Arterial Chemoembolization For Hepatocellular Carcinoma Research Articles

Diaphragmatic perforation after transcatheter arterial chemoembolization of hepatocellular carcinoma via inferior phrenic artery: a case report

BackgroundTranscatheter arterial chemoembolization (TACE) via the inferior phrenic artery has been recognized to have its own therapeutic role without causing serious procedural complications. We report a case of diaphragmatic perforation after repeated TACE sessions conducted via the right inferior phrenic artery.Case presentationA 43-year-old man diagnosed with hepatocellular carcinoma was admitted to the hospital with a chief complaint of cough. The patient underwent TACE via the right inferior phrenic artery 3 months prior and was discharged without specific complications. Physical examination revealed decreased breathing sounds in the right lower lung zone. Chest radiograph demonstrated a small right pleural effusion. Chest CT scan revealed a small diaphragmatic perforation. The patient was unable to undergo surgical exploration, and a follow-up CT scan after 2 months revealed progression of the right diaphragmatic perforation with massive herniation of omental fat into the thoracic cavity.ConclusionsAlthough TACE via the inferior phrenic artery is a relatively safe procedure, it can be associated with rare but serious complications after repeated procedures. This is a rare case report of diaphragmatic perforation after TACE via the right inferior phrenic artery. Early recognition and prompt surgical management are essential to prevent catastrophic outcomes.

Comparison of local recurrence in transcatheter arterial chemoembolization of hepatocellular carcinoma with or without accumulation of iodized oil beyond corona enhancement area: Short-term results.

BackgroundLocal tumor recurrence of hepatocellular carcinoma (HCC) often occurs in blood drainage areas. Corona enhancement is determined by computed tomography during hepatic arteriography (CTHA) and is considered to represent the blood drainage area. This study aimed to investigate the relationship between embolization of corona enhancement area and local tumor recurrence of patients with HCC who underwent transcatheter arterial chemoembolization (TACE).Patients and methodsThe study retrospectively selected 53 patients with 60 HCC nodules that showed corona enhancement area on late-phase CTHA and showed homogenous accumulation of iodized oil throughout the nodule on non-contrast-enhanced CT performed immediately after TACE. We divided the nodules into two groups, according to whether the accumulation of iodized oil covered the entire corona enhancement area (group A) or not (group B). Local tumor recurrence was compared between the two groups.ResultsThe cumulative local tumor recurrence rates for group A (n = 36) were 2.8%, 2.8%, 8.3% at 3, 6, and 12 months, respectively, whereas the recurrence rates for group B (n = 24) were 20.8%, 45.8%, 75% at 3, 6, and 12 months, respectively. The cumulative local tumor recurrence rates for group A were significantly lower than those for group B (hazard ratio, 0.079; 95% confidence interval, 0.026–0.24; p < 0.001).ConclusionsThe results of the study suggest that the corona enhancement area may be an accurate safety margin in TACE which should be performed until the embolic area covers the entire corona enhancement area.

The first two cases of posterior reversible encephalopathy syndrome (PRES) secondary to conventional transcatheter arterial chemoembolization of hepatocellular carcinoma

BackgroundPosterior reversible encephalopathy syndrome (PRES) is a very rare complication secondary to transcatheter arterial chemoembolization (TACE). Only two patients with liver metastasis have been reported. We report for the first time two cases of hepatocellular carcinoma (HCC) patients occurred PRES secondary toTACE.Case presentationThe two patients with HCC developed headache, epilepsy, expressive aphasia, visual impairment and loss of consciousness, 11 and 3 h after conventional TACE (c-TACE) surgery. One patient experienced raised blood pressure during and after TACE, accompanied by a significant elevated creatinine. The magnetic resonance imaging (MRI) of the two patients showed multiple abnormal signals in the brain, mainly located in the white matter region. Combined with the clinical symptoms and MRI findings, PRES was diagnosed. Their symptoms and MRI changes improved significantly in the next two weeks.ConclusionThe PRES in this report is chemoembolization-associated syndrome, which might be related to the use of chemotherapy agents during TACE. And if neurological symptoms occur after TACE, patients should be closely monitored to exclude PRES.

