Selective Transarterial Chemoembolization Research Articles

Transarterial Chemoembolization for Hepatic Metastasis of Solitary Fibrous Tumor

Background: Solitary fibrous tumors (SFT) are rare soft tissue tumors with a typically benign clinical course; however, up to 35% of SFT exhibit metastasis, resulting in a poor prognosis. The management of hepatic metastasis of SFT is yet to be established because of its rarity of cases. Objectives: Herein, we report the clinical results of 13 transarterial chemoembolization (TACE) sessions for hepatic metastasis in 5 patients with SFT. Patients and Methods: Patients with hepatic metastases from SFT who underwent TACE between May 2005 and April 2021 were retrospectively reviewed. Tumor response was evaluated using the modified response evaluation criteria in solid tumors (mRECIST). Results: Five patients (one male, mean age: 59.2 years) underwent 13 TACE sessions, resulting in four partial responses (PR, 30.8%), four stable disease cases (30.8%), and five progressive disease cases (38.5%). No severe complications occurred. Four of seven sessions (57.1%) of selective TACE showed partial response (PR). The mean progression-free survival (PFS) was 2.3 months (range: 0 - 8 months), and for sessions with PR, the mean PFS was 6.3 months (range: 3 - 8 months). The mean overall survival was 32.7 months (range: 18 - 44 months). Conclusion: This report suggests that TACE might be a potentially safe treatment option for hepatic metastasis of SFT, and it could offer a benefit in controlling local tumor growth in cases where selective TACE is applicable.

Achievement of cancer- and treatment-free status by atezolizumab plus bevacizumab combined with or without curative conversion in patients with transarterial chemoembolization-unsuitable, intermediate-stage hepatocellular carcinoma: A multicenter cohort study.

535 Background: Atezolizumab plus bevacizumab therapy is extremely effective in the treatment of intermediate-stage hepatocellular carcinoma (HCC), with a response rate of 44%, as reported in the IMbrave150 trial. Tumor shrinkage is achieved, and cancer- and treatment-free status is possible in many cases using curative conversion with resection, ablation, or selective transarterial chemoembolization (TACE). This concept, i.e., curative conversion by combining systemic therapy and locoregional therapy, has not been reported before. This multicenter study was conducted to clarify the value of curative conversion in intermediate-stage HCC meeting TACE-unsuitable criteria. Methods: This study included 110 consecutive Child-Pugh A patients who received atezolizumab plus bevacizumab as first-line treatment for unresectable and TACE-unsuitable intermediate-stage HCC at seven centers in Japan. Cancer-free rate, treatment-free rate, time to cancer-free status, change in liver function, efficacy in positron emission tomography (PET)-positive HCC, recurrence-free survival (RFS), and overall survival (OS) were assessed in patients who achieved cancer-free status using resection, ablation, selective TACE, or atezolizumab plus bevacizumab alone. Results: Cancer-free status was achieved in 38 patients (35%) (median observation period: 17. 7 months). The modalities of curative conversion were as follows: resection, 7; ablation (including patients who underwent ablation after TACE), 13; and selective TACE (including lenvatinib-TACE sequential therapy), 15. Three patients achieved cancer-free status with only atezolizumab plus bevacizumab therapy. Among the 38 cancer-free patients, 24 achieved treatment-free status. RF5 was 31.8 months (95% confidence interval, 30.5-33.0), and two patients experienced recurrence after reaching cancer-free status. Regarding OS, there were no deaths in any of the groups, and excellent outcomes were obtained. The albumin-bilirubin score did not deteriorate after locoregional therapy or resection. Of seven PET-positive patients who achieved cancer-free status, five achieved treatment-free status. Conclusions: The curative conversion rate (cancer-free rate) in patients treated with atezolizumab plus bevacizumab as the preceding therapy for unresectable and TACE-unsuitable intermediate-stage HCC was 35%. Overall, 22% of patients achieved treatment-free status. Thus, achieving cancer-free and/or treatment-free status should be a therapeutic goal for patients with intermediate-stage HCC without vascular invasion or extrahepatic spread. Clinical trial information: NCT03434379 .

