Transarterial Therapy Research Articles

Factors influencing adjuvant treatment decision making among Chinese patients with hepatocellular carcinoma (HCC): Results of a patient survey.

346 Background: This study aimed to understand patient decision-making factors for post-operative adjuvant treatment after resection of hepatocellular carcinoma (HCC) in China. Methods: Patients who had received surgical resection of HCC in the last 2 years at 27 hospitals in China were surveyed using a questionnaire (https://pro.wenjuan.com/t/jUZFU). Feedback was collected by telephone or online. The survey covered three domains: adjuvant treatment decision making, selection of treatment regimen and the influence of recurrence risk on willingness to receive adjuvant treatment. For each domain, participants were asked to identify decision makers and to score decision-making factors from 1 (no influence) to 7 (high influence). All factors with an average score of 6 or 7 points were considered impactful, and those with scores ≤5 were not considered impactful. Descriptive statistics were used to summarize the findings. This study was approved by the ethics committee of Zhongshan hospital and patients provided informed consent. Results: In total, 2,220 valid responses were collected (2,183 patients from Zhongshan Hospital, 37 from 26 other hospitals); 75% of respondents were male, 60% were aged 50-70 years, and 50% had a monthly family income ≤5,000 Chinese Yuan (~$740 USD). Among respondents, 62% had received adjuvant treatment: 56% received systemic therapy (chemotherapy, tyrosine kinase inhibitors, immune therapy and traditional Chinese medicine), 27% transarterial chemoembolization (TACE) plus systemic therapy and 17% TACE alone. The majority of respondents (75%) identified physicians as the decision makers for use of adjuvant therapy and selection of treatment regimen. Of the 38% of respondents who did not receive adjuvant treatment, 90% gave ‘physician recommendation’ as the reason. When patients were the decision makers, factors influencing decisions to use adjuvant treatment and selection of treatment regimen, ranked from most to least influential, were efficacy (for prevention of tumor recurrence), reimbursement status, treatment side effects and cost. Patient willingness to receive adjuvant treatment was influenced by predicted risk of recurrence; among respondents with an estimated 2-year recurrence risk > 10% and > 30%, 40% and 56%, respectively, believed they should receive adjuvant therapy. Conclusions: A majority of patients surveyed received adjuvant therapy, the most common of which were systemic therapy and TACE. Patients who underwent resection had a strong desire to reduce postoperative recurrence by using adjuvant therapy. Physician opinion was identified as the most important factor in treatment decision making, followed by economic factors. When patients were the decision maker, the most influential factors were treatment effectiveness followed by reimbursement status.

Efficacy of a Glass Membrane Emulsification Device to Form Mixture of Cisplatin Powder with Lipiodol on Transarterial Therapy for Hepatocellular Carcinoma.

To examine physiochemical characteristics and drug release properties of cisplatin powder and lipiodol mixtures formed by a glass membrane emulsification device compared with a 3-way stopcock. Seven different types of mixtures were evaluated: cisplatin powder and lipiodol directly mixed (suspension), complete cisplatin solution and lipiodol mixed by a 3-way stopcock or the device (emulsion), incomplete cisplatin solution and lipiodol mixed by a 3-way stopcock or the device (solid-in-water emulsion), and contrast material and cisplatin suspension mixed by a 3-way stopcock or the device (solid-in-oil emulsion). The percentages of water-in-oil were 98.08 ± 0.27% in the emulsion formed by the device, while 70.3 ± 4.63% in the emulsion formed by a 3-way stopcock (P = 0.037). Solid-in-water and solid-in-oil emulsions formed by the device showed 98.09 ± 0.38% and 98.70 ± 0.40% of water-in-oil, respectively, whereas both solid-in-water and solid-in-oil emulsions formed by a 3-way stopcock showed 0.00%. Homogenous droplet sizes were shown by using the device. The half release times of cisplatin in the emulsions formed by the device were 197 ± 19, 244 ± 24 and 478 ± 52min, respectively, which were significantly longer than the emulsion formed by a 3-way stopcock of 8 ± 8min (P = 0.046-0.050). Suspension showed the longest release time; however, the viscosity was lowest. The glass membrane emulsification device formed almost 100% water-in-oil, whereas 3-way stopcock produced 100% oil-in-water when incomplete solution or suspension was mixed. Slower cisplatin release was shown in the emulsions formed by the device.

