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Floridi C, Cacioppa LM, Rossini N, Macchini M, Bruno A, Agostini A, Consoli V, Inchingolo R, Acquafredda F, Nicolini D, Schiadà L, Svegliati Baroni G, Candelari R. Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function? LA RADIOLOGIA MEDICA 2024; 129:1252-1264. [PMID: 38958915 PMCID: PMC11322225 DOI: 10.1007/s11547-024-01842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. MATERIALS AND METHODS All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. RESULTS A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. CONCLUSION MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.
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Affiliation(s)
- Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Nicolò Rossini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Marco Macchini
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alessandra Bruno
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Andrea Agostini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Valeria Consoli
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Fabrizio Acquafredda
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Daniele Nicolini
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Laura Schiadà
- "Transplant and Hepatic Damage" Unit, University Politecnica Delle Marche, 60126, Ancona, Italy
| | | | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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Abdelmalak J, Strasser SI, Ngu N, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Nicoll A, Batt N, Sawhney R, Tang MJ, Lubel J, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Majeed A, Kemp W, Zalcberg J, Roberts SK. Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study. Cancers (Basel) 2023; 15:5741. [PMID: 38136287 PMCID: PMC10742146 DOI: 10.3390/cancers15245741] [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: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, and there is ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation. Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 1 January 2016 and 31 December 2020 who received ablation or resection as initial treatment were included in the study. A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Following propensity score matching using key covariates, 156 patients were available for analysis with 78 in each group. Patients who underwent resection had significantly improved overall survival (log-rank test p = 0.023) and local recurrence-free survival (log rank test p = 0.027) compared to those who received ablation. Based on real-world data, our study supports the use of surgical resection in preference to ablation as first-line curative therapy in appropriately selected BCLC 0/A HCC patients.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - Simone I. Strasser
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Natalie Ngu
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Claude Dennis
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Marie Sinclair
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Katherine Bateman
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Joshua H. Abasszade
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Daniel Saitta
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Kathryn Gazelakis
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Susan Byers
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Jacinta Holmes
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Dhivya Pandiaraja
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Suresh Sharma
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Merlyn Joseph
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Nicholas Batt
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Myo J. Tang
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - Stephen Riordan
- Department of Gastroenterology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Nicholas Hannah
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - James Haridy
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Eileen Lam
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Elysia Greenhill
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
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Wang L, Liu BX, Long HY. Ablative strategies for recurrent hepatocellular carcinoma. World J Hepatol 2023; 15:515-524. [PMID: 37206650 PMCID: PMC10190693 DOI: 10.4254/wjh.v15.i4.515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.
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Affiliation(s)
- Lin Wang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Bao-Xian Liu
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Hai-Yi Long
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