Circulating MiRNA-373 as a Predictor of Response to Super-selective Transarterial Chemoembolization Bridging Therapy in Hepatocellular Carcinoma Patients Awaiting Liver Transplantation.

Super selective transarterial chemoembolization (TACE) has emerged as a bridging therapy for early hepatocellular carcinoma (HCC) patients awaiting liver transplantation. This study aimed at assessing the expression profiles of circulating MiR-210 and MiR-373 as potential predictors of response to TACE bridging therapy in a group of Egyptian HCC cases on top of chronic hepatitis-C infection, awaiting liver transplantation. Fifty-three HCC cases awaiting liver transplantation referred for TACE, were followed up for three months, resulting in forty-five responders and eight non-responders based on modified response evaluation criteria in solid tumors (mRECIST). Circulating pre TACE MiR-210 and MiR-373 expressions were determined using reverse transcription quantitative polymerase chain reaction. Circulating pre TACE MiR-373, but not MiR-210, was significantly higher in non-responders than responders. Receiver operating characteristics (ROC) curve analysis of MiR-373, pre-TACE tumor volume, inflammatory score, and albumin bilirubin (ALBI) grade revealed highest sensitivity for pre-TACE tumor volume (cutoff>11.49 cm3) and highest specificity for pre-TACE MiR-373 (cutoff>1.46-fold change). Multivariate logistic regression revealed pre TACE MiR-373 as a significant independent predictor of TACE response after adjusting for pre TACE tumor volume. Circulating pre-TACE MiR-373 could assist as a noninvasive predictor marker of response to TACE bridging therapy in early HCC patients awaiting liver transplantation.

Long-term survival of a patient with liver metastases from clear cell gastric adenocarcinoma after multimodality treatment including interventional oncology techniques: case report

BackgroundGastric cancer (GC) is the fourth most common cancer and the third leading cancer-related cause of death worldwide since most patients are diagnosed at an advanced stage. The majority of GCs are adenocarcinomas (ACs), and the poorly characterized clear cell AC represents a unique subgroup of GCs and is an independent marker of poor prognosis. Even though the prognosis for patients with advanced GC is poor we present a report of a patient with long-term survival despite having liver metastases from clear cell gastric AC.Case presentationA 45-year-old male with clear cell gastric AC underwent subtotal gastrectomy and postoperative chemoradiation. Only a year and a half after his initial treatment the disease spread to his liver. He received two lines of chemotherapy treatment within the next two years before a right hepatectomy was suggested. Due to an initially insufficient future liver remnant (FLR), transarterial chemoembolization (TACE) and portal vein embolization (PVE) were performed, which made the surgical procedure possible. Shortly after a disease progression in the remaining liver was detected. In the following three years the patient was treated with a carefully planned combination of systemic therapy and different interventional oncology techniques including selective internal radiation therapy (SIRT) and TACE. And as illustrated, an attentive, patient-tailored, multimodality treatment approach can sometimes greatly benefit our patients as he had an overall survival of 88 months despite the poor prognosis of his disease.ConclusionTo the best of our knowledge, this report is the first to describe a patient with liver metastases from clear cell gastric AC treated with interventional oncology techniques (PVE, TACE, and SIRT) in combination with other locoregional and systemic therapies thereby presenting that these interventional oncology techniques can be successfully integrated into long-term management of non-conventional liver tumors.

