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Yu Q, Neale M, Ungchusri E, Rothenberger NJ, Liao C, Patel M, Pillai A, Navuluri R, Ahmed O, Ha TV. Tumor Size and Watershed Area Correlate with Incomplete Treatment and Tumor Progression after Selective Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2024:S1051-0443(24)00125-8. [PMID: 38336031 DOI: 10.1016/j.jvir.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To identify factors of incomplete treatment after segmental transarterial radioembolization (TARE) for treatment-naive and solitary hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 75 consecutive patients (age, 68.5 years [SD ± 8.0]; 25/75 [33.3%] women) with treatment-naive, solitary HCC underwent segmental or subsegmental TARE with glass microspheres (tumor size, 3.8 cm [SD ± 2.2]; administered dose, 222.6 Gy [SD ± 123.9]) at a single institution from November 2015 to June 2022. Radiologic response and progression-free survival (PFS) were assessed as per modified Response Evaluation Criteria in Solid Tumors. RESULTS Complete treatment was achieved in 48 of 75 (64.0%) patients (mean follow-up, 33.2 months [SD ± 27.4]). Patients with incomplete treatment (27/75, 36%) presented with larger tumor size (5.0 [SD ± 2.5] vs 3.1 [SD ± 1.6] cm; P = .0001), with more tumors located in the watershed zone (81.5% vs 41.7%; P = .001). These patients were less likely to be bridged to transplant or resection (22.2% vs 52.1%; P = .015). Watershed tumors demonstrated worse target tumor PFS (median PFS, 19 months vs not reached; P = .0104) and overall PFS (9.1 months vs not reached; P = .0077). Watershed location was associated with worse PFS among tumors >3 cm in size (8.4 months vs not reached; P = .035) but not in tumors ≤3 cm in size (52.2 months vs not reached; P = .915). CONCLUSIONS Tumor size and watershed location were associated with incomplete treatment after segmental TARE for HCC. Watershed tumors were associated with worse PFS, particularly tumors larger than 3 cm. These tumors may require careful treatment planning and repeated treatments to ensure a durable response.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Monika Neale
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | | | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Mikin Patel
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Anjana Pillai
- Department of Hepatology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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Kwak DH, Lionberg A, Patel M, Nijhawan K, Martens S, Yu Q, Cao D, Youssef S, Ahmed O. Quantitative differences in volumetric calculations for radiation dosimetry in segmental Y90 treatment planning using hybrid angiography-CT compared with anatomic segmentation. Br J Radiol 2024; 97:353-362. [PMID: 38308040 PMCID: PMC11027260 DOI: 10.1093/bjr/tqad056] [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: 06/19/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To compare treatment volumes reconstructed from hybrid Angio-CT catheter-directed infusion imaging and Couinaud anatomic model as well as the implied differences in Y-90 radiation dosimetry. METHODS Patients who underwent transarterial radioembolization (TARE) using Y-90 glass microspheres with pretreatment CT or MRI imaging as well as intraprocedural angiography-CT (Angio-CT) were analysed. Treatment volumes were delineated using both tumoural angiosomes (derived from Angio-CT) and Couinaud anatomic landmarks. Segmental and lobar treatment volumes were calculated via semi-automated contouring software. Volume and dose differences were compared by the two-tailed Student t test or Wilcoxon signed-rank test. Factors affecting volume and dose differences were assessed via simple and/or multiple variable linear regression analysis. RESULTS From September 2018 to March 2021, 44 patients underwent 45 lobar treatments and 38 patients received 56 segmental treatments. All target liver lobes and all tumours were completely included within the field-of-view by Angio-CT. Tumour sizes ranged between 1.1 and 19.5 cm in diameter. Segmental volumes and treatment doses were significantly different between the Couinaud and Angio-CT volumetry methods (316 vs 404 mL, P < .0001 and 253 vs 212 Gy, P < .01, respectively). Watershed tumours were significantly correlated with underestimated volumes by the Couinaud anatomic model (P < .001). There was a significant linear relationship between tumour diameter and percent volume difference (R2 = 0.44, P < .0001). The Couinaud model overestimated volumes for large tumours that exhibited central hypovascularity/necrosis and for superselected peripheral tumours. CONCLUSIONS Angio-CT may confer advantages over the Couinaud anatomic model and enable more accurate, personalized dosimetry for TARE. ADVANCES IN KNOWLEDGE Angio-CT may confer advantages over traditional cross-sectional and cone-beam CT imaging for selective internal radiation therapy planning.