Alternating Lenvatinib and Trans-Arterial Therapy Prolongs Overall Survival in Patients with Inter-Mediate Stage HepatoCellular Carcinoma: A Propensity Score Matching Study.

Simple SummaryThis study aimed to investigate the efficacy of alternating lenvatinib (LEN) and trans-arterial therapy (AT) in patients with intermediate-stage hepatocellular carcinoma (HCC) after propensity score matching analysis. AT and albumin-bilirubin (ALBI) grade 1 were identified as independent factors for overall survival in patients with intermediate-stage HCC. Decision tree analysis demonstrated that the recommended indication of AT was below 70 years of age with ALBI grade 1. This study may reveal clinical features associated with the efficacy of AT and may contribute to improving survival in patients with intermediate-stage HCC.We aimed to evaluate the impact of alternating lenvatinib (LEN) and trans-arterial therapy (AT) in patients with intermediate-stage hepatocellular carcinoma (HCC) after propensity score matching (PSM). This retrospective study enrolled 113 patients with intermediate-stage HCC treated LEN. Patients were classified into the AT (n = 41) or non-AT group (n = 72) according to the post LEN treatment. Overall survival (OS) was calculated using the Kaplan–Meier method and analyzed using a log-rank test after PSM. Factors associated with AT were evaluated using a decision tree analysis. After PSM, there were no significant differences in age, sex, etiology, or albumin-bilirubin (ALBI) score/grade between groups. The survival rate of the AT group was significantly higher than that of the non-AT group (median survival time; not reached vs. 16.3 months, P = 0.01). Independent factors associated with OS were AT and ALBI grade 1 in the Cox regression analysis. In the decision tree analysis, age and ALBI were the first and second splitting variables for AT. In this study, we show that AT may improve prognosis in patients with intermediate-stage HCC. Moreover, alternating LEN and trans-arterial therapy may be recommended for patients below 70 years of age with ALBI grade 1.

Therapeutic Decision Making in Hepatocellular Carcinoma According to Age and Child-Pugh Class: A Nationwide Cohort Analysis in South Korea.

Background We sought to analyze the preferred treatment modality by age and liver function in South Korea. Methods The Korean Liver Cancer Study Group randomly extracted the data of patients with hepatocellular carcinoma (HCC) enrolled in the Korean Central Cancer Registry from 2008 to 2014 from approximately 50 hospitals nationwide. After excluding distant and lymphatic metastases, the treatment preference for patients with a single lesion (excluding PVT (portal vein thrombosis), hepatic vessels, and bile duct invasion) and with PVT was evaluated in 7559 patients. Patients were grouped by age, and baseline liver function was divided based on the Child–Pugh class (CPC) A, B, and C. Results For a single HCC, the majority of patients selected transarterial therapy as the initial treatment, followed by surgical resection and local ablative therapy. The surgical resection rate decreased significantly with age (p < 0.001), and the transarterial therapy rate significantly increased (p < 0.001). For CPC C, liver transplantation was significantly increased to 11.5%, and 36.3% of patients received no treatment. In HCC with PVT, the transarterial therapy rate was the highest, followed by the rate of abandonment of treatment. The proportion of no treatment significantly increased with age (p < 0.001). In CPC C, transarterial therapy and systemic therapy were attempted in 15.4% and 5.8% of patients, respectively. Conclusions Age and liver function have a significant impact on the therapeutic decision-making of HCC patients in Korea. In unfavorable conditions, surgical resection was less favored in patients with single tumors, and no treatment was preferred in patients with PVT.

The effect of transarterial chemoembolization therapy on survival in patients with non-resectable hepatocellular carcinoma: Single-center study results.

