Superselective Transarterial Chemoembolization Research Articles

Radiation dose during transarterial chemoembolization and associated factors.

To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. We were able to provide detailed reports on radiation doses during TACE and associated factors.

Achievement of Complete Response and Drug-Free Status by Atezolizumab plus Bevacizumab Combined with or without Curative Conversion in Patients with Transarterial Chemoembolization-Unsuitable, Intermediate-Stage Hepatocellular Carcinoma: A Multicenter Proof-Of-Concept Study

Introduction: 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. When tumor shrinkage is obtained, achieving complete response (CR) is possible in many cases using curative conversion with resection, ablation, or superselective transarterial chemoembolization (TACE) with curative intent. This concept, i.e., curative conversion by combining systemic therapy and locoregional therapy, has not been reported before. This multicenter proof-of-concept study was conducted to show the value of curative conversion in immunotherapy-treated 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. CR rate, drug-free rate, time to CR, change in liver function, efficacy in positron emission tomography (PET)-positive HCC, progression-free survival (PFS), and overall survival (OS) were assessed in patients who achieved CR using resection, ablation, superselective TACE with curative intent following atezolizumab plus bevacizumab or atezolizumab plus bevacizumab alone. Results: Clinical or pathological CR was achieved in 38 patients (35%) (median observation period: 21.2 months). The modalities of curative conversion in 35 patients were as follows: resection, 7; ablation, 13; and superselective TACE, 15. Three patients achieved clinical CR with atezolizumab plus bevacizumab therapy alone. Among the 38 CR patients, 25 achieved drug-free status. PFS was not reached, and 3 patients experienced recurrence after reaching CR. Regarding OS, there were no deaths in any of the CR patients. The albumin-bilirubin score did not deteriorate after locoregional therapy or resection. Of seven PET-positive patients who achieved CR with atezolizumab plus bevacizumab followed by curative conversion, five achieved drug-free status. Conclusion: The achievement of CR rate by curative conversion in patients treated with atezolizumab plus bevacizumab as the preceding therapy for unresectable and TACE-unsuitable intermediate-stage HCC was 35%. Overall, 23% of patients achieved drug-free status and no recurrence was observed from this patient subgroup with CR and drug-free status. Thus, achieving CR and/or drug-free status should be a therapeutic goal for patients with intermediate-stage HCC without vascular invasion or extrahepatic spread.

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.

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.

Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm.

Simple SummaryAlthough transarterial chemoebolization (TACE) is indicated for small hepatocellular carcinoma (HCC) as a second choice, TACE for small HCC is frequently difficult and less effective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. The aim of this study was to evaluate the efficacy of superselective cTACE under guidance software for patients with HCC within three lesions smaller than 3 cm. By using TACE guidance software, 81.2% of HCC lesions could be completely embolized and the cumulative local tumor progression rates in 303 tumors at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

Super-selective transarterial chemoembolization of hepatocellular carcinoma with doxorubicin-eluting beads sized 40–75 microns: assessment of efficacy and safety

