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Sato R, Moriguchi M, Saiga A, Asahara K, Aramaki T. No lipiodol, no beads-another transcatheter arterial chemoembolization (TACE) with fine cisplatin powder and porous gelatin particles for TACE-naïve, multifocal, up-to-seven out hepatocellular carcinoma. Cancer Med 2024; 13:e7446. [PMID: 39015047 PMCID: PMC11252493 DOI: 10.1002/cam4.7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
AIM The Japanese Interventional oncology group (JIVROSG) showed the efficacy and safety of nonselective transarterial chemoembolization (TACE) with fine cisplatin powder (diamminedichloroplatinum; DDP-H) (65 mg/m2) and porous gelatin particles (DDP-H TACE) without lipiodol for extensive multifocal hepatocellular carcinoma (HCC). However, there are no studies on this method following the JIVROSG study. Therefore, we aimed to evaluate the efficacy of this new DDP-H TACE and its effect on liver function. METHODS We retrospectively reviewed the medical records of TACE-naïve patients with multifocal HCC (Child-Pugh class A, up-to-seven out, no prior history of systemic therapy) who underwent whole-liver DDP-H TACE between January 2006 and December 2019. RESULTS Sixty patients were included in this study. The median age of the patients was 71 (range, 35-88) years. The median maximum size of tumors was 26 (range, 8-184) mm; 86.7% of patients met the up-to-11 criteria out. The overall survival duration was 30.3 months. At the time of initial evaluation (median, 45 days), the overall response rate was 65.0%; the disease control rate was 86.7% based on the modified response evaluation criteria in solid tumors guideline. Although nine patients' liver function had deteriorated to Child-Pugh class B at initial evaluation, six of them recovered to Child-Pugh class A. Only three patients (5%) showed permanently impaired liver function. CONCLUSIONS Whole-liver DDP-H TACE without lipiodol or beads effectively reduced tumors and preserved liver function.
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Affiliation(s)
- Rui Sato
- Division of Interventional RadiologyShizuoka Cancer CenterShizuokaJapan
| | - Michihisa Moriguchi
- Molecular Gastroenterology and HepatologyGraduate School of Medical Science Kyoto Prefectural University of MedicineKyotoJapan
| | - Atsushi Saiga
- Division of Interventional RadiologyShizuoka Cancer CenterShizuokaJapan
| | - Kazuhisa Asahara
- Division of Interventional RadiologyShizuoka Cancer CenterShizuokaJapan
| | - Takeshi Aramaki
- Division of Interventional RadiologyShizuoka Cancer CenterShizuokaJapan
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association. JOURNAL OF LIVER CANCER 2023; 23:241-261. [PMID: 37449302 PMCID: PMC10565548 DOI: 10.17998/jlc.2023.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023]
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association. Clin Mol Hepatol 2023; 29:521-541. [PMID: 37482892 PMCID: PMC10366793 DOI: 10.3350/cmh.2023.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial Chemoembolization for Hepatocellular Carcinoma: 2023 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Korean J Radiol 2023; 24:606-625. [PMID: 37404104 DOI: 10.3348/kjr.2023.0385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 07/06/2023] Open
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post-procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea.
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Chang PY, Lee RC, Liang PC, Liu YS, Chuang VP, Wu DK, Cheng YF, Huang JI, Tseng HS, Hung CF, Wu RH, Chern MC, Cheng HM, Wu CH, Cheng SM, Chiang CL, Liang HL. Multidisciplinary Taiwan consensus for the use of conventional TACE in hepatocellular carcinoma treatment. Front Oncol 2023; 13:1186674. [PMID: 37427137 PMCID: PMC10328116 DOI: 10.3389/fonc.2023.1186674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Developed in early 1980s, transarterial chemoembolization (TACE) with Lipiodol was adopted globally after large-scale randomized control trials and meta-analyses proving its effectiveness were completed. Also known as "conventional TACE" (cTACE), TACE is currently the first-line treatment for patients with unresectable intermediate stage hepatocellular carcinoma (HCC) and delivers both ischemic and cytotoxic effects to targeted tumors. Although new technology and clinical studies have contributed to a more comprehensive understanding of when and how to apply this widely-adopted therapeutic modality, some of these new findings and techniques have yet to be incorporated into a guideline appropriate for Taiwan. In addition, differences in the underlying liver pathologies and treatment practices for transcatheter embolization between Taiwan and other Asian or Western populations have not been adequately addressed, with significant variations in the cTACE protocols adopted in different parts of the world. These mainly revolve around the amount and type of chemotherapeutic agents used, the type of embolic materials, reliance on Lipiodol, and the degree of selectiveness in catheter positioning. Subsequently, interpreting and comparing results obtained from different centers in a systematic fashion remain difficult, even for experienced practitioners. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to devise modernized recommendations that reflect recent clinical experiences, as well as cTACE protocols which are tailored for use in Taiwan. The conclusions of this expert panel are described herein.
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Affiliation(s)
- Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imagine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Vicent P. Chuang
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ding-Kwo Wu
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jen-I. Huang
- Department of Radiology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Hsiuo-Shan Tseng
- Department of Radiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chien-Fu Hung
- Department of Radiology, Chang−Gung Memorial Hospital, Taoyuan, Taiwan
| | - Reng-Hong Wu
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Chih Chern
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Hua-Ming Cheng
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Horng Wu
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - She-Meng Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:1-120. [PMID: 37384024 PMCID: PMC10202234 DOI: 10.17998/jlc.2022.11.07] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Affiliation(s)
- Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea
- Corresponding author: KLCA-NCC Korea Practice Guideline Revision Committee (KPGRC) (Committee Chair: Joong-Won Park) Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel. +82-31-920-1605, Fax: +82-31-920-1520, E-mail:
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Veloso Gomes F, de Baère T, Verset G, Coimbra É, Tovar-Felice G, Malagari K, Bruix J. Transarterial Chemoembolization with Anthracyclines-Loaded Polyethylene Glycol Drug Eluting Microspheres for the Treatment of Hepatocellular Carcinoma: A Pooled Multicentric Analysis of Survival in 580 Patients. Cardiovasc Intervent Radiol 2023; 46:436-446. [PMID: 36764953 DOI: 10.1007/s00270-023-03362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/07/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To evaluate survival, efficacy and safety of transarterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC), through a pooled analysis of patients with BCLC 0, A and B HCC stages, treated with polyethylene glycol drug eluting microspheres (PEG-DEM) TACE. MATERIALS AND METHODS Patients from 3 retrospective and 2 prospective registries were included. Overall survival (OS), progression-free survival (PFS), tumour response and safety were evaluated. Multivariate Cox regression analysis was performed to evaluate predictors of OS. RESULTS A total of 580 patients (72.1% males, mean age 66.9 ± 10.3 years) were included. 43.5% had BCLC A, and 41.0% BCLC B disease stage, and 85.8% were Child-Pugh class A. Complete and partial response (mRECIST or RECIST1.1) were achieved in 60.14% and 27.11% of patients, with overall response and disease control rates of 87.30% and 94.60%, respectively. Median OS was 50.8 months for the total population, and 61.2 and 38.1 months for BCLC 0 + A and BCLC B patients, respectively. Median PFS for the total population, BCLC 0 + A and BCLC B groups was 15.6, 21.6 and 12.7 months, respectively. CONCLUSIONS This multicentric pooled analysis confirmed efficacy and safety of PEG-DEM TACE, with a median OS of 50.8 months.
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Affiliation(s)
- Filipe Veloso Gomes
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. .,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Thierry de Baère
- Departement d'Anesthésie, de Chirurgie, Et de Radiologie Interventionnelle, Gustave Roussy, 102 rue Edourad Vaillant, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France.,Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, 102 rue Edourad Vaillant, Villejuif, France
| | - Gontran Verset
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Élia Coimbra
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gerardo Tovar-Felice
- Vascular and Interventional Radiology Unit, Hospital Universitari Germans Trias i Pujol, Carretera se Canyet S/N, 08916, Badalona, Spain
| | - Katerina Malagari
- National and Kapodistrian University of Athens, Evgenidion Hospital, Athens, Greece
| | - Jordi Bruix
- BCLC group Liver Unit, Hospital Clínic-IDIBAPS, CIBEREHD, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23:1126-1240. [PMID: 36447411 PMCID: PMC9747269 DOI: 10.3348/kjr.2022.0822] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:583-705. [PMID: 36263666 PMCID: PMC9597235 DOI: 10.3350/cmh.2022.0294] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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de Baere T, Ronot M, Chung JW, Golfieri R, Kloeckner R, Park JW, Gebauer B, Kibriya N, Ananthakrishnan G, Miyayama S. Initiative on Superselective Conventional Transarterial Chemoembolization Results (INSPIRE). Cardiovasc Intervent Radiol 2022; 45:1430-1440. [PMID: 35978174 PMCID: PMC9499883 DOI: 10.1007/s00270-022-03233-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/18/2022] [Indexed: 12/05/2022]
Abstract
Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) “selectively targetable” and “accessible to supraselective catheterization.” The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5–2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the “drop test.” Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care.