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Affiliation(s)
- Daniel H Kwak
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Alex Lionberg
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Mikin Patel
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Karan Nijhawan
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Spencer Martens
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Qian Yu
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
| | - David Cao
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Salma Youssef
- University College Dublin School of Medicine, Dublin 4, Ireland
| | - Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, The University of Chicago Medical Center, Chicago, IL 60637, United States
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Taiji R, Lin YM, Chintalapani G, Lin EY, Huang SY, Mahvash A, Avritscher R, Liu CA, Lee RC, Resende V, Nishiofuku H, Tanaka T, Kichikawa K, Klotz E, Gupta S, Odisio BC. A novel method for predicting hepatocellular carcinoma response to chemoembolization using an intraprocedural CT hepatic arteriography-based enhancement mapping: a proof-of-concept analysis. Eur Radiol Exp 2023; 7:4. [PMID: 36717474 PMCID: PMC9886747 DOI: 10.1186/s41747-022-00315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/01/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of a novel approach for predicting hepatocellular carcinoma (HCC) response to drug-eluting beads transarterial chemoembolization (DEB-TACE) using computed tomography hepatic arteriography enhancement mapping (CTHA-EM) method. METHODS This three-institution retrospective study included 29 patients with 46 HCCs treated with DEB-TACE between 2017 and 2020. Pre- and posttreatment CTHA-EM images were generated using a prototype deformable registration and subtraction software. Relative tumor enhancement (TPost/pre-RE) defined as the ratio of tumor enhancement to normal liver tissue was calculated to categorize tumor response as residual (TPost-RE > 1) versus non-residual (TPost-RE ≤ 1) enhancement, which was blinded compared to the response assessment on first follow-up imaging using modified RECIST criteria. Additionally, for tumors with residual enhancement, CTHA-EM was evaluated to identify its potential feeding arteries. RESULTS CTHA-EM showed residual enhancement in 18/46 (39.1%) and non-residual enhancement in 28/46 (60.9%) HCCs, with significant differences on TPost-RE (3.05 ± 2.4 versus 0.48 ± 0.23, respectively; p < 0.001). The first follow-up imaging showed non-complete response (partial response or stable disease) in 19/46 (41.3%) and complete response in 27/46 (58.7%) HCCs. CTHA-EM had a response prediction sensitivity of 94.7% (95% CI, 74.0-99.9) and specificity of 100% (95% CI, 87.2-100). Feeding arteries to the residual enhancement areas were demonstrated in all 18 HCCs (20 arteries where DEB-TACE was delivered, 2 newly developed collaterals following DEB-TACE). CONCLUSION CTHA-EM method was highly accurate in predicting initial HCC response to DEB-TACE and identifying feeding arteries to the areas of residual arterial enhancement.
