Transarterial Bland Embolization Research Articles

Safety and Efficacy of Peptide Receptor Radionuclide Therapy (PRRT) Following Bland Embolization for Metastatic Neuroendocrine Tumors

Rationale: Evaluating the long-term safety and efficacy of peptide receptor radionuclide therapy (PRRT) in patients with metastatic neuroendocrine tumors (mNETs) who have undergone prior bland hepatic transarterial embolization (TAE). Methods: Retrospective review of mNET patients who received PRRT with 177Lu-DOTATATE between 4/2018 and 02/2022 with and without prior TAE. The most recent clinical, imaging, and laboratory findings, including hepatic Common Terminology Criteria for Adverse Events v5.0, were compared to pre-PRRT. Results: 171 patients (95 M, 76 F, median age = 66) with mNET of different primary sites (9 foregut, 100 midgut, 9 hindgut, 44 pancreas, 9 unknown) received at least 1 cycle of PRRT with at least 6 months of follow-up, 110 of whom were embolization-naïve and 61 who had prior TAE. The median follow up was 22 months (range: 6–43). Patients with prior TAE had higher liver tumor burden on average than patients without prior TAE; however, the difference was not statistically significant (p = 0.06). There was no significant difference in the rates of G3 or G4 hepatotoxicity (p = 0.548 and p = 0.999, respectively) in patients who underwent prior TAE and those who were TAE-naïve. The hepatic progression-free survival was 22.9 months in TAE-naïve patients and 25.7, 20.2, and 12.8 months in patients with 1, 2, and 3 prior TAE treatments, respectively. Conclusion: Peptide receptor radionuclide therapy following transarterial bland embolization for mNET is safe and effective.

Comparison of transarterial bland embolization and drug-eluting beads transarterial chemoembolization for very early and early hepatocellular carcinoma not amenable for surgery or ablation: a single center retrospective data analysis.

Transarterial chemoembolization (TACE) is the accepted therapy for intermediate hepatocellular carcinoma (HCC). Although recent data suggests that bland transarterial embolization (TAE) is equally effective in intermediate HCC, not much is known about the efficacy in very early and early HCC not amenable for ablation or resection. We aimed to compare the outcome of patients with very early and early HCC treated by drug-eluting beads TACE (DEB-TACE), a specific technique of TACE using DC beads, and TAE using microparticles with a size of 100 µm up to 700 µm. Clinical data of totally 95 patients with very early and early HCC not amenable for surgery or ablation, treated between 2009 and 2019 at the Department of Visceral Surgery and Medicine and the Interdisciplinary Center of Vascular Interventions, University Hospital Bern, Switzerland, were retrospectively analyzed (52 patients in DEB-TACE and 42 patients in TAE group, respectively). All images were assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Primary endpoint was overall survival (OS). Secondary endpoints were local response rate and time to local progression. Most patients presented with Child-Pugh A. Thrombocytes were significantly lower in patients treated by TAE. Minor side effects occurred equally in both groups. No differences were detected in terms of OS, local tumor recurrence and response rate. Compared with DEB-TACE, TAE is an equally effective and save therapy for very early and early HCC not amenable for resection or ablation without differences in local tumor control and OS.

Transarterial Embolization and Percutaneous Ablation of Primary and Metastatic Soft Tissue Tumors.

Soft tissue tumors (STTs) include a range of benign and malignant tumors originating from soft tissues. Transarterial and percutaneous therapies are image-guided and minimally invasive approaches for managing primary and metastatic STTs. The objective of this review is to discuss transarterial and percutaneous therapies by examining the current literature, including indications, patient selection, safety, and effectiveness. Transarterial therapies (e.g., transarterial bland embolization and transarterial chemoembolization) involve the delivery of either embolic or chemotherapeutic particles using a catheter into arteries feeding the tumor, resulting in localized tumor destruction. Percutaneous therapies (e.g., radiofrequency ablation, cryoablation, irreversible electroporation, laser ablation, and magnetic resonance-guided high-intensity focused ultrasound) involve the delivery of either hot or cold temperatures, electrical current, laser, or ultrasound to specifically target tumor cells. Both therapies have been shown to be safe and effective for reducing morbidity and local control of STTs, specifically in patients who are surgically inoperable or who are unresponsive to conventional therapies. Accurate diagnosis, staging, and histological subtype identification are crucial for treatment selection. A multidisciplinary approach, a thorough understanding of tissue anatomy and surrounding structures, as well as individualized strategies based on assessment are essential for optimal patient care.

Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization.

BACKGROUNDAt the diagnosis of hepatocellular carcinoma (HCC), more than 90% of HCC patients present cirrhosis, a clinical condition often associated to malnutrition. Sarcopenia is an indirect marker of malnutrition assessable on computed tomography (CT).AIMTo evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization.METHODSPatients with HCC treated by a first session of trans-arterial (chemo)embolization and an available CT scan before treatment were included. Sarcopenia was assessed using skeletal muscle index at baseline and at the first radiological assessment. Radiological response was recorded after the first session of treatment using mRECIST.RESULTSOf 225 patients treated by trans-arterial bland embolization (n = 71) or trans-arterial chemoembolization (n = 154) for HCC between 2007 and 2013, Barcelona Clinic of Liver Cancer stage was A, B, and C in 27.5%, 55%, and 16.8% of cases, respectively. Sarcopenia was present in 57.7% of the patients. Patients with sarcopenia presented a higher rate of progressive disease (19% vs 8%, P = 0.0236), a shorter progression-free survival (8.3 vs 13.2 mo, P = 0.0035), and a shorter median overall survival (19.4 mo vs 35.5 mo, P = 0.0149) compared with non-sarcopenic patients. Finally, patients whose sarcopenia appeared after first transarterial treatment had the worst prognosis (P = 0.0004).CONCLUSIONSarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial (chemo)-embolization for HCC.

Abstract No. 251 Bland embolization of neuroendocrine tumor liver metastases: rates of periprocedural hemodynamic instability

Transarterial bland embolization (TAE) is commonly used for treatment of neuroendocrine tumor liver metastases (NETLMs). Hormonal release causing hemodynamic instability and carcinoid symptoms is frequently observed during bland embolization of NETLMs. Data are lacking about the hemodynamic changes that can occur following TAE of NETLMs. The purpose of our study was to investigate the rate of periprocedural hemodynamic instability (PPHDI) associated with TAE for NETLMs.

Abstract No. 250 Periprocedural hemodynamic instability in patients who have received both transarterial bland embolization and yttrium-90 radioembolization for neuroendocrine tumor liver metastases

Transarterial embolization (TAE) and transarterial radioembolization with Yttrium-90 (TARE) are two common treatments for neuroendocrine tumor liver metastases (NETLMs). Hormonal release causing hemodynamic instability and carcinoid symptoms is frequently observed during bland embolization of NETLMs. The difference in likelihood of periprocedural hemodynamic instability (PPHDI) between TAE and TARE has not been explored. The purpose of our study was to compare the occurrence of PPHDI in TAE with TARE in a cohort of patients who received each treatment at different points in time.

Abstract No. 556 Cost-effectiveness of radioembolization with Y-90 glass microspheres versus transarterial chemotherapies in the treatment of intermediate stage hepatocellular carcinoma: a U.S. hospital perspective

Transarterial radioembolization with Y-90 glass microspheres (“Y-90”) is a safe and effective alternative to transarterial chemoembolization (TACE) in patients with intermediate stage hepatocellular carcinoma (HCC). A previous economic evaluation from the UK National Health Service perspective found Y-90 to be cost-effective compared with TACE and transarterial bland embolization (TAE) in a population of unresectable HCC patients. This economic evaluation assessed the cost-effectiveness of Y-90 across the same patient population in the U.S.

Comparison of initial tumor responses to transarterial bland embolization and drug-eluting beads-transarterial chemoembolization in the management of hepatocellular carcinoma: a propensity-score matching analysis.