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Qiao W, Wang Q, Hu C, Zhang Y, Li J, Sun Y, Yuan C, Wang W, Liu B, Zhang Y. Interim efficacy and safety of PD-1 inhibitors in preventing recurrence of hepatocellular carcinoma after interventional therapy. Front Immunol 2022; 13:1019772. [PMID: 36389724 PMCID: PMC9650042 DOI: 10.3389/fimmu.2022.1019772] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Locoregional interventional therapy including transcatheter arterial chemoembolization (TACE) and ablation are the current standard of treatment for early-to-mid-stage hepatocellular carcinoma (HCC). However, questions remain unanswered regarding the management of recurrence after locoregional treatment. PD-1 inhibitors can block inhibitory signals of T-cell activation and proliferation to reduce the recurrence. We conducted a single-arm phase 2 trial to evaluate the efficacy and safety of PD-1 inhibitors following locoregional interventional therapy in HCC patients with high recurrence risk guided by our novel scoring system. METHODS Patients enrolled initially treated by TACE combined with ablation, then willingly joined the experimental group. One month later, they received the anti-PD-1 adjuvant therapy (intravenous injection of 200 mg), which was repeated every 3 weeks for a total of 4 or 8 cycles. Within this same period, other patients were screened into the control group to match the experimental group by 1:1 based on the propensity score matching method (PSM). The primary endpoint was relapse-free survival (RFS). Secondary endpoints included overall survival (OS) recurrence modality, safety, and quality of life. RESULT At the time of data cutoff, the median RFS of the control group was 7.0 months while the experimental group had not reached it. Moreover, the 1-year RFS rate was 73.3% in the experimental group and 46.7% in the control group, showing a significant difference (P =0.02). The rate of local tumor progression in the experimental group was clearly lower than that in the control group (P = 0.027). Benefits associated with anti-PD-1 adjuvant therapy were observed in patients with multiple tumors and tumor size ≤2cm. Univariate and multivariate analyses demonstrated that anti-PD-1 adjuvant therapy was an independent favorable prognostic factor for RFS in HCC patients. The most frequent AE observed in this study was RCCEP, and other AEs included diarrhea, hepatotoxicity, rash, pruritus, and fatigue. The incidence of GRADE ≥3 AE and withdrawal in this study was low with no deaths recorded. CONCLUSIONS Interim analysis from the study suggest the addition of anti-PD-1 adjuvant therapy after TACE combined with ablation could significantly prolong RFS with controllable safety for early-to-mid-stage HCC patients with high recurrence risk.
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Affiliation(s)
- Wenying Qiao
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
- Center for Infectious Diseases, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Caixia Hu
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yinghua Zhang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Jianjun Li
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yu Sun
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Chunwang Yuan
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Biyu Liu
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
- Research Center for Biomedical Resources, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
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Kexin L, Ning C, Zhihong L, Shuo X, Rong W. Intelligent Algorithm-Based Ultrasound Images in Evaluation of Therapeutic Effects of Radiofrequency Ablation for Liver Tumor and Analysis on Risk Factors of Postoperative Infection. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5232411. [PMID: 36262984 PMCID: PMC9546717 DOI: 10.1155/2022/5232411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023]
Abstract
This research aimed to explore the therapeutic effects of radiofrequency ablation (RFA) for liver tumors and to investigate the postoperative infection factors. Specifically, 80 patients with liver tumors undergoing ultrasound-guided FRA were selected as research subjects. They were diagnosed in the hospital. An intelligent fitting (IF) algorithm was compared with a genetic algorithm (GA) and applied to the RFA of the 80 patients. It was found that the running time of the IF algorithm was about 0.2 times than that of the GA, demonstrating better global searching capabilities. The mean diameter of single liver tumors was (3.45 ± 1.24) cm, and the complete ablation rate of tumors with diameters less than 3 cm was 87.88%, that of tumors with diameters of 3-5 cm was 72.92%, and that of tumors with a diameter of more than 5 cm was 63.33%. Posttreatment, the AST level decreased significantly and the ALB level increased significantly, and the difference was notable (P < 0.05P<); the TBIL level (36.8 ± 9.7 umol/L) was lower than prior treatment (17.9 ± 8.5 umol/L) and the ALT level (45.2 ± 6.8 g/L) was lower than prior treatment (19.6 ± 5.7 g/L), showing a notable difference (P < 0.05P<). The diameter, whether there was great vessel invasion, and TNM staging were associated with infection after RFA, and the difference was notable. The ultrasound images can effectively evaluate the therapeutic effects of RFA and the degree of inactivation of liver tumors. In addition, the tumor stage was an independent risk factor for postoperative infection.
