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Tang L, Hou Y, Huang Z, Huang J. Transarterial Chemoembolization Combined with Lenvatinib Plus Sequential Microwave Ablation for Large Hepatocellular Carcinoma Beyond Up-to-Seven Criteria: A Retrospective Cohort Study. Acad Radiol 2024; 31:2795-2806. [PMID: 38290885 DOI: 10.1016/j.acra.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with Lenvatinib plus sequential microwave ablation (MWA) for the treatment of patients with large hepatocellular carcinoma (HCC) beyond up-to-seven criteria. MATERIALS AND METHODS This retrospective cohort study assessed the medical records of patients with large HCC who underwent TACE combined with Lenvatinib plus sequential MWA (TLM) or TACE plus sequential MWA (TM). Lenvatinib was administered to patients within 3-5 days after TACE and sequential MWA was performed once they met the criteria for curative ablation after TACE or the combination therapy. The progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared between two groups. RESULTS Of the 81 patients who underwent TLM or TM, 64 who met the eligibility criteria were included in this study. Among them, 28 patients underwent TLM and 36 underwent TM. The inverse probability weighting method (IPTW) was used to balance differences between two groups. The TLM group had longer PFS than the TM group (median, before IPTW: 18.53 vs. 5.62 months, p < 0.001; median, after IPTW: 28.27 vs. 5.30 months, p < 0.001). Univariate and multivariate analyses revealed that TLM and the maximum tumor diameter were independent prognostic factors for PFS. The overall incidence rate of minor complications related to TACE or MWA was lower in the TLM group (32.1% vs. 66.7%, p = 0.006). CONCLUSION TACE combined with Lenvatinib plus sequential MWA can prolong the progression-free survival of patients with large HCC beyond up-to-seven criteria.
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Affiliation(s)
- Lu Tang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Yingwen Hou
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Zhimei Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Jinhua Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.).
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Wang D, Rao W. Bench-to-bedside development of multifunctional flexible embolic agents. Theranostics 2023; 13:2114-2139. [PMID: 37153738 PMCID: PMC10157739 DOI: 10.7150/thno.80213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/22/2022] [Indexed: 05/10/2023] Open
Abstract
Transarterial chemoembolization (TACE) has been demonstrated to provide a survival benefit for patients with unresectable hepatocellular carcinoma (HCC). However, conventional TACE still faces limitations associated with complications, side effects, unsatisfactory tumor responses, repeated treatment, and narrow indications. For further improvement of TACE, additional beneficial functions such as degradability, drug-loading and releasing properties, detectability, targetability, and multiple therapeutic modalities were introduced. The purpose here is to provide a comprehensive overview of current and emerging particulate embolization technology with respect to materials. Therefore, this review systematically identified and described typical features, various functions, and practical applications of recently emerging micro/nano materials as particulate embolic agents for TACE. Besides, new insights into the liquid metals-based multifunctional and flexible embolic agents were highlighted. The current development routes and future outlooks of these micro/nano embolic materials were also presented to promote advancement in the field.
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Affiliation(s)
- Dawei Wang
- Key Lab of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Key Lab of CryoBiomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- ✉ Corresponding author: Dr. Dawei Wang. ; Pro. Wei Rao.
| | - Wei Rao
- Key Lab of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Key Lab of CryoBiomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- ✉ Corresponding author: Dr. Dawei Wang. ; Pro. Wei Rao.