Conventional or Drug-Eluting Beads? Randomized Controlled Study of Chemoembolization for Hepatocellular Carcinoma: JIVROSG-1302

Introduction: With the advent of effective systemic therapy, transarterial chemoembolization (TACE) is established as a highly effective locoregional treatment modality for carefully selected patients with hepatocellular carcinoma (HCC). This randomized controlled trial was conducted to clarify whether selective TACE with drug-eluting beads (DEB-TACE) loaded with epirubicin or selective conventional TACE (cTACE) with epirubicin-ethiodized oil might be more effective for obtaining complete response(CR) in patients with HCC. Methods: Between March 2016 and May 2019, Child-Pugh class A or B patients with unresectable HCC who were scheduled to receive selective TACE were randomly assigned at a 1:1 ratio to the DEB-TACE arm or the cTACE arm. The primary endpoint was the CR rate at 3 months, as evaluated according to the modified Response Evaluation Criteria in Solid Tumors by an independent review committee, and the secondary endpoints were the CR rate at 1 month and incidences of adverse events. Results: A total of 200 patients (DEB-TACE, 99 patients; cTACE, 101 patients) were enrolled in the study. The CR rates at 3 months and 1 month were significantly higher in the cTACE arm (75.2%, 84.2%) as compared with the DEB-TACE arm (27.6%, 35.7%). However, the frequencies of adverse events of any grade, including pyrexia (DEB-TACE vs. cTACE, 19.4% vs. 45.5%, p = 0.0001), fatigue (5.1% vs. 15.8%, p = 0.0194), malaise (11.1% vs. 25.7%, p = 0.0103), appetite loss (12.1% vs. 28.7%, p = 0.0048), abdominal pain (12.1% vs. 23.8%, p = 0.0423), increased serum bilirubin (22.2% vs. 48.5%, p = 0.0002), hypoalbuminemia (43.4% vs. 60.3%, p = 0.0154), increased serum aspartate aminotransferase (35.7% vs. 81.2%, p < 0.0001), and increased serum alanine aminotransferase (35.7% vs. 77.2%, p < 0.0001), were also significantly higher in the cTACE arm than in the DEB-TACE arm. Conclusions: Selective cTACE appeared to have higher CR rates for local tumor control as compared to selective DEB-TACE for HCC. However, the frequency of postembolization syndrome was also significantly higher in the cTACE group than in the DEB-TACE group. Thus, to achieve CR, cTACE may be selected over DEB-TACE in patients who can be expected to tolerate postembolization syndrome.

Post -TACE Hepatocellular Carcinoma Response Assessment by Modified RECIST and Short Term Post TACE Survival

Background: Transarterial Chemoembolization(TACE) although not curative, can improve the overall survival of patients. Modified response evaluation criteria in solid tumors (mRECIST) is used for the evaluation of the treatment response in patients after TACE. Aims: To assess the post-TACE hepatocellular carcinoma(HCC) response by mRECIST criteria and the short term post-TACE survival. Methods: All patients underwent super selective TACE using epirubicin and mRECIST response was calculated using MRI. Factors were analyzed for the post-TACE response and survival. Results: Among 54 patients with HCC, 42 were analyzed. The mean age was 59.12 ± 8.74 years. Predominant etiology was NASH (31%) and alcohol (23.8%). 23 patients had complete response(CR), 8 patients had partial response(PR), 4 patients had stable disease(SD) and7 patients had progressive disease(PD) as per mRECIST criteria. Objective response(OR) is defined as patients achieving either CR or PR and poor response(PoR) as patients achieving either SD or PD. 73.8 % had an objective response and 26.2% had a poor response. HAP score(P=0.003) and CHILD stage(P=0.011) were the most important predictors of a favorable mRECIST response. 72.7% died during the study period. There was a significant survival difference among patients with (OR) (25.64 months) than patients with (PR) (13.10 months), P=0. 001. mRECIST response predicted survival among the patients but it was not an independent factor as per multivariate analysis (HR=1.08, P=0.02). The independent predictors for survival were post-TACE decompensation (B-1.43, P=0.03), ECOG performance status (B-1.41, P=0.010), and the number of malignant lesions for TACE (HR 2.20, P=0.017). Conclusion: Patients undergoing TACE for intermediate stage HCC has a significant survival advantage when they achieve an objective response as per mRECIST. Proper selection of patients for TACE is important for getting an objective response and for better short-term survival.

Blood Flow Diversion Within Hepatocellular Carcinoma (HCC) after Selective Occlusion of Feeding Arteries (SOFA) and Feasibility of Utilizing the SOFA Technique in Transarterial Chemoembolization (SOFA-TACE).