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Affiliation(s)
- Lou Kexin
- Department of Medical Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai 201600, China
- Department of Medical Ultrasound, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China
| | - Chen Ning
- Graduate School, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
- Department of Reproductive Medicine, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China
| | - Li Zhihong
- Department of Medical Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai 201600, China
| | - Xiao Shuo
- School of Computer Science and Technology, China University of Mining and Technology, Xuzhou 221000, Jiangsu, China
| | - Wu Rong
- Department of Medical Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai 201600, China
- Department of Medical Ultrasound, First People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai 201600, China
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Jiang C, Cheng G, Liao M, Huang J. Individual or combined transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma: a time-to-event meta-analysis. World J Surg Oncol 2021; 19:81. [PMID: 33741001 PMCID: PMC7980330 DOI: 10.1186/s12957-021-02188-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background There is still some debate as to whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is better than TACE or RFA alone. This meta-analysis aimed to compare the efficacy and safety of TACE plus RFA for hepatocellular carcinoma (HCC) with RFA or TACE alone. Methods We searched PubMed, MEDLINE, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) for all relevant randomized controlled trials and retrospective studies reporting overall survival (OS), recurrence-free survival (RFS), and complications of TACE plus RFA for HCC, compared with RFA or TACE alone. Results Twenty-one studies involving 3413 patients were included. TACE combined with RFA was associated with better OS (hazard ratio [HR]=0.62, 95% confidence intervals [CI] = 0.55–0.71, P < 0.001) and RFS (HR = 0.52, 95% CI = 0.39–0.69, P < 0.001) than TACE alone; compared with RFA alone, TACE plus RFA resulted in longer OS (HR = 0.63, 95% CI = 0.53–0.75, P < 0.001) and RFS (HR = 0.60, 95% CI = 0.51–0.71, P < 0.001). Subgroup analyses by tumor size also showed that combined treatment resulted in better OS and RFS compared with RFA alone in patients with HCC larger than 3 cm. Combined treatment resulted in similar rate of major complications compared with TACE or RFA alone (OR = 1.78, 95% CI = 0.99–3.20, P = 0.05; OR = 1.00, 95% CI = 0.42–2.38, P = 1.00, respectively). Conclusions TACE combined with RFA was more effective for HCC than TACE alone. For patients with a tumor larger than 3 cm, the combined treatment also achieved a better effect than RFA alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02188-4.
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Affiliation(s)
- Chuang Jiang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gong Cheng
- Department of Gastroenterology, Cadre Ward, Gansu Provincial Hospital, lanzhou, Gansu, China
| | - Mingheng Liao
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiwei Huang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Kuo MJ, Mo LR, Chen CL. Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods. BMC Cancer 2021; 21:250. [PMID: 33685409 PMCID: PMC7941925 DOI: 10.1186/s12885-021-07948-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07948-9.
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Affiliation(s)
- Ming-Jeng Kuo
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan.
| | - Lein-Ray Mo
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, and Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
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Park S, Rim CH, Jung YK, Yoon WS. Therapeutic Decision Making in Hepatocellular Carcinoma According to Age and Child-Pugh Class: A Nationwide Cohort Analysis in South Korea. Can J Gastroenterol Hepatol 2021; 2021:6640121. [PMID: 33505941 PMCID: PMC7811492 DOI: 10.1155/2021/6640121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/27/2023] Open
Abstract
Background We sought to analyze the preferred treatment modality by age and liver function in South Korea. Methods The Korean Liver Cancer Study Group randomly extracted the data of patients with hepatocellular carcinoma (HCC) enrolled in the Korean Central Cancer Registry from 2008 to 2014 from approximately 50 hospitals nationwide. After excluding distant and lymphatic metastases, the treatment preference for patients with a single lesion (excluding PVT (portal vein thrombosis), hepatic vessels, and bile duct invasion) and with PVT was evaluated in 7559 patients. Patients were grouped by age, and baseline liver function was divided based on the Child-Pugh class (CPC) A, B, and C. Results For a single HCC, the majority of patients selected transarterial therapy as the initial treatment, followed by surgical resection and local ablative therapy. The surgical resection rate decreased significantly with age (p < 0.001), and the transarterial therapy rate significantly increased (p < 0.001). For CPC C, liver transplantation was significantly increased to 11.5%, and 36.3% of patients received no treatment. In HCC with PVT, the transarterial therapy rate was the highest, followed by the rate of abandonment of treatment. The proportion of no treatment significantly increased with age (p < 0.001). In CPC C, transarterial therapy and systemic therapy were attempted in 15.4% and 5.8% of patients, respectively. Conclusions Age and liver function have a significant impact on the therapeutic decision-making of HCC patients in Korea. In unfavorable conditions, surgical resection was less favored in patients with single tumors, and no treatment was preferred in patients with PVT.