Background and Aim:This study was designed to investigate the tumor response and effect of drug-eluting transarterial chemoembolization (DEB-TACE) treatment on survival in patients diagnosed with hepatocellular carcinoma (HCC).Materials and Methods:The records of 40 patients who underwent DEB-TACE between March 2018 and November 2020 were retrospectively analyzed. Follow-up included abdominal computed tomography and measurement of serum albumin, bilirubin, prothrombin time, and alpha-fetoprotein values. The treatment response was evaluated using the European Association for the Study of the Liver criteria.Results:A total of 70 TACE sessions were performed in the 40 study patients with HCC. The etiology was chronic hepatitis B virus (n=32), secondary biliary cirrhosis (n=2), cryptogenic (n=2), or chronic hepatitis C virus (n=4). Based on the TACE response, complete response was observed in 22 patients, a partial response in 8 patients, and progression in 10 patients. Liver transplantation was performed for 4 patients who had a complete response. The formation of new nodules was observed in 8 patients during the follow-up period. In all, 29 patients survived and 11 died.Conclusion:The findings of this study suggest that DEB-TACE had a positive effect on the survival of patients diagnosed with HCC who could not be treated surgically.

NIR-absorbing Prussian blue nanoparticles for transarterial infusion photothermal therapy of VX2 tumors implanted in rabbits.

Nanomaterial-related photothermal therapy has been intensively investigated for treatment of hepatocellular carcinoma (HCC). However, owing to the low specificity to tumors and easy excretion from the systemic circulation, the low dose of photoactive nanomaterials in solid tumors severely hinders the photothermal therapy applications for HCC. Herein, an innovative strategy for transarterial infusion photothermal therapy (TAIPPT) of VX2 tumors implanted in rabbits is reported. NIR-absorbing Prussian blue nanoparticles were prepared by microemulsion methods, which demonstrate excellent photothermal therapy capacity and satisfactory biocompatibility. Prussian blue nanoparticles are transarterially infused into VX2 tumors and irradiated for photothermal therapy. TAIPPT achieves fast and efficient delivery of nanoparticles into tumors and complete ablation by one-time transarterial infusion treatment. Furthermore, TAIPPT could activate the immune cells in rabbits and inhibit distant tumors. Our findings describe a promising strategy for tumor eradication and may benefit future clinical HCC patients.

Transarterial drug delivery for liver cancer: numerical simulations and experimental validation of particle distribution in patient-specific livers

ABSTRACT Background: Transarterial therapies are routinely used for the locoregional treatment of unresectable hepatocellular carcinoma (HCC). However, the impact of clinical parameters (i.e. injection location, particle size, particle density etc.) and patient-specific conditions (i.e. hepatic geometry, cancer burden) on the intrahepatic particle distribution (PD) after transarterial injection of embolizing microparticles is still unclear. Computational fluid dynamics (CFD) may help to better understand this impact. Methods: Using CFD, both the blood flow and microparticle mass transport were modeled throughout the 3D-reconstructed arterial vasculature of a patient-specific healthy and cirrhotic liver. An experimental feasibility study was performed to simulate the PD in a 3D-printed phantom of the cirrhotic arterial network. Results: Axial and in-plane injection locations were shown to be effective parameters to steer particles toward tumor tissue in both geometries. Increasing particle size or density made it more difficult for particles to exit the domain. As cancer burden increased, the catheter tip location mattered less. The in vitro study and numerical results confirmed that PD largely mimics flow distribution, but that significant differences are still possible. Conclusions: Our findings highlight that optimal parameter choice can lead to selective targeting of tumor tissue, but that targeting potential highly depends on patient-specific conditions.