We aimed to evaluate the effectiveness and safety of super-selective transarterial chemoembolization (TACE) with doxorubicin-loaded drug-eluting beads (DEB) sized 40-75 μm for hepatocellular carcinoma (HCC) in early and intermediate stages according to Barcelona Clinic Liver Cancer (BCLC) staging system. This single-center retrospective study was conducted with 45 consecutive HCC patients treated by 72 sessions of DEB-TACE during the 2012-2017 period. Thirty-seven patients (82.2%) had single tumor staged BCLC A and B (53.3% and 46.7%, respectively). All procedures were performed by super-selective approach using 1.7-2.0 F microcatheters. Cone beam CT was performed to detect all tumor-feeding arteries and assess the treatment results immediately. Dynamic MRI and laboratory tests were obtained at 1-month follow-up and every 3 months thereafter. Response to treatment according to modified Response Evaluation Criteria in Solid Tumors, demographic and clinical status, laboratory tests, time-to-event durations and rates, complications according to the National Cancer Institute Criteria for Adverse Events were evaluated. A total of 45 patients (median age, 65.6 years; range, 35-88 years; 33 men, 73.4%) were included. Eight patients (17.7%) underwent liver transplantation after DEB-TACE, and 20 (44.4%) died during the follow-up period. Median follow-up was 22 months (range, 13-31), and 42 (93.3%) patients were followed up for more than 1 year. Overall complete response, partial response, and progressive disease rates were 53.3%, 33.3%, and 13.4% at one year and 22.2%, 26.7%, and 13.3% at three years, respectively. For target lesions, these rates were 60.0%, 26.7%, and 13.3% at one year and 28.9%, 6.7%, and 4.4% at three years, respectively. Median overall survival (OS) duration was 24 months (95% CI, 20.9-31.9 months). At one year and three years, OS rates were 71.0% and 44.4%, respectively. The only statistically significant relationship with OS was presence of chronic liver disease, which worsened the OS rate (P = 0.031). Time-to-progression (TTP) was 23 months (95% CI, 15.1-40.0), and progression-free survival (PFS) was 28 months (95% CI, 6.2-39.8). Post-embolization syndrome occurred in 10 patients (22.2%). Transient grade I/II bilirubin and aminotransferase elevation was observed in 26 (57.7%) and 18 (40%) patients, respectively. Super-selective DEB-TACE with doxorubicin-loaded beads sized 40-75 μm is an effective and safe treatment method with prolonged TTP and PFS in early and intermediate stages of HCC. Presence of chronic liver disease is the only significant factor that worsened OS ratios after DEB-TACE.

Transarterial- chemoembolization remains an effective therapy for intermediate-stage hepatocellular carcinoma with preserved liver function.

To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE. Of 158 treatment-naïve patients with intermediate-stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria: no combined therapy within 4weeks after initial TACE, and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analyses using Cox proportional hazards models. The deterioration of liver function after repeated TACE was also evaluated. The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2months. Survival rates at 1, 2, and 3years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75years (P = 0.022), serum α-fetoprotein level ≥ 200ng/mL (P = .010), tumor number ≥ 11 (P = 0.008), and heterogeneous enhancement on dynamic computed tomography (P = 0.024) were poor prognostic factors. The deterioration rate of Child-Pugh score and albumin-bilirubin grade was 18.5% and 12.3%, respectively, after the first TACE, 15.6% and 5.1%, respectively, after the second TACE, and 14.5% and 11.1%, respectively, after the third TACE. Superselective TACE can achieve high tumor response rates with prolonged overall survival for patients with intermediate-stage HCC with preserved liver function. Age, serum α-fetoprotein level, tumor number ≥ 11, and heterogeneous enhancement on dynamic computed tomography indicated significantly poor prognosis.

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.

Abstract No. 540 Usefulness of Dyna computed tomography in hepatocellular carcinoma: transarterial chemoembolization for segment 1 of the liver

To evaluate usefulness of the Dyna-CT in hepatocellular carcinoma treated by transarterial chemoembolization (TACE) for segment 1 (S1) of the liver. Total 24 session of TACE was performed in 20 patients (mean age, 63.0; range, 48-86 years) to treat HCC in S1 from March 2017 to July 2019. Multiplanar reconstruction (MPR) images and embolization guidance program by 3-dimensional reconstruction of the Dyna-CT were used for diagnosis of HCC and superselection of the feeding artery with microcatheter set. TACE procedures were done by conventional method with doxorubicin, ethiodized oil, and gelatin sponge. Digital subtraction angiogram (DSA) and Dyna-CT Images obtained during TACE including medical records were reviewed to evaluate detection of the HCC, tumor size, characteristics of the feeding artery, superselected artery, and radiation dose for Dyna-CT. Follow-up liver dynamic CT images were also reviewed to evaluate success of treatment. HCCs were visualized 14 cases (58.3%) on DSA and all cases on MPR images of the Dyna-CT. Mean size of HCCs was 16.1 mm(range, 5-94 mm) on Dyna-CT. Numbers of the feeding artery were one in 22 cases (91.7%) and two in 2 cases (8.3%). Among of 26 feeding arteries, they were originated from territory of the right hepatic artery (RHA) in 14 and left hepatic artery (LHA) in 12. Most common origin of the segment 1 hepatic artery (S1HA) was RHA (n = 11, 42.3%). Superselective TACE of the S1HA was successful in 15 arteries (57.7%) and TACE was done at proximal artery to origin of the S1HA in 11 arteries (42.3%). Dense uptake of ethiodized oil was detected in all cases after superselective TACE of the S1HA and in 2 cases (18.1%) after proximal TACE. Mean cumulative dose of radiation by Dyna-CT was 201.9 mGy. Dyna-CT was useful to detect the HCC in S1 compared with DSA. Embolization guidance seems to be helpful for superselective TACE and uptake of the ethiodized oil in the HCC.