Transarterial bland embolization (TABE) is widely used to treat the spontaneous rupture of hepatocellular carcinoma (HCC), and can lead to ischemic necrosis of the tumor. In this study, we used the propensity-score matching (PSM) method to compare the initial responses of treatment-naïve HCC patients to TABE and drug-eluting beads-transarterial chemoembolization (DEB-TACE), and the safety of these treatments. Patients with treatment-naïve HCC, who had been admitted to 2 medical centers from January 2016 to December 2020, were enrolled as the research subjects. The data of 26 patients treated with TABE for ruptured HCC and 52 patients treated with DEB-TACE for primary HCC were collected according to our inclusion and exclusion criteria, and a PSM analysis was conducted to assess the safety and effectiveness of these two interventional techniques 1 month postoperatively. In relation to ruptured HCC, TABE had a hemostatic success rate of 97.0%. Before PSM, the TABE group had a larger maximum tumor diameter (P<0.05), a higher proportion of multiple tumors (P<0.05), a higher proportion of Child-Pugh class B (P<0.05), and a higher proportion of Barcelona Clinic Liver Cancer (BCLC) stage B (P<0.05) than the DEB-TACE group. After PSM, the baseline characteristics of these two groups were well balanced, and there was no significant difference in patients' initial therapeutic responses and tumor recurrence rates (both P>0.05). The multivariate regression analysis showed that tumor size was an independent predictor of the objective response rate (ORR) [odds ratio (OR): 3.312; 95% CI: 0.152-5.944; P<0.05]. Tumor number and BCLC stage also affected ORR; however, ORR was not significantly correlated with the interventional technique (TABE vs. DEB-TACE; P>0.05). The incidences of post-embolization syndrome (PES) and 48-h hepatotoxicity were significantly lower in the TABE group than the DEB-TACE group (both P<0.05), but there was no significant difference in hepatotoxicity after 1 month (P>0.05). TABE is highly effective at managing hemorrhage from ruptured HCC. The initial therapeutic response of HCC to TABE is similar to that to DEB-TACE; however, TABE is associated with lower hepatotoxicity and fewer adverse effects, which paves the way for subsequent treatments and systemic therapies.

Comparison of Trans-Arterial Chemoembolization and Bland Embolization for the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis.

Simple SummaryIn this study, efficacy and safety of embolization alone and trans-arterial chemoembolization were compared in 265 patients with intermediate stage hepatocellular carcinoma. Trans-arterial chemoembolization was associated with a significant increase of complete radiological response, but without significant impact on overall response, and survival outcomes after propensity score matching. Both techniques showed similar safety profiles. To this day, embolization alone and trans-arterial chemoembolization are two available options in the treatment of intermediate stage hepatocellular carcinoma.No definitive conclusion could be reached about the role of chemotherapy in adjunction of embolization in the treatment of hepatocellular carcinoma (HCC). We aim to compare radiological response, toxicity and long-term outcomes of patients with hepatocellular carcinoma (HCC) treated by trans-arterial bland embolization (TAE) versus trans-arterial chemoembolization (TACE). We retrospectively included 265 patients with HCC treated by a first session of TACE or TAE in two centers. Clinical and biological features were recorded before the treatment and radiological response was assessed after the first treatment using modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Correlation between the treatment and overall, progression-free and transplantation-free survival was performed after adjustment using a propensity score matching: 86 patients were treated by bland embolization and 179 patients by TACE, including 44 patients with drug-eluting beads and 135 with lipiodol TACE, 89.8% of patients were male with a median age of 65 years old. Cirrhosis was present in 90.9% of patients with a Child Pugh score A in 84% of cases. After adjustment, no difference in the rate of AE, including liver failure, was observed between the two treatments. TACE was associated with a significant increase in complete radiological response (odds ratio (OR) = 8.5 (95% confidence interval (CI): 2.8–25.4)) but not in the overall response rate (OR = 2.2 (95% CI = 0.8–5.8)). No difference in terms of overall survival (p = 0.3905), progression-free survival (p = 0.4478) and transplantation-free survival (p = 0.9020) was observed between TACE and TAE. TACE was associated with a higher rate of complete radiological response but without any impact on overall radiological response, progression-free survival and overall survival compared to TAE.

Abstract No. 711 Assessing effect of cryoablation and transarterial bland embolization of renal cell carcinoma bone metastases on systemic biomarkers of tumor immunity: a pilot investigation to help guide timing of immunotherapy relative to osseous metastasis treatment with embolization and cryoablation

Abstract No. 711 Assessing effect of cryoablation and transarterial bland embolization of renal cell carcinoma bone metastases on systemic biomarkers of tumor immunity: a pilot investigation to help guide timing of immunotherapy relative to osseous metastasis treatment with embolization and cryoablation

Antitumor efficacy of concurrent everolimus with hepatic transarterial bland embolization (evero-embo) in patients with metastatic well differentiated neuroendocrine tumor (NET).

