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Rupture of hepatocellular carcinoma following transarterial embolization/chemoembolization: two cases report and systematic review

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The Chinese-German Journal of Clinical Oncology

Abstract

Objective

Rupture of hepatocellular carcinoma (HCC) following transarterial embolization/chemoembolization (TAE/TACE) is a rare but life-threatening complication. The aim of the study was to explore the incidence, risk factors, clinical characteristics, treatment, and outcomes of this complication.

Methods

We described two cases and reviewed all cases of ruptured HCC after TAE/TACE reported in the literature.

Results

Our search yielded 32 cases of ruptured HCC after TAE/TACE. The overall incidences were 0.45% per patient and 0.21% per session. The mean age of the patients was 57.4 years (range 28–90 years, n = 26, No. of cases with available information). Males accounted for 81% of cases (21/26). The 50% of the cases had histories of primary hypertension, diabetes or peripheral artery disease (6/12). Mean diameter of the tumors was 11.4 cm (range 3–20 cm, n = 27). The 100% of cases had superficial or exophytic tumors (23/23). Portal vein thrombosis was presented in 61.5% of patients (8/13). The median interval between TAE/TACE and rupture was 2 days (range 0 hour — 30 days, n = 31). Management choices included emergency TAE, surgery, and conservative treatment. The overall median survival time was 7 days (n = 19).

Conclusion

Rupture of HCC following TAE/TACE is relatively rare but potentially life-threatening. The management is difficult and prognosis is poor. Large tumor size, superficial or exophytic tumors as well as portal vein thrombosis and comorbidities such as primary hypertension, diabetes or peripheral artery disease may be predisposing factors for rupture.

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References

  1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61: 69–90.

    Article  PubMed  Google Scholar 

  2. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology, 2003, 37: 429–442.

    Article  PubMed  CAS  Google Scholar 

  3. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology, 2002, 35: 1164–1171.

    Article  PubMed  CAS  Google Scholar 

  4. Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 2002, 359: 1734–1739.

    Article  PubMed  Google Scholar 

  5. Chung JW, Park JH, Han JK, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology, 1996, 198: 33–40.

    PubMed  CAS  Google Scholar 

  6. Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med, 1995, 332: 1256–1261.

    Article  Google Scholar 

  7. Qi XH, Wu ZM, Liu Q, et al. Study of hepatic arterial infusion of Endostar combined with TACE on advanced hepatocellular carcinoma. Chinese-German J Clin Oncol, 2008, 7: 568–570.

    Article  Google Scholar 

  8. Gao TN, Lou MW, Wang H, et al. Treatment of primary hepatic carcinoma by transcatheter arterial perfusion of batroxobin combined with TACE: a preliminary clinical study. Chinese-German J Clin Oncol, 2011, 10: 96–99.

    Article  CAS  Google Scholar 

  9. Ritter CO, Wartenberg M, Mottok A, et al. Spontaneous liver rupture after treatment with drug-eluting beads. Cardiovasc Intervent Radiol, 2012, 35: 198–202.

    Article  PubMed  CAS  Google Scholar 

  10. Luo J, Guo RP, Lai EC, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol, 2011, 18: 413–420.

    Article  PubMed  Google Scholar 

  11. Bruls S, Joskin J, Chauveau R, et al. Ruptured hepatocellular carcinoma following transcatheter arterial chemoembolization. JBR-BTR, 2011, 94: 68–70.

    PubMed  CAS  Google Scholar 

  12. Sun JH, Wang LG, Bao HW, et al. Emergency embolization in the treatment of ruptured hepatocellular carcinoma following transcatheter arterial chemoembolization. Hepatogastroenterology, 2010, 57: 616–619.

    PubMed  Google Scholar 

  13. Reso A, Ball CG, Sutherland FR, et al. Rupture and intra-peritoneal bleeding of a hepatocellular carcinoma after a transarterial chemoembolization procedure: a case report. Cases J, 2009, 2: 68.

    Article  PubMed  Google Scholar 

  14. Reichman TW, Anthony T, Millis JM, et al. Uncharacteristically early fatal intraperitoneal rupture of hepatocellular carcinoma following transarterial chemoembolization. Dig Liver Dis, 2009, 41: 175–176.

    Article  PubMed  Google Scholar 

  15. Poon RT, Tso WK, Pang RW, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drugeluting bead. Clin Gastroenterol Hepatol, 2007, 5: 1100–1108.

    Article  PubMed  CAS  Google Scholar 

  16. Xie F, Xu F, Yang JM, et al. Analysis of serious complications of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma. J Med Coll PLA, 2007, 22: 62–64.

    Article  Google Scholar 

  17. Battula N, Srinivasan P, Madanur M, et al. Ruptured hepatocellular carcinoma following chemoembolization: a western experience. Hepatobiliary Pancreat Dis Int, 2007, 6: 49–51.

    PubMed  Google Scholar 

  18. Xia J, Ren Z, Ye S, et al. Study of severe and rare complications of transarterial chemoembolization (TACE) for liver cancer. Eur J Radiol, 2006, 59: 407–412.