Improved Local Tumor Control and Survival Rates by Obtaining a 3D-Safety Margin in Superselective Transarterial Chemoembolization for Small Hepatocellular Carcinoma.

To investigate technical factors affecting local tumor control of small hepatocellular carcinoma (HCC) treated by superselective conventional transarterial chemoembolization (cTACE) using lipiodol and to compare prognoses between groups with and without these factors. Sixty-three consecutive patients with 73 HCC nodules (diameter, 1-3cm) treated by cTACE were retrospectively analyzed. A positive or a negative 3D-safety margin was defined as a ≥ 1-mm area of lipiodol accumulation or as a diameter of lipiodol accumulation < 1mm in liver parenchyma surrounding the tumor using plain CT images obtained within a week after TACE. Uni- and multivariate analyses were performed to identify technical factors determining local tumor control rate. Subgroup analysis of survival rates in treatment-naïve patients was performed according to the detected factors. In univariate analyses, three-dimensional (3D)-safety margin and portal vein visualization were associated with local tumor control rates. In multivariate analysis, only positive 3D-safety margin remained a significant contributor (p = 0.001). Two-year cumulative local disease-free survival rates with positive and negative 3D-safety margin were 82.8% and 19.3%, respectively (p = 0.001). In subgroup survival analysis of the 36 newly diagnosed patients, the 1-, 2-, 3-, 4-, and 5-year cumulative OS rates for patients with and without positive margins were 100% versus 100%, 96.4% versus 75.0%, 81.8% versus 62.5%, 74.4% versus 41.7%, and 47.0% versus 0%, respectively (median survival time; 57.6months vs. 37.1, p = 0.047). Obtaining a 3D-safety margin can suppress local tumor recurrence and prolong survival in superselective cTACE for small HCC.

Monitoring Liver Function of Patients Undergoing Transarterial Chemoembolization (TACE) by a 13C Breath Test (LiMAx).

Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with preexisting liver damage. Current liver function tests may fail to accurately predict the functional liver reserve. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of LiMAx values. Forty patients with primary or secondary liver cancer underwent TACE and LiMAx test on the day before, the day after, and 4weeks after TACE. LiMAx results were evaluated, referenced to liver volume (CT/MR volumetry), correlated with the respective TACE volume (subsegmental vs. segmental vs. lobar), established liver function tests, and Child-Pugh and ALBI scores. The individual LiMAx values were significantly reduced by 10% (p = 0.01) on the day after TACE and fully recovered to baseline 1month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR, and creatinine. LiMAx did not correlate significantly with the treated liver volume, but did correlate with the baseline liver volume (< 1200ml vs. > 1200ml; p < 0.01). No significant changes were observed in the Child-Pugh score or ALBI score. LiMAx is capable of detecting changes in liver function, even modulations caused by superselective TACE procedures. Accordingly, it could be used as a tool for patient selection and monitoring of transarterial therapy. In comparison, Child-Pugh and ALBI scores did not reflect any of these changes. Some biochemical parameters also changed significantly after TACE, but they tend to be less specific in providing sufficient information on actual cellular dysfunction.