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Affiliation(s)
- Ryosuke Taiji
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA ,grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Yuan-Mao Lin
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Gouthami Chintalapani
- Siemens Medical Solutions USA Inc, 501 North Barrington Road, Hoffman Estates, IL 60192 USA
| | - Ethan Y. Lin
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Steven Y. Huang
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Armeen Mahvash
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Rony Avritscher
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Chien-An Liu
- grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Rheun-Chuan Lee
- grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Vivian Resende
- grid.8430.f0000 0001 2181 4888Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Hideyuki Nishiofuku
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Toshihiro Tanaka
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Kimihiko Kichikawa
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Ernst Klotz
- grid.481749.70000 0004 0552 4145Siemens Healthineers, Siemensstraße 3, 91301 Forchheim, Germany
| | - Sanjay Gupta
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Bruno C. Odisio
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
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Shah RP, Laeseke PF, Shin LK, Chin FT, Kothary N, Segall GM. Limitations of Fluorine 18 Fluoromisonidazole in Assessing Treatment-induced Tissue Hypoxia after Transcatheter Arterial Embolization of Hepatocellular Carcinoma: A Prospective Pilot Study. Radiol Imaging Cancer 2022; 4:e210094. [PMID: 35485937 PMCID: PMC9152693 DOI: 10.1148/rycan.210094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine the variance and correlation with tumor viability of fluorine 18 (18F) fluoromisonidazole (FMISO) uptake in hepatocellular carcinoma (HCC) prior to and after embolization treatment. Materials and Methods In this single-arm, single-center, prospective pilot study between September 2016 and March 2017, participants with at least one tumor measuring 1.5 cm or larger with imaging or histologic findings diagnostic for HCC were enrolled (five men; mean age, 68 years; age range, 61-76 years). Participants underwent 18F-FMISO PET/CT before and after bland embolization of HCC. A tumor-to-liver ratio (TLR) was calculated by using standardized uptake values of tumor and liver. The difference in mean TLR before and after treatment was compared by using a Wilcoxon rank sum test, and correlation between TLR and tumor viability was assessed by using the Spearman rank correlation coefficient. Results Four participants with five tumors were included in the final analysis. The median tumor diameter was 3.2 cm (IQR, 3.0-3.9 cm). The median TLR before treatment was 0.97 (IQR, 0.88-0.98), with a variance of 0.02, and the median TLR after treatment was 0.85 (IQR, 0.79-1), with a variance of 0.01; both findings indicate a narrow range of 18F-FMISO uptake in HCC. The Spearman rank correlation coefficient was 0.87, indicating a high correlation between change in TLR and nonviable tumor. Conclusion Although there was a correlation between change in TLR and response to treatment, the low signal-to-noise ratio of 18F-FMISO in the liver limited its use in HCC. Keywords: Molecular Imaging-Clinical Translation, Embolization, Abdomen/Gastrointestinal, Liver Clinical trial registration no. NCT02695628 © RSNA, 2022.
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Affiliation(s)
- Rajesh P Shah
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
| | - Paul F Laeseke
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
| | - Lewis K Shin
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
| | - Frederick T Chin
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
| | - Nishita Kothary
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
| | - George M Segall
- From the Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, MC 114, Palo Alto, CA 94304 (R.P.S., G.M.S.); Department of Radiology, Stanford University, Stanford, Calif (R.P.S., N.K., G.M.S.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.F.L.); Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Ariz (L.K.S.); and Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, Calif (F.T.C.)
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Combined transarterial iodized oil injection and computed tomography-guided thermal ablation for hepatocellular carcinoma: utility of the iodized oil retention pattern. Abdom Radiol (NY) 2022; 47:431-442. [PMID: 34642785 PMCID: PMC8776722 DOI: 10.1007/s00261-021-03305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022]
Abstract
Purpose To investigate whether the iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention pattern influences the treatment efficacy of combined transarterial Lipiodol injection (TLI) and thermal ablation in patients with hepatocellular carcinoma (HCC). Methods Data of 198 patients (280 HCC lesions), who underwent TLI plus computed tomography (CT)-guided thermal ablation at three separate medical institutions between June 2014 and September 2020, were reviewed and analyzed. The Lipiodol retention pattern was classified as complete or incomplete based on non-enhanced CT at the time of ablation. The primary outcome was local recurrence-free survival (LRFS) for lesions; the secondary outcome was overall survival (OS) for patients. Propensity score matching (PSM) was performed using a caliper width of 0.1 between the two groups. Differences in LRFS and OS between the two groups were compared using the log-rank test. Results A total of 133 lesions exhibited a complete Lipiodol retention pattern, while 147 exhibited an incomplete pattern. After PSM analysis of baseline characteristics of the lesions, 121 pairs of lesions were matched. LRFS was significantly longer for lesions exhibiting complete retention than for those exhibiting incomplete retention (P = 0.030). After PSM analysis of patient baseline characteristics, 74 pairs of patients were matched. There was no significant difference in OS between the two groups (P = 0.456). Conclusion Lipiodol retention patterns may influence the treatment efficacy of combined TLI and thermal ablation for HCC lesions. However, a survival benefit for the Lipiodol retention pattern among HCC patients was not observed and needs further confirmation.