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Affiliation(s)
- Sunmin Park
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
| | - Young Kul Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
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Gui CH, Baey S, D'cruz RT, Shelat VG. Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma - A meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:763-771. [PMID: 31937433 DOI: 10.1016/j.ejso.2020.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatocellular Carcinoma (HCC) remains the third most common cause of cancer death worldwide, with countries in Asia being affected the most. The mainstay of curative therapy for early HCC is radiofrequency ablation (RFA) or surgery; either surgical resection (SR) or liver transplantation. Latest evidence however suggests that combination of TACE+ RFA may provide outcomes comparable to SR. AIM To compare oncologic outcomes and safety profile of TACE + RFA to SR alone in HCC. MATERIALS AND METHODS A systematic review was conducted through Pubmed, EMBASE and Cochrane Library for literature published before April 2019. Outcomes measured were disease-free survival(DFS), overall survival(OS) and major complications. DFS was further divided into local tumour progression(LTP), intrahepatic distant recurrence(IDR) and distant metastasis(DM). RESULTS Eight retrospective studies and one randomized controlled trial, involving 1892 patients met eligibility criteria and were included. Unadjusted pooled analysis demonstrated no significant difference in 1-year, 3-year and 5-year OS and 1-year DFS between TACE+RFA and SR. SR had superior 3-year DFS (OR 0.78, 95% CI 0.62-0.98, p = 0.03) and 5-year DFS (OR 0.74, 95% CI 0.58-0.95, p = 0.02) compared to TACE+RFA. When analysing only the propensity matched data, the difference in 3-year DFS and 5-year DFS was not significant. TACE+RFA had a higher LTP rate (OR 2.48, 95% CI 1.05-5.86, p = 0.04) compared to SR but IDR and DM rates were not significant. DISCUSSION AND CONCLUSION TACE+RFA offer comparable oncologic outcomes in patients with HCC as compared with SR and with added benefit of lower morbidity.
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Kumar A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, Anand AC, Bhangui P, Chawla YK, Datta Gupta S, Dixit VK, Duseja A, Kalra N, Kar P, Kulkarni SS, Kumar R, Kumar M, Madhavan R, Mohan Prasad V, Mukund A, Nagral A, Panda D, Paul SB, Rao PN, Rela M, Sahu MK, Saraswat VA, Shah SR, Shalimar, Sharma P, Taneja S, Wadhawan M. 2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations. J Clin Exp Hepatol 2020; 10:43-80. [PMID: 32025166 PMCID: PMC6995891 DOI: 10.1016/j.jceh.2019.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/15/2019] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management of HCC in India and neighboring countries. However, since 2014, many new developments have taken place in the field of HCC diagnosis and management, hence INASL endeavored to update its 2014 consensus guidelines. A new Task Force on HCC was constituted that reviewed the previous guidelines as well as the recent developments in various aspects of HCC that needed to be incorporated in the new guidelines. A 2-day round table discussion was held on 5th and 6th May 2018 at Puri, Odisha, to discuss, debate, and finalize the revised consensus statements. Each statement of the guideline was graded according to the Grading of Recommendations Assessment Development and Evaluation system with minor modifications. We present here the 2019 Update of INASL Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri-2 Recommendations.
