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Kobe A, Tselikas L, Deschamps F, Roux C, Delpla A, Varin E, Hakime A, De Baère T. Single-session transarterial chemoembolization combined with percutaneous thermal ablation in liver metastases 3 cm or larger. Diagn Interv Imaging 2022; 103:516-523. [PMID: 35715327 DOI: 10.1016/j.diii.2022.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of transarterial chemoembolization (TACE) combined with percutaneous thermal ablation in patients with liver metastases 3 cm in diameter or larger. MATERIALS AND METHODS This retrospective study included 39 patients with a total of 46 liver metastases treated. There were 14 men and 25 women, with a mean age of 55 ± 13.3 (SD) (age range: 28-77 years). All patients were treated with a combination of TACE and thermal ablation in a single session. Primary outcome was local tumor progression. Secondary outcomes were procedure related complications and systemic disease progression. RESULTS Mean tumor size was 3.6 ± 0.6 (SD) cm (range: 3-5 cm). Conventional TACE was performed in 32 liver metastases (32/46; 70%) and drug-eluting beads-TACE in 14 liver metastases (14/46; 30%) followed by radiofrequency ablation in 34 (34/46; 74%), microwave ablation in 11 (11/46; 24%) and cryoablation in one (1/46; 2%) metastasis. Four grade 2 (4/39; 10%) complications were observed. After a mean follow up of 31.9 ± 26.1 (SD) months (range: 2-113 months) overall local tumor progression rate was 15% (7/46). Local tumor progression rate at 12 months was 13% (6/46). Overall systemic disease progression was seen in 29 patients (29/39; 74%) with a systemic disease progression rate at 12 months of 59% (23/39). CONCLUSION Treatment of large liver metastases with TACE and thermal ablation in a single session is safe and achieves high local control rate.
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Affiliation(s)
- Adrian Kobe
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France.
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
| | - Frédéric Deschamps
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Alexandre Delpla
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Eloi Varin
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Antoine Hakime
- Centre Imagerie Medicale Bachaumont Paris Centre, 75002 Paris, France
| | - Thierry De Baère
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
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2
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Lanza E, Muglia R, Bolengo I, Poretti D, D’Antuono F, Ceriani R, Torzilli G, Pedicini V. Survival analysis of 230 patients with unresectable hepatocellular carcinoma treated with bland transarterial embolization. PLoS One 2020; 15:e0227711. [PMID: 31935255 PMCID: PMC6959584 DOI: 10.1371/journal.pone.0227711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
Locoregional therapies for hepatocellular carcinoma (HCC) include endovascular treatments such as chemoembolization (TACE) and bland embolization (TAE). TACE is the most adopted technique, despite a lack of definitive evidence of superiority over TAE, which is less costly and better tolerated due to the absence of chemotherapy. However, few studies have reported data on TAE monotherapy for unresectable HCC. We report our results in a cohort of 230 patients with unresectable HCC treated with TAE (TAE with 40-100micron microparticles, TAE with microparticles plus n-butyl-2-cyanoacrylate, TAE with Lipiodol) over the course of seven years. Thirty-seven patients (14%) were down-staged during observation and also received a percutaneous ablation. We observed 1-, 2-, 3-, 4- and 5-year rates of 84,8%, 58,7%, 38,3%, 28,3%, and 18,7%. Patients who also received percutaneous treatment performed best. Our results broaden the body of evidence for the use of TAE in advanced HCC.
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Affiliation(s)
- Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
- * E-mail:
| | - Riccardo Muglia
- Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Isabella Bolengo
- Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Felice D’Antuono
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Roberto Ceriani
- Department of Internal Medicine - Hepatology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Guido Torzilli
- Department of Surgery - Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
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Lewis AR, Padula CA, McKinney JM, Toskich BB. Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions. Semin Intervent Radiol 2019; 36:303-309. [PMID: 31680721 DOI: 10.1055/s-0039-1697641] [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: 02/08/2023]
Abstract
Thermal ablation is widely regarded as definitive therapy for early-stage hepatocellular carcinoma, but its efficacy decreases in tumors greater than 3 cm. Extensive clinical studies have supported improved outcomes provided through combining transarterial embolic therapy with ablation in the treatment of larger tumors. This article will provide a survey of the science and data for combination therapy in both thermal and nonthermal ablation modalities, as well as describe emerging applications.
