|
1
|
Oliveira Ribeiro MCD, Moda KA, Alvarez M, Koga KH, Moriguchi SM, Carvalho FC, Pinheiro RSN, Qi X, Romeiro FG. Objective Tumor Response of Hepatocellular Carcinoma Obtained by Transarterial Radioembolization with Iodine-131-Lipiodol Versus Transarterial Chemoembolization for Patients with and without Portal Venous Thrombosis: A Controlled Interventional Trial. Acad Radiol 2024; 31:1839-1848. [PMID: 38016824 DOI: 10.1016/j.acra.2023.10.029] [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: 08/27/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/30/2023]
Abstract
RATIONALE AND OBJECTIVES Hepatocellular carcinoma (HCC) treatment often requires transarterial chemoembolization (TACE). However, TACE efficacy is controversial in the presence of portal vein thrombosis (PVT). Although transarterial radioembolization (TARE) benefit was previously documented in PVT, neither the objective tumor response (OTR) after TARE with Iodine-131-lipiodol (131I-lipiodol) nor the PVT effect on the results of locoregional therapies was accurately measured in prospective clinical trials. The aim of this study was to compare OTR and survival obtained by TARE with 131I-lipiodol versus TACE in patients with cirrhosis and HCC, as well as between those with and without PVT. MATERIALS AND METHODS 33 patients were included, from whom 38 tumors were assessed. OTR was quantified by a special algorithm to measure hypervascular HCC tissue. RESULTS 19 tumors received each therapy. Nine subjects (27%) had PVT, most of them in the TARE group (p = 0.026). Mean OTR according to the tumor volumes was 24.2% ± 56% after TARE and 32.8% ± 48.9% after TACE, with no difference between the treatments (p = 0.616). Similar values were also observed between those with and without PVT (p = 0.704). Mean survival was 340 days and did not differ between the two treatments (p = 0.596), but was 194 days in PVT cases (p = 0.007). CONCLUSIONS This is the first study in which OTR obtained by TARE with 131I-lipiodol is accurately measured. Additionally, PVT impact on survival after TARE and TACE was precisely documented. Although the TARE group had more PVT subjects (who had shorter survival), TARE and TACE achieved similar OTR and OS rates.
Collapse
Affiliation(s)
| | - Kerolyn Adorne Moda
- Department of Internal Medicine, Sao Paulo State University (UNESP), Brazil (M.C.O.R., K.A.M., C.C., F.G.R.)
| | - Matheus Alvarez
- Center of Medical Physics and Radiation Protection, Clinical Hospital at Botucatu School of Medicine-HC-FMB, Botucatu, Brazil (M.A.)
| | - Katia Hiromoto Koga
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Sao Paulo State University (UNESP), Brazil (K.H.K., S.M.M.)
| | - Sônia Marta Moriguchi
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Sao Paulo State University (UNESP), Brazil (K.H.K., S.M.M.)
| | - Fábio Cardoso Carvalho
- Department of Internal Medicine, Sao Paulo State University (UNESP), Brazil (M.C.O.R., K.A.M., C.C., F.G.R.)
| | - Rafael Soares Nunes Pinheiro
- Liver and Digestive Organs Transplantation Division, Gastroenterology Department, Clinical Hospital of Sao Paulo University - HCFMUSP, Brazil (R.S.N.P.)
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China (X.Q.)
| | - Fernando Gomes Romeiro
- Department of Internal Medicine, Sao Paulo State University (UNESP), Brazil (M.C.O.R., K.A.M., C.C., F.G.R.).
| |
Collapse
|
|
2
|
Schönherr J, Seifert P, Gühne F, Winkens T, Rauchfuß F, Settmacher U, Freesmeyer M, Drescher R. Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts. Cancers (Basel) 2024; 16:235. [PMID: 38201662 PMCID: PMC10778280 DOI: 10.3390/cancers16010235] [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: 12/07/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
We investigated transarterial radioembolization (TARE) as a palliative measure and bridging-to-transplant therapy in hepatocellular carcinoma (HCC) patients. A total of 167 patients (50 bridging, 117 palliative) with 245 TARE procedures were assessed. Fourteen patients underwent subsequent liver transplantation (LT). Patients undergoing LT exhibited significantly prolonged progression-free survival (PFS) compared to those with bridging-without-transplant (p = 0.033). No significant differences were observed between patients with bridging-without-transplant and palliative cases (p = 0.116). Median overall survival (OS) post-TARE was 16.6 months, with estimated OS rates at 6/12 months of 82.0%/60.5%, respectively. Patients who underwent LT demonstrated statistically significantly longer OS compared to those with bridging-without-transplant (p = 0.001). No marked outcome distinctions were found between bridging-without-transplant and palliative groups. The findings underscored the superiority of LT over alternative treatments. TARE served as an important component in non-LT scenarios, allowing for subsequent therapeutic options. The study reflected the highly variable and complex situations of patients with HCC, emphasizing the need for further investigations to define an optimal multimodal approach.