Emerging Ablative and Transarterial Therapies for Pancreatic Cancer

AbstractPancreatic adenocarcinoma is a highly aggressive malignancy with a poor prognosis secondary to late presentation with metastases, challenging resection, and limited alternative therapies. Standard treatment strategies for pancreatic cancer include surgery, chemotherapy, and radiation therapy. These options can extend survival and/or relieve symptoms but are seldom curative. Thermal ablative therapies have been utilized in pancreatic cancer mostly in an open surgical setting. Irreversible electroporation (IRE) is a nonthermal ablative option for pancreatic cancer that uses high voltage, low energy direct current to induce cell death. IRE technology has been shown to spare critical structures such as blood vessels and bile ducts. The safety and efficacy of the percutaneous IRE in Stage 3 pancreas cancer has been studied and there is currently a Food and Drug Administration approved, randomized, controlled trial, and registry enrolling patients in the United States. Recent animal studies have also demonstrated that the advantages of IRE may extend beyond the local tumor effect. In addition to this local ablative option, a phase 3 trial is studying a transarterial option in the management of pancreatic cancer.

Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium-90 selective internal radiotherapy for primary and secondary liver tumours.

To describe rates and management strategies of arterial dissections in transarterial chemoembolization (TACE) and Yttrium-90 selective internal radiotherapy (90Y SIRT) for primary and secondary liver tumours. This retrospective review included 1377 hepatic angiographies between May 2010 and June 2015 in a single centre for TACE and 90Y SIRT of liver tumours. The angiogram results, management, treatment outcomes and follow-up angiography/imaging findings were recorded. Twelve cases of arterial dissections (12/1377, 0.87%) were documented. Three dissections (3/633, 0.47%) occurred during TACE, seven (7/449, 1.56%) during pre-treatment planning angiographies (PTPA) for 90Y SIRT, and two (2/249, 0.80%) during the treatment procedure of 90Y SIRT. The preferred management strategy was to manoeuvre past the dissection and complete the procedure, which was achieved in six patients (50%). Angioplasty with stenting was performed in one patient. In three patients, the procedure was held off for up to 3 months to allow the dissection to heal before repeating the procedure. A dissection that occurred during PTPA was detected only when the patient returned for 90Y SIRT. PTPA was immediately repeated for this patient. The last patient opted for sorafenib. Residual 50% stenosis was seen in one patient on follow-up hepatic angiography, but he was otherwise asymptomatic. In the remaining patients, no residual dissection or clinical sequelae was observed on follow-up. Arterial dissection is a rare but important complication of transarterial locoregional therapy. Where possible, attempts should be made at completing the therapy. Deferring treatment can be considered as dissections usually heal within 3 months. Level 4, case series.

Hepatocellular Carcinoma in Korea between 2012 and 2014: an Analysis of Data from the Korean Nationwide Cancer Registry.

Considering the high prevalence and mortality of hepatocellular carcinoma (HCC) in Korea, accurate statistics for HCC are important. We evaluated the characteristics of Korean patients with newly diagnosed HCC. We retrospectively evaluated data from the Korean Primary Liver Cancer Registry (KPLCR). The baseline characteristics, treatment modalities, and overall survival (OS) of 4,572 patients with HCC registered in the KPLCR between 2012 and 2014 were investigated. At the time of HCC diagnosis, the median age was 60.0 years, with male predominance (79.6%). Hepatitis B virus infection was the most common etiology (59.1%). The rates of Barcelona Clinic Liver Cancer (BCLC) stages 0, A, B, C, and D at diagnosis were 3.9%, 36.9%, 12.5%, 39.4%, and 7.3%, respectively. The proportion of very early or early stage HCC at diagnosis (BCLC stage 0 or A) in the 2012-2014 cohort was significantly lower than that in the 2008-2011 cohort (40.8% vs. 48.3%, P<0.001). Transarterial therapy (37.5%) was the most commonly performed initial treatment, followed by surgical resection (19.8%), best supportive care (19.1%), and local ablation (10.6%). The median OS was 2.9 years, and the 1-, 3-, and 5-year OS rates were 67.7%, 49.3% and 41.9%, respectively. The OS rate of the 2012-2014 cohort was significantly higher than that of the 2008-2011 cohort (log-rank, P<0.001). The OS of HCC patients registered in the KPLCR between 2012 and 2014 significantly improved. Nevertheless, as about half of the HCC patients were diagnosed at an advanced stage, vigorous and optimized HCC screening strategies should be implemented.

Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors.