Arterial feeders supplying a hepatocellular carcinoma are known to be interconnected through the sinusoid-like tumor vasculature. It was observed angiographically that when one of the feeders is selectively catheterized for drug delivery in transarterial chemoembolization (TACE), the whole tumor vasculature will be filled up, if the arterial inflow from all the other feeders is temporarily arrested with selective occlusion of feeding arteries (SOFA) using an additional catheter (balloon catheter). The feasibility of using the SOFA technique in TACE (SOFA-TACE) is discussed. In this prospective, monocentric feasibility study, with informed consent obtained, 8 consecutive patients of median age 64.5years (60-68.8) and tumor dimension 4.7cm (3.2-6.1), having specific tumor features (solitary, hypervascularity, well-defined, ≤ 7cm, multiple tumor feeders), received SOFA-TACE using ethiodized oil-cisplatin suspension. Tumor response was assessed with 3-monthly CT using modified RECIST. A single tumor feeder was catheterized for drug delivery (8 cases). All other tumor feeders were successfully occluded with a balloon at one site (8 cases). Complete filling of the vasculature of the whole tumor was achieved in 7 of 8 cases with the SOFA technique as shown on arteriogram and CT, except in a case with an intratumoral septum. There was no complication. Surveillance CT (median 25months, range 22-28) showed complete response in all cases. SOFA-TACE is feasible with reasonable safety and favorable treatment outcome; it may be a valuable technical option that may facilitate the procedures of selective TACE in technically challenging cases.

To turn weakness into a strength-preoperative future liver remnant (FLR) augmentation with special focus on local tumor control and in-situ immunization for patients with advanced hepatocellular carcinoma (HCC) and liver cirrhosis (LC)

Portal vein embolization (PVE) provokes tumor progression. LC decreases FLR regeneration capacity doubling the risk for patient dropout. Our aim was to develop method of FLR augmentation that convert aggressive tumor into safe vaccine and prolonged waiting period for FLR regeneration into effective In situ immunization period. 3 initially unresectable patients due to small FLR with advanced hepatocellular carcinoma (HCC) and LC were treated. Selective transarterial chemoembolization with short term biodegradable starch microspheres (DSM-TACE), into tumor bearing liver to be resected, was followed by simultaneous PVE of latter. Upon completion of PVE selective intratumoral immunotherapy (HIT-IT) with antiPD-L1 (atezolizumab 1,200 mg) into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells. Predominantly T and NK cells response was observed. All patients had successfully underwent major liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis, even more, in 1 (33%) case planned amount of liver resection was decreased due to achieved tumor downsizing. There were no severe morbidity or Immune-related adverse events (irAEs). Herein we had proposed new aggressive but safe method of FLR augmentation for patients with HCC and LC that could potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation and possible improves long-term outcomes by means of tumor downsizing and HCC immunoscore conversion.

Combined Surgical/Interventional-Radiological Cytoreduction in a Patient with Disseminated Highly Differentiated Neuroendocrine Ileal Tumor

A combined approach to cytoreduction in a patient with a neuroendocrine tumor G1 the ileum with multiple bilobar metastases G2 in the liver, originally considered as a candidate only for drug therapy, has been demonstrated. The first stage was laparoscopic resection of the ileocecal segment of the intestine, followed by interventional radiological intervention — a two-stage selective transarterial oil chemoembolization of the liver with bleomycin. As a result, 90 % cytoreduction, suppression of clinical manifestations, normalization of chromogranin A and serotonin were achieved. The patient continues to be observed without signs of progression for more than 4 years from the moment of diagnosis. It is shown that multidisciplinary treatment of patient with timely inclusion of interventional-radiological interventions allows achieving long-term favorable results in patients with advanced stage of disease.

