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Floridi C, Cacioppa LM, Rossini N, Macchini M, Bruno A, Agostini A, Consoli V, Inchingolo R, Acquafredda F, Nicolini D, Schiadà L, Svegliati Baroni G, Candelari R. Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function? LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01842-7. [PMID: 38958915 DOI: 10.1007/s11547-024-01842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. MATERIALS AND METHODS All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. RESULTS A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. CONCLUSION MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.
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Affiliation(s)
- Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Nicolò Rossini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Marco Macchini
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alessandra Bruno
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Andrea Agostini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Valeria Consoli
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Fabrizio Acquafredda
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Daniele Nicolini
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Laura Schiadà
- "Transplant and Hepatic Damage" Unit, University Politecnica Delle Marche, 60126, Ancona, Italy
| | | | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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Shi Q, Huang P, Zhang Z, Zhang W, Liu L, Yan Z. Hepatocellular Carcinoma with Radiological Progression: Lenvatinib Plus PD-1 Inhibitor Combined with Microwave Ablation and Synchronous Transarterial Chemoembolization. J Hepatocell Carcinoma 2023; 10:1861-1871. [PMID: 37885925 PMCID: PMC10599250 DOI: 10.2147/jhc.s426308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose To determine the clinical outcomes of lenvatinib plus PD-1 inhibitor combined with microwave ablation (MWA) and synchronous transarterial chemoembolization (TACE) in patients with progressive hepatocellular carcinoma (pHCC). Materials and Methods This retrospective study enrolled pHCC patients who underwent lenvatinib plus PD-1 inhibitor combined with MWA and TACE (LP-MT) or lenvatinib combined with MWA and TACE (L-MT) from January 2019 to December 2022. Treatment-related adverse events (AEs) were recorded during the follow-up. Progression-free survival (PFS) and overall survival (OS) were the primary outcomes. The prognostic analyses for survival were performed using Cox proportional hazard regression model. Results In total, 90 eligible patients with pHCC who received combination therapy were included in the study. Among them, 42 patients received LP-MT and 48 patients received L-MT. There were no significant differences in the baseline characteristics between the two groups. Patients who underwent lenvatinib plus PD-1 inhibitor combined with MWA and TACE had better PFS (median, 10.0 vs 7.4 months, P = 0.03) than those who underwent combination therapy without PD-1 inhibitor, although no significant difference was found in OS (median, 22.5 vs 20.0 months, P = 0.19) between the two groups. The disease control rate of LP-MT group was higher than that of L-MT group (88.1% vs 64.6%, P = 0.01), especially in patients with BCLC stage C (89.3% vs 70.0%, P = 0.03). Univariate and multivariate analyses indicated that treatment method and Child-Pugh class were independent prognostic factors for PFS. The AEs of LP-MT group were comparable and tolerable to those of L-MT group (Any grade, 78.6% vs 62.5%, P = 0.10; Grade 3, 23.8% vs 12.5%, P = 0.16). Conclusion Lenvatinib plus PD-1 inhibitor may be slightly superior to lenvatinib alone when combined with local interventional therapy for progressive HCC, especially in patients with BCLC stage C.
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Affiliation(s)
- Qin Shi
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Peng Huang
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Institution of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
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Kim JH, Kim JH, Yoon HK, Ko GY, Shin JH, Gwon DI, Ko HK, Chu HH, Kim SH, Kim GH, Kim Y, Aljerdah S. Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes. Front Oncol 2023; 13:1072922. [PMID: 37346065 PMCID: PMC10281503 DOI: 10.3389/fonc.2023.1072922] [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: 10/18/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To evaluate the safety and efficacy of TACE and factors predicting survival in patients with advanced hepatocellular carcinoma (HCC) without macrovascular invasion (MVI) or extrahepatic spread (EHS). Methods This single-center retrospective study included 236 treatment-naïve patients who underwent TACE as first-line treatment for advanced HCC without MVI or EHS between January 2007 and December 2021. Results Following TACE, the median overall survival (OS) was 24 months. Multivariate Cox regression analyses revealed that tumor number ≥4 (risk point: 3), maximal tumor size >10 cm (risk point: 2), Child-Pugh class B (risk point: 2), alpha-fetoprotein (AFP) concentration ≥400 ng/mL (risk point: 2), and presence of HCC rupture (risk point: 2) were risk factors significantly associated with OS. The expected median OS among patients with <2, 2-4, and 5-9 risk points were 72, 29, and 12 months respectively. The major complication rates were significantly lower in patients with maximal tumor size ≤10 cm than in those with maximal tumor size >10 cm (4% [5/138] vs 21% [21/98], p = 0.001). Conclusion TACE may be safe and effective in selected patients with advanced HCC without MVI or EHS, with a median OS of 24 months. Patients with limited tumor burden, compensated liver function, absence of HCC rupture, and favorable biologic markers may benefit the most from TACE. TACE is not recommended for patients with huge HCCs (>10 cm) because of its high rate of major complications (21%).