    Article  PubMed  Google Scholar 

  19. Ying KS, Huang SH, Chao CJ, et al. Hepatocellular carcinoma rupture after transcatheter arterial chemoembolization. Chin J Radiol, 2004, 29: 41–45.

    Google Scholar 

  20. Choi JH, Kim JH, Won JH, et al. Spontaneous intratumoral hemorrhage into hepatocellular carcinoma during transcatheter arterial embolization: a case report. J Korean Med Sci, 2004, 19: 895–897.

    Article  PubMed  Google Scholar 

  21. Ng SH, Cheung YC, Ko SF, et al. Fatal liver abscess and tumor rupture after transcatheter arterial chemoembolization for hepatocellular carcinoma. Chin J Radiol, 2001, 26: 275–278.

    Google Scholar 

  22. Sakamoto Y, Kita Y, Takayama T, et al. Rupture of hepatocellular carcinoma after transcatheter arterial embolization: an unusual case. Hepatogastroenterology, 1999, 46: 453–456.

    PubMed  CAS  Google Scholar 

  23. Pijl ME, Pattynama PM, van Hoek B. Liver rupture after transcatheter arterial chemoembolization of a giant hepatocellular carcinoma. J Vasc Interv Radiol, 1999, 10: 895–897.

    Article  PubMed  CAS  Google Scholar 

  24. Sakamoto I, Aso N, Nagaoki K, et al. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics, 1998, 18: 605–619.

    PubMed  CAS  Google Scholar 

  25. Liu CL, Ngan H, Lo CM, et al. Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization. Br J Surg, 1998, 85: 512–514.

    Article  PubMed  CAS  Google Scholar 

  26. Raoul JL, Guyader D, Bretagne JF, et al. Prospective randomized trial of chemoembolization versus intra-arterial injection of 131I-labelediodized oil in the treatment of hepatocellular carcinoma. Hepatology, 1997, 26: 1156–1161.

    PubMed  CAS  Google Scholar 

  27. Bismuth H, Morino M, Sherlock D, et al. Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg, 1992, 163: 387–394.

    Article  PubMed  CAS  Google Scholar 

  28. Bilbao JI, Ruza M, Longo JM, et al. Intraperitoneal hemorrhage due to rupture of hepatocellular carcinoma after transcatheter arterial embolization with Lipiodol. A case report. Eur J Radiol, 1992, 15: 68–70.

    Article  CAS  Google Scholar 

  29. Venook AP, Stagg RJ, Lewis BJ, et al. Chemoembolization for hepatocellular carcinoma. J Clin Oncol, 1990, 8: 1108–1114.

    PubMed  CAS  Google Scholar 

  30. Nakao N, Kotake M, Miura K, et al. Rupture of hepatocellular carcinoma following transcatheter arterial embolization. Radiat Med, 1988, 6: 147–149.

    PubMed  CAS  Google Scholar 

  31. Jeng KS, Ching HJ. The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma. World J Surg, 1988, 12: 362–368.

    Article  PubMed  CAS  Google Scholar 

  32. Yamashita Y, Shinzato J, Saito R, et al. Ruptured hepatocellular car- cinoma following transcatheter arterial embolization: a case report. Rinsho Hoshasen (Japanese), 1986, 31: 1053–1055.

    CAS  Google Scholar 

  33. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 1999, 19: 329–338.

    Article  PubMed  CAS  Google Scholar 

  34. Raoul JL, Sangro B, Forner A, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev, 2011, 37: 212–220.

    Article  PubMed  Google Scholar 

  35. Liver Cancer Study Group of Japan. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg, 1990, 211: 277–287.

    Google Scholar 

  36. Chearanai O, Plengvanit U, Asavanich C, et al. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation. Cancer, 1983, 51: 1532–1536.

    Article  PubMed  CAS  Google Scholar 

  37. Ong GB, Chu EP, Yu FY, et al. Spontaneous rupture of hepatocellular carcinoma. Br J Surg, 1965, 52: 123–129.

    Article  PubMed  CAS  Google Scholar 

  38. Clarkston W, Inciardi M, Kirkpatrick S, et al. Acute hemoperitoneum from rupture of a hepatocellular carcinoma. J Clin Gastroenterol, 1988, 10: 221–225.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary Surgery Centre, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China

    Ping Sun, Zifang Song, Qinggang Hu, Jun Xiong, Shaobo Hu, Ruiqing He & Qichang Zheng

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  1. Ping Sun
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  2. Zifang Song
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  3. Qinggang Hu
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Correspondence to Qichang Zheng.

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Sun, P., Song, Z., Hu, Q. et al. Rupture of hepatocellular carcinoma following transarterial embolization/chemoembolization: two cases report and systematic review. Chin. -Ger. J. Clin. Oncol. 12, 76–82 (2013). https://doi.org/10.1007/s10330-012-1101-y

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  • DOI: https://doi.org/10.1007/s10330-012-1101-y

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