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Affiliation(s)
- Thierry de Baere
- Institut Gustave Roussy, Service Radiodiagnostic et Imagerie Médicale, 39, rue Camille Desmoulins, 94800, Villejuif, France.
| | - Maxime Ronot
- Department of Medical Imaging, Beaujon University Hospital, Clichy, France
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Rita Golfieri
- Unità Operativa Radiologia Universitaria (Pad 1, 2), Dipartimento delle Radiologie, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Roman Kloeckner
- Radiology Department, Mainz University: Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center (NCC), Goyang-si, South Korea
| | - Bernhard Gebauer
- Department of Diagnostic Radiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum: Charite, Berlin, Germany
| | - Nabil Kibriya
- Department of Radiology, Kings College Hospital, NHS Foundation Trust, London, UK
| | | | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-Ken Saiseikai Hospital, Fukui, Japan
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You R, Xu Q, Wang Q, Zhang Q, Zhou W, Cao C, Huang X, Ji H, Lv P, Jiang H, Lu Y, Jin Y, Li Y, Cheng L, Wang W, Xu H, Zhu X, Yin G. Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study. Front Oncol 2022; 12:816198. [PMID: 35982962 PMCID: PMC9378838 DOI: 10.3389/fonc.2022.816198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Camrelizumab is a newly developed program-death receptor one inhibitor; the real-world evidence about its application in hepatocellular carcinoma (HCC) treatment is lacking. Therefore, this prospective, multi-center, real-world study evaluated the efficacy and safety of camrelizumab plus transarterial chemoembolization (TACE) in treating intermediate-to-advanced HCC patients. Methods This study consecutively enrolled 101 intermediate to advanced HCC patients. All patients received camrelizumab-based treatment within 30 days of the perioperative period of the TACE operation. The primary outcome was progression-free survival (PFS), and the secondary effects were overall survival (OS), objective response rate (ORR), disease control rate (DCR), and AEs. Results Specifically, the median PFS was 9.7 (95% confidence interval: 7.4–12.0) months, with a 1-year PFS rate of 30.6%. Meanwhile, the median OS was not reached (NR) yet, with a 1-year OS rate of 61.9%. Besides, the CR, PR, SD, and PD rates were 12.8%, 44.9%, 29.5%, and 12.8%, respectively. The ORR and DCR were 57.7% and 87.2%, respectively. More cycles of camrelizumab were independently correlated with prolonged PFS (hazard ratio (HR): 0.415, P = 0.002), whereas longer intervals between camrelizumab administration and TACE were independently associated with unfavorable PFS (HR: 1.873, P = 0.032). The incidence of total AEs was 90.1%; most AEs were grade 1 (20.8%), grade 2 (28.7%) and grade 3 (37.6%), while only 3 (3.0%) patients had grade 4 AEs. Conclusion The camrelizumab plus TACE regimen is effective and safe, indicating its potential to serve as a promising treatment choice for intermediate to advanced HCC patients.
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Affiliation(s)
- Ran You
- Interventional Radiology Department, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Qingyu Xu
- Interventional Radiology Department, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Qi Wang
- Interventional Radiology Department, The First People’s Hospital of Changzhou, Changzhou, China
| | - Qingqiao Zhang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weizhong Zhou
- Interventional Radiology Department, Jiangsu Province Hospital, Nanjing, China
| | - Chi Cao
- Interventional Radiology Department, Xuzhou Central Hospital, Xuzhou, China
| | - Xiangzhong Huang
- Interventional Radiology Department, Jiangyin People’s Hospital, Jiangyin, China
| | - Honghai Ji
- Interventional Radiology Department, Yancheng No. 1 People’s Hospital, Yancheng, China
| | - Penghua Lv
- Interventional Radiology Department, The Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Hao Jiang
- Interventional Radiology Department, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - You Lu
- Interventional Radiology Department, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yong Jin
- Interventional Radiology Department, The Second Affiliated Hospital of SooChow University, Suzhou, China
| | - Yongjun Li
- Interventional Radiology Department, Nantong Tumor Hospital, Nantong, China
| | - Long Cheng
- Interventional Radiology Department, Xuzhou Central Hospital, Xuzhou, China
| | - Weidong Wang
- Interventional Radiology Department, Wuxi People’s Hospital, Wuxi, China
| | - Hao Xu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- *Correspondence: Guowen Yin, ; Xiaoli Zhu, ; Hao Xu,
| | - Xiaoli Zhu
- Interventional Radiology Department, The First Affiliated Hospital of SooChow University, Suzhou, China
- *Correspondence: Guowen Yin, ; Xiaoli Zhu, ; Hao Xu,
| | - Guowen Yin
- Interventional Radiology Department, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Guowen Yin, ; Xiaoli Zhu, ; Hao Xu,
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SIB-IMRT combined with apatinib for unresectable hepatocellular carcinoma in patients with poor response to transarterial chemoembolization. Clin Res Hepatol Gastroenterol 2022; 46:101897. [PMID: 35240318 DOI: 10.1016/j.clinre.2022.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radiotherapy combined with apatinib exhibits synergistic anti-tumor effect, while the application of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) combined with apatinib in HCC patients is scarce. Hence, this study aimed to explore the treatment response, survival, and safety profile of the SIB-IMRT combined with apatinib in unresectable HCC (uHCC) patients. METHODS A total of 19 uHCC patients with deficient response to transarterial chemoembolization (TACE), who scheduled for SIB-IMRT combined with apatinib treatment were enrolled. The SIB-IMRT was applied at the following dose: 95% planning target volume (PTV) at 30-50 Gy/2-2.5 Gy/15-20f and 90% Boost of 45-72 Gy/3-4.5 Gy/15-20f at 5 times per week with cone beam computerized tomography validation. During and after radiotherapy, the apatinib was administrated orally with the initial dose of 500 mg per day. RESULTS The complete response, partial response, stable disease, and progressive disease rates were 31.6%, 36.8%, 21.1% and 10.5%, respectively. Consequently, the objective response rate and disease control rate were 68.4% and 89.5%, respectively. During a median follow-up duration of 9.0 months, the median progression-free survival (PFS) was 6.0 (95% confidential interval (CI): 4.9-7.1) months with 1-year PFS rate of 42.1%; the median overall survival (OS) was not reached with 1-year OS rate of 54.6%. The safety profile was acceptable with the most common adverse events including myelosuppression (42.1%), skin reaction (36.8%), and albuminuria (26.3%). CONCLUSION SIB-IMRT combined with apatinib exhibits a good efficacy and tolerable safety profile, which could be considered as a potential treatment choice for uHCC patients who have deficient response to TACE.
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Transarterial chemoembolization (TACE) plus apatinib-combined therapy versus TACE alone in the treatment of intermediate to advanced hepatocellular carcinoma patients: A real-world study. Clin Res Hepatol Gastroenterol 2022; 46:101869. [PMID: 35108656 DOI: 10.1016/j.clinre.2022.101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Apatinib exhibits the synergistic effect with transarterial chemoembolization (TACE) though inhibiting the neoangiogenetic reaction caused by TACE. In this real-world study, we aimed to evaluate the efficacy and safety of TACE plus apatinib-combined therapy (ACT) in intermediate to advanced hepatocellular carcinoma (HCC) patients. METHODS Data from 168 intermediate to advanced HCC patients who received TACE alone (N = 49) or TACE plus ACT (N = 119) were extracted. Besides, ACT was defined as apatinib with or without other therapy, such as arsenic trioxide, microwave ablation and radioactive seed implantation. RESULTS In TACE plus ACT group, the median overall survival (OS) was 30 months (95% confidence interval (CI): 24-40 months) with 1-year, 3-year and 5-year OS rate of 84.0%, 41.2% and 21.5%, respectively. While in TACE group, the median OS was only 14 months (95%CI: 11-17 months) with 1-year, 3-year and 5-year OS rate of 55.1%, 18.4% and 16.1%, separately. By comparation, the OS was prolonged in TACE plus ACT group compared with TACE group (P<0.001). After adjusted by multivariate Cox's regression analysis, TACE plus ACT (vs. TACE) independently related to the longer OS (hazard ratio: 0.504, P = 0.001). In TACE plus ACT group, the most frequent adverse events included hand-foot syndrome (95.8%), hypertension (95.8%), fatigue (90.8%), albuminuria (85.7%), anorexia (79.0%), diarrhea (66.4%), myelosuppression (58.8%), nausea/vomiting (49.6%) and abdominal pain (39.5%), besides, no grade 4 adverse events and treatment-related death occurred. CONCLUSION TACE plus ACT is a promising treatment choice for the intermediate to advanced HCC patients.