Super-Selective Transarterial Chemoembolization with Doxorubicin-Loaded Drug-Eluting Beads Sized Below and Above 100 Microns in Hepatocellular Carcinoma: A Comparative Study.

Objectives To compare efficacy and safety of super-selective DEB-TACE with doxorubicin-loaded microspheres sized below and above 100 microns for treatment of hepatocellular carcinoma (HCC). Material and methods All consecutive patients with HCC who underwent DEB-TACE were included in this retrospective study. Regarding to microsphere size (>100 microns or <100 microns), patients were determined as Group A (n = 28) and Group B (n = 30), respectively. Results Of the 58 patients (78% males), no statistically significant difference was found between the two groups in terms of age and gender (P = 0.388, P = 0.888, respectively). There were no significant differences between the two groups in terms of BCLC stages, presence of chronic liver disease, and Child-Pugh classes (P = 0.593, P = 0.081, P = 0.391, respectively). Although statistically insignificant, median overall survival (19 months vs 32 months, P = 0.190) and median progression-free survival (13 months vs 20 months (P = 0.574) were longer and 1-3-years objective response rates (7.40% vs 23.33%, P = 0.330) were higher in Group B than in Group A, respectively. No mortality or major complications were observed. Grade I/ II adverse events were detected in all patients. Transient elevations in liver function tests (Grade III adverse events) were similar in both groups (3.57% vs 3.33%; P = 0.980). Conclusion Super-selective DEB-TACE with doxorubicin-loaded microspheres sized <100 microns is an effective and safe method for the HCC treatment. Objective response rates are higher and survival durations are longer after DEB-TACE performed with doxorubicin-loaded microspheres sized below 100 microns. Keywords Chemoembolization Doxorubicin Microspheres Drug-eluting beads Hepatocellular carcinoma

Color coded perfusion imaging with contrast enhanced ultrasound (CEUS) for post-interventional success control following trans-arterial chemoembolization (TACE) of hepatocellular carcinoma.

AimEvaluation of an external color coded perfusion quantification software with CEUS for the post-interventional success control following TACE in patients with HCC.Material and methods31 patients (5 females, 26 males, age range 34–82 years, mean 66.8 years) with 59 HCC lesions underwent superselective TACE using DSM Beads between 01/2015 and 06/2018. All patients underwent CEUS by an experienced examiner using a convex multifrequency probe (1–6 MHz) within 24 hours following TACE to detect residual tumor tissue. Retrospective evaluation using a perfusion quantification software regarding pE, TTP, mTT, Ri and WiAUC in the center of the lesion, the margin and surrounding liver.ResultsIn all lesions, a post-interventional visual reduction of the tumor microvascularization was observed. Significant differences between center of the lesion vs. margin and surrounding liver were found regarding peak enhancement (867.8 ± 2416 center vs 2028 ± 3954 margin p<0.005) and center 867.8 ± 2416 vs 2824 ± 4290 surrounding liver, p<0.0001)). However, no significant differences were found concerning Ri, WiAuC, mTT and TTP.ConclusionCEUS with color- coded perfusion imaging is a valuable supporting tool for post-interventional success control following TACE of liver lesions. Peak enhancement seems to be the most valuable parameter.

Safety margin of embolized area can reduce local recurrence of hepatocellular carcinoma after superselective transarterial chemoembolization.

