Clinical efficacy of TACE using coil or gelatin sponge combined with targeted therapy in the treatment of giant hepatocellular carcinoma with arterioportal fistulas

Abstract

Abstract Background The present study aimed to evaluate the effectiveness of spring coils or gelatin sponges for the embolization of giant hepatocellular carcinoma (HCC) with a hepatic arterioportal shunt (APS) in targeted therapy. Methods A total of 81 patients with a large HCC complicated with APS were divided into two groups on the basis of the use of block-APS embolic agents: the coil group and the gelatin sponge group. Both groups received lipiodol transarterial chemoembolization (TACE) after APS was correspondingly blocked with a coil or gelatin sponge. Sorafenib or lenvatinib was administered 3–5 days before TACE. Results Both groups showed improvement in the incidence of fistula one month after the first TACE session and the last TACE session compared with before treatment. In addition, the improvement in the incidence of fistulas in the coil group was greater than that in the gelatin sponge group [p = 0.003], whereas the compensation of extrahepatic blood vessels was more severe in the coil group. There was no significant difference in median overall survival (OS) (11.13 months, 95% CI 7.67–14.59 months vs. 15.13 months, 95% CI 10.18–20.09 months, p = 0.303) or progression-free survival (PFS) (5.37 months, 95% CI 5.04–5.70 months vs. 5.7 months, 95% CI 0.66–10.74 months, p = 0.376) between the two groups. However, both groups showed early progression of intrahepatic lesions. Conclusions Spring coil or gelatin sponge embolization combined with APS was used for giant HCC patients, which significantly improved the incidence of fistulas.

Keywords

• Arterioportal shunt
• Transarterial chemoembolization
• Hepatocellular carcinoma
• Coil
• Gelatin sponge