Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany.
Cardiovasc Intervent Radiol. 2019 Oct;42(10):1494-1499. doi: 10.1007/s00270-019-02294-7. Epub 2019 Jul 30.
Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC.
Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal (n = 1) or liver veins (n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA.
All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand-foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE (n = 2) or TARE (n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively.
Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients.
肿瘤供血动脉与门静脉或肝静脉之间存在明显的肿瘤内分流是肝动脉治疗 HCC 的禁忌症，因为这些分流的介入治疗通常是不够的。索拉非尼具有抗血管生成作用，适用于 HCC 患者的姑息治疗。在这里，我们报告了使用索拉非尼关闭计划接受 HCC 肝动脉治疗的患者肿瘤内分流的经验。
3 名 HCC 患者，年龄分别为 65 岁、82 岁和 79 岁，表现为肿瘤动脉向门静脉（n = 1）或肝静脉（n = 2）的明显肿瘤内分流。在所有情况下，基于术前 CT 血管造影，已经怀疑存在肿瘤内分流，DSA 证实了分流。所有患者均口服索拉非尼（800 mg/天）至少 4 周，专门用于闭塞分流。此后，对患者进行 CT 和 DSA 重新评估。
所有患者均至少耐受了完整处方剂量 4 周。在 1 例中，由于索拉非尼相关手足综合征，治疗延长并调整剂量（400 mg/天）。索拉非尼治疗后，CT 和 DSA 证实所有患者的肿瘤内分流完全闭塞。未观察到肿瘤进展。此后，所有 3 例患者均成功接受 TACE（n = 2）或 TARE（n = 1）的肝动脉治疗，无并发症。根据 mRECIST，无进展生存期分别为 501、397 和 599 天。
即使短期口服索拉非尼似乎也能有效地闭塞 HCC 患者的肿瘤内分流，从而可能使这些患者能够接受肝动脉治疗。