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Hoshiai S, Irie T, Mori K, Hasegawa N, Fukuda K, Ishige K, Mori K, Arai H, Takahashi N, Nakajima T. A Transarterial Chemoembolization of Balloon-Occluded Alternate Infusions of Cisplatin and Gelatin Particles for Hepatocellular Carcinoma: A Phase I/II Multicenter Prospective Study of Safety and Efficacy. J Vasc Interv Radiol 2021; 33:169-176.e1. [PMID: 34715322 DOI: 10.1016/j.jvir.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/18/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of a newly developed technique of balloon-occluded alternate infusions of cisplatin and gelatin particles in transarterial chemoembolization (BOAI-TACE) for hepatocellular carcinoma (HCC), and to evaluate liver damage following BOAI-TACE. MATERIALS AND METHODS Forty-three patients with HCC from four medical centers were enrolled in this multicenter, prospective study. Of these, 41 patients were observed for 6 months following BOAI-TACE. The primary endpoint was the safety of BOAI-TACE, and the secondary endpoint was the objective response rate (ORR) of the HCCs at 2 months following treatment. RESULTS Three patients experienced adverse events, including one patient with facial swelling and skin rash, dissection of the celiac artery, and a bland portal vein thrombus. No major adverse events were identified. 4.9% of the patients regressed from a Child-Pugh classification of A to B. The BOAI-TACE treatment achieved a 22.0% complete response (CR) rate and a 73.2% ORR (95% confidence interval [CI]: 57.9-84.4%). In a retrospective analysis of 23 patients with HCCs above the up-to-7 criteria, the CR rate and ORR of the BOAI-TACE were 21.7% and 82.6% (95% CI: 62.3-93.6%), respectively. CONCLUSIONS BOAI-TACE is safe and effective for achieving a high ORR while preserving liver function.
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Affiliation(s)
- Sodai Hoshiai
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Irie
- Department of Radiology, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Kensaku Mori
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Japan
| | - Naoyuki Hasegawa
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan
| | - Kuniaki Fukuda
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan; Department of Gastroenterology, Kasumigaura Medical Center, Tsuchiura, Japan
| | - Kazunori Ishige
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan; Department of Gastroenterology, Kasumigaura Medical Center, Tsuchiura, Japan
| | - Kouichi Mori
- Department of Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Nobuyuki Takahashi
- Department of Radiology, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan; Department of Radiology, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Takahito Nakajima
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Japan
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Feasibility and safety of a novel indwelling catheter system via the femoral artery for intermittent transarterial therapy for treating malignant liver tumors. Jpn J Radiol 2021; 40:326-333. [PMID: 34699022 DOI: 10.1007/s11604-021-01202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE An indwelling arterial access system via the brachial artery, System-i, has been previously reported. We have modified the technique for the femoral artery approach. This study aimed to evaluate the feasibility and safety of the modified System-i for patients with malignant liver tumors. MATERIALS AND METHODS The modified System-i is an indwelling catheter that provides vascular access for inserting a microcatheter without repeated punctures to the femoral artery. Between 2018 and 2020, the system was implanted for 50 patients with malignant liver tumors. We used the system for patients with difficulty in inserting the conventional indwelling catheter system. To place the system, a side-holed catheter was implanted in the femoral artery, and the tip of the catheter was placed in the superficial femoral artery through the contralateral iliac artery. Using this system, transcatheter arterial chemoembolization or hepatic arterial infusion chemotherapy was performed. A shaped high-flow microcatheter and a non-tapered microcatheter were used with the system. The technical aspects and outcomes of the system were also assessed. RESULTS Implantation of the system was successful in all patients. The median implantation time was 40 min. The main reason for implantation was obstruction or stenosis of the hepatic artery. Among the 50 patients, 11 (22%) showed complications, of which four had major complications/class C based on the SIR criteria. CONCLUSION The modified System-i is a safe system that can be a feasible repeated interventional radiological treatment via the femoral approach. We need to evaluate the efficacy of this system in the treatment of advanced cancers in the future. The modified System-i is a novel indwelling catheter system that allows vascular access to perform intermittent transarterial therapy, such as transcatheter arterial chemoembolization and hepatic arterial infusion chemotherapy via the femoral approach. In this study, we report the technical details and safety of the system.
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Bucalau AM, Tancredi I, Verset G. In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play? Cancers (Basel) 2021; 13:5129. [PMID: 34680278 PMCID: PMC8533902 DOI: 10.3390/cancers13205129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
Conventional transarterial embolization (cTACE) has been proven to be effective for intermediate stage hepatocellular carcinoma (HCC), with a recent systematic review showing an overall survival (OS) of 19.4 months. Nevertheless, due to the rapid development of the systemic therapeutic landscape, the place of TACE is becoming questionable. Is there still a niche for TACE in the era of immunotherapy and combination treatments such as atezolizumab-bevacizumab, which has shown an OS of 19.2 months with excellent tolerance? The development of drug-eluting microspheres (DEMs) has led to the standardization of the technique, and along with adequate selection, it showed an OS of 48 months in a retrospective study. In order to increase treatment selectivity, new catheters have also been added to the TACE arsenal as well as the use of cone-beam CT (CBCT), which provides three-dimensional volumetric images and guidance during procedures. Moreover, the TACE indications have also widened. It may serve as a "bridging therapy" for liver transplantation candidates while they are on the waiting list, and it represents a valuable downstaging tool to transplantation criteria. The aim of this review is to explore the current data on the advancements of TACE and its future place amongst the growing panel of treatments.
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Affiliation(s)
- Ana-Maria Bucalau
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Illario Tancredi
- Department of Interventional Radiology, Hôpital Erasme, 1070 Brussels, Belgium;
| | - Gontran Verset
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
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Yu SCH. Blood Flow Diversion Within Hepatocellular Carcinoma (HCC) after Selective Occlusion of Feeding Arteries (SOFA) and Feasibility of Utilizing the SOFA Technique in Transarterial Chemoembolization (SOFA-TACE). Cardiovasc Intervent Radiol 2021; 45:121-126. [PMID: 34604919 DOI: 10.1007/s00270-021-02973-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/09/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Arterial feeders supplying a hepatocellular carcinoma are known to be interconnected through the sinusoid-like tumor vasculature. It was observed angiographically that when one of the feeders is selectively catheterized for drug delivery in transarterial chemoembolization (TACE), the whole tumor vasculature will be filled up, if the arterial inflow from all the other feeders is temporarily arrested with selective occlusion of feeding arteries (SOFA) using an additional catheter (balloon catheter). The feasibility of using the SOFA technique in TACE (SOFA-TACE) is discussed. MATERIALS AND METHODS In this prospective, monocentric feasibility study, with informed consent obtained, 8 consecutive patients of median age 64.5 years (60-68.8) and tumor dimension 4.7 cm (3.2-6.1), having specific tumor features (solitary, hypervascularity, well-defined, ≤ 7 cm, multiple tumor feeders), received SOFA-TACE using ethiodized oil-cisplatin suspension. Tumor response was assessed with 3-monthly CT using modified RECIST. RESULTS A single tumor feeder was catheterized for drug delivery (8 cases). All other tumor feeders were successfully occluded with a balloon at one site (8 cases). Complete filling of the vasculature of the whole tumor was achieved in 7 of 8 cases with the SOFA technique as shown on arteriogram and CT, except in a case with an intratumoral septum. There was no complication. Surveillance CT (median 25 months, range 22-28) showed complete response in all cases. CONCLUSION SOFA-TACE is feasible with reasonable safety and favorable treatment outcome; it may be a valuable technical option that may facilitate the procedures of selective TACE in technically challenging cases.
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Affiliation(s)
- Simon Chun Ho Yu
- Department of Imaging and Interventional Radiology, Vascular and Interventional Radiology Foundation Clinical Science Center, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
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Golfieri R, Bezzi M, Verset G, Fucilli F, Mosconi C, Cappelli A, Paccapelo A, Lucatelli P, Magand N, Rode A, De Baere T. Balloon-Occluded Transarterial Chemoembolization: In Which Size Range Does It Perform Best? A Comparison of Its Efficacy versus Conventional Transarterial Chemoembolization, Using Propensity Score Matching. Liver Cancer 2021; 10:522-534. [PMID: 34721513 PMCID: PMC8529335 DOI: 10.1159/000516613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The aim of this multicenter comparison of balloon-occluded transarterial chemoembolization (B-TACE) versus conventional TACE (cTACE) in treating hepatocellular carcinoma (HCC) was to assess in which size range the 2 techniques offered higher complete response (CR) and objective response (OR) rates in a single session, and to evaluate the possibility of using B-TACE to reduce the need for re-treatment. METHODS 325 patients were retrospectively evaluated: 91 patients in the B-TACE group (22 with cTACE [B-cTACE] and 69 with drug-eluting microsphere TACE [B-DEM-TACE]) and 234 in the cTACE group. The results were compared according to tumor size: (A) <30 mm, (B) 30-50 mm, and (C) >50 mm; OR and CR rates after the first session and the number of TACE re-interventions within a 6-month period were also evaluated using propensity score matching (PSM). RESULTS The best target ORs were very high (93.2%) and similar between the 2 treatments both before (94.4% for cTACE and 90.1% for B-TACE) and after PSM (94.5% for cTACE and 90.1%; p = 0.405), with slightly better results for the cTACE cohort probably due to better cTACE effectiveness in smaller lesions. In lesions <30 mm, cTACE obtained a slightly higher CR rate than B-TACE (61.9 vs. 56.3%, p = 0.680), whereas in intermediate-sized HCCs (30-50 mm), B-TACE showed a significant superiority in achieving a CR (72.3 vs. 54.1%, respectively; p = 0.047). In larger lesions (>50 mm), cTACE and B-TACE performed equally, with a poor CR rate (22.6 vs. 23.1%, respectively; p = 1.000). These results were additionally confirmed using PSM. The patients treated with B-TACE had a significantly lower re-treatment rate than the cTACE cohort (12.1 vs. 26.9%, respectively; p = 0.005). B-cTACE and B-DEM-TACE demonstrated similar ORs, with a slightly better CR rate for B-cTACE (68.2 vs. 56.5%, respectively; p = 0.456). CONCLUSION In HCCs of 30-50 mm, B-TACE should be preferred to cTACE, whereas in smaller nodules (<30 mm), cTACE can suffice in achieving a good CR rate. The statistically significant lower re-treatment rate of the B-TACE cohort after a single procedure reduced the risk of complications due to multiple TACE, which could worsen the patient prognosis.
