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J Gastroenterol Dig Dis 2017 | Volume 2, Issue 3
World Gastroenterological &
Gastroenterology and Endoscopy
October 30-31, 2017 | Toronto, Canada
World Congress on
Background & Aims:
In the treatment Hepatocellular
Carcinoma infiltrating the hepatic hilum (hh-HCC), surgery
and loco-regional therapies are uneffective and can be
unsafe for possible damage to structures at the hepatic
hilum. Electrochemotherapy (ECT) is a non-thermal ablation
technique able to induce cancer cells necrosis without
affecting stromal structures, biliary ducts and vessels next to
the tumor. We evaluated the feasibility, efficacy and safety of
ECT in a series of patients with hh-HCC.
Materials & Methods:
15 patients (13M, 2F; 43-85 year,
mean: 61 year), 11 in Child-Pugh-A, 4 in Child-Pugh-B-class,
with biopsy proven hh-HCC (diameter range: 2.5-5.5 cm;
mean: 3.6 cm) underwent ECT. 7 patients had complete
right and/or left portal vein tumor thrombosis (PVTT), 2
patients showed partial right PVTT, 6 patients had a hh-HCC
next to main portal vein bifurcation. All patients underwent
endoscopy for evaluation of gastro-aesophageal varices
(GEV) within 3 months before treatment. ECT was performed
with insertion of 4-6 electrode-needles connected to a
generator (Cliniporator Vitae - IGEA, Carpi, Italy) under
general anesthesia plus myorelaxation. 8 minutes after i.v.
injection of Bleomicin (15,000 IU/m2), high voltage electric
pulses were delivered. All patients underwent control of the
efficacy by contrast-enhanced-MDCT 4weeks after treatment
and follow-up CT controls every 6 months thereafter.
Results:
Endoscopy detected grade-F1-GEV in 6 and F2-GEV
in 9 patients. No perioperative major complication occurred.
2/15 (13%) patients died because of hemorrhage fromGEV at
4 and 5weeks after treatment. Both 2 patients had PVTT. Post-
treatment CT showed complete absence of enhancement of
the treated nodule and/or PVTT in 11/13(85%) and partial
necrosis in 2/13(15%) cases. The follow-up ranged from 9
to 28 months (median: 14 months). Follow-up-CT showed
local progression of the tumor in the 2 cases of partial
response. 4 patients dropped-out the follow-up at 6, 9,
10 and 12 months because of death from liver failure in 3
and hemorrhage from gastroaesophageal varices in 1 case,
respectively. In these 4 patients, 6-months-CT confirmed
complete necrosis and absence of local recurrence. In the
other 7 patients, no local recurrence was detected at CT
during follow-up. In 4 patients with PVTT, 2 with partial and
2 with complete PVTT, the imaging showed a patent portal
vein during follow-up. Other 3 patients showed a persistent
avascular non-tumoral shrinked thrombus. During follow-up,
intrahepatic recurrences in other segments were detected in
4/13 (31%) patients.
Conclusions:
ECT seems to be a feasible and effective
treatment for local control of hh-HCC, with a good safety
profile. Patients with PVTT and GEV>F1 are at high risk for
short-term hemorrhage from GEV after ECT (13% in our
series).
e:
luciano_tarantino@fastwebnet.itPercutaneous electro chemotherapy of hepatocellular carcinoma at hepatic hilum: A feasibility study
Luciano Tarantino
1
, Giuseppina Busto
1
, Aurelio Nasto
1
, Fristachi Raffaele
1
, Luigi Cacace
1
, Maria Talamo
1
, Catello Accardo
1
, Sara Bortone
1
, Paolo Gallo
1
,
Paolo Tarantino
1
, Riccardo Aurelio Nasto
1
, Matteo Nicola Dario Di Minno
2
and Pasquale Ambrosino
2
1
Andrea Tortora Cancer Hospital, Italy
2
Federico II University, Italy