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Ghabili K, Windham-Herman AM, Konstantinidis M, Murali N, Borde T, Adam LC, Laage-Gaupp F, Lin M, Chapiro J, Georgiades C, Nezami N. Outcomes of repeat conventional transarterial chemoembolization in patients with liver metastases. Ann Hepatol 2024; 29:101529. [PMID: 39033928 DOI: 10.1016/j.aohep.2024.101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/18/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Although unlimited sessions of conventional transarterial chemoembolization (cTACE) may be performed for liver metastases, there is no data indicating when treatment becomes ineffective. This study aimed to determine the optimal number of repeat cTACE sessions for nonresponding patients before abandoning cTACE in patients with liver metastases. MATERIALS AND METHODS In this retrospective, single-institutional analysis, patients with liver metastases from neuroendocrine tumors (NET), colorectal carcinoma (CRC), and lung cancer who underwent consecutive cTACE sessions from 2001 to 2015 were studied. Quantitative European Association for Study of the Liver (qEASL) criteria were utilized for response assessment. The association between the number of cTACE and 2-year, 5-year, and overall survival was evaluated to estimate the optimal number of cTACE for each survival outcome. RESULTS Eighty-five patients underwent a total of 186 cTACE sessions for 117 liver metastases, of which 30.7 % responded to the first cTACE. For the target lesions that did not respond to the first, second, and third cTACE sessions, response rates after the second, third, and fourth cTACE sessions were 33.3 %, 23 %, and 25 %, respectively. The fourth cTACE session was the optimal number for 2-year survival (HR 0.40; 95 %CI: 0.16-0.97; p = 0.04), 5-year survival (HR 0.31; 95 %CI: 0.11-0.87; p = 0.02), and overall survival (HR 0.35; 95 %CI: 0.13-0.89; p = 0.02). CONCLUSIONS Repeat cTACE in the management of liver metastases from NET, CRC, and lung cancer was associated with improved patient survival. We recommend at least four cTACE sessions before switching to another treatment for nonresponding metastatic liver lesions.
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Affiliation(s)
- Kamyar Ghabili
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA; Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Austin-Marley Windham-Herman
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Interventional Radiology, University of California San Diego, La Jolla, California, USA
| | - Menelaos Konstantinidis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Nikitha Murali
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA; Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tabea Borde
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Charité Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Lucas C Adam
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Charité Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Fabian Laage-Gaupp
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - MingDe Lin
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Julius Chapiro
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nariman Nezami
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical imaging, Yale University School of Medicine, New Haven, Connecticut, USA; Division of Vascular and Interventional Radiology, Department of Radiology, Medstar Georgetown Hospital, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA; Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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Wu C, Hormuth DA, Easley T, Pineda F, Karczmar GS, Yankeelov TE. Systematic evaluation of MRI-based characterization of tumor-associated vascular morphology and hemodynamics via a dynamic digital phantom. J Med Imaging (Bellingham) 2024; 11:024002. [PMID: 38463607 PMCID: PMC10921778 DOI: 10.1117/1.jmi.11.2.024002] [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: 06/06/2023] [Revised: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Validation of quantitative imaging biomarkers is a challenging task, due to the difficulty in measuring the ground truth of the target biological process. A digital phantom-based framework is established to systematically validate the quantitative characterization of tumor-associated vascular morphology and hemodynamics based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Approach A digital phantom is employed to provide a ground-truth vascular system within which 45 synthetic tumors are simulated. Morphological analysis is performed on high-spatial resolution DCE-MRI data (spatial/temporal resolution = 30 to 300 μ m / 60 s ) to determine the accuracy of locating the arterial inputs of tumor-associated vessels (TAVs). Hemodynamic analysis is then performed on the combination of high-spatial resolution and high-temporal resolution (spatial/temporal resolution = 60 to 300 μ m / 1 to 10 s) DCE-MRI data, determining the accuracy of estimating tumor-associated blood pressure, vascular extraction rate, interstitial pressure, and interstitial flow velocity. Results The observed effects of acquisition settings demonstrate that, when optimizing the DCE-MRI protocol for the morphological analysis, increasing the spatial resolution is helpful but not necessary, as the location and arterial input of TAVs can be recovered with high accuracy even with the lowest investigated spatial resolution. When optimizing the DCE-MRI protocol for hemodynamic analysis, increasing the spatial resolution of the images used for vessel segmentation is essential, and the spatial and temporal resolutions of the images used for the kinetic parameter fitting require simultaneous optimization. Conclusion An in silico validation framework was generated to systematically quantify the effects of image acquisition settings on the ability to accurately estimate tumor-associated characteristics.