4115 Background: Hepatic transarterial embolization (HAE) is an effective loco-regional therapy for neuroendocrine tumor (NET) management. Systemic targeted therapies, such as everolimus and sunitinib, are typically held 2-4 weeks prior to and after procedures. The safety of concurrent use of everolimus with HAE has been previously reported (GI-ASCO). HAE induces anoxic injury while everolimus effects cell growth, proliferation and survival. Combining these two modalities may result in clinical synthetic lethality effectively debulking significant hepatic disease and/or delay progression. Historically bland HAE has a median hepatic PFS of ~9 months. In this study, the clinical efficacy of evero-embo is examined. Methods: A review of clinical and radiographic data was conducted for all sequential patients who underwent evero-embo between September 2016 and April 2018 at the University of Kentucky Markey Cancer Center. An independent radiologist performed RECIST measurements. Patients were required to have had systemic everolimus for ≥ 1 month prior to embolization in order to be included in this study and be on everolimus immediately post procedure. Patients with at least 12 months post procedure follow up were included for efficacy review. Results: A total of 51 HAEs with concurrent systemic everolimus were performed in 34 NET patients. Twenty one of 24 patients were noted to have a partial response. Rest had stable disease. Hepatic progression was not observed. Twenty-one of the 34 patients have had 12 or more months of follow up post procedure (median of 17 months). None of these 21 patients have had hepatic progression. Conclusions: Evero-embo results in a partial response rate of 62% and may have significant antitumor activity when compared to bland hepatic artery embolization in NET patients. With a median follow-up of 17 mos, hepatic progression has not occurred in any patient. Additional follow up is necessary to compare the median hepatic PFS of evero-embo to the historical drug-eluting bead HAE PFS.

Y90 Radioembolization is a Cost-Effective Bridging Therapy for Hepatocellular Carcinoma

Introduction: Most patients awaiting liver transplantation (LT) for hepatocellular carcinoma (HCC) will require locoregional therapy (LRT) to maintain tumor burden within Milan criteria. Our institution utilizes a variety of LRT modalities including transarterial chemoembolization (TACE), transarterial bland embolization (TAE), Y90 transarterial radioembolization (TARE), microwave ablation (MWA), and MWA and TAE used in combination (MWA/TAE). Because TARE has been shown to prolong time to progression of HCC, our protocol has shifted to adapt TARE as the primary LRT to treat HCC. Nevertheless, several factors limit the widespread use of TARE including the high costs per procedure. In this analysis, we seek to compare the total cost of all LRTs prior to LT. Methods: We evaluated all patients who underwent LT at our institution between June 2012 and May 2017 with the indication of HCC. Patients were divided into two groups based on the LRT protocol with which they were treated. Between 6/2012 and 2/2014 they were treated with a variety of LRT modalities which did not include TARE (non-TARE group), where between 10/2014 and 5/2017 they were treated according to a protocol where TARE was the primary LRT (TARE group). All LRT treatment sessions were identified for each patient. Using cost estimates from other authors, the average total cost of LRT from diagnosis to LT was calculated for each group. Results: There were 57 patients who met the inclusion criteria; 10 in the TARE group and 47 in the non-TARE group. There were no differences in baseline characteristics except for bilirubin, which was lower in the TARE group (1.05 vs. 1.59, p=0.03). Time on the transplant list did not differ between the two groups. The average number of LRT treatments was lower in the TARE group (1.2 vs. 2.47, p=0.001). Patients in the TARE group were treated with TARE only while in the non-TARE group 70% were treated with TACE, 51% with MWA, 32% with MWA/TAE, and 10% with TAE. The average total cost of LRT for patients in the TARE group was $39,009 while it was $39,066 in the non-TARE group (p=0.99). Conclusion: Based on our institutional experience, patients in the TARE group require a lower number of LRT sessions prior to LT. Therefore, although TARE costs more per procedure, the cost of maintaining a patient within Milan criteria using TARE does not differ compared to a more conventional approach based on TACE and MWA.