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Aramburu J, Antón R, Fukamizu J, Nozawa D, Takahashi M, Ozaki K, Ramos JC, Sangro B, Bilbao JI, Tomita K, Matsumoto T, Hasebe T. In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization. BIOLOGY 2021; 10:biology10121341. [PMID: 34943256 PMCID: PMC8698760 DOI: 10.3390/biology10121341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.
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Affiliation(s)
- Jorge Aramburu
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- Correspondence:
| | - Raúl Antón
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
| | - Junichi Fukamizu
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Daiki Nozawa
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Makoto Takahashi
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Kouji Ozaki
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Juan Carlos Ramos
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Liver Unit and CIBEREHD, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Department of Radiology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
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Li X, Wang Y, Ye X, Liang P. Locoregional Combined With Systemic Therapies for Advanced Hepatocellular Carcinoma: An Inevitable Trend of Rapid Development. Front Mol Biosci 2021; 8:635243. [PMID: 33928118 PMCID: PMC8076864 DOI: 10.3389/fmolb.2021.635243] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Despite the application of antiviral drugs and improved surveillance tools, the number of patients diagnosed with hepatocellular carcinoma (HCC) at an advanced stage and with a dismal prognosis is still on the rise. Systemic treatment with multiple multitargeted tyrosine kinase inhibitors (TKIs), such as sorafenib, has been a widely utilized approach for a decade. In addition, the use of a combination of TKIs with other types of compounds, including immune checkpoint inhibitors (ICIs) and antiangiogenic inhibitors, has shown efficacy in treating advanced HCC. However, the presence of intolerable adverse events, low disease response and control rates, and relative short overall survival of such combinatory therapies makes novel or optimized therapies for advance HCC urgently needed. Locoregional therapy (transarterial chemoembolization, and thermal ablation) can destroy primary tumors and decrease tumor burden and is widely used for HCC management. This type of treatment modality can result in local hypoxia and increased vascular permeability, inducing immunogenic effects by releasing tumor antigens from dying cancer cells and producing damage-associated molecular patterns that facilitate antiangiogenic therapy and antitumor immunity. The combination of systemic and locoregional therapies may further produce synergistic effects without overlapping toxicity that can improve prognoses for advanced HCC. In preliminary studies, several combinations of therapeutic modes exhibited promising levels of safety, feasibility, and antitumor effects in a clinical setting and have, thus, garnered much attention. This review aims to provide a comprehensive, up-to-date overview of the underlying mechanisms of combined systemic and locoregional therapies in the treatment of advanced HCC, commenting on both their current status and future direction.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yaxi Wang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Padia SA, Johnson GE, Lewandowski RJ, Gabr A, Toskich BB. Transarterial Yttrium-90 Radioembolization of Hepatocellular Carcinoma Perfused by the Cystic Artery: Multi-institutional Feasibility Study. J Vasc Interv Radiol 2020; 31:2022-2027. [PMID: 33187861 DOI: 10.1016/j.jvir.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the safety and efficacy of transarterial yttrium-90 radioembolization via the cystic artery for patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder with cystic artery supply. MATERIALS AND METHODS This retrospective study included 17 patients treated at 4 institutions. Patients with HCC perfused by the cystic artery who received ablative-dose radioembolization were included. Median tumor size was 3.8 cm (range, 2.0-8.8 cm). Fourteen patients (82%) had Child-Pugh class A cirrhosis and 3 (18%) had class B cirrhosis. Adverse events, tumor response, and time to progression were analyzed. RESULTS Median dose to the tissue perfused by the cystic artery was 340 Gy (range, 200-720 Gy). There were no occurrences of acute cholecystitis warranting invasive intervention. Four patients (24%) experienced transient right upper quadrant pain, with symptom resolution within 3 mo. Six patients (35%) exhibited gallbladder wall edema on follow-up imaging. Two (12%) and 0 grade 3/4 increases in alkaline phosphatase and bilirubin were observed, respectively. Follow-up imaging demonstrated complete response in 13 target tumors (76%) and partial response in 4 (24%). There were no cases of target tumor progression during a median follow-up of 9 mo (range, 3-72 mo). CONCLUSIONS Direct infusion of 90Y microspheres via the cystic artery appears to have an acceptable safety profile, without resulting in acute cholecystitis warranting invasive intervention. In selected patients with HCC in whom other treatments may be contraindicated and the tumor is supplied via the cystic artery, treatment with selective ablative radioembolization can be considered.