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Affiliation(s)
- Chengyue Wu
- University of Texas at Austin, Oden Institute for Computational Engineering and Sciences, Austin, Texas, United States
- MD Anderson Cancer Center, Department of Imaging Physics, Houston, Texas, United States
- MD Anderson Cancer Center, Department of Breast Imaging, Houston, Texas, United States
- MD Anderson Cancer Center, Department of Biostatistics, Houston, Texas, United States
| | - David A. Hormuth
- University of Texas at Austin, Oden Institute for Computational Engineering and Sciences, Austin, Texas, United States
- University of Texas at Austin, Livestrong Cancer Institutes, Austin, Texas, United States
| | - Ty Easley
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Federico Pineda
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Gregory S. Karczmar
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Thomas E. Yankeelov
- University of Texas at Austin, Oden Institute for Computational Engineering and Sciences, Austin, Texas, United States
- MD Anderson Cancer Center, Department of Imaging Physics, Houston, Texas, United States
- University of Texas at Austin, Livestrong Cancer Institutes, Austin, Texas, United States
- University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- University of Texas at Austin, Department of Diagnostic Medicine, Austin, Texas, United States
- University of Texas at Austin, Department of Oncology, Austin, Texas, United States
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Cathomas M, Mueller F, Mertineit N, Baumgartner I, Candinas D, Berzigotti A, Maurer MH, Lachenmayer A. Comparison of transarterial bland embolization and drug-eluting beads transarterial chemoembolization for very early and early hepatocellular carcinoma not amenable for surgery or ablation: a single center retrospective data analysis. J Gastrointest Oncol 2023; 14:2167-2177. [PMID: 37969817 PMCID: PMC10643597 DOI: 10.21037/jgo-23-261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 11/17/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) is the accepted therapy for intermediate hepatocellular carcinoma (HCC). Although recent data suggests that bland transarterial embolization (TAE) is equally effective in intermediate HCC, not much is known about the efficacy in very early and early HCC not amenable for ablation or resection. We aimed to compare the outcome of patients with very early and early HCC treated by drug-eluting beads TACE (DEB-TACE), a specific technique of TACE using DC beads, and TAE using microparticles with a size of 100 µm up to 700 µm. Methods Clinical data of totally 95 patients with very early and early HCC not amenable for surgery or ablation, treated between 2009 and 2019 at the Department of Visceral Surgery and Medicine and the Interdisciplinary Center of Vascular Interventions, University Hospital Bern, Switzerland, were retrospectively analyzed (52 patients in DEB-TACE and 42 patients in TAE group, respectively). All images were assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Primary endpoint was overall survival (OS). Secondary endpoints were local response rate and time to local progression. Results Most patients presented with Child-Pugh A. Thrombocytes were significantly lower in patients treated by TAE. Minor side effects occurred equally in both groups. No differences were detected in terms of OS, local tumor recurrence and response rate. Conclusions Compared with DEB-TACE, TAE is an equally effective and save therapy for very early and early HCC not amenable for resection or ablation without differences in local tumor control and OS.
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Affiliation(s)
- Marionna Cathomas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Flavian Mueller
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology, Cantonal Hospital Solothurn, Solothurn, Switzerland
| | - Iris Baumgartner
- Department of Angiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin H. Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Microspheres as a Carrier System for Therapeutic Embolization Procedures: Achievements and Advances. J Clin Med 2023; 12:jcm12030918. [PMID: 36769566 PMCID: PMC9917963 DOI: 10.3390/jcm12030918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
The targeted delivery of anti-cancer drugs and isotopes is one of the most pursued goals in anti-cancer therapy. One of the prime examples of such an application is the intra-arterial injection of microspheres containing cytostatic drugs or radioisotopes during hepatic embolization procedures. Therapy based on the application of microspheres revolves around vascular occlusion, complemented with local therapy in the form of trans-arterial chemoembolization (TACE) or radioembolization (TARE). The broadest implementation of these embolization strategies currently lies within the treatment of untreatable hepatocellular cancer (HCC) and metastatic colorectal cancer. This review aims to describe the state-of-the-art TACE and TARE technologies investigated in the clinical setting for HCC and addresses current trials and new developments. In addition, chemical properties and advancements in microsphere carrier systems are evaluated, and possible improvements in embolization therapy based on the modification of and functionalization with therapeutical loads are explored.
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Saghafian Larijani R, Shabani Ravari N, Goodarzi N, Akhlaghpour S, Saghafian Larijani S, Rouini MR, Dinarvand R. Current status of transarterial chemoembolization (TACE) agents in hepatocellular carcinoma treatment. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goyal P, Salem R, Mouli SK. Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines. Br J Radiol 2022; 95:20220379. [PMID: 35867889 PMCID: PMC9815732 DOI: 10.1259/bjr.20220379] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. Liver transplant remains the goal of curative treatment, but limited supply of organs decreases accessibility and prolongs waiting time to transplantation. Therefore, interventional oncology therapies have been used to treat the majority of HCC patients, including those awaiting transplant. The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system in management of HCC that helps allocate treatments. Since its inception in 1999, it was updated for the fifth time in November 2021 and for the first time shaped by expert opinions outside the core BCLC group. The most recent version includes additional options for early-stage disease, substratifies intermediate disease into three groups, and lists alternates to Sorafenib that can double the expected survival of advanced-stage disease. The group also proposed a new BCLC staging schema for disease progression, and endorsed treatment stage migration (TSM) directly into the main staging and treatment algorithm. This article reviews the recent developments underlying the current BCLC guidelines and highlights ongoing research, particularly involving radioembolization, that will shape future best practice.
