-23, 84016 Pagani, Italy.
luciano_tarantino@fastwebnet.it
Telephone: +39-81-9213587 Fax: +39-81-9213520
Received: October 8, 2016
Peer-review started: October 10, 2016
First decision: October 20, 2016
Revised: November 14, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 7, 2017
Processing time: 106 Days and 8.3 Hours
AIM
To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.
METHODS
Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.
RESULTS
Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.
CONCLUSION
In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
Core tip: Six patients with portal vein tumor thrombus (PVTT) at hepatic hilum underwent electrochemotherapy (ECT), a new non thermal ablative technique. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patient, the follow-up computed tomography (CT) demonstrated complete patency of the treated portal vein. Three patients showed a persistent avascular non-tumoral shrinked thrombus at CT during follow-up. No local recurrence was observed in 5/6 patients. One patient, was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after treatment. ECT seems effective and safe for curative treatment of PVTT at hepatic hilum.