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Affiliation(s)
- Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, 757 Westwood Plaza, Room 2125, Los Angeles, CA 90095.
| | - Guy E Johnson
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Beau B Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
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Huang Z, Zuo M, Ni J, Gu Y, Zhang T, Jiang Y, Zhuo S, An C, Huang J. Assessment in the Survival Outcome After Transarterial Chemoembolization Combined with Cryoablation for Hepatocellular Carcinoma (Diameter > 4cm) Based on the Albumin-Bilirubin Grade and Platelet-Albumin-Bilirubin grade: A Preliminary Study. Cancer Manag Res 2020; 12:1373-1385. [PMID: 32158269 PMCID: PMC7049291 DOI: 10.2147/cmar.s234116] [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: 10/10/2019] [Accepted: 02/13/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Based on the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to assess the long-term outcomes of patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with cryoablation (TACE-CRA). Materials and Methods We studied 86 patients with HCC nodules (up to 3 HCCs with maximum diameters of 4.1–12.0 cm) who subsequently underwent TACE-CRA from July 2007 to August 2018. The overall survival (OS) was compared between groups classified by ALBI and PALBI grade. Baseline characteristics were collected to identify the risk factors for determination of poor OS after TACE-CRA. The prognostic performances of CTP class, ALBI and PALBI grade were compared. Results After a median follow-up time of 33.8 months, 41 patients had died. The cumulative1-, 3- and 5-year OS rates were 74.5%, 38.0% and 29.3%, respectively. Stratified according to ALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 41.2% in grade 1, respectively, and 20.9% and 9.8% in grades 2–3, respectively (P < 0.001). Stratified according to PALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 37.5% in grade 1, respectively, and 36.3% and 21.2% in grades 2–3, respectively (P = 0.002). Multivariate analysis results showed that older age, and ALBI grade 2–3 were associated with overall mortality. ALBI grade demonstrated significantly greater area under the curve values than CTP class and PALBI in predicting 1-, 3- and 5-year OS. Conclusion ALBI grade offers accurate prediction of long-term outcome for patients with HCC (diameter > 4 cm) after TACE-CRA.
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Affiliation(s)
- Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Mengxuan Zuo
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jiayan Ni
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yangkui Gu
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Tianqi Zhang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yiquan Jiang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Shuiqing Zhuo
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Chao An
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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The Beauty and Bane of Pressure-Directed Embolotherapy: Hemodynamic Principles and Preliminary Clinical Evidence. AJR Am J Roentgenol 2019; 212:686-695. [DOI: 10.2214/ajr.18.19975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Klimkowski S, Baker JC, Brown DB. Red Flags, Pitfalls, and Cautions in Y90 Radiotherapy. Tech Vasc Interv Radiol 2019; 22:63-69. [PMID: 31079712 DOI: 10.1053/j.tvir.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Radioembolization with yttrium-90 (Y90) microspheres is increasingly used to palliate patients with liver-dominant malignancy. With appropriate patient selection, this outpatient treatment is efficacious with limited toxicity profile. This article reviews common scenarios that can present in daily practice including evaluation of liver functions, evaluation of previous therapies, integrating Y90 into ongoing systemic therapy, determining performance status, and considering retreatment for patients who have already undergone Y90 who have hepatic dominant progression. Finally, we address the importance of evaluating tumors in potential watershed zones to maximize treatment response by using c-arm computed tomography. Many of these potential variables can overlap in an individual patient. By considering these factors individually, the consulting Interventional Radiologist can present a thorough treatment plan with a full description of expected outcomes and toxicities to clinic patients.
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Affiliation(s)
- Sergio Klimkowski
- The Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer C Baker
- The Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel B Brown
- The Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN; The Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN.