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Affiliation(s)
- Piyush Goyal
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Samdeep K. Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
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7
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Delache O, Landreau A, Royer L, Petit A, Rousseau C, Rolland Y, Lalys F. A new software tool for planning interventional procedures in liver cancer. MINIM INVASIV THER 2021; 31:737-746. [PMID: 34355657 DOI: 10.1080/13645706.2021.1954953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intra-arterial therapy is an effective way of performing chemotherapy or radiation therapy in patients with primary liver cancer (i.e. hepatocellular carcinoma). Although this minimally invasive approach is now an established treatment option, support tools for pre-operative planning and intra-operative assistance might be helpful. MATERIAL AND METHODS We developed an approach for semi-automatic segmentation of computed tomography angiography images of the main arterial branches (required for access path to the treatment site), automatic segmentation of the liver, arterial and venous tree, and interactive segmentation of the tumors (required for procedure-specific planning). This approach was then integrated into a liver-specific workflow within EndoSize® solution, a planning software for endovascular procedures. The main branches extraction approach was qualitatively evaluated inside the software, while the automatic segmentation methods were quantitatively assessed. RESULTS Main branches extraction provides a success rate of 85% (i.e. all arteries correctly extracted) in a dataset of 172 patients. On public databases, a mean DICE of 0.91, 0.47 and 0.92 was obtained for liver, venous and arterial trees segmentation, respectively. CONCLUSIONS This pipeline is suitable for directly accessing the treatment site, giving anatomic measurements, and visualizing the hepatic trees, liver, and surrounding arteries during the pre-operative planning. ABBREVIATIONS HCC: hepatocellular carcinoma; TACE: transarterial chemoembolization; SIRT: selective internal radiation therapy; CT: computed tomography; CTA: computed tomography angiography; AMS: superior mesenteric artery; LGA: left gastric artery; RHA: right hepatic artery; LHA: left hepatic artery; rbHA: right branch of the hepatic artery; lbHA: left branch of the hepatic artery; GDA: gastroduodenal artery; VOI: volume of interest; SD: standard deviation; MICCAI: medical image computing and computer assisted interventions; MR: magnetic resonance.
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Affiliation(s)
- Ondine Delache
- Department of Interventional Radiology, Centre Eugène Marquis, Rennes, France
| | | | | | | | - Chloé Rousseau
- Department of Clinical Pharmacology - CIC Inserm 1414, Centre Hospitalier Universitaire de Rennes - Hôpital Pontchaillou, Rennes, France
| | - Yan Rolland
- Department of Interventional Radiology, Centre Eugène Marquis, Rennes, France
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Intra-Arterial Therapies for Liver Metastatic Breast Cancer: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2021; 44:1868-1882. [PMID: 34322751 DOI: 10.1007/s00270-021-02906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Performing a systematic review and meta-analysis to assess the evidence of intra-arterial therapies in liver metastatic breast cancer (LMBC) patients. METHODS A systemic literature search was performed in PubMed, EMBASE, SCOPUS for studies regarding intra-arterial therapies in LMBC patients. Full text studies of LMBC patients (n ≥ 10) published between January 2010 and December 2020 were included when at least one outcome among response rate, adverse events or survival was available. Response rates were pooled using generalized linear mixed models. A weighted estimate of the population median overall survival (OS) was obtained under the assumption of exponentially distributed survival times. RESULTS A total of 26 studies (1266 patients) were included. Eleven articles reported on transarterial radioembolization (TARE), ten on transarterial chemoembolization (TACE) and four on chemo-infusion. One retrospective study compared TARE and TACE. Pooled response rates were 49% for TARE (95%CI 32-67%), 34% for TACE (95%CI 22-50%) and 19% for chemo-infusion (95%CI 14-25%). Pooled median survival was 9.2 months (range 6.1-35.4 months) for TARE, 17.8 months (range 4.6-47.0) for TACE and 7.9 months (range 7.0-14.2) for chemo-infusion. No comparison for OS was possible due to missing survival rates at specific time points (1 and 2 year OS) and the large heterogeneity. CONCLUSION Although results have to be interpreted with caution due to the large heterogeneity, the superior response rate of TARE and TACE compared to chemo-infusion suggests first choice of TARE or TACE in chemorefractory LMBC patients. Chemo-infusion could be considered in LMBC patients not suitable for TARE or TACE. LEVEL OF EVIDENCE 3a.