New Developments in Interventional Oncology: Liver Metastases From Colorectal Cancer.

Colorectal cancer is the third leading cause of cancer death in the United States. Although hepatic excision is the first-line treatment for colorectal liver metastasis (CRLM), few patients are candidates. Locoregional therapy (LRT) encompasses minimally invasive techniques practiced by interventional radiology. These include ablative treatments (radiofrequency ablation, microwave ablation, and cryosurgical ablation) and transcatheter intra-arterial therapy (hepatic arterial infusion chemotherapy, transarterial "bland" embolization, transarterial chemoembolization, and radioembolization with yttrium 90). The National Comprehensive Cancer Network recommends LRT for unresectable CRLM refractory to chemotherapy. The following is a review of LRT in CRLM, including salient features, advantages, limitations, current roles, and future considerations.

Klebsiella pneumoniae Hepatic Abscess and Bacteremia Despite Prophylactic Antibiotics Posttransarterial Bland Embolization

Abstract Transarterial embolizations have become a common treatment of both unresectable primary and metastatic liver tumors. Infectious complications of this procedure are relatively uncommon because most patients are treated with empiric broad spectrum antibiotics after the procedure. However, infections that may occur include skin infection at the puncture site, hepatic abscess, necrotizing pancreatitis, and cholecystitis. Hepatic abscess formation typically occurs in patients with previous biliary intervention and can often prove fatal. This case describes a patient with no previous biliary intervention who developed Klebsiella pneumoniae hepatic abscess and bacteremia despite prophylactic antibiotics after transarterial bland embolization of a liver metastasis.

Percutaneous bone lesion ablation.

Benign tumors and metastatic bone lesions can be treated by ablation techniques performed either alone or in combination with other percutaneous techniques. Ablation techniques include ethanol or acetic acid injection and thermal ablation by means of energy deposition [including laser, radiofrequency, microwave, cryoablation, radiofrequency ionization and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU)]. Goal definition of the therapy is crucial: ablation techniques can be proposed as curative treatments in benign bone tumors or oligometastatic disease (<3 lesions). Alternatively, these techniques can be proposed as palliative treatments aiming at reduction of pain, local control of the disease and tumor decompression. Depending on the lesion's location ablation can be combined with cementation with or without further metallic augmentation; local tumor control can be enhanced by combining ablation with transarterial bland embolization or chemoembolization. Thermal ablation of bone and soft tissues is characterized by high success and relatively low rates of potential complications, mainly iatrogenic thermal damage of surrounding sensitive structures. Successful thermal ablation requires a sufficient ablation volume and thermal protection of the surrounding vulnerable structures. This article will describe the general principles governing ablation and the mechanism of action for each technique and in addition will review the literature about safety and effectiveness of percutaneous imaging-guided ablation for benign and malignant (primary and metastatic) lesions.

Transarterial Embolization of Symptomatic Focal Nodular Hyperplasia

PurposeTo evaluate the effectiveness of small size trisacryl gelatin microsphere embolization as a minimally invasive treatment option for patients with symptomatic focal nodular hyperplasia (FNH). Materials and MethodsA retrospective review was performed of experience with transarterial bland embolization of FNH during the period 2006–2011 in 12 patients (10 women and 2 men; age range, 18–61 y) with a total of 17 lesions presenting with symptoms of pain. FNH was pathologically proven in 11 lesions from 10 patients; the remaining lesions exhibited the classic imaging appearance for FNH. All patients underwent superselective embolization with 100–300 μm trisacryl gelatin microspheres. Lesion size and contrast enhancement before and after treatment were compared to determine success of the procedure. Clinical response was determined by review of the electronic medical record. ResultsAfter embolization, seven patients showed complete resolution and five patients showed partial resolution of symptoms. Compared with imaging performed before the procedure, mean decrease in lesion size after embolization was 61% (range, 26%–90%) on cross-sectional imaging obtained 4–10 weeks after embolization and 87% (range, 54%–98%) on subsequent imaging. Diminished contrast enhancement was universally noted, with 5 of 17 lesions showing complete lack of residual enhancement. ConclusionsTransarterial bland embolization of FNH with trisacryl gelatin microspheres in symptomatic patients is a suitable treatment alternative to surgical resection.