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12
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Smolock AR, Cristescu MM, Hinshaw A, Woo KM, Wells SA, Ziemlewicz TJ, Lubner MG, Dalvie PS, Louis Hinshaw J, Brace CL, Ozkan OS, Lee FT, Laeseke P. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom Radiol (NY) 2018; 43:2497-2504. [PMID: 29450606 DOI: 10.1007/s00261-018-1464-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC). METHODS Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.8 cm) in 16 patients (13 males; median age 64 years) were treated using TACE monotherapy. Combination TACE + MWA was used to treat 23 HCCs (median diameter 4.2 cm) in 22 patients (18 males; median age 61 years). Microwave ablation was performed at a target time of two weeks following TACE. Individual tumors were followed by serial contrast-enhanced CT or MR. Response to treatment was evaluated on a tumor-by-tumor basis using mRECIST criteria with the primary outcome being local tumor progression (LTP). Data were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Time to LTP was estimated with the Kaplan-Meier method. RESULTS Relative to TACE monotherapy, TACE + MWA provided a trend toward both a lower rate of LTP (34.8% vs. 62.5%, p = 0.11) and a higher complete response rate (65.2% vs. 37.5%; p = 0.12). Time to LTP (22.3 months vs. 4.2 months; p = 0.001) was significantly longer in the TACE + MWA group compared to TACE monotherapy. CONCLUSIONS Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3-5 cm HCC.
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Affiliation(s)
- Amanda R Smolock
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Mircea M Cristescu
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Audrey Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Kaitlin M Woo
- Departments of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Shane A Wells
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Prasad S Dalvie
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Christopher L Brace
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Medical Physics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Orhan S Ozkan
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Paul Laeseke
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA.
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Hepatic Arterial Embolization Using Cone Beam CT with Tumor Feeding Vessel Detection Software: Impact on Hepatocellular Carcinoma Response. Cardiovasc Intervent Radiol 2017; 41:104-111. [PMID: 28770316 DOI: 10.1007/s00270-017-1758-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Dedicated tumor feeding vessel detection software (TFVDS) using cone beam CT has shown a higher sensitivity to detect tumor feeding vessels during hepatic arterial embolization (HAE) of hepatocellular carcinoma (HCC) compared to 2D imaging. Our primary hypothesis was that HCC tumors treated with HAE guided by a TFVDS would show more complete response (CR) than when treated with 2D imaging alone. Secondary analysis of the impact on X-ray exposure was performed. MATERIALS AND METHODS Nineteen males and 8 females (median age: 69 year, 46-85) with 44 tumors (median size: 38 mm, 6-100) treated with selective HAE between January 2013 and December 2014 were included. Exclusion criteria were: extra-hepatic supply, >4 tumors, tumor size >10 cm, and adjunctive local therapy. Baseline patient and procedure characteristics were reviewed. Differences in CR per modified Response Evaluation Criteria in Solid Tumors were assessed by univariate and multivariate analyses for tumor size, number, location, particles size, and use of TFVDS. RESULTS Median imaging follow-up was 20.1 months (2-33). Use of TFVDS (13 patients, 19 tumors) was the only factor predictive of CR (OR = 3.85 [CI95%: 1.09, 13.67], p = 0.04) on univariate analysis but not on multivariate analysis (OR = 3.26 [0.87, 12.23], p = 0.08). A higher rate of CR was observed for HAE using TFVDS guidance versus 2D imaging alone (68.4%, 13-19, vs. 36%, 9-25, p = 0.03). Median dose area product was lower when TFVDS was used (149.7 Gy.cm2, 38-365, vs. 227.8 Gy.cm2, 85.3-468.6, p = 0.05). CONCLUSIONS HCC embolized with TFVDS may result in improved local tumor response without increasing the dose exposure.
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Müller K, Datta S, Gehrisch S, Ahmad M, Mohammed MAA, Rosenberg J, Hwang GL, Louie JD, Sze DY, Kothary N. The Role of Dual-Phase Cone-Beam CT in Predicting Short-Term Response after Transarterial Chemoembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2017; 28:238-245. [DOI: 10.1016/j.jvir.2016.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022] Open
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