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Javor D, Moyses J, Loewe C, Schernthaner RE. Radiation dose reduction capabilities of a new C-arm system with optimized hard- and software. Eur J Radiol 2020; 134:109367. [PMID: 33221618 DOI: 10.1016/j.ejrad.2020.109367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the radiation dose reduction capabilities and the image quality of a new C-arm system in comparison to a standard C-arm system. METHOD Prospective, randomized, IRB approved two-arm trial design. 49 consecutive patients with primary or secondary liver cancer were treated with transarterial chemoembolization (TACE) on two different angiography units. 28 patients were treated on a conventional angiography unit B, 21 patients on unit A which provides improved hardware and optimized image processing algorithms. Dose area product (DAP) and fluoroscopy time were recorded. DSA image quality of all procedures was assessed on a four-rank-scale by two independent and blinded readers. RESULTS Both cohorts showed no significant differences with regard to patient characteristics, tumor burden and fluoroscopy time. The new system resulted in a statistically significant reduction of cumulative DAP of 72% compared to the old platform (median 76 vs. 269 Gy*cm2). Individually, Fluoro-DAP and DSA-DAP decreased by 48% and 77% (p = 0.012 and p < 0.01), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. CONCLUSIONS The new C-arm system significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. The combination of optimized hardware and software yields the highest radiation dose reduction and is of utmost importance for patients and interventionalists.
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Affiliation(s)
- Domagoj Javor
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Johanna Moyses
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ruediger E Schernthaner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Bajwa R, Madoff DC, Kishore SA. Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions. DIGESTIVE DISEASE INTERVENTIONS 2020; 4:134-147. [PMID: 32832829 DOI: 10.1055/s-0040-1712146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractPrimary and secondary liver cancers are a major cause of mortality worldwide. Transarterial liver-directed therapy, or embolotherapy, represents an important locoregional treatment strategy for primary and secondary liver tumors. Embolotherapeutic modalities include bland embolization (transarterial embolization), chemoembolization (transarterial chemoembolization), and radioembolization or selective internal radiotherapy. A brief technical overview of embolotherapeutic modalities as well as supportive evidence for the treatment of most common primary and secondary liver tumors will be discussed in this review. Several potential future applications, including synergy with systemic therapy, interventional theranostics, and artificial intelligence will also be reviewed briefly.
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Affiliation(s)
- Raazi Bajwa
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Division of Interventional Radiology, New York, NY, USA
| | - David C Madoff
- Yale University School of Medicine, Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, New Haven, CT, USA
| | - Sirish A Kishore
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Division of Interventional Radiology New York, NY, USA
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Analysis of prognostic factors in patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma. Nucl Med Commun 2020; 41:73-77. [PMID: 31800509 DOI: 10.1097/mnm.0000000000001122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM This study aimed to analyze the prognostic factors of patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma. MATERIAL AND METHOD Eighty-six (73 M and 13F; mean age: 64.3 ± 9.8 years) patients who received transarterial radioembolization for unresectable hepatocellular carcinoma were included. Relationship between serum alpha-fetoprotein and international normalization ratio level, albumin-bilirubin grade, neutrophil-lymphocyte ratio, presence of portal venous thrombosis and extrahepatic metastases, the dimension of index lesion and OS were analyzed. RESULTS Neutrophil lymphocyte ratio was ≤ 5 in 76 (88%) and >5 in 10 (12%) of patients. Sixty-two (72%) patients died during a mean of 25.6± 9.7 months follow-up. Mean OS for all patients was calculated as 12.9 ± 14.6 months. In univariate analysis, albumin-bilirubin grade (22.3 ± 3.8 vs. 11.6 ± 4.2; P = 0.03), neutrophil-lymphocyte ratio (21.8 ± 3.6 vs. 7.3 ± 2.6; P =0.04), presence of extrahepatic metastases (30.1 ± 5.4 vs. 7.4 ± 2.0; P = 0.001) and portal venous thrombosis (26.5± 4.8 vs. 10.5 ± 2.1; P = 0.01) had significant effect on OS. In multivariate analysis, serum international normalization ratio (P = 0.005) and alpha-fetoprotein level (P = 0.004), albumin-bilirubin grade (P = 0.05), neutrophil-lymphocyte ratio (P = 0.007), Child-Pugh score (0.006) and presence of ascites (P = 0.005) were significantly correlated with OS. CONCLUSION Patients with low basal albumin-bilirubin grade and neutrophil-lymphocyte ratio survive longer after transarterial radioembolization for unresectable hepatocellular carcinoma. Presence of extrahepatic metastases and portal venous thrombosis seems to have a prognostic value.
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Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update. Cancers (Basel) 2020; 12:cancers12040791. [PMID: 32224882 PMCID: PMC7226474 DOI: 10.3390/cancers12040791] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) represents a significant contributor to cancer-related morbidity and mortality with increasing incidence in both developing and developed countries. Embolotherapy as a locoregional therapeutic strategy consists of trans-arterial or “bland” embolization (TAE), trans-arterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Trans-catheter arterial therapies can be applied along all stages of HCC, either as an alternative or neoadjuvant to surgical resection/transplantation in very early and early stage HCC or as a palliative option for local disease control in unresectable and advanced stage HCC. In advanced stage HCC, SIRT did not demonstrate superiority in comparison to systemic treatment options in several recent large prospective trials, though for carefully selected patients, may confer improved tolerability with similar disease control rates. The latest embolotherapeutic techniques and literature as they pertain to the management of HCC, as well as future directions, are reviewed in this article.