A case of pulmonary foreign body granuloma formation after transcatheter arterial chemoembolization for hepatocellular carcinoma.

Key messageWe experienced a case of pulmonary foreign body granuloma diagnosed by bronchoscopy in a patient with multiple lung lesions after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma. We speculate that the lesions may be caused by transarterial migration of the materials used for TACE.

The Risk Assessment and Clinical Research of Bile Duct Injury After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma.

PurposeTo retrospectively evaluate the risk factors and the clinical outcomes of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and to evaluate factors that aid clinical detection and subsequent treatment of the injured bile duct.Materials and MethodsAll patients undergoing TACE for HCC were retrospectively reviewed for identification of bile duct injury. The clinical spectrum of all the patients analyzed including patients’ demographics, laboratory data, radiologic imaging and mode of treatment.ResultsFrom January 2015 to December 2017, a total of 21 patients (4.3%) out of 483 patients with 693 TACE procedures were identified to have bile duct injury at our single institution. There were 17 males and 4 females, with a mean age of 59.8±11.6 years (range 34–84). About 14.3% (3/21) patients show the high-density shadow around the bile duct wall in one week non-enhanced CT, and 76.2% (16/21) cases ALP>200 U/L, all these patients showed bile duct injury on the subsequent follow-up CT. Post-TACE follow-up blood biochemistry showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increased significantly compared with pre-TACE level. The incidence of various types of bile duct injuries on CT was intrahepatic bile duct dilatation (57.1%), biloma (25.7%) and hepatic hilar biliary strictures (17.1%), respectively. Patients with prior hepatectomy as well as proximal arterial chemoembolization carried a higher risk of post-TACE bile duct injury in terms of microvascular damage to the peribiliary capillary plexus.ConclusionBile duct injury complicating TACE is not caused by a single factor, but by a variety of factors, and is closely related to the microvascular compromise of the bile ducts and subsequent chronic biliary infection. Lipiodol deposited along the bile duct wall and the sharp rise of ALP>200 U/L in one week after TACE can predict bile duct injury and early intervention may prevent the occurrence of serious complications. The probability of bile duct injury in patients with prior hepatectomy and proximal arterial chemoembolization increases significantly.

Application of iron/barium ferrite/carbon-coated iron nanocrystal composites in transcatheter arterial chemoembolization of hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has been widely used in clinical practice as a first-line treatment for unresectable hepatocellular carcinoma (HCC). However, the current therapeuticeffect of TACE is far from satisfactory and thus requires further improvement. TACE combined with multifunctional magnetic particles may be a promising approach for the treatment of HCC. In this study, we designed a new magnetic drug carrier system consisting of micron-sized iron powder, barium ferrite (BaFe12O19), and carbon-coated iron nanocrystals (CCINs). CCINs possess properties, such as high drug loading and sustained release. BaFe12O19 could attract both CCINs and iron powder to form larger clusters after magnetization. Altogether, the triple therapeutic effects of chemotherapeutic enhancement, embolization, and thermal ablation could be realized herein. Further experiments indicate that the system has a high drug-loading capacity, good controlled-release effect, and no significant cytotoxicity. Under the action of a medium-frequency magnetic induction device, the magnetic induction temperature could reach 43 °C in one min while the maximum temperature of 70.8 °C could be reached in 2.5 h. Overall, this new carrier system displayed excellent antitumor effects in a mouse model. Our findings demonstrate the great application prospects of this system in TACE for HCC.

