- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04386772
Portal Vein Embolization Using Coils Plus TAGM vs Multiple Coils for Patients With Perihilar Cholangiocarcinoma or Hepatocellular Carcinoma
Preoperative Portal Vein Embolization Using Coils Plus TAGM vs Multiple Coils for Patients With Perihilar Cholangiocarcinoma or Hepatocellular Carcinoma: a Randomized Controlled Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Perihilar cholangiocarcinoma (pCCA) and hepatocellular carcinoma (HCC) both are common primary hepatobiliary tumors, which often require extensive hepatic resection and challenge perioperative management as surgery remains the only chance of long-term survival for such patients. PVE induces effective hypertrophy on one side of the liver parenchyma ahead of a planned liver resection of the other side which becomes atrophic.
Technically, the percutaneous transhepatic approach becomes the standard of care for PVE. PVEs themselves with different embolization materials could vary in the degree of liver hypertrophy, though some techniques, such as TAE, HVE and stem cell, have been already used in combination with PVE and could promote the hypertrophy. Several aspects on the use of PVE are insufficiently studied and most recommendations are based on low-grade evidence. Large clinical studies that compare the effect of different embolic materials on the hypertrophy response are lacking. PVE using multiple coils to completely occlude all the target segmental and sectional branches is a conventional and fundamental approach in our center, which ensured a reliable hypertrophy response with a low PVE-related morbidity and post-hepatectomy liver failure rate in the past decades. PVE using with tris-acryl gelatin microspheres (TAGM) distally and coils proximally, which needs more interventional experience, has become one of standard approaches in our center. However, the study of high-grade evidence regarding the hypertrophy effect of PVE with TAGM and coils is still lacking.
In this randomized study, the investigators aim to compare PVE using TAGM plus coils to PVE using coils alone, in term of PVE-related complications, hypertrophy degree, hepatectomy completion rate, post-hepatectomy liver failure rate, features of immunohistochemical examination on parenchyma, for patients stratified by either pCCA or HCC.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Feng SHEN, MD, PhD
- Phone Number: 0086-21-81875005
- Email: shenfengehbh@sina.com
Study Contact Backup
- Name: Bin YI, MD, PhD
- Phone Number: 0086-21-81887805
- Email: billyyi11@163.com
Study Locations
-
-
Shanghai
-
Shanghai, Shanghai, China, 200438
- Recruiting
- Easter hepatobiliary surgery hospital
-
Contact:
- Bin YI, MD
- Phone Number: 021-81887565
- Email: billyyi11@163.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Male or female patients > 18 years and ≤ 70 years of age.
- Diagnosis of pCCA or HCC (through imaging, serology, and/or histological biopsy)
- Performance status: Karnofsky score ≥ 70
- Candidates for right portal vein embolization for potential major hepatectomy with curative intent. Volumetric indication for PVE is less than 40% of standardized FLR.
- Selective biliary drainage on FLR side for patients with pCCA should be performed when total bilirubin level is above 85.5μmol/L or bile duct dilation of FLR presents. Transcatheter arterial chemoembolization should be performed between 1 and 4 weeks before PVE for patients with HCC.
- Criteria of liver function: Child-Pugh A-B7 level, serum total bilirubin < 85.5μmol/L after biliary drainage in pCCA, alanine aminotransferase and aspartate aminotransferase ≤ 3 times the upper limit of normal value.
- Patients who can understand this trial and have signed the informed consent.
Exclusion Criteria:
- Patients with apparent cardiac, pulmonary, cerebral and renal dysfunction, which may affect the treatment.
- Patients with a history of any other malignant tumor, or allergic to iodine or gelatin.
- Subjects participating in other clinical trials.
- Platelet count < 80×109/L and/or moderate or severe esophageal varices.
- ICGR15 ≥ 15% for HCC patients
- Obstructive jaundice lasts for >2 months before PVE for pCCA patients.
- Tumor becomes unresectable by local progression and/or distant metastasis presents before PVE.
- Right portal vein is occluded by tumor invasion or embolus before PVE.
- Free portal vein pressure >20 mmHg or porto-hepatic vein fistula at the beginning of PVE procedure.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: PVE with coils plus TAGM
PVE with coils proximally plus TAGM distally and subsequent major hepatectomy
|
PVE with TAGM distally and coils proximally and subsequent scheduled major hepatectomy.
Sequential transcatheter arterial chemoembolization and PVE for patients with HCC.
Selective biliary drainage on future liver remnant (FLR) side for patients with pCCA when obstructive jaundice is present.
|
Active Comparator: PVE with multiple coils
PVE with multiple coils and subsequent major hepatectomy
|
Procedure: PVE with multiple coils PVE with multiple coils proximally and distally and subsequent scheduled major hepatectomy.
Sequential transcatheter arterial chemoembolization and PVE for patients with HCC.
Selective biliary drainage on FLR side for patients with pCCA when obstructive jaundice is present.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PVE related morbidity
Time Frame: During and 2 weeks after PVE procedure
|
The rate of major and minor PVE-related complications
|
During and 2 weeks after PVE procedure
|
Hypertrophy degree of standardized FLR
Time Frame: 2 weeks after PVE procedure
|
The difference of standardized FLR ratios before and 2 weeks after PVE
|
2 weeks after PVE procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hepatectomy completion rate
Time Frame: The end of hepatectomy procedure
|
The rate of completed major hepatectomy in each Arm group
|
The end of hepatectomy procedure
|
Liver failure rate after major hepatectomy
Time Frame: 3 months after hepatectomy
|
The rate of liver failure measured by 50-50, TB peak 7mg, and ISGLS criteria
|
3 months after hepatectomy
|
Immunohistochemical stainings of liver parenchyma
Time Frame: During (sampling) and immediately after hepatectomy (IHC examination)
|
Immunohistochemical stainings of hypertrophic and atrophic parenchyma including anti-albumin, anti-PCNA, TUNEL staining, etc.
|
During (sampling) and immediately after hepatectomy (IHC examination)
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Adenocarcinoma
- Neoplasms, Glandular and Epithelial
- Digestive System Neoplasms
- Liver Diseases
- Liver Neoplasms
- Pathological Conditions, Anatomical
- Carcinoma
- Carcinoma, Hepatocellular
- Hypertrophy
- Cholangiocarcinoma
- Klatskin Tumor
Other Study ID Numbers
- EHBHKY2018-02-024
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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