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Affiliation(s)
- Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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Banzato T, Rubini G, Orlandi R, Bargellini P, Bonsembiante F, Zotti A. Contrast-enhanced ultrasound features of hepatocellular carcinoma in dogs. Vet Rec 2019; 186:187. [PMID: 31662577 PMCID: PMC7035695 DOI: 10.1136/vr.105282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
Background This study aimed to describe the contrast-enhanced ultrasound (CEUS) features of canine hepatocellular carcinoma (HCC) in relation to cellular differentiation and lesion size. Methods Sixty dogs with a cytological diagnosis of HCC and that underwent a CEUS examination were retrospectively selected. The wash-in and wash-out patterns of contrast enhancement, along with the time to wash-in and the time to wash-out, of each lesion were recorded. A dimensional cut-off value of 3 cm was adopted for classification. Results Cellular differentiation had a significant influence on both wash-in (chi-squared=16.99; P<0.001) and wash-out (chi-squared=10.9; P=0.004) patterns of contrast enhancement. Lesion size had a lower, but still significant, influence on both wash-in (chi-squared=12.7; P=0.005) and wash-out (chi-squared=7.42; P=0.024) patterns. A homogeneous hyperenhancement in the arterial phase followed by homogeneous wash-out were suggestive of a well-differentiated HCC. The cellular differentiation of lesions with inhomogeneous hyperenhancement or hypoenhancement/no enhancement as well as an inhomogeneous wash-out or no wash-out could not be inferred. Conclusions No significant difference in the time to wash-in and the time to wash-out in relation to cellular differentiation or lesion size was evident. CEUS has the potential to improve efficiency in the diagnosis of HCCs in dogs.
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Affiliation(s)
- Tommaso Banzato
- Department of Animal Medicine, Productions, and Health, Università degli Studi di Padova, Legnaro, Italy
| | | | | | | | - Federico Bonsembiante
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Productions, and Health, Università degli Studi di Padova, Legnaro, Italy
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A Nomogram Predicting Microvascular Invasion Risk in BCLC 0/A Hepatocellular Carcinoma after Curative Resection. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9264137. [PMID: 31428651 PMCID: PMC6683833 DOI: 10.1155/2019/9264137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023]
Abstract
Background Numerous studies have shown that hepatocellular carcinoma (HCC) without microvascular invasion (MVI) may have better outcomes. This study established a preoperative MVI risk nomogram mainly incorporating three related risk factors of MVI in BCLC 0/A HCC after surgery. Methods Independent predictors for the risk of MVI were investigated, and an MVI risk nomogram was established based on 60 patients in the training group who underwent curative hepatectomy for BCLC 0/A HCC and validated using a dataset in the validation group. Results Univariate analysis in the training group showed that hepatitis viral B (HBV) DNA (P=0.034), tumor size (P<0.001), CT value in the venous phase (P=0.039), CT value in the delayed phase (P=0.017), peritumoral enhancement (P=0.013), visible small blood vessels in the arterial phase (P=0.002), and distance from the tumor to the inferior vena cava (IVC) (DTI, P=0.004) were risk factors significantly associated with the presence of MVI. According to multivariate analysis, the independent predictive factors of MVI, including tumor size (P=0.002), CT value in the delayed phase (P=0.018), and peritumoral enhancement (P=0.057), were incorporated in the corresponding nomogram. The nomogram displayed an unadjusted C-index of 0.851 and a bootstrap-corrected C-index of 0.832. Calibration curves also showed good agreement on the presence of MVI. ROC curve analyses showed that the nomogram had a large AUC (0.851). Conclusions The proposed nomogram consisting of tumor size, CT value in the delayed phase, and peritumoral enhancement was associated with MVI risk in BCLC 0/A HCC following curative hepatectomy.
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Iodized Oil Transarterial Chemoembolization and Radiofrequency Ablation for Small Periportal Hepatocellular Carcinoma: Comparison with Nonperiportal Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2017; 41:120-129. [PMID: 28924943 DOI: 10.1007/s00270-017-1783-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aims to evaluate the treatment outcomes of iodized oil transarterial chemoembolization (TACE) and subsequent radiofrequency ablation (RFA) for small (≤3 cm) periportal hepatocellular carcinoma (HCC) compared with nonperiportal HCC. METHODS Twenty-three patients [periportal group (PG); mean age, 59.8 years; 22 men, 1 woman] with periportal HCC (in contact with the portal vein >3 mm in diameter) and 279 patients [nonperiportal group (NPG); mean age, 59.1 years; 234 men, 45 women] with nonperiportal HCC were treated between March 2010 and January 2014. All cases were contraindicated for ultrasound-guided RFA or resection. Mean tumor size was 1.2 cm in each group. The baseline characteristics were not different between the groups, except for alpha-fetoprotein level (41.0 ng/dL in NPG vs. 8.8 ng/dL in PG, p = 0.001). Local tumor progression (LTP), disease-free survival (DFS), overall survival (OS), intrasegmental recurrence, and complications were analyzed using the Kaplan-Meier method and Fisher's exact test. RESULTS TACE and RFA were successfully performed in all patients. Mean follow-up period of PG and NPG was 33.8 and 42.8 months, respectively. LTP (p = 0.701), DFS (p = 0.718), and OS (p = 0.359) were not different between the two groups. Intrasegmental recurrence occurred in two patients (one in each group), and its incidence was not different (p = 0.212). Complications requiring further treatment occurred in 1/23 (4.3%) in PG and 5/279 (1.8%) in NPG. No procedure-related mortality occurred. CONCLUSIONS Iodized oil TACE and subsequent RFA are effective alternative treatments for small periportal HCC (≤3 cm) when percutaneous ultrasound- or CT-guided RFA or resection is not feasible.