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Al-Tikriti Y, Hansson P. Drug-Eluting Polyacrylate Microgels: Loading and Release of Amitriptyline. J Phys Chem B 2020; 124:2289-2304. [PMID: 32105083 DOI: 10.1021/acs.jpcb.0c00030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We investigated the loading of an amphiphilic drug, amitriptyline hydrochloride (AMT), onto sodium polyacrylate hydrogels at low ionic strength and its release at high ionic strength. The purpose was to show how the self-assembling properties of the drug and the swelling of the gel network influenced the loading/release mechanisms and kinetics, important for the development of improved controlled-release systems for parenteral administration of amphiphilic drugs. Equilibrium studies showed that single microgels (∼100 μm) in a large solution volume underwent a discrete transition between swollen and dense states at a critical drug concentration in the solution. For single macrogels in a small solution volume, the transition progressed gradually with increasing amount of added drug, with swollen and dense phases coexisting in the same gel; in a suspension of microgels, swollen and collapsed particles coexisted. Time-resolved micropipette-assisted microscopy studies showed that drug self-assemblies accumulated in a dense shell enclosing the swollen core during loading and that a dense core was surrounded by a swollen shell during release. The time evolution of the radius of single microgels was determined as functions of liquid flow rate, network size, and AMT concentration in the solution. Mass transport of AMT in the surrounding liquid, and in the dense shell, influenced the deswelling rate during loading. Mass transport in the swollen shell controlled the swelling rate during release. A steady-state kinetic model taking into account drug self-assembly, core-shell phase separation, and microgel volume changes was developed and found to be in semiquantitative agreement with the experimental loading and release data.
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Affiliation(s)
- Yassir Al-Tikriti
- Department of Pharmacy, Uppsala University, Box 580, 751 23 Uppsala, Sweden
| | - Per Hansson
- Department of Pharmacy, Uppsala University, Box 580, 751 23 Uppsala, Sweden
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14
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Inchingolo R, Posa A, Mariappan M, Spiliopoulos S. Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions. World J Gastroenterol 2019; 25:4614-4628. [PMID: 31528090 PMCID: PMC6718039 DOI: 10.3748/wjg.v25.i32.4614] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant. The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.
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Affiliation(s)
- Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
- Department of Radiology, King´s College Hospital, London SE5 9RS, United Kingdom
| | - Alessandro Posa
- Department of Radiology, IRCSS Fatebenefratelli Hospital, Roma 00186, Italy
| | - Martin Mariappan
- Interventional Radiology Department, Aberdeen Royal Infirmary Hospital, Aberdeen AB25 2ZN, United Kingdom
| | - Stavros Spiliopoulos
- 2nd Radiology Department, School of Medicine; National and Kapodistrian University of Athens, Chaidari Athens 12461, Greece
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15
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Degrauwe N, Hocquelet A, Digklia A, Schaefer N, Denys A, Duran R. Theranostics in Interventional Oncology: Versatile Carriers for Diagnosis and Targeted Image-Guided Minimally Invasive Procedures. Front Pharmacol 2019; 10:450. [PMID: 31143114 PMCID: PMC6521126 DOI: 10.3389/fphar.2019.00450] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
We are continuously progressing in our understanding of cancer and other diseases and learned how they can be heterogeneous among patients. Therefore, there is an increasing need for accurate characterization of diseases at the molecular level. In parallel, medical imaging and image-guided therapies are rapidly developing fields with new interventions and procedures entering constantly in clinical practice. Theranostics, a relatively new branch of medicine, refers to procedures combining diagnosis and treatment, often based on patient and disease-specific features or molecular markers. Interventional oncology which is at the convergence point of diagnosis and treatment employs several methods related to theranostics to provide minimally invasive procedures tailored to the patient characteristics. The aim is to develop more personalized procedures able to identify cancer cells, selectively reach and treat them, and to assess drug delivery and uptake in real-time in order to perform adjustments in the treatment being delivered based on obtained procedure feedback and ultimately predict response. Here, we review several interventional oncology procedures referring to the field of theranostics, and describe innovative methods that are under development as well as future directions in the field.
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Affiliation(s)
- Nils Degrauwe
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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16
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Petrillo M, Patella F, Pesapane F, Suter MB, Ierardi AM, Angileri SA, Floridi C, de Filippo M, Carrafiello G. Hypoxia and tumor angiogenesis in the era of hepatocellular carcinoma transarterial loco-regional treatments. Future Oncol 2018; 14:2957-2967. [DOI: 10.2217/fon-2017-0739] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This review focuses upon interactions and potential therapeutic targets in the ‘vicious cycle’ between hypoxia and neoangiogenesis following treatment of hepatocellular carcinoma with transarterial loco-regional therapies. Biomarkers correlated with angiogenesis have been studied by many authors as prognostic determinants following transarterial intrahepatic therapy. According to these results future therapies directed toward specific factors related to angiogenesis could play a significant role in preventing local tumor recurrence and remote metastasis.