Transcatheter arterial chemoembolization of hepatocellular carcinoma on liver cirrhosis in patients awaiting liver transplantation

Transcatheter arterial chemoembolization of hepatocellular carcinoma on liver cirrhosis in patients awaiting liver transplantation OBJECTIVE. To evaluate the role of TACE as a method of neoadjuvant antitumor therapy of HCC before LT.METHODS AND MATERIALS. From January 1998 to April 2020, we performed 245 OLTs in 229 patients, among them in 25 (10.2 %) for HCC associated with LC. We analyzed treatment results of 16 patients who received 49 TACE sessions as neoadjuvant therapy. 10 (62.5 %) patients fell under Milan criteria, 6 (37.5 %) – beyond them. According to the Child – Pugh score of LC, two (12.5 %) patients matched A stage, 12 (75 %) – B stage, two (12.5 %) – C stage. According to the BCLC (Barcelona Clinic Liver Cancer) staging system, 10 patients matched A1–A4 stage and 6 – B stage. Totally, we performed 49 TACE sessions, both classical with lipiodol and hemostatic sponge, and with drug-eluting beads from 1 to 7 (on average 3) times. In all cases Doxorubicin was used.RESULTS. Technical success was 100 %. There were no complications. We performed RFA in three patients as an adjunct, in two patients – laparoscopic RFA-assisted atypical liver resection and in one patient – sequential resection and RFA. According to the m-Recist criteria, a complete response was observed in 6 (37.5 %), partial – in 7 (43.75 %), and stabilization – in 3 (18.75 %) patients. It was possible to achieve a tumor response to the treatment in 4 patients and return them to the Milan criteria. LT was performed in all 16 patients, among them – 14 (87.5 %) within the Milan criteria. The waiting periods for LT from the beginning of TACE were from 2 to 30 (on average 12.5) months. According to the histological studies, in 13 (81 %) patients, total and subtotal necrosis of HCC was revealed in excised organs.CONCLUSION. The results of the performed study indicate that neoadjuvant TACE delays the growth of HCC masses and prolongs (up to 30 months) a safe waiting period for the donor liver.

Comparison of the effectiveness of celiac versus common hepatic artery injection for the detection of hepatocellular carcinoma and of the feeding artery on cone-beam computed tomographs obtained during hepatic angiography.

BackgroundCone-beam computed tomography (CBCT) has been widely used during transcatheter arterial chemoembolization for hepatocellular carcinoma.PurposeTo evaluate the sensitivity of CBCT for the detection of hepatocellular carcinomas and the tumor feeders by comparing celiac artery (CA) and common hepatic artery (CHA) injection.Material and methodsWe retrospectively enrolled 30 patients (52 hepatocellular carcinoma lesions) who had undergone CBCT-assisted transcatheter arterial chemoembolization. In 17 procedures (28 hepatocellular carcinomas) we acquired CBCT scans using CA injections (CBCT-CA) and in 18 (24 hepatocellular carcinomas) we used CHA injections (CBCT-CHA). Of the 30 patients, 5 underwent CBCT-CA and CBCT-CHA at different transcatheter arterial chemoembolization procedures. We performed inter-group comparisons of the detectability of hepatocellular carcinoma, the feeding artery, the intrahepatic artery branch order, and the tumor-to-liver contrast.ResultsCBCT-CA detected all 28 hepatocellular carcinomas and 27 of their feeders (96.4%); CBCT-CHA identified 22 of 24 hepatocellular carcinomas (91.7%) and 21 of their feeders (95.5%). There was no significant inter-group difference in the detectability of hepatocellular carcinoma lesions (p = 0.21) or feeding arteries (p = 0.69). CBCT-CHA was superior for the assessment of the tumor-to-liver contrast and the intrahepatic artery branch order (both: p < 0.01).ConclusionCBCT-CA and CBCT-CHA were equally useful for the detection of hepatocellular carcinoma and of the feeding artery, although CBCT-CHA yields better visualization of hepatocellular carcinoma and the hepatic artery. Thus CA injection seems sufficient for lesion and vessel detection when the insertion of an angiographic catheter into the CHA is difficult.