Background/AimsWe aimed to determine the relationship between the safety margin of an embolized area and local tumor recurrence (LTR) of patients with hepatocellular carcinoma (HCC) who underwent superselective transarterial chemoembolization (TACE).MethodsThe medical records of 77 HCC patients with 109 HCC nodules who underwent superselective TACE were retrospectively analyzed for LTR. Univariate and multivariate analyses were performed for 16 potential factors using Cox proportional hazard regression. Iodized oil deposition on cone-beam computed tomography (CBCT) imaging was divided into three grades: A=complete tumor staining and complete circumferential safety margin, B=complete tumor staining but incomplete safety margin, C=incomplete tumor staining. The effect of a safety margin on LTR was evaluated by comparison between grade A and B group.ResultsUnivariate and multivariate analyses revealed that grade A iodized oil deposition and portal vein visualization were the only two independent significant factors of LTR (P<0.001 and P=0.029, respectively). The 12- and 24-month LTR rates of tumors for grade A (n=62), grade B (n=30), and grade C (n=17) were 16% vs. 41% vs. 100% and 16% vs. 61% vs. 100%, respectively (P<0.001). The tumors in the grade A group had a 75% risk reduction in LTR (odds ratio, 0.25; 95% confidence interval, 0.10 to 0.64; P=0.004) compared to the grade B group.ConclusionsLTR was significantly lower when a greater degree of iodized oil deposition occurred with a complete circumferential safety margin. In superselective TACE, the safety margin of the embolized areas using intraprocedural CBCT affected LTR in HCC patients.

Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas

Transarterial embolization of liver hemangiomas has not been considered to be consistently effective. The charts of 25 patients who underwent superselective transarterial chemoembolization with the bleomycin–lipiodol emulsion were evaluated retrospectively. Twenty-two patients had abdominal pain; asymptomatic/vaguely symptomatic enlargement was the treatment indication in three patients. A single session was conducted in 17 patients, two sessions in 7 and three sessions in one. After the first session, lesion volume decreased by median (range) 51% (10–92%) from median (range) 634 (226–8435) to 372(28–4710) cm3 (p 1000 cm3) lesions may require two sessions.

Superselective Transarterial Chemoembolization as an Alternative to Surgery in Symptomatic/Enlarging Liver Hemangiomas

Superselective Transarterial Chemoembolization as an Alternative to Surgery in Symptomatic/Enlarging Liver Hemangiomas

4:21 PM Abstract No. 281 Long-term outcomes in superselective transarterial chemoembolization using lipiodol with 3D: safety margin versus radiofrequency ablation for solitary small hepatocellular carcinoma

To compare tumor control rate and survival duration between superselective transarterial chemoembolization using lipiodol (cTACE) and radiofrequency ablation (RFA) as an initial treatment of solitary small HCC. In 798 consecutive patients with newly diagnosed HCC between 2007 and 2015, 130 patients with solitary small HCC (mean 1.7 cm, 0.5- 3.0 cm in diameter) who underwent superselective cTACE alone (62 patients) or RFA alone (68 patients) were retrospectively analyzed. 3D-safety margin was obtained in 45 patients (72.3%) in cTACE. Local progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method. Median OS/local PFS of cTACE with and without 3D-safety margin were 86.0/51.0 months and 25.2/13.5 months, respectively, while 89.3/49.8 months in RFA. There were no significant differences in OS and PFS between cTACE with margin and RFA, although those of cTACE without margin showed significantly shorter survival. The 1-, 3-, 5-year rates of OS/local PFS of cTACE with margin were 97.8/88.8%, 88.3/66.0% and 69.6/44.8%, respectively, while those of RFA were 97.1/ 88.1%, 82.6/57.9% and 58.6/44.8%, respectively. Superselective cTACE obtaining 3D-safety margin demonstrated a high tumor control rate with encouraging long survival duration, which could produce similar outcomes to RFA, in patients with initial solitary small HCC.

Dual-phase Cone-beam CT-based Navigation Imaging Significantly Enhances Tumor Detectability and Aids Superselective Transarterial Chemoembolization of Liver Cancer