Collapse
Affiliation(s)
- Jacqueline Schönherr
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| | - Falk Rauchfuß
- Center of Transplant Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.R.); (U.S.)
| | - Utz Settmacher
- Center of Transplant Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.R.); (U.S.)
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| | - Robert Drescher
- Clinic of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany; (J.S.); (P.S.); (F.G.); (T.W.); (R.D.)
| |
Collapse
|
|
3
|
Iezzi R, Posa A, Contegiacomo A, Lee IJ, Bale R, Tanzilli A, Tenore L, Giuliante F, Gasbarrini A, Goldberg SN, Jakobs T, Pompili M, Bargellini I, Sala E, Kim HC. Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives. Cancers (Basel) 2023; 15:3988. [PMID: 37568804 PMCID: PMC10416919 DOI: 10.3390/cancers15153988] [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: 07/10/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the actual treatment is usually discussed by a multidisciplinary tumor board in a personalized manner, leading to potential treatment differences based on Western and Eastern perspectives. The aim of this paper is to integrate literature evidence with the eminent experiences collected during a focused session at the Mediterranean Interventional Oncology (MIO) Live Congress 2023.
Collapse
Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Reto Bale
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | | | - Lorenzo Tenore
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Felice Giuliante
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Hepatobiliary Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Tobias Jakobs
- Clinic of Interventional Radiology, Hospital Barmherzige Brueder, 93049 Munich, Germany;
| | - Maurizio Pompili
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | | | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| |
Collapse
|
|
4
|
Yu CY, Huang PH, Tsang LLC, Hsu HW, Lim WX, Weng CC, Huang TL, Hsu CC, Chen CL, Ou HY, Cheng YF. Yttrium-90 Radioembolization as the Major Treatment of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:17-26. [PMID: 36660410 PMCID: PMC9843618 DOI: 10.2147/jhc.s385478] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Background The purpose of this study was to assess the safety and efficacy of Yttrium-90 radioembolization using in unresectable hepatocellular carcinoma. Methods From 2017 to 2021, 32 patients with unresectable hepatocellular carcinoma, with mean tumor diameter about 7cm (21 males, 11 females; median age, 57.5 years of age), treated with Yttrium-90 radioembolization using resin microspheres were reviewed at pre-Yttrium-90 and post-Yttrium-90 follow-up. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors. Outcomes including overall survival and progression-free survival were reported. Results Median follow-up was 18 months. At follow-up examinations at 3-, 6-, and 12-months follow-up, the overall survival rates were 94%, 87% and 59%, and the progression-free survival rates were 78%, 64% and 60%, respectively. Complete response, partial response, stable disease, and progressive disease were noted in 7 (21.9%), 14 (43.7%), 4 (12.5%), and 7 (21.9%) patients, respectively. The disease control rate was 78.1%, the objective response rate was 65.6%, and the successful downstage rate was 34.4% (11 of 32). Nine of thirty-two patients underwent resection or transplantation after Yttrium-90 radioembolization with 2-year overall survival being 100%. No serious adverse events occurred after Yttrium-90 treatment. Worse overall survival was related to the larger tumor, higher stage, Eastern Cooperative Oncology Group performance status, and Child-Pugh score. And worse progression-free survival was related to the higher tumor burden, and pre-Yttrium-90 serum α-fetoprotein level >100. Conclusion Yttrium-90 Radioembolization can control hepatocellular carcinoma well even in advanced diseases. Patients successfully downstaging/bridging to resection or transplantation have excellent overall survival.
Collapse
Affiliation(s)
- Chun-Yen Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Hsun Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsien-Wen Hsu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Xiong Lim
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Chun Weng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tung-Liang Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Chin Hsu
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-You Ou
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan,Correspondence: Yu-Fan Cheng; Hsin-You Ou, Tel/Fax +88677317123-3027, Email ;
| |
Collapse
|