Simple SummaryBile duct necrosis (BDN) is rare but serious complication of transarterial therapy for liver tumors. During development of BDN, ischemia of the peribiliary vascular plexus (PBP) induces the disruption of the bile duct epithelial protection mechanism, causing necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN starts, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On CT images, BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Clinicians should be aware that although BDN and biloma can usually be treated conservatively, in the presence of symptoms such as moderate or severe infection or interval growth of the biloma, prompt treatment is essential to avoid lethal abscess formation and sepsis.Bile duct necrosis (BDN) with biloma formation is a type of ischemic bile duct injury that is one of the serious complications associated with transarterial therapies, such as transcatheter chemoembolization therapy (TACE), and radioembolization for hepatocellular carcinoma (HCC) and hepatic arterial infusion chemotherapy (HAIC) for metastatic liver cancer from colorectal carcinoma. In terms of the occurrence of BDN and subsequent biloma formation, ischemic injury to the peribiliary vascular plexus (PBP), the supporting vessel of bile duct epithelium, is thought to be intimately associated. In this paper, we first describe the anatomy, blood supply, and function of the intrahepatic bile duct, and then illustrate the pathophysiology of BDN, and finally present the imaging findings of BDN. Under the process of BDN formation, ischemia of the PBP induces the disruption of the bile duct epithelial protection mechanism that causes coagulation and fibrinoid necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN occurs, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On pre-contrast and contrast-enhanced computed tomography (CT), BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Differentiation of imaging findings on CT and ultrasound (US)/magnetic resonance (MR) imaging/MR cholangiopancreatography (MRCP) is important for correct diagnosis of BDN.

Selective internal radiation therapies for unresectable early-, intermediate- or advanced-stage hepatocellular carcinoma: systematic review, network meta-analysis and economic evaluation.

Hepatocellular carcinoma is the most common type of primary liver cancer. Treatment choice is dependent on underlying liver dysfunction and cancer stage. Treatment options include conventional transarterial therapies for patients with intermediate-stage disease and systemic therapy [e.g. sorafenib (Nexavar®; Bayer plc, Leverkusen, Germany)] for patients with advanced-stage disease. Selective internal radiation therapies deliver radiation to liver tumours via microspheres that are injected into the hepatic artery. There are three selective internal radiation therapies: TheraSphere™ [BTG Ltd, London, UK (now Boston Scientific, Marlborough, MA, USA)], SIR-Spheres® (Sirtex Medical Ltd, Woburn, MA, USA) and QuiremSpheres® (Quirem Medical BV, Deventer, the Netherlands). To assess the clinical effectiveness and cost-effectiveness of selective internal radiation therapies for treating patients with unresectable early-, intermediate- or advanced-stage hepatocellular carcinoma. A search was undertaken to identify clinical effectiveness literature relating to selective internal radiation therapies and relevant comparators for the treatment of hepatocellular carcinoma. Studies were critically appraised and summarised. The network of evidence was mapped to estimate the relative effectiveness of the different selective internal radiation therapies and comparator treatments. An economic analysis evaluated the cost-effectiveness. Twenty studies were included in the clinical effectiveness review. Two large randomised controlled trials rated as having a low risk of bias [SARAH: Vilgrain V, Pereira H, Assenat E, Guiu B, Ilonca AD, Pageaux GP, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled Phase 3 trial. Lancet Oncol 2017;18:1624-36; and SIRveNIB: Chow PKH, Gandhi M, Tan SB, Khin MW, Khasbazar A, Ong J, et al. SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol 2018;36:1913-21] found no significant difference in overall survival or progression-free survival between SIR-Spheres and sorafenib (systemic therapy) in an advanced population, despite greater tumour response in the SIR-Spheres arm of both trials. There were some concerns regarding generalisability of the SARAH and SIRveNIB trials to UK practice. All other studies of SIR-Spheres, TheraSphere or QuiremSpheres were either rated as being at a high risk of bias or caused some concerns regarding bias. A network meta-analysis was conducted in adults with unresectable hepatocellular carcinoma who had Child-Pugh class A liver cirrhosis and were ineligible for conventional transarterial therapies. The analysis included the SARAH and SIRveNIB trials as well as a trial comparing lenvatinib (Kisplyx®; Eisai Ltd, Tokyo, Japan) (systemic therapy) with sorafenib. There were no meaningful differences in overall survival between any of the treatments. The base-case economic analysis suggested that TheraSphere may be cost-saving relative to both SIR-Spheres and QuiremSpheres. However, incremental cost differences between TheraSphere and SIR-Spheres were small. In a fully incremental analysis, which included confidential Patient Access Scheme discounts, lenvatinib was the most cost-effective treatment and dominated all selective internal radiation therapies. In pairwise comparisons of sorafenib with each selective internal radiation therapy, sorafenib also dominated all selective internal radiation therapies. The existing evidence cannot provide decision-makers with clear guidance on the comparative effectiveness of treatments in early- and intermediate-stage hepatocellular carcinoma or on the efficacy of TheraSphere or QuiremSpheres. In the advanced-stage hepatocellular carcinoma population, two large randomised trials have shown that SIR-Spheres have similar clinical effectiveness to sorafenib. None of the selective internal radiation therapies was cost-effective, being more costly and less effective than lenvatinib, both at list price and with Patient Access Scheme discounts. Future studies may wish to include early- and intermediate-stage hepatocellular carcinoma patients and the low tumour burden/albumin-bilirubin 1 subgroup of advanced-stage patients. Future high-quality studies evaluating alternative selective internal radiation therapies would be beneficial. This study is registered as PROSPERO CRD42019128383. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 48. See the NIHR Journals Library website for further project information.