Preoperative future liver remnant(FLR) augmentation with local tumor control and in-situ immunization for patients with advanced hepatocellular carcinoma (HCC)

Purpose: Portal vein embolization(PVE) provokes tumor progression. Liver Cirrhosis(LC) decreases FLR regeneration capacity doubling the risk for patient dropout. Our aim was to turn weakness into a strength- develop method of FLR augmentation that converts aggressive tumor into a safe vaccine and prolonged waiting period for FLR regeneration into effective In situ immunization period Method: 3 initially unresectable patients due to small FLR with advanced hepatocellular carcinoma(HCC) and liver cirrhosis were treated. Selective transarterial chemoembolization with short term biodegradable starch microspheres(DSM-TACE), into tumor bearing liver to be resected, was followed by simultaneous PVE of latter. Upon completion of PVE selective intratumoral immunotherapy(HIT-IT) with antiPD-L1(atezolizumab 1200mg) into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells level in peripheral blood had started. Anticancer immune response was investigated by comparison of initial histopathology specimen with specimens obtained just before second DSM-TACE+ HIT-IT and finally with specimen of resected tumor bearing liver. Latter were analyzed along with peripheral blood flow cytometry. Results: Predominantly T and NK cells response was observed. All patients had successfully underwent extended liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis, even more, in 1(33%) case planned amount of liver resection was decreased due to achieved tumor downsizing. There were no severe morbidity or Immune-related adverse events (irAEs). Conclusion: Herein we had proposed new aggressive but safe method of FLR augmentation for patients with HCC and liver cirrhosis that could potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation and possible improves long-term outcomes by means of tumor downsizing and HCC immunoscore conversion.

Reverse ALPPS on Makuuchi Vein after Combined Systemic and Local Chemotherapy: Compound Existing CRLM Management Techniques to Achieve Surgical Resectability

Aims: The main aim of this report to show how incorporation of different techniques in CRLM management has created an opportunity for the resection of locally advanced hepatic tumors formerly considered unresectable. Materials and methods: The current study reports the case of a 38 year-old patient with synchronous CRLM involving all three hepatic veins initially deemed unresectable. The patient developed systemic chemotherapy with molecularly targeted therapy and selective transarterial chemoembolization during 12 months. Subsequent imaging demonstrated a decrease in tumor size with unchanged involvement of the major hepatic veins. However, a right accessory hepatic vein (Makuuchi vein) remained free of disease. Left trisectionectomy by reverse-ALPPS technique with right accessory hepatic vein preservation has been performed. Results: The patient was discharged on POD 14. At the most recent follow-up (23 months), he had presented without evidence of disease. Conclusions: Isolated CRLM where surgical resection is first-line treatment, technical advances and surgical innovations can expand the spectrum of curative interventions. Meantime in patients as was presented only the combination of cross-disciplinary techniques may transform primary irresectability. In this report, the simultaneous utilization of non surgical therapies and advanced surgical skills enabled resection for patients with complex tumors.

Oncological care for the patients with hepatocellular carcinoma in COVID-19 pandemic

On April 27, 2020, COVID-19 pandemic affected more than 2,5 million of people in more than 200 countries and caused 185 000 deaths. Healthcare systems have come under enormous stress. In COVID-19 pandemic oncological patients face two serious challenges: the risk of severe infectious disease course and the risk of malignant tumor progression. Forced correction of existing oncological standards of care is based on expert and professional community opinions, and daily gaining experience. The issue resumes the data on COVID-19 influence on liver function among the patients with chronic liver diseases and hepatocellular carcinoma. The guidance on HCC management in COVID-19 pandemic are provided. More than 1,5 million of people suffers from the liver pathology caused by chronic virus hepatitis, alcohol consumption, nonalcoholic fatty liver disease. Mild COVID-19 is often followed by transient liver function disorder which do not need specific treatment. Severe COVID-19 lids to the increase of aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), to the decrease of serum albumin in most cases. Regarding the HCC treatment preference should be given to telemedicine, limitation of contacts in health-care facilities, outpatient treatment, including oral medication (tyrosine kinase inhibitors), and if possible delay of invasive procedures with the help of bridge-therapy and active monitoring. Selecting the patients for surgery, ablation or transarterial chemoembolization (TACE) patients with minimal risk of decompensation, with maximum treatment benefit (on the base of prognostic scales), with lack of comorbid should be preferred. Selective and super selective TACE with drug-eluting beads or radioembolization should be used to reduce the risk of immunosuppression and postembolic syndrome. Live organ transplantation should be considered to be postponed. Targeted therapy could be a temporarily alternative to invasive procedures.