Effect and Molecular Mechanisms of Jiedu Recipe on Hypoxia-Induced Angiogenesis after Transcatheter Arterial Chemoembolization in Hepatocellular Carcinoma.

Transcatheter arterial chemoembolization (TACE) is one of the effective treatment methods for hepatocellular carcinoma (HCC) in middle and late phases. However, TACE-induced hypoxia may promote the angiogenesis and section of some cytokines, such as IL-8, and, thereby, lead to tumor metastasis. Therefore, we investigated the effect of Jiedu Recipe (JR), which has been demonstrated as an effective Traditional Chinese Medicine (TCM) recipe on HCC, on TACE-induced cytokines upregulation and hypoxia-induced angiogenesis. A total of 88 hepatocellular carcinoma (HCC) patients treated with TACE were enrolled and divided into a JR group or control group. TACE induced significant increases of neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), IL-1β, IL-2R, IL-6, and IL-8. JR treatment significantly inhibited the elevation of IL-8 compared with control. In vitro, JR significantly inhibited the hypoxia-induced overexpression of IL-8, HIF-1α, and VEGF mRNA in Huh 7 cells. ELISA assay demonstrated the effect of JR on IL-8 expression. Both hypoxia and IL-8 may promote angiogenesis which was suppressed by JR. Western blot showed that IL-8 upregulated the expression of phosphorylation of AKT, ERK, NF-κB, and VEGFR, which were inhibited by JR. On the other hand, effects of IL-8 on the increase of p-AKT and p-ERK were also blocked by LY294002 and U0126, respectively. In conclusion, our results indicated that JR may inhibit hypoxia-induced angiogenesis through suppressing IL-8/HIF-1α/PI3K and MAPK/ERK pathways after TACE in HCC patients.

ACUTE LUNG INJURY FOLLOWING TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION WITH DRUG ELUTING BEADS LOADED WITH DOXORUBICIN

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Transcatheter arterial chemoembolization (TACE) is commonly used as palliative management of primary hepatocellular carcinoma (HCC). Acute lung injury after this procedure is very rarely reported but has been seen. We describe a case of TACE-induced pneumonitis. CASE PRESENTATION: A 60-year old female with significant past medical history of hepatocellular carcinoma, hepatitis C cirrhosis complicated by ascites, bleeding varices, and encephalopathy presented for scheduled transcatheter arterial chemoembolization (TACE). She received TACE of LC beads loaded with doxorubicin of the left hepatic artery. She had this procedure three times prior in the past year without any complications. On hospital day 3 she was noted to have an episode of desaturation to the mid-70s, chest x-ray was done and showed no acute pathology. She continued to require 1-2L of oxygen via nasal cannula and desaturation with ambulation. Pulmonary computed tomography angiography (CTA) was ordered due to continued oxygen requirement which showed new bilateral central ground-glass and reticular opacities with relative sparing of the lung bases, new since a CT chest performed 2 months prior. The patient had no infectious symptoms or leukocytosis, and remained hypoxemic despite aggressive diuresis- a workup for diffuse parenchymal lung disease included ANA, ANCA, CCP, RF, and hypersensitivity pneumonitis which were all negative. Bronchoscopic evaluation of the patient was considered, however she declined. She was started on prednisone for presumed TACE-induced pneumonitis and was discharged with home oxygen and follow-up with pulmonology. She was seen one month after discharge with repeat chest imaging which showed near complete resolution of the diffuse ground-glass opacities. She was no longer requiring supplemental oxygen at home and was started on a gradual steroid taper with plans to continue until subsequent follow-up in three months, however the patient passed away from complications of cirrhosis. DISCUSSION: TACE is commonly used as palliative treatment in primary HCC. The procedure involves occluding portions of the hepatic artery that supplies the tumor. Commonly reported complications of this procedure include postembolization syndrome which is characterized by fatigue and abdominal pain, other local complications such as ischemic necrosis which could result in liver failure, spontaneous rupture of tumor, and gallbladder infarction can occur. We described a case of acute lung injury three days after TACE with doxorubicin-eluting beads (DEB-TACE). Review of the literature revealed only a few case reports of such a complication. CONCLUSIONS: Although an unusual complication, this entity will be more important given the increasing prevalence of DEB-TACE. Reference #1: Aladdin, M. & Ilyas, M. (2011). Chemoembolization of Hepatocellular Carcinoma with Drug-Eluting Beads Complicated by Interstitial Pneumonitis. Seminars in Interventional Radiology, 28(2), 218-211. Reference #2: Alifakioti D. et al. (2014). Acute Eosinophilic and Neutrophilic Pneumonia Following Transarterial Chemoembolization with Drug-Eluting Beads loaded with Doxorubicin for Hepatocellular Carcinoma: A Case Report. Respiration 88, 426-429. Reference #3: Fang, LJ. et al. (2019). Clinical Characteristics and Outcomes of Acute Lung Injury Caused by Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A retrospectiveCohort Study from a Single Institution in China. Anal Cell Pathol. DISCLOSURES: No relevant relationships by Luan Nghiem, source=Web Response No relevant relationships by Sheshadrie Saha, source=Web Response no disclosure on file for Ryan Webster

