Repeated ultraselective transcatheter arterial chemoembolization (rusTACE) for hepatocellular carcinoma with portal vein thrombus

Abstract Objectives To investigate the safety and long-term effectiveness of repeated ultraselective transarterial chemoembolization (rusTACE) using a 1.7-Fr-tip microcatheter in HCC patients with portal vein tumor thrombus (PVTT). Methods This retrospective analysis includes HCC patients with PVTT treated with rusTACE between May 2014 and July 2022. A 1.7-Fr-tip microcatheter was used to perform rusTACE for ultraselective embolization of the tumor-feeding artery. Treatment was repeated at least 2 times within 2 months. Treatment responses, survival rates, adverse event, liver function, and tumor-feeding arteries were assessed. Results Twenty patients underwent rusTACE with a mean interval of 42 days between treatments. RusTACE was well-tolerated. Median survival time was 26.1 months, with 1-, 2-, 3-, and 5-year survival rates of 85.0%, 61.0%, 40.9%, and 24.6%, respectively. Complete response (CR) of PVTT was achieved in 75%. Among these, 35% maintained CR of PVTT throughout follow-up (mean, 25.0 months). Univariate analysis showed prognostic factors included Child–Pugh score 5, CR of PVTT, CR of systemic tumors at the end of rusTACE, and liver tumor burden <30%. In 17%, a peribiliary vascular plexus or communicating artery was identified as the tumor-feeding artery. Conclusions RusTACE is a safe and effective treatment option for HCC with PVTT in selected patients (Child–Pugh class A). RusTACE showed a high CR rate and long overall survival. The short interval between treatments and ultraselective embolization of tumor-feeding arteries contributed to favorable outcomes. Advances in knowledge RusTACE can be safely performed in HCC with PVTT and has a high local control rate.