A prospective randomized controlled trial of selective transarterial chemoembolization using drug-eluting beads loaded with epirubicin versus selective conventional transarterial chemoembolization using epirubicin-lipiodol for hepatocellular carcinoma: The JIVROSG-1302 PRESIDENT study.

4518 Background: Transarterial chemoembolization (TACE) with selective catheterization into the segmental or subsegmental hepatic arteries supplying HCC is often performed to achieve the complete local control of HCC in the patients with a limited number of small sized nodules. To clarify which of TACE with drug-eluting beads loaded with epirubicin (DEB-TACE) or conventional TACE with epirubicin-lipiodol (cTACE) can achieve the complete response (CR) more frequently, we performed a randomized controlled trial of DEB-TACE vs. cTACE. Methods: Between March 2016 and May 2019, unresectable HCC patients with Child-Pugh class A or B who were scheduled to receive selective TACE were randomly assigned 1:1 to the DEB-TACE group and the cTACE group. The primary endpoint was the CR rate at 3 months, and the secondary endpoints were the CR rate at 1 month and rate of adverse events (AEs). The response and AEs were assessed according to the modified RECIST by an independent review committee and the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0., respectively. Results: A total of 200 patients (DEB-TACE, 99 patients; cTACE 101 patients) were enrolled from 22 Japanese institutions. The patient characteristics were well-balanced between the two groups. The median number of tumors was one in both groups and the median tumor size was 20.0 mm in the DEB-TACE group and 20.5 mm in the cTACE group. The table shows the CR rates and frequencies of AEs. The CR rates of cTACE at 3 and 1 months were significantly higher than those of DEB-TACE. The frequency of AEs (all grades), including pyrexia, malaise, increased serum total bilirubin (T-Bil) and increased serum alanine transaminase (ALT), was significantly higher in the cTACE group than in the DEB-TACE group. Conclusions: Selective cTACE appeared to have greater efficacy for local tumor control as compared to selective DEB-TACE, however, the frequencies of post-embolization syndromes were higher in the cTACE group than in the DEB-TACE group. Clinical trial information: UMIN000021250 . [Table: see text]

Transarterial Chemoembolization of Metastatic Liver Lesions in Patients with Colorectal Cancer

Aim. To evaluate the efficacy of transarterial chemoembolization in patients with metastases of colorectal cancer in the liver.Materials and methods. A study aimed at investigating the effect of selective transarterial chemoembolization (TACE) of the hepatic artery on liver metastases in colorectal cancer was conducted at the Oncology Centre of the RZhD Central Clinical Hospital No. 2 named after N.A. Semashko, Moscow. The research basis included data for 10 patients, who had undergone chemoembolization of the hepatic arteries using Biosphere microspheres 50– 100 µm — 25 mg and doxorubicin 50 mg.Results. Both immediate and long-term results of up to 12 months were evaluated using the RECIST 1.1 scale. A partial response was achieved after 4 TACE treatments in 22.2 % of cases. The stabilization of the oncological process in the liver was observed after 9 TACE treatments in 50 % of cases. Disease progression was noted after 5 procedures in 27.8 % of cases.Conclusions. Transarterial chemoembolization of metastatic liver lesions in patients with colorectal cancer can be used according to certain indications in specialized centres providing endovascular treatment services.

Stereotactic body radiotherapy in patients with hepatocellular carcinoma in amultimodal treatment setting.