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Affiliation(s)
- Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,*Rita Golfieri,
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Rome, Italy
| | - Gontran Verset
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Fucilli
- Radiology Unit, “S. De Bellis” National Institute of Gastroenterology Research Hospital, Bari, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Rome, Italy
| | - Nicolas Magand
- Diagnostic and Interventional radiology Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Agnes Rode
- Diagnostic and Interventional radiology Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry De Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
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Locoregional therapy in hepatocellular carcinoma: when to start and when to stop and when to revisit. ESMO Open 2021; 6:100129. [PMID: 33887687 PMCID: PMC8086015 DOI: 10.1016/j.esmoop.2021.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
With increasing therapeutic options available for advanced hepatocellular carcinoma (HCC), the timing and sequencing of locoregional and systemic therapy need to be re-examined. This is especially so for patients with intermediate HCC, so as to optimize responses while preserving liver reserves, and in so allowing our patients to achieve the best survival outcomes possible.
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Hepatic Toxicity After Selective Chemoembolization Is Associated With Decreased Survival Among Patients With Hepatocellular Carcinoma. AJR Am J Roentgenol 2021; 216:1283-1290. [PMID: 33703926 DOI: 10.2214/ajr.20.23478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this study was to identify risk factors for and outcomes of hepatotoxicity after selective chemoembolization of hepatocellular carcinoma. MATERIALS AND METHODS. This retrospective study included 182 patients (136 men and 46 women; median age, 63 years [interquartile range, 57-70 years]) who underwent 338 consecutive doxorubicin drug-eluting bead (DEB) chemoembolization procedures between 2011 and 2014. Outcomes were assessed until November 2019. In 97% of procedures, two or fewer segments were targeted. The Barcelona Clinic Liver Cancer (BCLC) stage was 0 or A for 77 procedures (22.8%), B for 75 (22.2%), C for 122 (36.1%), and D for 64 (18.9%). Hepatotoxicity was defined as worsened ascites or encephalopathy or as grade 3 or 4 elevations in liver function test results, creatinine levels, or the international normalized ratio within 30 days. Risk factors were assessed by univariate and multivariable generalized estimating equations. Transplant-free survival was assessed using Cox proportional hazard models. RESULTS. Hepatotoxicity was observed after 84 of 338 procedures (24.9%) performed for 70 of 182 patients (38.5%) and was irreversible for 40 procedures (11.8%). On multivariable analysis, risk factors for irreversible toxicity included Child-Pugh class C liver function (odds ratio [OR], 4.4; 95% CI, 1.0-19.0; p = .04), BCLC stage C (OR, 5.0; 95% CI, 1.6-16.0; p = .006) or D (OR, 7.4; 95% CI, 2.1-25.5; p = .002) disease, TIPS or hepatofugal portal venous flow (OR, 6.3; 95% CI, 2.3-17.0; p < .001), and a serum α-fetoprotein level of 200 ng/mL or greater (OR, 2.6; 95% CI, 1.1-6.1; p = .03). Irreversible toxicity was associated with reduced transplant-free survival among patients who were ineligible for liver transplant (hazard ratio, 2.5; standard error, 0.42; p = .03). CONCLUSION. Irreversible hepatotoxicity was common after selective chemoembolization in patients with advanced stage disease, an elevated serum α-fetoprotein level, or reduced hepatic portal venous perfusion, and it may hasten death among patients who are ineligible for liver transplant.
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Kobayashi S, Tajiri K, Murayama A, Entani T, Futsukaichi Y, Nagata K, Takahashi K, Yasuda I. Drug-eluting Bead-Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma Refractory to Conventional Lipiodol-based Transcatheter Arterial Chemoembolization. J Hepatocell Carcinoma 2020; 7:181-189. [PMID: 33117752 PMCID: PMC7569043 DOI: 10.2147/jhc.s273929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 01/27/2023] Open
Abstract
Purpose To evaluate the potential of drug-eluting bead (DEB)-transcatheter arterial chemoembolization (TACE) as a treatment option for patients with refractory to conventional lipiodol-based TACE (c-TACE) especially with decreased liver function. Patients and Methods We retrospectively evaluated the treatment results of DEB-TACE for 89 HCC nodules in 27 patients with c-TACE refractory according to liver function. Results Although overall survival was significantly better in Child–Pugh A patients than in Child–Pugh B patients (median survival time, MST: 561 vs 347 days, p=0.031), progression-free survival was almost similar in both patients between Child–Pugh A and B (MST: 79 vs 87 days, p=0.534). Regarding antitumor response, the objective response rate (ORR) and disease-control rate (DCR) were 5.3/12.5% and 52.7/87.5% in Child–Pugh A/B, respectively. In each 89 HCC nodules, ORR and DCR were almost similar between Child–Pugh A and B (ORR, 20.3 vs 13.3%; DCR, 77.0 vs 73.3%, respectively). Adverse events of DEB-TACE were well-tolerated, and liver function was reserved during DEB-TACE procedures. Conclusion DEB-TACE could be a therapeutic option for advanced HCC patients with c-TACE refractory and decreased liver function.
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Affiliation(s)
- Saito Kobayashi
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Aiko Murayama
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Toshiki Entani
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Yuka Futsukaichi
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Kohei Nagata
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Kosuke Takahashi
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
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22
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Arterial Embolization Using Microspheres for Hypervascular Liver Metastases Refractory to Standard Treatments: A Multicenter Prospective Clinical Trial. Cardiovasc Intervent Radiol 2020; 44:392-400. [PMID: 33098022 DOI: 10.1007/s00270-020-02673-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical utility of bland arterial embolization using microspheres in patients with hypervascular liver metastases refractory to standard treatments. MATERIALS AND METHODS Primary endpoints of this prospective single-arm non-comparative study were objective response and disease control rates (ORR and DCR), based on the modified Response Evaluation Criteria in Solid Tumors at 4 weeks after embolization. Secondary endpoints were ORR according to primary tumor, overall survival, progression-free survival (PFS), and safety. RESULTS Twenty-five patients with a median age of 66 years (range, 40-95 years) were enrolled in this study. The median maximum diameter of liver metastasis was 3.7 cm (range, 2.0-15.2 cm). Primary lesions were colorectal cancer in 12 patients (48%, 12/25), other cancer in 7 (28%, 7/25), neuroendocrine tumor in 4 (16%, 4/25), and sarcoma in 2 (8%, 2/25). ORR and DCR were 52% (13/25) and 72% (18/25) in all patients, 42% (5/12) and 75% (9/12) in colorectal cancer patients, and 62% (8/13) and 69% (9/13) in other malignant tumor patients (p = 0.43, p > 0.99). Median survival time was 19 months in all patients, 19 months in colorectal cancer patients, and 8 months (p = 0.16) in other malignant tumor patients. Median PFS time was 4 months in all patients, 4 months in colorectal cancer patients, and 6 months (p = 0.0085) in other malignant tumor patients. There were no grade-3 or -4 adverse events. CONCLUSION Microsphere embolization appears to be an effective and safe treatment for hypervascular liver metastases refractory to standard treatments.
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23
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Saito N, Tanaka T, Nishiohuku H, Sato T, Masada T, Matsumoto T, Anai H, Sakaguchi H, Sueyoshi S, Marugami N, Kichikawa K. Transarterial- chemoembolization remains an effective therapy for intermediate-stage hepatocellular carcinoma with preserved liver function. Hepatol Res 2020; 50:1176-1185. [PMID: 32721060 DOI: 10.1111/hepr.13550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022]
Abstract
AIM 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. METHODS 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 4 weeks 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. RESULTS The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2 months. Survival rates at 1, 2, and 3 years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75 years (P = 0.022), serum α-fetoprotein level ≥ 200 ng/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. CONCLUSION 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.