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Chai J, Liu K, Lu D, Lv W, Chu S, Cheng D, Xu B, Wang L. Clinical effectiveness of transcatheter arterial chemoembolization sequential microwave ablation for lack of blood supply in hepatocellular carcinoma. Future Oncol 2022; 18:4005-4015. [PMID: 36382581 DOI: 10.2217/fon-2022-0795] [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: 11/17/2022] Open
Abstract
Aims: To determine the effectiveness and safety of sequential computed tomography-guided percutaneous microwave ablation (MWA) after transcatheter arterial chemoembolization (TACE) for hypovascular liver lesions <5 cm in size. Methods: The clinical data of 69 hypovascular hepatocellular carcinoma lesions <5 cm in 60 patients treated with TACE followed by MWA were retrospectively analyzed. Results: There was no significant difference in AFP levels among AFP-positive patients before and after TACE (p = 0.515), but levels were significantly lower 1 month after MWA than before MWA (p = 0.039). Compared with 1 month after TACE, the objective response rate (p < 0.001) and disease control rate (p = 0.004) were increased 1 month after MWA. Any adverse events were well tolerated, and the albumin bilirubin score did not deteriorate within 4 weeks. Conclusion: Sequential MWA after TACE was found to be safe and effective for treating hypovascular hepatocellular carcinoma for lesions <5 cm in size.
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Affiliation(s)
- Jie Chai
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Kaicai Liu
- Infection Hospital, The First Affiliated Hospital of the University of Science & Technology of China, Hefei, 230061, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Weifu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Senlin Chu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Delei Cheng
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Beibei Xu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
| | - Lijun Wang
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei, 230001, China
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Chen X, Ma Y, Zhang J, Yang W, Jin C, Ran L, Zhu H, Bai J, Zhou K. Evaluating the long-term survival benefits of high intensity focused ultrasound ablation for hepatocellular carcinoma with portal vein tumor thrombus: a single center retrospective study. Int J Hyperthermia 2022; 39:1245-1253. [PMID: 36137611 DOI: 10.1080/02656736.2022.2122595] [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: 10/14/2022] Open
Abstract
AIMS To evaluate the long-term survival benefits of high intensity focused ultrasound (HIFU) ablation in patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombus (PVTT). METHODS The data of patients with HCC-PVTT treated with HIFU from January 2014 to December 2019 were retrospectively analyzed. All patients received HIFU ablation for both PVTT and liver tumor in one session. Perioperative adverse events (AEs) were recorded, and follow-up was performed postoperatively. The Kaplan-Meier method was used for survival analysis. RESULTS Median follow-up was 13.75 ± 1.31 months. A total of 144 patients (male/female: 122/22, age: 54.15 ± 11.84 years old) were included in the study. A total of 267 liver tumors (tumor number: 1.87 ± 1.65, range 1-10) were treated with HIFU. The mean ± SD diameter of viable liver tumors was 100.98 ± 61.65 mm. The reported postoperative AEs of HIFU were skin edema (93.75%), local pain (69.44%) and fever (7.64%). There was no liver failure, gastrointestinal bleeding or perioperative death. The median overall survival (OS) time was 14 months, while the cumulative survival rates of 0.5, 1, 2 and 3 years were 79.0%, 58.6%, 33.3% and 5.9%, respectively. The median OS of PVTT types I, II and III was 22, 13 and 14 months, respectively, and the difference was not statistically significant (p > 0.05). CONCLUSION HIFU is a minimally invasive method for HCC-PVTT with fewer complications, which could prolong the OS. Patients with PVTT type III could benefit more from HIFU, compared to types I and II.
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Affiliation(s)
- Xing Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yuhong Ma
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jun Zhang
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wei Yang
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chengbing Jin
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lifeng Ran
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui Zhu
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jin Bai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Kun Zhou
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Sparchez Z, Radu P, Bartos A, Nenu I, Craciun R, Mocan T, Horhat A, Spârchez M, Dufour JF. Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines? World J Gastrointest Oncol 2021; 13:1896-1918. [PMID: 35070032 PMCID: PMC8713312 DOI: 10.4251/wjgo.v13.i12.1896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options–from surgery to immunotherapy trials–it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.
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Affiliation(s)
- Zeno Sparchez
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Pompilia Radu
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Adrian Bartos
- Department of Surgery, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Iuliana Nenu
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Rares Craciun
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Tudor Mocan
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Adelina Horhat
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Mihaela Spârchez
- Department of Mother and Child, 2nd Paediatric Clinic, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400177, Romania
| | - Jean-François Dufour
- Department for BioMedical Research, Hepatology, University of Bern, Bern 3008, Switzerland
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