Retrospective evaluation of stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC). We retrospectively analyzed 36 patients (45 lesions) treated between 2011 and 2017. Twenty-seven had previous treatments. Current treatment consisted of SBRT alone (n = 15) or selective transarterial chemoembolization (TACE) followed by SBRT to the same lesions (n = 21). Eight patients received additional local treatments to different lesions. Liver function was predominantly moderately restricted (ChildA: 29, ChildB: 6, ChildC: 1). Treatment planning was based on 4D-computed tomography, dose/fractionation varied depending on location and size, most commonly 3 fractions of 12.5 Gy (65% isodose) and 5 fractions of 8Gy (80% isodose). Median follow-up was 15months. Local recurrence was observed in 3lesions (7%), resulting in 1‑and 2‑year local control rates of 93%. The only significantly predicting factor was the use of abdominal compression. New hepatic lesions occurred in 19patients (52%), 1‑ and 2‑year freedom-from-hepatic-failure (FFHF) was 39% and 32%, respectively. Only the number of treated lesions was predictive for FFHF. Sixteen patients have died, resulting in 1‑ and 2‑year overall survival (OS) of 64% and 41%, respectively, significantly impacted by the number of treated lesions and Child-Pugh class. Severe acute and late toxicity (≥grade 3) was observed in 3% and 8%, respectively. 6patients (17%) received liver transplantation (OLT) after SBRT, of whom 5 showed pathological complete remission. SBRT (±TACE) in highly pretreated HCC is effective and associated with excellent LC and low toxicity. SBRT may be used as definitive or bridging treatment prior to OLT. Patients with multifocal lesions have significantly decreased 1‑ and 2‑year FFHF and OS.

Influence of pretreatment tumor growth rate on objective response of hepatocellular carcinoma treated with transarterial chemoembolization

The study aims to assess the influence of pretreatment tumor growth rate (TGR) on modified response evaluation criteria in solid tumors (mRECIST) objective response (OR) after a first session of selective transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). One hundred fifteen patients (101 men [88%], mean 65.1±10.5years [range 26-87]) with 169 tumors (mean 34.2±29.3mm [10-160]), undergoing a first session of selective TACE for the treatment of HCC between 2011 and 2016, were included. TGR was calculated as the percentage change in tumor volume per month (%/month) on imaging before treatment. TGR cut-off for prediction of OR was identified by receiver operating characteristic curve analysis. Overall 88/189 (52%) and 46/189 (27%) tumors showed complete response (CR) and partial response (PR) (OR rate 79%), while 32/189 (19%) showed stable disease (SD), and 3/189 (2%) were progressive disease (PD) on computed tomography at 1-month post-TACE. The mean pretreatment TGR was 12.0±15.4 (-3.2-90.4) %/month. TGR of tumors showing CR, PR, SD, and PD was a mean 13.2±16.4%, 12.1±15.1%, 5.3±4.5%, and 44.8±20.4%, respectively (P<0.001). The three tumors showing PD had TGR values >20%/month. TGR was significantly higher in tumors with OR (12.8±15.9% vs 5.3±4.5% in SD, P=0.009). A cut-off value of 6.5%/month had the highest predictive value of OR (AUROC 0.65±0.05, P=0.009). Pretreatment TGR is highly variable in HCC before TACE with a U-shaped distribution for the prediction of tumor response. It provides insight into tumor biology that may be used during pretreatment workup to help stratify patients.

Selective TACE with irinotecan-loaded 40 \u03bcm microspheres and FOLFIRI for colorectal liver metastases: phase I dose escalation pharmacokinetic study