Abstract 6136: Generation and characterization of colorectal cancer cell lines from the Buffalo rat

Abstract Introduction: Rat models of metastatic colorectal cancer (mCRC) to the liver are ideal for the development of transarterial therapies. To date, only one model of CRC cells grown in vitro and implanted into the liver of syngeneic rats is available. Yet, the small size of the WAG-Rij rat limits the use of the CC-531/WAG-Rij model for transarterial interventions. This work was aimed at generating an analogous model on the Buffalo rat, strain that has successfully been used for transarterial interventions in primary liver cancer. Materials and Methods: To induce CRC, 5 6-week old Buffalo rats were treated with Azoxymethane (AOM) and Dextran Sodium Sulfate (DSS). To assess tumor progression, the rats were regularly examined by colonoscopy as well as to T1- and T2-MR imaging from w20 up to w63. Standard procedures of tumor cell isolation and in vitro expansion were used. Once the polyclonal lines were established, expression of E-cadherin, Ceacam5, Mucin1, Vimentin1, and S100a4 was evaluated by flow cytometry (FACS) or qPCR. Additionally, the gene regions of APC (nt. 3049 to 3697) and β-catenin (nt. 371 to 1104) were analyzed by Sanger sequencing. Lastly, 23 adult Buffalo rats received implantations of 0.4-1 × 107 cells in the liver only or in the liver as well as subcutaneously. Results: Colonoscopies, MRIs, and histopathology demonstrated that all 5 rats treated with AOM/DSS developed colorectal neoplasms by w22. Tumors were harvested at various time points, at weeks 24, 32, 45, and 63. 2 polyclonal cell lines derived from invasive adenocarcinomas of a female (18L002) and a male (18L004) were successfully established and have proliferated in vitro &amp;gt;1year. FACS and qPCR results showed that both lines express the epithelial markers E-cadherin, Ceacam5, and Mucin1. Interestingly, despite high E-cadherin expression in both lines (&amp;gt;90% by FACS), qPCR data revealed that both lines also express the mesenchymal markers Vimentin and S100a4, suggestive of a trans-differentiated phenotype. DNA sequences of regions of the APC and β-catenin genes frequently mutated by AOM treatment appeared to be intact in both lines. MRIs of the 23 rats that received implants showed that 4 seem to have allowed for short-term growth (~14d) of the 18L004 cells in the liver before being re-absorbed. Histopathological analyses showed evidence of a serosal reaction at the site of implantation in those cases. Conclusions: Two polyclonal CRC lines with phenotypical characteristics of trans-differentiated cells were successfully generated from AOM/DSS-treated Buffalo rats. In spite of continued in vitro growth for over a year, neither line was tumorigenic in vivo, potentially due to the lack of mutations in key regions of the APC and β-catenin genes. Forced expression of mutant genes known to drive CRC progression such as β-catenin, Kras, or P53 could potentially increase in vivo tumorigenicity and allow for the establishment of a rat model of mCRC suitable for the study of transarterial therapies. Citation Format: Nina M. Muñoz, Crystal J. Dupuis, Katherine A. Dixon, Malea L. Williams, Kiersten L. Maldonado, Asif Rashid, Alda L. Tam. Generation and characterization of colorectal cancer cell lines from the Buffalo rat [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6136.