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Affiliation(s)
- Mario Petrillo
- Diagnostic & Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | - Francesca Patella
- Postgraduation School of Radiodiagnostic of Milan, Department of Health Sciences, Milan, Italy
| | - Filippo Pesapane
- Postgraduation School of Radiodiagnostic of Milan, Department of Health Sciences, Milan, Italy
| | - Matteo B Suter
- Department of Medical Oncology, ASST Sette laghi, Varese, Italy
| | - Anna M Ierardi
- Diagnostic & Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | | | - Chiara Floridi
- Department of Diagnostic & Interventional Radiology Fatebenefratelli Hospital, Milan, Italy
| | - Massimo de Filippo
- Department of Medicine & Surgery Via Gramsci Azienda Ospedaliero Universitaria di Parma, 14 Parma, Italy
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17
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In vivo stability of supramolecular host-guest complexes monitored by dual-isotope multiplexing in a pre-targeting model of experimental liver radioembolization. J Control Release 2018; 293:126-134. [PMID: 30485797 DOI: 10.1016/j.jconrel.2018.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Cyclodextrin (CD)-based supramolecular interactions have been proposed as nanocarriers for drug delivery. We previously explored the use of these supramolecular interactions to perform targeted hepatic radioembolization. In a two-step procedure the appropriate location of the diagnostic pre-targeting vector can first be confirmed, after which the therapeutic vector will be targeted through multivalent host-guest interactions. Such a procedure would prevent therapeutic errors that come from a mismatch between diagnostic and therapeutic procedures. In the current study we explored the use of dual-isotope imaging to assess the in vivo stability of the formed complex and individual components. METHODS Dual-isotope imaging of the host and guest vectors was performed after labeling of the pre-targeted guest vector, being adamantane (Ad) functionalized macro-aggregated albumin (MAA) particles, with technetium-99 m (99mTc-MAA-Ad). The host vector, Cy50.5CD9PIBMA39, was labeled with indium-111 (111In-Cy50.5CD9PIBMA39). The in situ stability of both the individual vectors and the resulting [MAA-Ad-111In-Cy50.5CD9PIBMA39] complexes was studied over 44 h at 37 °C in a serum protein-containing buffer. In vivo, the host vector 111In-Cy50.5CD9PIBMA39 was administered two hours after local deposition of 99mTc-MAA-Ad in mice. Dual-isotope SPECT imaging and quantitative biodistribution studies were performed between 2 and 44 h post intravenous host vector administration. RESULTS The individual vectors portrayed <5% dissociation of the radioisotope over the course of 20 h. Dissociation of [MAA-Ad-111In-Cy50.5CD9PIBMA39] complexes remained within a 10-20% range after incubation in serum. In vivo dual-isotope SPECT imaging of host-guest interactions revealed co-localization of the tracer components. Quantitative assessment of the biodistribution revealed that the hepatic accumulation of the host vector nearly doubled between 2 h and 44 h post-injection (from 14.9 ± 6.1%ID/g to 26.2 ± 2.1%ID/g). CONCLUSIONS Assessment of intra-hepatic host-guest complexation was successfully achieved using dual isotope multiplexing, underlining the complex stability that was found in situ (up to 44 h in serum). Overall, the results obtained in this study highlight the potential of supramolecular chemistry as a versatile platform that could advance the field of nanomedicine.
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Qian B, Strübing F, Wang Z, Mehrabi A, Ryschich E. Microsurgical Technique of Locoregional Injection into the Hepatic Artery in Tumor-Bearing Mice. Eur Surg Res 2018; 59:339-348. [DOI: 10.1159/000494429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/04/2018] [Indexed: 11/19/2022]
Abstract
Background: Intraarterial injection into the hepatic artery represents an important route for locoregional administration for the treatment of hepatic tumors. In the present work, we describe microsurgical methodology for injection into the hepatic artery in mice. The technique was recently used for analysis of the phenomenon of endothelial capture in liver tumors. Methods: Two different models of hepatic tumors in C57BL/6 mice were used. Tumors were induced by intrahepatic cell inoculation. The preferential blood supply of tumors was studied using blocking of bioavailability of nontumoral endothelial epitope and the subsequent injection of fluorescent endothelium-specific antibody. The selective intraarterial injection of labeled antibody was performed in tumor-bearing mice. The procedure addressed variations of vascular anatomy of the hepatic artery in mice and used direct intraarterial injection with dispensable catheterization. Results: Both experimental tumor models showed preferential blood supply from the hepatic artery. The technique of hepatic arterial injection was adapted and performed according to two major anatomic variations of the hepatic artery. Using this technique, the selective enrichment of labeled antibody to tumor and liver blood vessels, which were perfused during the first intravascular passage, was demonstrated. Conclusions: The experimental hepatic arterial injection in mice is a feasible but demanding microsurgical procedure. The choice of subsequent operation steps is dependent on the vascular anatomy of the hepatic artery which has two major variations in mice.