Biliary complications after transcatheter arterial chemoembolization for hepatocellular carcinoma

Biliary complications after transcatheter arterial chemoembolization for hepatocellular carcinoma

Clinical Characteristics and Outcomes of Acute Lung Injury Caused by Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Retrospective Cohort Study from a Single Institution in China

Background Acute lung injury (ALI) is a rare but life-threatening pulmonary complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The aim of this study was to characterize the common risk factors, clinical features, imaging findings, treatments, and outcomes of acute lung injury caused by TACE. Methods A retrospective study was performed on all TACE-associated ALI cases that were diagnosed at authors' hospital from January 2015 to June 2018. Results The study included 14 ALI cases where the mean age of patients was 60.9 ± 11.7 years (range 41-82 years), with a mean onset time of 2.4 ± 1.6 d after TACE. Of the 14 patients, 8 patients (57.1%) developed acute respiratory distress syndrome (ARDS). 7 patients (50%) had underlying chronic respiratory disease and hepatic arteriovenous fistula was detected in 6 patients (42.6%), both of which were significantly higher than control group (P < 0.05). Dyspnea (92.9%) was the most common symptoms. Pleural effusion (64.3%), diffuse pulmonary infiltration (42.9%), and accumulation of Lipiodol in lung field (42.9%) were frequent radiologic abnormalities. 11 patients (78.6%) achieved remission after treatment, and the 30-day mortality rate was approximately 21.4%. Patient's median survival time after the development of ALI was merely 4.3 months, which was obviously worse than control group (4.3 months vs. 13.5 months, P < 0.05). Conclusion This study illustrates that TACE-associated ALI is a rare pulmonary complication with a high mortality rate. We infer that pulmonary Lipiodol embolization might be one of the main causes of TACE-associated ALI. Thus, HCC patients who are at high risk should be closely evaluated and monitored during TACE to avoid such potentially fatal complication.

The Efficacy and Safety of Steroids for Preventing Postembolization Syndrome after Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma.

Steroids are often administered at the time of transcatheter arterial chemoembolization (TACE), a standard treatment of hepatocellular carcinoma (HCC), with the expectation of preventing postembolization syndrome. Here we investigated the precise effects of steroids on TACE. We prospectively enrolled 144 HCC patients from 10 hospitals who underwent TACE. Three hospitals used steroids (steroid group, n=77) and the rest did not routinely use steroids (control group, n=67). The occurrence of adverse events and the algetic degree at 1-5 days post-treatment were compared between the groups. Fever (grades 0-2) after TACE was significantly less in the steroid group (56/21/0) compared to the control group (35/29/3, p=0.005, Cochran-Armitage test for trend). The suppressive effect of steroids against fever was prominent in females (p=0.001). Vomiting (G0/G1/ G2-) was also less frequent in the steroid group (70/5/2) versus the control group (53/10/3), but not significantly (p=0.106). The algetic degree and the grade of hematological adverse events, including hyperglycemia, did not differ between the groups. We conclude that the administration of steroids was useful for the prevention of adverse events after TACE in patients with HCC.