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Affiliation(s)
- Natsuhiko Saito
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Hideyuki Nishiohuku
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Takeshi Sato
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Tetsuya Masada
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Takeshi Matsumoto
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Hiroshi Anai
- Department of Radiology, Nara City Hospital, Nara, Japan
| | | | - Satoru Sueyoshi
- Department of Radiology, Saiseikai Chuwa Hospital, Sakurai, Japan
| | - Nagaaki Marugami
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, IVR Center, Nara Medical University, Kashihara, Japan
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Takaki H, Hirata Y, Ueshima E, Kodama H, Matsumoto S, Wada R, Suzuki H, Nakasho K, Yamakado K. Hepatic Artery Embolization Enhances Expression of Programmed Cell Death 1 Ligand 1 in an Orthotopic Rat Hepatocellular Carcinoma Model: In Vivo and in Vitro Experimentation. J Vasc Interv Radiol 2020; 31:1475-1482.e2. [PMID: 32800663 DOI: 10.1016/j.jvir.2020.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/21/2020] [Accepted: 03/29/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the effects of hepatic artery embolization (HAE) on the expression of programmed cell death 1 ligand 1 (PD-L1) in an orthotopic rat hepatocellular carcinoma (HCC) model. MATERIALS AND METHODS A rat HCC model was established in Sprague-Dawley rats with the RH7777 cell line. Six animals each were assigned to receive HAE or sham treatment. Liver tissues were harvested 24 h after the procedure. Immunohistochemistry (IHC) was used to compare expression of PD-L1 and hypoxia-inducible factor (HIF)-1α in the intratumoral and peritumoral regions and normal liver tissue. In vitro cell culture study was performed for 24 h under normoxic and hypoxic conditions, and protein expression of PD-L1 and HIF-1α and the effects of HIF-1α inhibitors were assessed. RESULTS IHC showed that PD-L1- and HIF-1α-positive areas were significantly larger in the HAE group vs the sham group in intratumoral (P = .006 and P < .001, respectively) and peritumoral regions (both P < .001). The expression of PD-L1 positively correlated with HIF-1α expression in the intratumoral region (r2 = 0.551; P < .001). In vitro cell culture study revealed that protein expression of PD-L1 and HIF-1α were significantly higher when cells were incubated under hypoxic vs normoxic conditions (P = .028 and P = .010, respectively). PD-L1 expression was suppressed significantly when the HIF-1α inhibitor rapamycin was added to the culture medium (P = .024). CONCLUSIONS HAE enhances intratumoral and peritumoral PD-L1 expression in a rat HCC model. The HIF-1α pathway is a possible mechanism underlying increased intratumoral PD-L1 expression after HAE.
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Affiliation(s)
- Haruyuki Takaki
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Yutaka Hirata
- Department of Physiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Eisuke Ueshima
- Department of Diagnostic and Interventional Radiology, Kobe University, Kobe, Japan
| | - Hiroshi Kodama
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Seiji Matsumoto
- Division of Thoracic Surgery and Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Reona Wada
- Department of Molecular and Cellular Biology, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Hitomi Suzuki
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Keiji Nakasho
- Department of Pathology, Suita Tokushukai Hospital, Osaka, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Kudo M, Han KH, Ye SL, Zhou J, Huang YH, Lin SM, Wang CK, Ikeda M, Chan SL, Choo SP, Miyayama S, Cheng AL. A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements. Liver Cancer 2020; 9:245-260. [PMID: 32647629 PMCID: PMC7325125 DOI: 10.1159/000507370] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/11/2020] [Indexed: 02/04/2023] Open
Abstract
The Asia-Pacific Primary Liver Cancer Expert (APPLE) Consensus Statement on the treatment strategy for patients with intermediate-stage hepatocellular carcinoma (HCC) was established on August 31, 2019, in Sapporo, Hokkaido during the 10th Annual APPLE Meeting. This manuscript summarizes the international consensus statements developed at APPLE 2019. Transarterial chemoembolization (TACE) is the only guideline-recommended global standard of care for intermediate-stage HCC. However, not all patients benefit from TACE because intermediate-stage HCC is a heterogeneous disease in terms of tumor burden and liver function. Ten important clinical questions regarding this stage of HCC were raised, and consensus statements were generated based on high-quality evidence. In intermediate-stage HCC, preservation of liver function is as important as achieving a high objective response (OR) because the treatment goal is to prolong overall survival. Superselective conventional TACE (cTACE) is recommended as the first choice of treatment in patients eligible for effective (curative) TACE, whereas in patients who are not eligible, systemic therapy is recommended as the first choice of treatment. TACE is not indicated as the first-line therapy in TACE-unsuitable patients. Another important statement is that TACE should not be continued in patients who develop TACE failure/refractoriness in order to preserve liver function. Targeted therapy is the recommended first-line treatment for TACE-unsuitable patients. Especially, the drug, which can have higher OR rate, is preferred. Immunotherapy, transarterial radioembolization, TACE + targeted therapy or other modalities may be considered alternative options in TACE-unsuitable patients who are not candidates for targeted therapy. Better liver function, such as albumin-bilirubin grade 1, is an important factor for maximizing the therapeutic effect of systemic therapy.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sheng-Long Ye
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Kwe Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital, Ren-Ai Branch and Kang Ning Hospital, Taipei, Taiwan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa-shi, Japan
| | - Stephen Lam Chan
- Department of Clinical Oncology, State Key Laboratory of Translation Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Ann Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, School of Medicine, National Taiwan University, Taipei, Taiwan
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26
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Song Q, Ren W, Fan L, Zhao M, Mao L, Jiang S, Zhao C, Cui Y. Long-Term Outcomes of Transarterial Chemoembolization Combined with Radiofrequency Ablation Versus Transarterial Chemoembolization Alone for Recurrent Hepatocellular Carcinoma After Surgical Resection. Dig Dis Sci 2020; 65:1266-1275. [PMID: 31312995 DOI: 10.1007/s10620-019-05733-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is lack of data for identifying optimal local therapy for the management of recurrent hepatocellular carcinoma (HCC) after hepatic resection. AIMS A retrospective study was performed to compare the effectiveness of transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with that of TACE alone for recurrent HCC. METHODS From 2007 to 2013, patients with recurrent HCC ≤ 5 cm were treated with either TACE plus RFA (n = 96) or TACE (n = 63). Inverse probability of treatment weighting was used to make allowances for imbalances in treatment assignment. The disease-free survival (DFS) and overall survival (OS) were retrospectively analyzed. RESULTS The TACE group had lower pretreatment Child-Pugh class (P = 0.025) and shorter pretreatment interval of recurrence (P = 0.028). The 1-, 3-, and 5-year DFS rates for the TACE-RFA group were 55.1%, 22.5%, and 9.7%, respectively, and 41.1%, 9.9%, and 4.9%, respectively, for the TACE group. The OS rates at 1, 3, and 5 years were 82.3%, 42.7%, and 16.5%, respectively, in the TACE-RFA group, and 75.9%, 30.7%, and 11.3%, respectively, in the TACE group. Cirrhosis was significantly associated with disease progression (hazard ratio [HR] 1.53; 95% CI 1.09-2.14; P = 0.014). CONCLUSIONS In patients with recurrent HCC ≤ 5 cm, TACE-RFA shows better DFS than TACE alone as a first-line local therapy.
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Affiliation(s)
- Qingfeng Song
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Weizheng Ren
- Department of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Liwei Fan
- Department of Interventional Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Meiqi Zhao
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Lisha Mao
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Shichai Jiang
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Chang Zhao
- Department of Interventional Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Ying Cui
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China.
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27
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Ogasawara S, Ooka Y, Koroki K, Maruta S, Kanzaki H, Kanayama K, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Saito T, Kondo T, Suzuki E, Nakamoto S, Tawada A, Chiba T, Arai M, Kato J, Kato N. Switching to systemic therapy after locoregional treatment failure: Definition and best timing. Clin Mol Hepatol 2020; 26:155-162. [PMID: 31937081 PMCID: PMC7160341 DOI: 10.3350/cmh.2019.0021n] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 12/11/2022] Open
Abstract
In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.
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Affiliation(s)
- Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Susumu Maruta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kengo Kanayama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
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Identification of the feeding arteries of hepatocellular carcinomas by performing dual arterial phase CT during pre-transarterial chemoembolization angiography. Abdom Radiol (NY) 2019; 44:2276-2282. [PMID: 30788560 DOI: 10.1007/s00261-019-01950-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the usefulness of performing dual arterial phase computed tomography (CT) during pre-transarterial chemoembolization (TACE) angiography for identifying the feeding arteries of hepatocellular carcinomas (HCC). MATERIALS AND METHODS Dual arterial phase CT was performed during pre-TACE angiography in 73 patients with 139 HCC. Ten HCC underwent this procedure twice, so the total number of examined HCC was 149. Early and late arterial phase images were obtained 6 seconds after injection of an iodinated contrast material serially during a single breath-hold. The feeding artery was defined as the branch of the hepatic artery that was connected to the enhanced areas of the tumor. For HCC that could not be visualized on the early arterial phase images, fusion images superimposing the early and late arterial phase images were constructed. Furthermore, technical success defined as successful catheterization of the subsegmental or more distal feeding artery was evaluated. RESULTS The feeding artery was correctly identified on dual arterial phase CT in 146 of the 149 tumors (98.0%). In two HCC, the feeding arteries could not be identified due to severe motion artifacts, and in one, due to the presence of anastomosis between the right and left hepatic arteries. Catheterization of the subsegmental feeding artery was successful in all TACE procedures (technical success rate: 100%). CONCLUSION Performing dual arterial phase CT during angiography appears to be useful for identifying the feeding arteries of HCC.