BackgroundEfficacy of treatments for colorectal liver metastases after failure of first-line chemotherapy is limited. The aim of this study was to prospectively evaluate the feasibility, tolerability, and pharmacokinetics of selective transarterial chemoembolization (TACE) with irinotecan-loaded 40 μm microspheres combined with systemic FOLFIRI for colorectal liver metastases refractory to oxaliplatin regimen.MethodsThe dose escalation study was conducted in three patient groups with different amounts of irinotecan loaded (50, 75 and 100 mg per mL-microspheres). Selective catheterization was performed to embolize subsegments or segments of located tumors using TACE navigation system. FOLFIRI was administrated 7 days after TACE. Plasma concentration was measured before and time points after administration.ResultsNine patients successfully underwent a total of 22 TACE procedures. Dose-limiting toxicity did not appear at any level. The overall response rate was 55.6%. The median progression free and overall survival were 8.1 and 18.2 months, respectively. The AUC and Cmax of plasma SN-38 per 1 mg injected irinotecan dose were significantly higher in irinotecan-loaded microspheres compared with FOLFIRI (P = 0.009 and P < 0.001, respectively).ConclusionSelective TACE using 40 μm irinotecan-loaded microspheres combined with systemic FOLFIRI was feasible and safe even when a high dose of irinotecan was loaded. Irinotecan-loaded microspheres resulted in a higher plasma concentration and AUC of SN-38 than treatment with FOLFIRI. Further large scale trials to evaluate the efficacy are mandatory.Trial registrationUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry, Registration number; UMIN000015367; Registered date; 08,10,2014.

Rate and Predictive Factors for Sustained Complete Response after Selective Transarterial Chemoembolization (TACE) in Patients with Hepatocellular Carcinoma

Background:To determine the effectiveness and performance of selective conventional transarterial chemoembolization (TACE) and analyze the potential predictive factors of sustained complete response (CR) for patients with hepatocellular carcinoma (HCC).Materials and Methods:Total of 52 patients with HCC (33 males, 19 females; mean age 64.0 ± 9.6 years) who underwent 81 sessions of selective TACE between November 2015 and March 2017 at Songklanagarind hospital were reviewed. The Kaplan-Meier method was used to describe CR rates at various time points. Univariate and multivariate logistic regression models were performed to determine the predictive factors for sustained CR at six months.Results:The CR rates after selective TACE at 1, 4, 6, 9 and 12 months were 87%, 81%, 62%, 40% and 31%, respectively. Univariate and multivariate analyses demonstrated that alpha fetoprotein level <100ng/ml, a tumor size in summation ≤ 30 mm, ≤ 2 sessions of selective TACE and unilobar involvement had a significantly higher odds of sustaining complete response at six months (p =0.018, 0.031, 0.032, and 0.044, respectively).Conclusions:Selective TACE has a good therapeutic results and can sustained complete response in selected HCC patients. Serum AFP≤ 100 ng/ml, a few sessions of selective TACE, tumor size in summation ≤ 30 mm and unilobar involvement were favorable predictive factors for sustained complete response of HCC patients.

3:27 PMAbstract No. 286 - Tumor necrosis after selective transarterial chemoembolization for hepatocellular carcinoma, the role of bead concentration

3:27 PMAbstract No. 286 - Tumor necrosis after selective transarterial chemoembolization for hepatocellular carcinoma, the role of bead concentration

Risks factors for severe pain after selective liver transarterial chemoembolization.

Post-procedural pain is frequent after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), and is only partially prevented by treatment selectivity. Our aim was to determine the risk factors of severe pain after selective TACE for HCC. From January 2012 to June 2014, all treatment-naïve patients undergoing a first selective TACE were included. Risk factors for severe pain, that is, the need for opioid analgesics (grade II-III), were identified by uni- and multivariate analysis. Internal validation of a logistic regression model for prediction of opioid intake was done with bootstrapping. We analysed 335 tumours (mean 47±37mm) in 159 patients (131 men), mean 63.4years old (20-92). Twenty-seven patients (17%) requested opioids. In univariate analysis, opioid intake was associated with young age (P=.021), doxorubicin dose received (P=.031), large HCC (P=.038), absence of chronic liver disease (P<.001) and alpha-foetoprotein levels (P=.03). In multivariate analysis, opioid intake was associated with young age (OR=0.65 per 10years increment, P=.048), absence of chronic liver disease (OR=31.7, P<.001) and a higher fraction of the doxorubicin dose (OR=1.32 per 10% increment, P=.009). The optimism-corrected area under the curve of the prediction model for opioid intake using these three factors was 0.751. In patients with HCC treated with TACE, selective procedure does not always prevent from severe pain. Young patients without chronic liver disease may be more susceptible to severe pain.