Incidence and risk factors of contrast-induced nephropathy after transcatheter arterial chemoembolization in hepatocellular carcinoma.

Transcatheter arterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate incidence and risk factors of contrast-induced nephropathy (CIN) after TACE in patients with HCC. In this single-center retrospective study, we examined 461 consecutive TACE sessions in 260 patients between January 2003 and October 2015. CIN was defined as an increase in serum creatinine levels by ≥ 0.5mg/dl or ≥ 25% from baseline within 72h after TACE. We calculated incidence rate of CIN and tried to identify its risk factors by logistic regression analysis. Twenty-one cases of CIN (5%) were observed in 461 TACE sessions. One patient required subsequent hemodialysis transiently. In univariate analysis, tumor size > 5cm [odds ratio (OR) 5.76, 95% confidence interval (CI) 2.34-14.14, p < 0.001], chronic kidney disease (OR 2.54, 95% CI 1.05-6.14, p = 0.04), serum hemoglobin level [OR 0.79 (per 1g/dl increase), 95% CI 0.64-0.98, p = 0.03] and serum albumin level [OR 0.44 (per 1g/dl increase), 95% CI 0.19-1.02, p = 0.05] were associated with the development of CIN. Stepwise logistic regression methods showed that tumor size > 5cm (OR 7.81, 95% CI 2.99-20.46, p < 0.001) and serum albumin [OR 0.29 (per 1g/dl increase), 95% CI 0.11-0.75, p = 0.01] were risk factors of CIN. In this study, HCC tumor size and lower serum albumin level were independent predictors of CIN after TACE.

Randomized clinical trial of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization for hepatocellular carcinoma with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria.

4077 Background: To determine treatment efficacy and safety of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) (hereafter, TACE+RFA) in patients with intermediate stage (BCLC stage B) hepatocellular carcinoma (HCC) beyond Milan criteria. Methods: In this randomized clinical trial, 110 patients with intermediate stage HCC beyond Milan criteria (single tumor with diameter 5-7cm, median; 3-5 multiple nodules with diameter less than 5cm) were included and randomly assigned to TACE+RFA group (n=55) and TACE group (n=55) at liver cancer institute, Zhongshan hospital. The primary endpoint was overall survival (OS). The secondary end point was progression-free survival (PFS) , time to progress (TTP) and best objective response (BOR). Results: The median OS in TACE+RFA and TACE group were 29 and 18 months, respectively. The median TTP and BOR were 15.7 months and 69.1 % in TACE+RFA group and 12.4 months and 40.0 % in TACE group (P=0.004). The 1-, 3-, and 4-year overall survivals for TACE+RFA group and TACE group were 97.2%, 67.9% and 59.4% versus 84.0%, 46.7% and 37.3% , respectively (P = 0.008). The corresponding PFS were 47.3%, 27.2% and 21.7% versus 35.6%,15.3% and 11.4% , respectively (P = 0.04).The incidences of major complications in TACE+RFA group were comparable to those in TACE group (P=0.14). Conclusions: TACE+RFA was superior to TACE in improving tumor response and overall survival for patients with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria. Clinical trial information: NCT03636620.