The objective of this study was to investigate the impact of a dual-phase cone-beam computed tomography (DP-CBCT)-based navigation imaging during transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) in a perspective randomized study. Forty-two patients with HCC (39 men, 57 ± 9 years, 13 first-time TACE) underwent TACE using three-dimensional image guidance with automatic detection of tumor-feeding vessels computed from DP-CBCT (early and delayed arterial phases). Forty-nine other patients with HCC (44 men, 55 ± 12 years, 14 first-time TACE) were treated conventionally using digital subtraction angiography (DSA). Tumor detectability in DP-CBCT was compared to DSA and preoperative CT or magnetic resonance (MR) imaging. Tumor-feeding vessel visibility was rated (good, fair, and poor) intraoperatively by the operators. The superselective embolization success rate, the number of DSA acquisitions, fluoroscopy time, and patient radiation dose were collected and compared using paired t test and the Mann-Whitney U test. Tumor detection of DP-CBCT was superior to DSA (100% vs 83%, P = .001) and comparable to CT-MR (96%, P = .456). Tumor and feeder visibilities were significantly enhanced by DP-CBCT (P < .001). Compared to using DSA, more superselective embolization was achieved (60% vs 49%) with less DSA acquisitions (n = 2.6 ± 0.8 vs n = 3.4 ± 0.7, P < .001) and shorter fluoroscopy time (4.1 ± 2.6 vs 7.1 ± 4.2 minutes, P < .001) with a slight increase in patient radiation exposure, that is, air kerma (median: 0.33, first to third quartiles: 0.24-0.48 vs 0.30, 0.24-0.44 Gy; P = .519) and dose-area product (134, 92-181 vs 97, 75-140 Gy⋅cm2, P = .048). DP-CBCT and navigation imaging improve tumor detectability and superselective embolization in TACE.

Single-session combined radiofrequency ablation and transarterial chemoembolization in the treatment of hepatocellular carcinoma

Aim of the studyTo evaluate the efficacy of the combined use of both transarterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) in a single session for the treatment of large (≥3 cm in diameter) hepatocellular carcinoma. Patients and methodsThis study was carried out on 30 patients (23 males and 7 females, with age range between 46 and 74 years), with either solitary or multiple hepatocellular carcinomas. Every patient was subjected to a single-session combined RFA with TACE. Targeting the lesion with RFA needle was first done, to secure its access into the lesion, under ultrasound guidance. Super-selective TACE was then performed, followed by the RFA procedure. ResultsOne-month follow-up revealed complete ablation of the tumour in 25 patients (83.3%), while 5 patients (16.7%) showed residual tumour activity, requiring an additional TACE session. No major complications related to the procedure were recorded during the duration of this study. The probability of encountering, both intra- and post-procedural, minor complications was significantly higher with large focal lesion diameters (P = .039 and .003, respectively). ConclusionSingle-session combined TACE and RFA is a safe and effective treatment option for the control of large HCC lesions, with no major procedure-related complications.

Superselective Transarterial Chemoembolization as an Alternative to Surgery in Symptomatic/Enlarging Liver Hemangiomas.

Transarterial embolization of liver hemangiomas has not been considered to be consistently effective. The charts of 25 patients who underwent superselective transarterial chemoembolization with the bleomycin-lipiodol emulsion were evaluated retrospectively. Twenty-two patients had abdominal pain; asymptomatic/vaguely symptomatic enlargement was the treatment indication in three patients. A single session was conducted in 17 patients, two sessions in 7 and three sessions in one. After the first session, lesion volume decreased by median (range) 51% (10-92%) from median (range) 634 (226-8435) to 372(28-4710) cm3 (p<0.01), after a median period of 4months (range 2-8). A second session was performed in eight patients (median (range) initial volume 1276 (441-8435)cm3) with persistent complaints and/or large lesions receiving feeders from both right and left hepatic arteries (staged treatment). Median (range) lesion size decreased further from 806 (245-4710) to 464 (159-2150)cm3 (p<0.01). Three patients experienced a postembolization syndrome that persisted after the first week. Seventeen of the 22 symptomatic patients (77%) reported resolution or marked amelioration of complaints. Regrowth after initial regression was not observed during median (range) 14 (8-39)months of follow-up (n:18). Transarterial chemoembolization with the bleomycin-lipiodol emulsion is a potential alternative to surgery for symptomatic/enlarging liver hemangiomas. Volume reduction is universal, and symptom control is satisfactory. Centrally located and very large (>1000cm3) lesions may require two sessions.