New prognostic score utilizing glypican-3 serum levels for the prediction of 6-month outcome after transarterial therapies for patients with intermediate stage hepatocellular carcinoma

New prognostic score utilizing glypican-3 serum levels for the prediction of 6-month outcome after transarterial therapies for patients with intermediate stage hepatocellular carcinoma

Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions.

AbstractPrimary and secondary liver cancers are a major cause of mortality worldwide. Transarterial liver-directed therapy, or embolotherapy, represents an important locoregional treatment strategy for primary and secondary liver tumors. Embolotherapeutic modalities include bland embolization (transarterial embolization), chemoembolization (transarterial chemoembolization), and radioembolization or selective internal radiotherapy. A brief technical overview of embolotherapeutic modalities as well as supportive evidence for the treatment of most common primary and secondary liver tumors will be discussed in this review. Several potential future applications, including synergy with systemic therapy, interventional theranostics, and artificial intelligence will also be reviewed briefly.

Oligometastatic Colorectal Cancer Management: A Survey of the Italian College of Interventional Radiology.

European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network guidelines(NCCN) have recently included interventional procedures among the standard treatments for the management of colorectal cancer (CRC) oligometastatic disease (OMD). This study overviews the practice of Interventional Radiology (IR) in Italian centers. A practice focused questionnaire on locoregional treatments of CRC-OMD was submitted to all Italian IR centers to assess practice patterns. Thirty-three IR centers completed the questionnaire. The majority reported practice was established within a tumor board (97%), which included input from hepatobiliary surgery (94%). When considering the number of percutaneous ablation and liver-directed trans-arterial therapies performed for all tumor types, 33.5% and 13.4% were performed to specifically treat CRC-OMD. Lung ablations for CRC OMD were performed in 45.5% of centers. Regarding liver ablation,The most common technology was the microwave ablation (68.1%), which was typically performed under US guidance (78%) with conscious sedation used as the most common anaesthesia method (81%). While indication for percutaneous IR treatments was heterogeneous, 51% were performed in combination with chemotherapy in unresectable OMD. Despite new ESMOand NCCN guidelines, 59% of centers did not subjectively appreciate any change in the perception of IR treatments by other specialists; however, 63%of respondents believe that IR will have a more relevant role in the CRC-OMD management in the future. CRC-OMD treatment represents a relevant part of the everyday clinical practice of the IR Italian centers with promising future prospects. Heterogeneity persists in clinical indications, requiring more robust evidence to set indications and to diffuse clinical applications.

A kit based methodology for convenient formulation of 166Ho-Chitosan complex for treatment of liver cancer

The effectiveness of 166Ho-chitosan complex as a radiopharmaceutical for trans-arterial radiation therapy of liver cancer has been established in clinical trials. We have developed a simple kit-bade strategy for convenient formulation of therapeutically relevant doses of 166Ho-chitosan complex in a hospital radiopharmacy in order to facilitate its widespread utilization. Quality control studies established the suitability of the radiopharmaceutical formulated using the developed strategy for in vivo administration. Biodistribution studies in normal Wistar rats showed excellent retention of the radiopharmaceutical in the liver, thus, paving the way towards utility of this approach in clinical context.