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Cassinotto C, Aubé C, Dohan A. Diagnosis of hepatocellular carcinoma: An update on international guidelines. Diagn Interv Imaging 2017; 98:379-391. [PMID: 28395852 DOI: 10.1016/j.diii.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Imaging is essential for the successful management of patients with or at risk of developing hepatocellular carcinoma (HCC). If ultrasound remains the key screening modality, computed tomography and magnetic resonance imaging (MRI) can play a major role in the characterization and noninvasive diagnosis of nodules in patients at risk of developing HCC. Each technique has succeeded in adapting to the wide histological spectrum of focal liver lesions. In this review, we discuss recent advancements in imaging techniques and evaluation - notably diffusion-weighted imaging, contrast-enhanced ultrasound, and liver-specific MRI contrast agents - as well as their addition to international guidelines and reporting systems such as the Liver imaging reporting and data system (LI-RADS).
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Affiliation(s)
- C Cassinotto
- Department of diagnostic and interventional imaging, Hôpital Haut-Lévêque, university hospital of Bordeaux, CHU de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France.
| | - C Aubé
- Department of diagnostic and interventional imaging, university hospital of Angers, 49933 Angers, France
| | - A Dohan
- McGill university health center, department of radiology, McGill university health center, Montreal, QC, Canada
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Wu SE, Charles HW, Park JS, Goldenberg AS, Deipolyi AR. Obesity conveys poor outcome in patients with hepatocellular carcinoma treated by transarterial chemoembolization. Diagn Interv Imaging 2016; 98:37-42. [PMID: 27372418 DOI: 10.1016/j.diii.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the impact of obesity on radiologic outcomes in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). MATERIALS AND METHODS A total of 100 TACE procedures performed in 57 patients (42 men, 15 women) with a mean age of 62 years±8.4 (SD) (range: 39-83 years) were retrospectively reviewed. The 1-2-month follow-up computed tomography or magnetic resonance imaging examinations was assessed for new or residual disease and radiologic response using mRECIST criteria. Patients were categorized into two groups according to body mass index (BMI). Patients with BMI<25kg/m2 were further referred as to low BMI patients and those with BMI≥25kg/m2 as high BMI patients. Outcomes were compared between the two groups. RESULTS Low and high BMI patients were similar in regard to age, gender, HCC etiology and stage, and pre-procedure disease burden. TACE for high BMI, compared to low BMI, patients resulted in lower complete response (39% vs. 66%) and higher progressive disease (21% vs. 5%) rates (P=0.04), and higher rates of residual disease (63% vs. 39%, P=0.02) and new lesions in untreated liver (39% vs. 18%, P=0.04) on 1-2-month follow-up imaging. CONCLUSIONS High BMI is associated with significantly more residual disease, new lesions, and progressive disease in patients with HCC treated by TACE.
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Affiliation(s)
- S E Wu
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - H W Charles
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - J S Park
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, 550 1st avenue, New York, NY 10016, USA
| | - A S Goldenberg
- Hematology, Department of Medicine, NYU Langone Medical Center, 157 East 32nd Street, 2nd Floor, New York, NY 10016, USA
| | - A R Deipolyi
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA.
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Doreille A, N'Kontchou G, Halimi A, Bouhafs F, Coderc E, Sellier N, Seror O. Percutaneous treatment of extrahepatic recurrence of hepatocellular carcinoma. Diagn Interv Imaging 2016; 97:1117-1123. [PMID: 27138073 DOI: 10.1016/j.diii.2015.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 11/07/2015] [Accepted: 11/24/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The goal of this study was to retrospectively evaluate the results of imaging-guided percutaneous ablation in patients with controlled intrahepatic hepatocellular carcinoma (HCC) with limited extrahepatic disease. MATERIALS AND METHODS Eleven patients with limited extrahepatic disease and/or potential short-term clinical manifestations with controlled primary intrahepatic HCC were included into the study. There were nine men and two women, with a mean age of 67.4 years±10.2 (SD) (range: 54-85 years). All patients had extrahepatic disease treated by either radiofrequency ablation or electroporation. Extrahepatic disease consisted of lymph node metastases (5 patients), tumor seeding along a needle tract (3 patients), adrenal gland metastasis, bone metastasis and pulmonary metastasis (one patient each). RESULTS Response to treatment was complete in 7/11 patients (64%). The mean survival time after treatment was 18.8±12.7 (SD) months (median, 16 months; range: 4-42 months). No severe complications associated with percutaneous treatment were observed. CONCLUSION Our results suggest that imaging-guided percutaneous ablation techniques should be considered as a useful option for the treatment of extrahepatic disease in patients with HCC. Further studies are needed, however to fully determine the potential role of these techniques in this elective application.
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Affiliation(s)
- A Doreille
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France
| | - G N'Kontchou
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service d'Hépatologie, 93140 Bondy, France
| | - A Halimi
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - F Bouhafs
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - E Coderc
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France
| | - N Sellier
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France
| | - O Seror
- Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Hôpital Jean-Verdier, Service de Radiologie, 93140 Bondy, France; Université Paris 13, COMUE Sorbonne Paris Cité, UFR SMBH, 93000 Bobigny, France; Inserm, UMR 1162, Génomique fonctionnelle des Tumeurs solides, 75010 Paris, France.
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