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29
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Kakiuchi Y, Sakata S, Nakamura K, Okabayashi H, Akaike K, Tokunaga T, Saeki S, Fujii K, Ichiyasu H. Acute Exacerbation of Idiopathic Interstitial Pneumonia in a Patient with Hepatocellular Carcinoma after Transcatheter Arterial Therapy Using Miriplatin. Intern Med 2019; 58:1329-1333. [PMID: 30626817 PMCID: PMC6543208 DOI: 10.2169/internalmedicine.1446-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A 76-year-old Japanese woman with recurrent hepatocellular carcinoma presented with acute exacerbation of idiopathic interstitial pneumonia (AE-IIP) after transcatheter arterial therapy using miriplatin. She had a history of preexisting IIP five years before presenting at our hospital. On day 4 after transcatheter arterial therapy, she complained of shortness of breath. Subsequently, she developed acute respiratory failure on day 11 after transcatheter arterial therapy. Chest computed tomography revealed extensive ground-glass opacity and traction bronchiectasis in bilateral lung fields; subsequently, she was diagnosed with AE-IIP triggered by transcatheter arterial therapy using miriplatin. Despite systemic administration of high-dose corticosteroid and cyclophosphamide, she died of respiratory failure on day 36.
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Affiliation(s)
- Yosuke Kakiuchi
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | - Shinya Sakata
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | | | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | - Kimitaka Akaike
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | - Takayuki Tokunaga
- Department of Gastroenterology and Hepatology, Graduate School of Medical Science, Kumamoto University, Japan
| | - Sho Saeki
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | - Kazuhiko Fujii
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Kumamoto University Hospital, Japan
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30
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Miyayama S. Ultraselective conventional transarterial chemoembolization: When and how? Clin Mol Hepatol 2019; 25:344-353. [PMID: 31022779 PMCID: PMC6933118 DOI: 10.3350/cmh.2019.0016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui, Japan
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31
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Abstract
With the increasing incidence of hepatocellular carcinoma (HCC) and its high mortality rates, effective treatment options are of urgent need, preferably in a multidisciplinary setting. In the management of those patients, interventional radiologists play a key role. In this article, we reviewed the current literature for regional, intraarterial treatment strategies of advanced-stage HCC including conventional transarterial chemoembolization, transarterial embolization, transarterial embolization with drug-eluting beads, and selective internal radiation therapy.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Bannangkoon K, Hongsakul K, Tubtawee T, McNeil E, Sriplung H, Chongsuvivatwong V. Rate and Predictive Factors for Sustained Complete Response after Selective Transarterial Chemoembolization (TACE) in Patients with Hepatocellular Carcinoma. Asian Pac J Cancer Prev 2018; 19:3545-3550. [PMID: 30583681 PMCID: PMC6428524 DOI: 10.31557/apjcp.2018.19.12.3545] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: To determine the effectiveness and performance of selective conventional transarterial chemoembolization (TACE) and analyze the potential predictive factors of sustained complete response (CR) for patients with hepatocellular carcinoma (HCC). Materials and Methods: Total of 52 patients with HCC (33 males, 19 females; mean age 64.0 ± 9.6 years) who underwent 81 sessions of selective TACE between November 2015 and March 2017 at Songklanagarind hospital were reviewed. The Kaplan-Meier method was used to describe CR rates at various time points. Univariate and multivariate logistic regression models were performed to determine the predictive factors for sustained CR at six months. Results: The CR rates after selective TACE at 1, 4, 6, 9 and 12 months were 87%, 81%, 62%, 40% and 31%, respectively. Univariate and multivariate analyses demonstrated that alpha fetoprotein level <100ng/ml, a tumor size in summation ≤ 30 mm, ≤ 2 sessions of selective TACE and unilobar involvement had a significantly higher odds of sustaining complete response at six months (p =0.018, 0.031, 0.032, and 0.044, respectively). Conclusions: Selective TACE has a good therapeutic results and can sustained complete response in selected HCC patients. Serum AFP≤ 100 ng/ml, a few sessions of selective TACE, tumor size in summation ≤ 30 mm and unilobar involvement were favorable predictive factors for sustained complete response of HCC patients.
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Affiliation(s)
- Kittipitch Bannangkoon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla, Thailand.
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Zhou C, Zu QQ, Wang B, Zhou CG, Shi HB, Liu S. Efficacy and prognostic factors of transarterial embolization as initial treatment for spontaneously ruptured hepatocellular carcinoma: a single-center retrospective analysis in 57 patients. Jpn J Radiol 2018; 37:255-263. [PMID: 30511145 DOI: 10.1007/s11604-018-0799-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/26/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the efficacy and prognostic factors following transarterial embolization (TAE) as initial treatment for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS From June 2012 to June 2016, a total of 57 spontaneously ruptured HCC patients who received TAE as initial therapy were retrospectively studied at our institution. Patients were followed until October 2016. Survival rates were estimated using the Kaplan-Meier method, and prognostic factors related to survival were evaluated using Cox regression analysis. RESULTS Among them, 8 (14.0%) patients died within 30 days after initial TAE. The median overall survival time was 208 days. The 6-month, 1-year, and 2-year cumulative overall survival rates were 50.3%, 35.9%, and 14.7%, respectively. Multivariate analysis indicated that tumor size [HR (hazard ratio) 1.12; 95% CI (confidence interval) 1.02-1.23, P = 0.022] Child-Pugh class (HR 1.78; 95% CI 1.13-2.80; P = 0.013), absence of shock on admission (HR 0.40; 95% CI 0.17-0.95; P = 0.039), and embolization with lipiodol and gelatin sponge particles (HR 0.33; 95% CI 0.16-0.70; P = 0.004) were independent prognostic factors for survival. CONCLUSION TAE appeared to be an effective initial treatment for spontaneously ruptured HCC. The results indicated that large tumors, poor Child-Pugh class, and shock on admission were associated with poor prognosis. For these patients, embolization with lipiodol and gelatin sponge particles could achieve better survival than PVA particles used.
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Affiliation(s)
- Chun Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Bin Wang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
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Khalaf MH, Sundaram V, AbdelRazek Mohammed MA, Shah R, Khosla A, Jackson K, Desai M, Kothary N. A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma. Radiology 2018; 290:254-261. [PMID: 30299233 DOI: 10.1148/radiol.2018180257] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To develop and validate a predictive model for postembolization syndrome (PES) following transarterial hepatic chemoembolization (TACE) for hepatocellular carcinoma. Materials and Methods In this single-center, retrospective study, 370 patients underwent 513 TACE procedures between October 2014 and September 2016. Seventy percent of the patients were randomly assigned to a training data set and the remaining 30% were assigned to a testing data set. Variables included demographic, laboratory, clinical, and procedural details. PES was defined as pain and/or nausea beyond 6 hours after TACE that required intravenous medication for symptom control. The predictive model was developed by using conditional inference trees and Lasso regression. Results Demographics, laboratory data, performance, tumor characteristics, and procedural details were statistically similar for the training and testing data sets. Overall, 83 of 370 patients (22.4%) after 107 of 513 TACE procedures (20.8%) met the predefined criteria. Factors identified at univariable analysis included large tumor burden (P = .004), drug-eluting embolic TACE (P = .03), doxorubicin dose (P = .003), history of PES (P < .001) and chronic pain (P < .001), of which history of PES, tumor burden, and drug-eluting embolic TACE were identified as the strongest predictors by the multivariable analysis and were used to develop the predictive model. When applied to the testing data set, the model demonstrated an area under the curve of 0.62, sensitivity of 79% (22 of 28), specificity of 44.2% (53 of 120), and a negative predictive value of 90% (53 of 59). Conclusion The model identified history of postembolization syndrome, tumor burden, and drug-eluting embolic chemoembolization as predictors of protracted recovery because of postembolization syndrome. © RSNA, 2018.
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Affiliation(s)
- Mohamed H Khalaf
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Vandana Sundaram
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Mohammed Ahmed AbdelRazek Mohammed
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Rajesh Shah
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Ankaj Khosla
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Katherine Jackson
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Manisha Desai
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
| | - Nishita Kothary
- From the Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H3630, Stanford, CA 94305-5642 (M.H.K., M.A.A.M., R.S., A.K., K.J., N.K.); and Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, Calif (V.S., M.D.)