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Key Words
- AFP, alpha-fetoprotein
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- DAA, direct-acting antiviral
- DALY, disability-adjusted life-year
- DNA, deoxyribonucleic acid
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- Gd-BOPTA, gadolinium benzyloxypropionictetraacetate
- Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid
- HBV, hepatitis B virus
- HBeAg, hepatitis B envelope antigen
- HCC, hepatocellular carcinoma
- HIV, human immunodeficiency virus
- IARC, International Agency for Research on Cancer
- IFN, interferon
- INASL, Indian National Association for Study of the Liver
- MiRNA, micro-RNA
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PIVKA, protein induced by vitamin K absence
- RFA
- RNA, ribonucleic acid
- SVR, sustained virological response
- TACE
- TACE, trans-arterial chemoembolization
- TARE, transarterial radioembolization
- TNF, tumor necrosis factor
- WHO, World Health Organization
- liver cancer
- targeted therapy
- transplant
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Anil C. Anand
- Department of Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221 005, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Suyash S. Kulkarni
- Division of Interventional Radiology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, Maharashtra, 400 012, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Ram Madhavan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682 041, India
| | - V.G. Mohan Prasad
- Department of Gastroenterology, VGM Gastro Centre, 2100, Trichy Road, Rajalakshmi Mills Stop, Singanallur, Coimbatore, Tamil Nadu, 641 005, India
| | - Amar Mukund
- Department of Radiology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Dipanjan Panda
- Department of Oncology, Institutes of Cancer, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600 100, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Samir R. Shah
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Praveen Sharma
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India
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Cao WZ, Zhou ZQ, Jiang S, Li H, Niu W, Gao P, Li GJ, Chen F. Efficacy and safety of drug-eluting beads for transarterial chemoembolization in patients with advanced hepatocellular carcinoma. Exp Ther Med 2019; 18:4625-4630. [PMID: 31798699 DOI: 10.3892/etm.2019.8163] [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] [Received: 05/27/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) has more recently become a leading cause of cancer-associated mortality worldwide. Particularly at an advanced stage, the prognosis is generally poor due to lack of effective treatments. Transarterial chemoembolization (TACE) is now a recognized therapy for advanced HCC, serving to deprive tumors of feeder arteries through induced ischemic necrosis. However, there is also a potential for undesired circulatory toxicity owing to drug reflux from tumor artery to surrounding healthy tissues. Although effective chemotherapeutic drug concentrations are thus lowered, the side effects of systemic chemotherapy are aggravated. The mid-2000 emergence of drug-eluting beads (DEB) loaded with anti-neoplastic drugs has proven particularly advantageous, enabling localized treatment and directed delivery of chemotherapeutics. DEB-TACE (dTACE) augments local infusion of anti-neoplastic agents to prolong agent/tumor contact, expanding upon conventional TACE. At present, data on DEB use in China are limited, particularly in terms of proprietary microspheres (CalliSpheres; Hengrui Medicine Co.). To explore the efficacy and safety of CalliSpheres, A total of 90 patients receiving this means of dTACE for advanced HCC were assessed in the present study. Clinical efficacy was evaluated based on tumor response and overall survival rates using the National Cancer Institute Common Terminology Criteria for Adverse Events to assess tolerability. The satisfactory tumor response and acceptable tolerability demonstrated in the follow-up confirm the promising utility of CalliSpheres in treating patients with advanced HCC.
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Affiliation(s)
- Wen-Zhen Cao
- Intensive Care Unit, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Zhu-Qian Zhou
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Song Jiang
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Hao Li
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Wei Niu
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Peng Gao
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Gui-Jie Li
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
| | - Feng Chen
- Department of Interventional Radiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, P.R. China
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vanSonnenberg E, Mueller PR. Complex Therapeutic Strategies for Hepatocellular Carcinoma: Expanding Criteria. Radiology 2019; 293:716-717. [PMID: 31638861 DOI: 10.1148/radiol.2019192151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Eric vanSonnenberg
- From the Department of Radiology, University of Arizona College of Medicine Phoenix, PO Box 4681, Cave Creek, Ariz 85327 (E.v.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (E.v.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (P.R.M.)
| | - Peter R Mueller
- From the Department of Radiology, University of Arizona College of Medicine Phoenix, PO Box 4681, Cave Creek, Ariz 85327 (E.v.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (E.v.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (P.R.M.)
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