Therapeutic Effect of Ethanol-gelfoam Mixture for the Treatment of Arterioportal Shunts (APS) in Patients With HCC

Inclusion Criteria: * Age \> 18 * Child-Pugh A or B cirrhosis * ECOG performance status Grade 2 or below * No serious concurrent medical illness * No prior treatment (including surgery) for HCC * Histologically or cytologically proven HCC (an alphafetoprotein level \> 500 ug/ml in the presence of radiological findings suggestive of HCC in a patient with chronic HBV or HCV infection can be considered eligible at investigator's discretion) * Unresectable and locally advanced disease without extra-hepatic disease * Massive expansive or nodular tumor morphology with measurable lesion on CT * Size of largest tumor \<= 15cm in largest dimension * Number of main tumor \<= 5, excluding associated small satellite lesions * Arterioportal shunts (APS) is found in the angiography of HCC blood supply Exclusion Criteria: * History of prior malignancy except skin cancer * History of significant concurrent medical illness such as ischemic heart disease or heart failure * History of acute tumor rupture * Serum creatinine level \> 180 umol/L * Presence of biliary obstruction not amenable to percutaneous drainage * Child-Pugh C cirrhosis * History of hepatic encephalopathy, or * Intractable ascites not controllable by medical therapy, or * History of variceal bleeding within last 3 months, or * Serum total bilirubin level \> 50 umol/L, or * Serum albumin level \< 28g/L, or * INR \> 1.3 * Presence of extrahepatic metastasis * Predominantly infiltrative lesion * Diffuse tumor morphology with extensive lesions involving both lobes. * Hepatic artery thrombosis, or * Partial or complete thrombosis of the main portal vein, or * Tumor invasion of portal branch of contralateral lobe, or * Hepatic vein tumor thrombus