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19
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Choi MH, Park GE, Oh SN, Park MY, Rha SE, Lee YJ, Jung SE, Choi JI. Reproducibility of mRECIST in Measurement and Response Assessment for Hepatocellular Carcinoma Treated by Transarterial Chemoembolization. Acad Radiol 2018; 25:1363-1373. [PMID: 29555570 DOI: 10.1016/j.acra.2018.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) for hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using multiphasic computed tomography. MATERIALS AND METHODS The institutional review board approved this retrospective study. We evaluated 97 patients who underwent TACE (60 conventional TACE [cTACE] and 37 drug-eluting bead TACE [DEB-TACE]) for HCC from 2010 to 2014. Four radiologists evaluated pairs of dynamic liver CTs scanned within 2 months before and after TACE based on mRECIST. Assessment of intra- or interobserver reproducibility for response categorization and sum of long diameter were evaluated using weighted kappa statistics (κ) and intraclass correlation coefficients, respectively. The relationship between concordance of target lesion selection and agreement of target lesion response was evaluated using Fisher exact test. RESULTS Intraobserver reproducibility for overall response was moderate to excellent (κ = 0.525-0.865). Interobserver reproducibility was improved on the second review compared to the first review and it was good in both treatment groups (κ = 0.627 for cTACE and 0.602 for DEB-TACE). Between the two treatment methods, intra- or interobserver reproducibility was better after cTACE than DEB-TACE. Intraclass correlation coefficients for sum of long diameter measurement showed excellent intra- or interobserver reproducibility. The concordance rate of target lesion selection was significantly higher for patients with radiologists' agreement for target lesion response than patients with disagreed response (P = .003). CONCLUSIONS The intra- and interobserver reproducibility of mRECIST in patients with HCC after TACE was moderate to excellent, and the reproducibility was slightly better after cTACE than DEB-TACE.
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20
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Pang G, Duan Z, Shao C, Zhao F, Zhong H, Shao G. Heterogeneity analysis of triphasic CT scan perfusion parameters in differential diagnosis of hepatocellular carcinoma and hemangioma. Medicine (Baltimore) 2018; 97:e12512. [PMID: 30235766 PMCID: PMC6160147 DOI: 10.1097/md.0000000000012512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study is to investigate quantitative measures and heterogeneity of perfusion parameters in the differential diagnosis of hepatocellular carcinoma (HCC) and hemangioma.In total, 32 HCC and 44 hemangioma (types 1, 2, and 3) cases were included in this retrospective study. Hepatic artery coefficient (HAC), portal vein coefficient (PVC), and arterial enhancement fraction (AEF) were calculated. Tumor heterogeneity was analyzed. Perfusion parameters and corresponding percentiles were compared between the HCC and hemangioma (especially atypical hemangioma) cases, as well as between the substantial lesion part and surrounding normal tissue.The mean value, and the 10th, 50th, 75th, and 90th percentiles of PVC were significantly lower in the HCC cases than the types 1 and 2 hemangioma cases (P < .01). Moreover, the 90th percentile PVC in the HCC cases was also significantly lower than the type 3 hemangioma case (P < .01), while the mean value, and all the percentiles of AEF in the HCC cases were higher than the types 2 and 3 hemangioma cases (P < .01). The 10th percentile HAC in the HCC cases was higher than the type 2 hemangioma cases (P < .05). The mean value, and the 10th and 50th percentile HAC in the HCC cases were higher than the type 3 hemangioma case (P < .05). However, there was no statistically significant difference in HAC between the HCC and type 1 hemangioma cases (P > .05).Quantitative measurement of perfusion parameters and heterogeneity analysis show significance differences in the early detection and differential diagnosis of HCC and hemangioma cases, which might contribute to increasing the diagnostic accuracy.
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Affiliation(s)
- Guodong Pang
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Zuyun Duan
- Department of Radiology, The Second People's Hospital of Dongying, Dongying
| | - Chunchun Shao
- Department of Evidence-Based Medicine, The Second Hospital of Shandong University
| | - Fang Zhao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hai Zhong
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Guangrui Shao
- Department of Radiology, The Second Hospital of Shandong University, Jinan
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21
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Radiation Therapy in Hepatocellular Carcinoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_44-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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22
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Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related deaths worldwide with rapidly growing incidence rates in the USA and Europe. Despite improving surveillance programs, most patients are diagnosed at intermediate to advanced stages and are no longer amenable to curative therapies, such as ablation, surgical resection and liver transplantation. For such patients, catheter-based image-guided embolotherapies such as transarterial chemoembolization (TACE) represent the standard of care and mainstay therapy, as recommended and endorsed by a variety of national guidelines and staging systems. The main benefit of these therapies is explained by the preferentially arterial blood supply of liver tumors, which allows to deliver the anticancer therapy directly to the tumor-feeding artery while sparing the healthy hepatic tissue mainly supplied by the portal vein. The tool box of an interventional oncologist contains several different variants of transarterial treatment modalities. Ever since the first TACE more than 30 years ago, these techniques have been progressively refined, both with respect to drug delivery materials and with respect to angiographic micro-catheter and image-guidance technology, thus substantially improving therapeutic outcomes of HCC. This review will summarize the fundamental principles, technical and clinical data on the application of different embolotherapies, such as bland transarterial embolization, Lipiodol-based conventional transarterial chemoembolization as well as TACE with drug-eluting beads (DEB-TACE). Clinical data on 90Yttrium radioembolization as an emerging alternative, mostly applied for niche indications such as HCC with portal vein invasion, will be discussed. Furthermore, we will summarize the principle of HCC staging, patient allocation and response assessment in the setting of HCC embolotherapy. In addition, we will evaluate the role of cone-beam computed tomography as a novel intra-procedural image-guidance technology. Finally, this review will touch on new technical developments such as radiopaque, imageable DEBs and the rationale and role of combined systemic and locoregional therapies, mostly in combination with Sorafenib.
