Abstract
Purpose
This study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe.
Methods
Between January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization.
Results
In 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response.
Conclusions
HCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.
Similar content being viewed by others
References
Tanaka S, Shimada M, Shirabe K et al (2005) Surgical outcome of patients with hepatocellular carcinoma originating in the caudate lobe. Am J Surg 190:451–455
Lu CL, Wu JC, Chiang JH et al (1997) Hepatocellular carcinoma in the caudate lobe: early diagnosis and active treatment may result in long-term survival. J Gastroenterol Hepatol 12:144–148
Chaib E, Ribeiro MA Jr, Silva Fde S et al (2007) Surgical approach for hepatic caudate lobectomy: review of 401 cases. J Am Coll Surg 204:118–127
Sakamoto Y, Nara S, Hata S et al (2011) Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe. Surgery 150:959–967
Seror O, Haddar D, N’Kontchou G et al (2005) Radiofrequency ablation for the treatment of liver tumors in the caudate lobe. J Vasc Interv Radiol 16:981–990
Yamakado K, Nakatsuka A, Akeboshi M et al (2005) Percutaneous radiofrequency ablation for the treatment of liver neoplasms in the caudate lobe left of the vena cava: electrode placement through the left lobe of the liver under CT-fluoroscopic guidance. Cardiovasc Intervent Radiol 28:638–640
Terayama N, Miyayama S, Tatsu H et al (1998) Subsegmental transcatheter arterial embolization for hepatocellular carcinoma in the caudate lobe. J Vasc Interv Radiol 9:501–508
Kim HC, Chung JW, Jae HJ et al (2010) Caudate lobe hepatocellular carcinoma treated with selective chemoembolization. Radiology 257:278–287
Miyayama S, Yamashiro M, Hattori Y et al (2011) Angiographic evaluation of feeding arteries of hepatocellular carcinoma in the caudate lobe of the liver. Cardiovasc Intervent Radiol 34:1244–1253
Yoon CJ, Chung JW, Cho BH et al (2008) Hepatocellular carcinoma in the caudate lobe of the liver: angiographic analysis of tumor-feeding arteries according to subsegmental location. J Vasc Interv Radiol 19:1543–1550
Choi JW, Kim HC, Chung JW et al (2012) Chemoembolization via branches from the splenic artery in patients with hepatocellular carcinoma. Cardiovasc Intervent Radiol 35:90–96
Kim HC, Chung JW, Lee IJ et al (2011) Intercostal artery supplying hepatocellular carcinoma: demonstration of a tumor feeder by C-arm CT and multidetector row CT. Cardiovasc Intervent Radiol 34:87–91
Miyayama S, Matsui O, Taki K et al (2006) Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 29:39–48
Hur S, Kim HC, Chung JW et al (2011) Hepatocellular carcinomas smaller than 4 cm supplied by the intercostal artery: can we predict which intercostal artery supplies the tumor? Korean J Radiol 12:693–699
Kim HC, Chung JW, An S et al (2011) Transarterial chemoembolization of a colic branch of the superior mesenteric artery in patients with unresectable hepatocellular carcinoma. J Vasc Interv Radiol 22:47–54
Loukas M, Hullett J, Wagner T (2005) Clinical anatomy of the inferior phrenic artery. Clin Anat 18:357–365
Gwon DI, Ko GY, Yoon HK et al (2007) Inferior phrenic artery: anatomy, variations, pathologic conditions, and interventional management. Radiographics 27:687–705
Miyayama S, Yamashiro M, Shibata Y et al (2012) Arterial blood supply to the caudate lobe of the liver from the proximal branches of the right inferior phrenic artery in patients with recurrent hepatocellular carcinoma after chemoembolization. Jpn J Radiol 30:45–52
Miyayama S, Yamashiro M, Yoshie Y et al (2010) Hepatocellular carcinoma in the caudate lobe of the liver: variations of its feeding branches on arteriography. Jpn J Radiol 28:555–562
Kim HC, Chung JW, Lee W et al (2005) Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 25:S25–S39
Choi WS, Kim H-C, Hur S et al (2014) Role of C-Arm CT in identifying caudate arteries supplying hepatocellular carcinoma. J Vasc Interv Radiol. doi:10.1016/j.jvir.2014.02.028
Kim HC, Chung JW, An S et al (2008) Hepatocellular carcinoma: detection of blood supply from the right inferior phrenic artery by the use of multi-detector row CT. J Vasc Interv Radiol 19:1551–1557
Kumon M (1985) Anatomy of the caudate lobe with special reference to portal vein and bile duct. Acta Hepatol Jpn 26:1193–1199
Sacks D, McClenny TE, Cardella JF et al (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202
Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60
Acknowledgments
This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2013R1A1A2A10011007).
Conflict of interest
Sungmin Woo, Hyo-Cheol Kim, Jin Wook Chung, Hyun-Seok Jung, Saebeom Hur, Myungsu Lee and Hwan Jun Jae have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Woo, S., Kim, HC., Chung, J.W. et al. Chemoembolization of Extrahepatic Collateral Arteries for Treatment of Hepatocellular Carcinoma in the Caudate Lobe of the Liver. Cardiovasc Intervent Radiol 38, 389–396 (2015). https://doi.org/10.1007/s00270-014-0929-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-014-0929-7