Assessment of Treatment Efficacy Immediately After Combined Therapy of Ultrasound-Guided Radiofrequency Ablation and Conventional Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Comparison Between Multidetector-Row CT and MRI

Background: In the case of combined therapy, potential accumulation of iodized oil (lipiodol) in the liver parenchyma around the index tumor may directly interfere with the imaging evaluation of the treatment efficacy immediately after the procedure. We postulated that magnetic resonance imaging (MRI) has the potential to precisely evaluate the ablation zone immediately after radiofrequency ablation (RFA) combined with conventional transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) because the effect of lipiodol retention on MRI signal intensity is minimal. Objectives: To prospectively compare multidetector-row CT (MDCT) and MRI for evaluation of the ablative margin (AM) and index tumor immediately after combined treatment with conventional TACE and ultrasound-guided RFA for HCC. Patients and Methods: This study included 33 consecutive patients with 45 HCCs in whom both contrast-enhanced MDCT and MRI were performed immediately after RFA combined with TACE. Two radiologists independently reviewed the images in terms of the ease of visually discriminating between the AM and index tumor (positive versus negative target sign) and the AM status within the RFA zone. The AM status was divided into AM-plus (completely surrounding tumor), AM-zero (partly discontinuous, without bulging tumor portion), and AM-minus (partly discontinuous, with bulging tumor portion). The McNemar test and kappa statistics were used to compare the CT and MRI data for the incidence of a target sign. The clinical and imaging features were analyzed for the correlation with the local tumor progression using univariate and multivariate analysis. Results: The AM and index tumor were visually discriminated within the ablation zone in 36 (80%) and 40 (88.9%) of 45 ablation zones on MDCT and MRI, respectively (P = 0.387; slight agreement, k = 0.0). On the basis of the results of MDCT and MRI, AM status was classified as AM plus (n = 27 and 31, respectively) and AM zero (n = 9 each). Local tumor progression occurred significantly less in cases with AM-plus on MDCT (P = 0.015) and MRI (P = 0.023) during the follow-up period. Conclusion: MDCT and MRI had equivalent ability to differentiate between the AM and index tumor within the ablation zones immediately after RFA combined with TACE.

Change in Perfusion Angiography During Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Predicts Short-Term Outcomes.

OBJECTIVE. The purpose of this study is to quantitatively assess perfusion reductions occurring in hepatocellular carcinoma (HCC) during transcatheter arterial chemoembolization (TACE) using 2D perfusion angiography and to evaluate the relationships between various 2D perfusion angiography parameter changes and short-term tumor response. SUBJECTS AND METHODS. This prospective study included 172 patients (144 men and 28 women; mean [± SD] age, 65.4 ± 10.2 years) who underwent TACE for HCC between November 2015 and November 2017. Two-dimensional perfusion angiography was performed before and after TACE. Pre- and postprocedural CT images were also reviewed. Index lesions were defined as all discrete lesions 1.5 cm or larger. The tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Periprocedural 2D perfusion angiography parameters, including the arrival time, time to peak, wash-in rate, width, AUC, and mean transit time, were compared using the Wilcoxon signed rank test. Correlations between 2D perfusion angiography parameter changes and objective tumor response were evaluated using multivariate logistic regression analysis. RESULTS. A total of 187 lesions meeting the inclusion criteria were identified in 172 patients. All analyzed 2D perfusion angiography parameters were significantly different after versus before TACE (p < 0.001). A significant relationship between periprocedural change in AUC and short-term tumor response was found (odds ratio, 1.535; 95% CI, 1.314-1.793; p < 0.001). CONCLUSION. Two-dimensional perfusion angiography could objectively quantify perfusion reductions and predict short-term tumor response to TACE in patients with HCC.