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Grözinger G, Bitzer M, Syha R, Ketelsen D, Nikolaou K, Lauer U, Horger M. Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization. World J Radiol 2016; 8:683-692. [PMID: 27551338 PMCID: PMC4965352 DOI: 10.4329/wjr.v8.i7.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).
METHODS: From October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.
RESULTS: Signal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.
CONCLUSION: VPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.
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Monier A, Guiu B, Duran R, Aho S, Bize P, Deltenre P, Dunet V, Denys A. Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion. Eur Radiol 2016; 27:1431-1439. [PMID: 27436016 DOI: 10.1007/s00330-016-4488-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/03/2016] [Accepted: 06/22/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To compare transarterial chemoembolization (TACE)-related hepatic toxicities of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with intermediate-stage hepatocellular carcinoma. METHODS In this retrospective study, 151 consecutive patients undergoing cTACE or DEB-TACE and MRI 3-6 weeks before and after therapy were included. Toxicity was assessed on imaging (global hepatic damages (GHD), overall biliary injuries, biliary cast, bile duct dilatation, intrahepatic biloma, portal thrombosis), and clinico-biological follow-ups. Tumour response, time to progression (TTP), and overall survival were assessed. Factors influencing complication rate were identified by generalized equation logistic regression model. RESULTS Biliary injuries and intrahepatic biloma incidence were significantly higher following DEB-TACE (p < 0.001). DEB-TACE showed a significant increased risk of GHD (OR: 3.13 [1.74-5.63], p < 0.001) and biliary injuries (OR: 4.53 [2.37-8.67], p < 0.001). A significant relationship was found between baseline prothrombin value and GHD, biliary injuries and intrahepatic biloma (all p < 0.01), and between the dose of chemotherapy and intrahepatic biloma (p = 0.001). Only TTP was significantly shorter following DEB-TACE compared to cTACE (p = 0.025). CONCLUSIONS DEB-TACE was associated with increased hepatic toxicities compared to cTACE. GHD, biliary injuries, and intrahepatic biloma were more frequently observed with high baseline prothrombin value, suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis. KEY POINTS • DEB-TACE demonstrated more therapy-related hepatic locoregional complications compared to cTACE. • TACE-related hepatic locoregional toxicities occurred more frequently with high baseline PT value. • cTACE may be more appropriate in patients with high baseline PT value.
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Affiliation(s)
- Arnaud Monier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland
| | - Boris Guiu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.,Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, 34000, Avenue Emile Bertin Sans, France
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland
| | - Serge Aho
- Department of Epidemiology, University Hospital, Dijon, 21000, boulevard Jeanne d'Arc, France
| | - Pierre Bize
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland
| | - Pierre Deltenre
- Department of Gastroenterology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
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Huynh CT, Nguyen QV, Lym JS, Kim BS, Huynh DP, Jae HJ, Kim YI, Lee DS. Intraarterial gelation of injectable cationic pH/temperature-sensitive radiopaque embolic hydrogels in a rabbit hepatic tumor model and their potential application for liver cancer treatment. RSC Adv 2016. [DOI: 10.1039/c6ra03263j] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Radiopaque embolic solutions employing cationic poly(amino ester urethane)-based copolymers are injected into a rabbit hepatic tumor artery and form hydrogels in response to local temperature and pH for chemoembolization.
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Affiliation(s)
- Cong Truc Huynh
- Theranostic Macromolecules Research Center
- School of Chemical Engineering
- Sungkyunkwan University
- Suwon
- Korea
| | - Quang Vinh Nguyen
- Theranostic Macromolecules Research Center
- School of Chemical Engineering
- Sungkyunkwan University
- Suwon
- Korea
| | - Jae Seung Lym
- Theranostic Macromolecules Research Center
- School of Chemical Engineering
- Sungkyunkwan University
- Suwon
- Korea
| | - Bong Sup Kim
- Theranostic Macromolecules Research Center
- School of Chemical Engineering
- Sungkyunkwan University
- Suwon
- Korea
| | - Dai Phu Huynh
- National Key Lab for Polymer & Composite
- Faculty of Materials Technology
- Ho Chi Minh City University of Technology
- Vietnam National University – Ho Chi Minh City
- Ho Chi Minh City
| | - Hwan Jun Jae
- Department of Radiology
- Seoul National University Hospital
- Seoul
- Korea
| | - Young Il Kim
- Department of Radiology
- Seoul National University Hospital
- Seoul
- Korea
- Department of Radiology
| | - Doo Sung Lee
- Theranostic Macromolecules Research Center
- School of Chemical Engineering
- Sungkyunkwan University
- Suwon
- Korea
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