Hepatocellular Carcinoma in Korea Between 2008 and 2011: an Analysis of Korean Nationwide Cancer Registry.

Backgrounds/Aims: In Korea, hepatocellular carcinoma (HCC) is the sixth most common cancer and results in the second-highest cancer death rate among all cancers. We aimed to describe the characteristics of patients who were newly diagnosed with HCC in Korea between 2008 and 2011. The Korean Primary Liver Cancer Registry (KPLCR) is a random sample consisting of approximately 15% of patients with newly diagnosed primary liver cancer registered in the Korean Central Cancer Registry. We investigated the baseline characteristics, treatment modalities, and overall survival (OS) of patients with HCC registered in the KPLCR between 2008 and 2011. A total of 6,083 patients were histologically or radiologically diagnosed with HCC. The hepatitis B virus was the predominant HCC etiology (72.0%). According to the Barcelona Clinic Liver Cancer (BCLC) staging system, stages 0, A, B, C, and D accounted for 8.6%, 39.7%, 11.5%, 33.8%, and 6.9%, respectively. Transarterial therapy (41.7%) was the most commonly performed initial treatment, followed by best supportive care (21.7%), surgical resection (16.7%), and local ablation therapies (10.6%). The overall rate of adherence to the BCLC treatment guideline was only 37.7%. The 1-, 3-, and 5-year OS rates were 65.6%, 46.2%, and 36.8%, respectively. Between 2008 and 2011, approximately half of patients with HCC (48.3%) were candidates for curative treatment (BCLC stage 0 or A), but one-third of patients (33.8%) had advanced HCC (BCLC stage C). Transarterial therapy was the most commonly conducted initial treatment and the 5-year OS rate was 36.8% in this period.

Abstract No. 708 Short-term toxicity of peptide receptor radionuclide therapy in patients with neuroendocrine tumors treated with prior transarterial liver-directed therapy

Abstract No. 708 Short-term toxicity of peptide receptor radionuclide therapy in patients with neuroendocrine tumors treated with prior transarterial liver-directed therapy

Abstract No. 532 Comparative efficacy of transarterial embolization versus transarterial embolization plus microwave ablation for hepatocellular carcinoma 3 to 5 cm in size

To compare time to retreatment of transarterial monotherapy versus combination therapy in conjunction with ablation for hepatocellular carcinoma (HCC) with tumor size 3-5 cm. Following institutional review board approval, we retrospectively reviewed all hepatocellular carcinoma (HCC) patients with solitary tumors 3 to 5 cm in size, who received locoregional therapy at a single institution between 2006 and 2018. Patients who had undergone prior locoregional therapy or prior surgical resection were excluded. Those who underwent liver transplant or surgical resection following locoregional therapy were censored at time of surgery. Baseline patient demographics, and comorbidities were compared using Chi-squared test. Time to retreatment and overall survival were assessed compared between groups using log-rank test. A total of 29 HCC patients met our study inclusion criteria. 24/29 (83%) had bland embolization or chemoembolization monotherapy, while the other five underwent combination therapy consisting of transarterial therapy plus ablation. There were no significant differences between the monotherapy and combination therapy groups in mean age (65.8 vs. 73.3 years, P = 0.13), gender (25% vs. 20% female, P = 1.00), and medical comorbidities (diabetes mellitus (41.7% vs. 60%, P = 0.64), heart disease (33.3% vs. 20%, P = 0.65), chronic kidney disease (12.5% vs. 20%, P = 1) or history of other malignancy (8.3% vs. 0%, P = 1)), respectively. The median time to retreatment following monotherapy was 41 days compared to 105 days in the combination therapy group (P = 0.06). Overall survival could not be accurately compared between groups due to too few events during median study follow-up time of 482 days. In this comparative study, although there was no significant difference in time to retreatment between the monotherapy and combination therapy groups, there was clearly a trend towards improved time to retreatment with combination therapy. Additional larger, prospective studies are needed to further assess the potential survival benefit of combination therapy over monotherapy for this group whom have several treatment options available.