Abstract No. 619 A novel scoring system to predict overall survival from transhepatic arterial chemoembolization for hepatocellular carcinoma using neutrophil/lymphocyte ratio, albumin, bilirubin, and procedure number

We hypothesized that overall survival (OS) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) can be predicted by baseline labs and initial treatment success. We reviewed 265 HCC patients who underwent 465 TACEs. Neutrophil/lymphocyte ratio (NLR), albumin (g/dL), bilirubin (mg/dL) and procedure number (NALBIP) were evaluated. Lab data were within 3 mo before TACE and modeled as time-varying covariates using uni- and multivariate Cox proportional hazard regressions. Each parameter was assigned a score based on hazard ratio (HR) < 2.5 = 1 (vs. 0) pt or HR ≥ 2.5 = 2 (vs. 0) pts. NALBIP grade was defined by sum of scores from each parameter as: grade A = 0-1 pts, B = 2-3 pts, and C = 4-6 pts. NALBIP grades were compared to OS with Kaplan-Meier analysis. Univariate analysis showed pre-TACE NLR > 3 (HR: 1.74, p=0.0118), log(albumin) < 0.53 (HR: 2.19, p=0.0002), bilirubin > 2 mg/dL (HR: 2.5, p=0.0002), and procedures ≥ 3 (HR: 2.57, p=0.0006) were associated with worse OS. Multivariate analysis indicated all parameters were independently predictive of OS (Table 1). Survival analysis of NALBIP grades revealed that patients assigned grade A, B and C had median OS > 60 mo, 31 mo and 11 mo respectively (log-rank test, P<0.0001; table 1). The NALBIP grade reliably predicts OS and can be a useful tool to guide post-TACE follow-up, in which patients with worse grades will require shorter follow-up intervals.Table 1Predictors of OSParameterUnivariateMultivariateHR95% CIP ValueHR95% CIP ValueNLR>31.741.13-2.680.01181.571.01-2.430.0443log(alb)<0.532.191.45-3.310.00021.681.09-2.610.0183bilirubin>22.51.55-4.050.00022.191.34-3.590.0018procedure≥32.571.50-4.400.00062.131.23-3.670.006795% CINALBIP GradeMedian OS (mo)LowerUpperA>60censoredcensoredB3124censoredC11815alb: albumin, CI: confidence interval, HR: hazard ratio, NALBIP: NLR-albumin-bilirubin-procedure number, NLR: neutrophil/lymphocyte ratio, OS: overall survival. Open table in a new tab

Blood oxygen level–dependent functional magnetic resonance imaging can evaluate the efficiency of transcatheter arterial chemoembolization in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is among the most common malignant tumors worldwide, and transcatheter arterial chemoembolization (TACE) technology has become the first-line treatment for advanced HCC. Another important, recently developed technique is blood oxygen level–dependent functional magnetic resonance imaging (BOLD-fMRI), which utilizes hemoglobin as an endogenous contrast agent and measures deoxygenated hemoglobin content by sampling the oxygen content of tissues, thus reflecting the hemodynamics and pathophysiologic changes in body organs. Currently this technology is being used in patients with liver tumors; that is, it serves as an important tool in follow-up after TACE. The present paper summarizes these developments.

Perforation of the esophagus due to thermal injury after laparoscopic radiofrequency ablation for hepatocellular carcinoma: a case for caution

BackgroundSeveral reported complications associated with radiofrequency ablation for liver tumors are due to thermal damage of neighboring organs. We herein report a first case of esophageal perforation due to thermal injury of laparoscopic radiofrequency ablation (RFA).Case presentationA 75-year-old woman was treated repeatedly with RFA (percutaneous and laparoscopic) and transcatheter arterial chemoembolization for hepatocellular carcinoma. One week after laparoscopic RFA for recurrent HCC located in segment 2 of the liver, dysphagia and thoracic pain occurred. Upper gastrointestinal endoscopy revealed a perforated esophageal ulcer at the esophago-gastric junction. Inflammation was localized because of severe intra-abdominal adhesion due to repeat surgery, so we decided to treat the patient conservatively. The perforation of the esophagus gradually scarred, and exacerbation did not occur after restarting oral intake.ConclusionsWhen patients with a history of abdominal surgery or intra-abdominal inflammation undergo thermal ablation therapy, caution is required, as there is a possibility of thermal injury of unexpected organs.