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A Data Mining-based Prognostic Algorithm for NAFLD-related Hepatoma Patients: A Nationwide Study by the Japan Study Group of NAFLD. Sci Rep 2018; 8:10434. [PMID: 29992975 PMCID: PMC6041283 DOI: 10.1038/s41598-018-28650-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
The prognosis of patients with nonalcoholic fatty liver disease-related hepatocellular carcinoma (NAFLD-HCC) is intricately associated with various factors. We aimed to investigate the prognostic algorithm of NAFLD-HCC patients using a data-mining analysis. A total of 247 NAFLD-HCC patients diagnosed from 2000 to 2014 were registered from 17 medical institutions in Japan. Of these, 136 patients remained alive (Alive group) and 111 patients had died at the censor time point (Deceased group). The random forest analysis demonstrated that treatment for HCC and the serum albumin level were the first and second distinguishing factors between the Alive and Deceased groups. A decision-tree algorithm revealed that the best profile comprised treatment with hepatectomy or radiofrequency ablation and a serum albumin level ≥3.7 g/dL (Group 1). The second-best profile comprised treatment with hepatectomy or radiofrequency ablation and serum albumin levels <3.7 g/dL (Group 2). The 5-year overall survival rate was significantly higher in the Group 1 than in the Group 2. Thus, we demonstrated that curative treatment for HCC and serum albumin level >3.7 g/dL was the best prognostic profile for NAFLD-HCC patients. This novel prognostic algorithm for patients with NAFLD-HCC could be used for clinical management.
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Delicque J, Guiu B, Boulin M, Schwanz H, Piron L, Cassinotto C. Liver chemoembolization of hepatocellular carcinoma using TANDEM ® microspheres. Future Oncol 2018; 14:2761-2772. [PMID: 29953255 DOI: 10.2217/fon-2018-0237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Transarterial chemoembolization (TACE) combines intra-arterial delivery of a chemotherapeutic agent with selective embolization to obtain a synergistic effect. TACE is recognized as the standard treatment of hepatocellular carcinoma patients at an intermediate stage. If conventional TACE, defined as the injection of an emulsion of a drug with ethiodized oil, still has a role to play, the development of drug-eluting beads has allowed many improvements and optimization of the technique. TANDEM® microspheres are second-generation drug-loadable microspheres. This device raised a special interest due to its tightly calibrated spherical microspheres, with small sizes down to 40 μm available. In this review, we describe the technical characteristics of these microspheres, analyze the scientific literature and hypothesize on the future perspectives.
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Affiliation(s)
- Julien Delicque
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France.,INSERM U1194, Montpellier Cancer Research Institute, 34298 Montpellier, France
| | - Mathieu Boulin
- Department of Pharmacy, University Hospital of Dijon, 21000 Dijon, France
| | | | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
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Inaba Y, Arai Y, Sone M, Aramaki T, Osuga K, Tanaka H, Kanemasa K. Clinical trial for development of a steerable microcatheter. MINIM INVASIV THER 2018; 28:1-5. [DOI: 10.1080/13645706.2018.1467458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Sizuoka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Fohlen A, Tasu JP, Kobeiter H, Bartoli JM, Pelage JP, Guiu B. Transarterial chemoembolization (TACE) in the management of hepatocellular carcinoma: Results of a French national survey on current practices. Diagn Interv Imaging 2018; 99:527-535. [PMID: 29609903 DOI: 10.1016/j.diii.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/09/2018] [Accepted: 03/09/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To report current practices of transarterial chemoembolization (TACE) by interventional radiologists (IR) for hepatocellular carcinoma (HCC) through a French national survey. MATERIALS AND METHODS An electronic survey was sent by e-mail to 232 IRs performing TACE in 32 private or public centers. The survey included 66 items including indications for TACE, technical aspects of TACE, other locally available treatments for HCC, follow-up imaging and general aspects of interventional radiology practices. RESULTS A total of 64 IRs (64/232; 27%) answered the survey. Each IR performed a mean of 49±45 (SD) TACE procedures per year. Marked variations in indications for TACE in HCC were observed. Six percent of IRs (4/64) treated only patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC. Antibioprophylaxis was not used by 43/64 of IRs (67%). The number of HCC nodules was considered to select conventional TACE versus drug-eluting beadsTACE (DEB-TACE) by 17/49 IRs (35%) followed by patient performance status and Child-Pugh score by 6/49 IRs (12%). Seventy-three percent of IRs (45/62) treated nodules selectively in patients with unilobar disease with cTACE. Thirty-three percent of IRs (21/64) planned systematically a second TACE session. Doxorubicin was the most frequently used drug (52/64; 81%) and 15/64 IRs (23%) used gelatine sponge as the only embolic agent. For DEB-TACE, 100-300μm beads were used by 26/49 IRs (53%) and no additional embolization was performed by 19/48 IRs (39%). Monopolar radiofrequency technique was widely available (59/63; 94%) compared to selective internal radiation therapy (37/64; 58%). Magnetic resonance imaging was used for follow-up by 13/63 IRs (20%). CONCLUSION Current practices of TACE for HCC varied widely among IRs suggesting a need for more standardized practices.
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Affiliation(s)
- A Fohlen
- Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, Caen Cedex 14033, France; Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, 14000 Caen, France.
| | - J P Tasu
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, Poitiers Cedex, France
| | - H Kobeiter
- Department of Medical Imaging, AP-HP, Groupe Henri-Mondor Albert-Chenevrier, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; University of Medicine, Université Paris 12, 94000 Créteil, France
| | - J M Bartoli
- Department of Radiology, Hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 05, France
| | - J P Pelage
- Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, Caen Cedex 14033, France; Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, 14000 Caen, France
| | - B Guiu
- Department of Radiology, St-Eloi University Hospital-Montpellier, 80, Avenue Augustin Fliche, 34295 Montpellier, France
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González W, Idée JM, Ballet S. Comment on "In Vivo Drug Delivery Performance of Lipiodol-Based Emulsion or Drug-Eluting Beads in Patients with Hepatocellular Carcinoma". Mol Pharm 2018; 15:332-335. [PMID: 29193977 DOI: 10.1021/acs.molpharmaceut.7b00138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Accuracy of a Cone-Beam CT Virtual Parenchymal Perfusion Algorithm for Liver Cancer Targeting during Intra-arterial Therapy. J Vasc Interv Radiol 2017; 29:254-261.e2. [PMID: 29191614 DOI: 10.1016/j.jvir.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate accuracy of virtual parenchymal perfusion (VPP) algorithm developed for targeting liver cancer during intra-arterial therapy (IAT) using cone-beam CT guidance. MATERIALS AND METHODS VPP was retrospectively applied to 15 patients who underwent IAT for liver cancer. Virtual territory (VT) was estimated after positioning a virtual injection point on nonselective dual-phase (DP) cone-beam CT images acquired during hepatic arteriography at the same position chosen for selective treatment. Targeted territory (TT) was used as the gold standard and was defined by parenchymal phase enhancement of selective DP cone-beam CT performed before treatment start. Qualitative evaluation of anatomic conformity between VT and TT was performed using a 3-rank scale (poor, acceptable, excellent) by 3 double-blinded readers. VT and TT were also quantitatively compared using spatial overlap-based (Dice similarity coefficient [DSC], sensitivity, and positive predictive value), distance-based (mean surface distance [MSD]), and volume-based (absolute volume error and correlation between pairwise volumes) metrics. Interreader agreement was evaluated for the 2 evaluation methods. RESULTS Eighteen DP cone-beam CT scans were performed. Qualitative evaluation showed excellent overlap between VT and TT in 88.9%-94.4%, depending on the readers. DSC was 0.78 ± 0.1, sensitivity was 80%, positive predictive value was 83%, and MSD was 5.1 mm ± 2.4. Absolute volume error was 15%, and R2 Pearson correlation factor was 0.99. Interreader agreement was good for both qualitative and quantitative evaluations. CONCLUSIONS VPP algorithm is accurate and reliable in identification of liver arterial territories during IAT using cone-beam CT guidance.
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Experiments for the Development of a Steerable Microcatheter. Cardiovasc Intervent Radiol 2017; 40:1921-1926. [DOI: 10.1007/s00270-017-1789-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/01/2017] [Indexed: 01/01/2023]
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Wang Z, Hansis E, Chen R, Duran R, Chapiro J, Sheu YR, Kobeiter H, Grass M, Geschwind JF, Lin M. Automatic bone removal for 3D TACE planning with C-arm CBCT: Evaluation of technical feasibility. MINIM INVASIV THER 2016; 25:162-70. [PMID: 26923140 DOI: 10.3109/13645706.2015.1129970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the technical feasibility of automatically removing the ribs and spine from C-arm cone-beam computed tomography (CBCT) images acquired during transcatheter arterial chemoembolization (TACE). MATERIAL AND METHODS Fifty-eight patients (45.8 ± 5.0 years) with unresectable hepatocellular carcinoma (HCC) underwent transcatheter arterial chemoembolization and had intraprocedural CBCT imaging. Automatic bone removal was performed using model-based segmentation of the ventral cavity. Two interventional radiologists independently evaluated the performance of bone removal, remaining soft tissue retention, and general usability (where both the bone is appropriately removed while retaining soft tissue) for 3D TACE planning on a four-level (complete/excellent, adequate/good, incomplete/questionable, insufficient/bad) score. The proportion of inter-reader agreement was calculated. RESULTS For ribs and spine removal, 98.3-100% and 100% of cases showed complete or adequate performance, respectively. In 96.6% of the cases, soft tissue was at least adequately retained. 91.3-93.1% of the cases demonstrated good or excellent general usability for TACE planning. Satisfactory inter-reader agreement proportion was achieved in ribs (93.1%) and spine removal (89.7%), soft tissue retention (84.5%), and general usability for TACE planning (72.4%). CONCLUSION Intraprocedural automatic bone removal on CBCT images is technically feasible and offers good removal of ribs and spine while preserving soft tissue. Its clinical value needs further assessment.