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Affiliation(s)
- Ji Hoon Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
- Ajou University Hospital, College of Medicine, Ajou University, Najran, Saudi Arabia
| | - Jin Hyoung Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Hyun-Ki Yoon
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Gi-Young Ko
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Ji Hoon Shin
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Dong Il Gwon
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Heung-Kyu Ko
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Hee Ho Chu
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Seong Ho Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Gun Ha Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Yonghun Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Shakir Aljerdah
- College of Medicine, Najran University, Najran, Saudi Arabia
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Nosaka T, Matsuda H, Sugata R, Akazawa Y, Takahashi K, Naito T, Ohtani M, Kinoshita K, Tsujikawa T, Sato Y, Maeda Y, Tamamura H, Nakamoto Y. Longer Survival and Preserved Liver Function after Proton Beam Therapy for Patients with Unresectable Hepatocellular Carcinoma. Curr Oncol 2023; 30:3915-3926. [PMID: 37185409 PMCID: PMC10136995 DOI: 10.3390/curroncol30040296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Proton beam therapy (PBT) has been recently reported to achieve excellent tumor control with minimal toxicity in patients with unresectable hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) was investigated for larger HCC. This study was designed to evaluate the therapeutic effect of PBT on unresectable HCC in comparison with TACE combined with RFA. Methods: We retrospectively analyzed 70 patients with HCC which was difficult to control by surgical resection or RFA monotherapy, 24 patients treated with PBT and 46 patients with TACE plus RFA. The therapeutic effects were assessed as local progression-free survival (PFS) and overall survival (OS). Results: The local PFS was more than 65% in 60 months for PBT and TACE plus RFA. The patients treated with PBT showed 82% OS at 60 months post-treatment. In contrast, those treated with TACE plus RFA showed 28% OS. When comparing the changes of ALBI scores in patients with different severities of chronic liver disease, the scores of PBT-treated patients were maintained at the baseline; however, those of TACE plus RFA-treated patients worsened after the treatments. Conclusions: The results indicated that PBT may show better benefits than TACE plus RFA therapy in terms of OS in patients with unresectable HCC by sparing the non-tumor liver tissues.
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Frager SZ, Cooper W, Saenger Y, Schwartz JM. Treatment of recurrent hepatocellular carcinoma following liver resection, ablation or liver transplantation. World J Meta-Anal 2023; 11:47-54. [DOI: 10.13105/wjma.v11.i2.47] [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: 10/20/2022] [Revised: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and causes one third of cancer related deaths world-wide. Approximately one third of patients with HCC are eligible for curative treatments that include hepatic resection, liver transplantation or imaging guided tumor ablation. Recurrence rates after primary therapy depends on tumor biology and pre-treatment tumor burden with early recurrence rates ranging from 30%-80% following surgical resection and ablation. HCC recurs in over ten percent following liver transplantation for HCC. Treatment modalities for tumor recurrence following resection and ablation include repeat liver resection, salvage liver transplantation, locoregional therapies, and systemic chemotherapy/immunotherapy. Locoregional and immune mediated therapies are limited for patients with tumor recurrence following liver transplantation given potential immune related allograft rejection. Given the high HCC recurrence rates after primary tumor treatment, it is imperative for the clinician to review the appropriate treatment strategy for this disease entity. This article will review the current literature regarding HCC recurrence after primary curative therapies and will discuss the relevant future trends in the HCC field.
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Affiliation(s)
- Shalom Z Frager
- Department of Medicine, Division of Hepatology, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Weston Cooper
- Cancer Center, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Yvonne Saenger
- Cancer Center, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Jonathan M Schwartz
- Department of Medicine, Division Hepatology, Montefiore Medical Center, Bronx, NY 10467, United States
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Solbiati LA, Arai Y. Interventional oncology of liver tumors: how it all started and where are we now. Br J Radiol 2022; 95:20220434. [PMID: 35776630 PMCID: PMC9815741 DOI: 10.1259/bjr.20220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Liver was the very first organ for which interventional procedures were applied for the local treatment of primary and secondary malignancies. In this paper, the history of Interventional Oncology of liver, from the very beginning to the current situation, is summarized, including both percutaneous and intravascular procedures, and together with the evolution of the techniques for image guidance. The main ongoing developments, such as new techniques, combined interventional treatments and association of local interventions with new drugs are briefly described, too.
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Affiliation(s)
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan
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Zhang Z, Li C, Liao W, Huang Y, Wang Z. A Combination of Sorafenib, an Immune Checkpoint Inhibitor, TACE and Stereotactic Body Radiation Therapy versus Sorafenib and TACE in Advanced Hepatocellular Carcinoma Accompanied by Portal Vein Tumor Thrombus. Cancers (Basel) 2022; 14:cancers14153619. [PMID: 35892878 PMCID: PMC9332229 DOI: 10.3390/cancers14153619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background: This study compared the effectiveness of the combined administration of sorafenib, an immune checkpoint inhibitor, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) (SITS group) vs. sorafenib combined with TACE (ST group) in treating and downstaging advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The present study included patients with advanced HCC and PVTT treated with one of the above combination therapies. The downstaging rate, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events (AEs) were assessed. Results: Sixty-two patients were analyzed. The ORR was elevated in the SITS group compared with the ST group (p = 0.036), but no differences were found in DCR (p = 0.067). The survival analysis revealed higher PFS (p = 0.015) and OS (p = 0.013) in the SITS group, with median PFS and OS times of 10.4 and 13.8 months, respectively. Ten patients displayed successful downstaging and underwent surgery in the SITS group, vs. none in the ST group. The prognosis was better in surgically treated patients compared with the non-surgery subgroup, based on PFS (p < 0.001) and OS (p = 0.003). Despite a markedly higher rate of AEs in the SITS group (p = 0.020), including two severe AEs, the SITS combination therapy had an acceptable safety profile. Conclusion: The SITS combination therapy yields higher PFS and OS than the combined administration of sorafenib and TACE in patients with advanced HCC and PVTT, especially as a downstaging strategy before surgery.
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Affiliation(s)
- Zeyu Zhang
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410078, China; (Z.Z.); (W.L.); (Z.W.)
| | - Chan Li
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410078, China;
| | - Weijun Liao
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410078, China; (Z.Z.); (W.L.); (Z.W.)
| | - Yun Huang
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410078, China; (Z.Z.); (W.L.); (Z.W.)
- Correspondence: ; Tel.: +86-137-8710-2228
| | - Zhiming Wang
- Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410078, China; (Z.Z.); (W.L.); (Z.W.)
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