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Affiliation(s)
- Zhijun Wang
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;,b Interventional Radiology Department , Chinese PLA General Hospital , Beijing , China
| | | | - Rongxin Chen
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Rafael Duran
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Julius Chapiro
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Yun Robert Sheu
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Hicham Kobeiter
- d Service d'Imagerie Médicale, Unité de Radiologie interventionnelle et thérapeutique Vasculaire et Oncologique, Université Paris-Est Créteil, Assistance Publique-Hôpitaux de Paris, Centre Hospitalo-Universitaire Henri Mondor , France
| | | | - Jean-François Geschwind
- e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA
| | - MingDe Lin
- e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA ;,f U/S Imaging and Interventions (UII), Philips Research North America , Cambridge , MA , USA
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Balloon Blocking Technique (BBT) for Superselective Catheterization of Inaccessible Arteries with Conventional and Modified Techniques. Cardiovasc Intervent Radiol 2015; 39:920-6. [DOI: 10.1007/s00270-015-1271-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/29/2015] [Indexed: 12/18/2022]
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Arizumi T, Ueshima K, Iwanishi M, Minami T, Chishina H, Kono M, Takita M, Kitai S, Inoue T, Yada N, Hagiwara S, Ida H, Minami Y, Sakurai T, Nishida N, Kitano M, Kudo M. Evaluation of ART Scores for Repeated Transarterial Chemoembolization in Japanese Patients with Hepatocellular Carcinoma. Oncology 2015; 89 Suppl 2:4-10. [PMID: 26584030 DOI: 10.1159/000440625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Transarterial chemoembolization (TACE) is recommended as a first-line therapy for hepatocellular carcinoma (HCC) patients ineligible for curative therapy and without portal invasion. The Assessment for Retreatment with TACE (ART) scoring system was recently proposed for identifying patients who would not show sufficient survival benefit from repeated TACE. We reevaluated the performance of ART in HCC patients treated in Japan, where selective TACE is commonly used. METHODS Between 2000 and 2013, 988 patients with HCC underwent TACE at Kinki University Hospital, and 627 received ≥2 sessions of TACE. Seventy-six patients who underwent ≥2 TACE sessions within 90 days were investigated for their performance of the ART score in the context of overall survival (OS). RESULTS Only 12% (76/627) of patients underwent ≥2 TACE sessions within 90 days. Of those, 52 patients showed a low ART score (0-1.5), and 24 had a high ART score (≥2.5); the median OS was 20.2 and 37.6 months, respectively (p = 0.8207). CONCLUSION The ART scoring system did not demonstrate a sufficiently predictive impact on OS among the patients who underwent ≥2 TACE sessions within 90 days. Application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating OS.
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Affiliation(s)
- Tadaaki Arizumi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kinki University, Osaka-Sayama, Japan
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Development of Conventional Transarterial Chemoembolization for Hepatocellular Carcinomas in Japan: Historical, Strategic, and Technical Review. AJR Am J Roentgenol 2015; 205:764-73. [DOI: 10.2214/ajr.15.14825] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion. Cardiovasc Intervent Radiol 2015; 39:334-43. [PMID: 26390875 DOI: 10.1007/s00270-015-1208-y] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022]
Abstract
Transarterial chemoembolization with Lipiodol (Lipiodol TACE), also called conventional TACE, was developed in the early 1980s and widely adopted worldwide after randomized control trials and meta-analysis demonstrated superiority of Lipiodol TACE to best supportive care. Presently, there is no level one evidence that other TACE techniques are superior to Lipiodol TACE for intermediate stage hepatocellular carcinoma (HCC), which includes patients with preserved liver function and nonsurgical large or multinodular HCC without distant metastases. In addition, TACE is part of the treatment for progressive or symptomatic liver metastases from gastroenteropancreatic neuroendocrine tumors. When injected into the hepatic artery, Lipiodol has the unique property of selective uptake and retention in hyperarterialyzed liver tumors. Lipiodol/drug emulsion followed by particle embolization has been demonstrated to improve the pharmacokinetic of the drug and tumor response. Radio opacity of Lipiodol helps to monitor treatment delivery, with retention of Lipiodol serving as an imaging biomarker for tumor response. For 30 years, Lipiodol TACE has been inconsistently referenced in many publications with various levels of details for the method of preparation and administration, with reported progressive outcomes following improvements in the technique and the devices used to deliver the treatment and better patient selection. Consequently, there is no consensus on the standard method of TACE regarding the use of anticancer agents, embolic material, technical details, and the treatment schedule. In order to develop an internationally validated technical recommendation to standardize the Lipiodol TACE procedure, a worldwide panel of experts participated in a consensus meeting held on May 10, 2014 .
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Abstract
Transcatheter arterial chemoembolization (TACE) is performed worldwide for patients with intermediate-stage hepatocellular carcinoma (HCC). TACE has produced survival advantages in two randomized controlled trials and a meta-analysis, and is currently the mainstay of treatment for this stage of HCC. However, there are currently no global guidelines regarding the dose, choice or combination of cytotoxic agents for TACE; therefore, it is difficult to compare data from different TACE studies. In Japan, most of the TACE procedures have been based on iodized oil as conventional TACE, utilizing the microembolic and drug-carrying characteristic of iodized oil. Superselective TACE with lipiodol is the primary TACE procedure that has reported satisfactory levels of local control associated with a lower risk of complications. Conversely, TACE performed using drug-eluting beads has been widely used in western countries, and this has shown similar tumor response and median survival compared to conventional TACE. Moreover, the combination of TACE and molecular targeted agents is now ongoing to evaluate the synergistic effect. In this review, the indication, technical issues, and complications of TACE are reviewed.
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Affiliation(s)
- Masakatsu Tsurusaki
- *Masakatsu Tsurusaki, MD, Department of Radiology, Kinki University, Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511 (Japan), Tel. +81 72 366 0221 (ext. 3133), E-mail
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Yamakado K, Miyayama S, Hirota S, Mizunuma K, Nakamura K, Inaba Y, Yamamoto S, Matsuo K, Nishida N, Aramaki T, Anai H, Kora S, Oikawa S, Watanabe K, Yasumoto T, Furuichi K, Yamaguchi M. Prognosis of patients with intermediate-stage hepatocellular carcinomas based on the Child-Pugh score: subclassifying the intermediate stage (Barcelona Clinic Liver Cancer stage B). Jpn J Radiol 2014; 32:644-9. [DOI: 10.1007/s11604-014-0358-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/27/2014] [Indexed: 01/10/2023]
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Yamakado K, Miyayama S, Hirota S, Mizunuma K, Nakamura K, Inaba Y, Maeda H, Matsuo K, Nishida N, Aramaki T, Anai H, Koura S, Oikawa S, Watanabe K, Yasumoto T, Furuichi K, Yamaguchi M. Subgrouping of intermediate-stage (BCLC stage B) hepatocellular carcinoma based on tumor number and size and Child-Pugh grade correlated with prognosis after transarterial chemoembolization. Jpn J Radiol 2014; 32:260-5. [PMID: 24615165 DOI: 10.1007/s11604-014-0298-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/17/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To find a subgroup that benefits most from transarterial chemoembolization (TACE) in terms of tumor number and size and liver profile in patients with intermediate-stage hepatocellular carcinoma (HCC). MATERIALS AND METHODS Data of 325 intermediate-stage HCC patients who received TACE as the initial treatment were gathered. Four tumor numbers (3-6 tumors) and five maximum tumor diameters (3-7 cm) as well as all of their combinations but one (3 tumors and 3 cm) and Child-Pugh grade were used as variables to ascertain prognostic factors. RESULTS The respective 1-, 3-, and 5-year overall survival rates in all patients were 86.5, 47.0, and 23.7%, respectively. Tumor numbers of 4 (P = 0.00145) and 5 (P = 0.036), and tumor size of 7 cm (P = 0.015), and 12 other combinations of tumor number and size, and Child-Pugh grade (P = 0.0015) were identified as significant prognostic factors in univariate analysis, and 4 tumors of 7 cm (P = 0.0008) and Child-Pugh grade (P = 0.0036) remained significant in the stepwise Cox proportional hazard model. The overall survival was significantly better in a patient subgroup having two factors other than patient subgroups having one or no prognostic factors. CONCLUSION A patient subgroup having two prognostic factors benefited most from TACE in intermediate-stage HCC patients.
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Affiliation(s)
- Koichiro Yamakado
- Department of Interventional Radiology, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan,
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Miyayama S, Yamashiro M, Ikuno M, Okumura K, Yoshida M. Ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinoma guided by automated tumor-feeders detection software: technical success and short-term tumor response. ACTA ACUST UNITED AC 2014; 39:645-56. [DOI: 10.1007/s00261-014-0094-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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