1
|
Titano JJ, Fischman AM, Cherian A, Tully M, Stein LL, Jacobs L, Rubin RA, Bosley M, Citron S, Joelson DW, Shrestha R, Arepally A. End-hole Versus Microvalve Infusion Catheters in Patients Undergoing Drug-Eluting Microspheres-TACE for Solitary Hepatocellular Carcinoma Tumors: A Retrospective Analysis. Cardiovasc Intervent Radiol 2019; 42:560-568. [PMID: 30635728 PMCID: PMC6394778 DOI: 10.1007/s00270-018-2150-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pre-transplant locoregional therapy for hepatocellular carcinoma (HCC) during bridge-to-transplant impacts recurrence and survival rates following liver transplantation. Optimizing the effectiveness of transarterial chemoembolization (TACE) in this population is imperative, and microvalve infusion catheters offer a means of such improvement. METHODS All treatment-naive patients with solitary HCC tumors < 6.5 cm who underwent drug-eluting microspheres (DEM) TACE between 04/2015 and 08/2017 were retrospectively reviewed. Eighty-eight included patients underwent DEM-TACE with either standard end-hole catheters (EH) or microvalve infusion catheters (MVI). The EH (n = 70) and MVI (n = 18) cohorts had similar baseline tumor size, laboratory values, and tumor etiologies. RESULTS Initial objective response rates were significantly higher in MVI vs. EH (100% vs. 76.5%, p = 0.019). There was no difference in adverse events between groups (p = 0.265). MVI patients exhibited lower AST (p = 0.003) and ALT (p = 0.044) at 6 months. Blinded pathological analysis of explanted livers showed greater concentrations of microspheres within the tumor relative to the surrounding tissue in MVI explants (88.7 ± 10.6%) versus the EH explants (55.3 ± 32.7%) (p = 0.002). There was significantly higher percentage tumor necrosis in the MVI group (89.0 ± 2.2%) compared with the EH group (56.1 ± 44.5%) (p = 0.006). CONCLUSION In this retrospective study of a single-center cohort, DEM-TACE procedures with MVI were associated with improved tumor response, increased deposition of microspheres within tumor tissue, and higher percentage tumor necrosis at explant relative to those performed using EH catheters.
Collapse
Affiliation(s)
- Joseph J Titano
- Department of Interventional Radiology, Mount Sinai, New York, NY, USA
| | - Aaron M Fischman
- Department of Interventional Radiology, Mount Sinai, New York, NY, USA
| | - Arnav Cherian
- Transplant Institute, Piedmont Healthcare, Atlanta, GA, USA
| | - Madeline Tully
- Transplant Institute, Piedmont Healthcare, Atlanta, GA, USA
| | - Lance L Stein
- Transplant Institute, Piedmont Healthcare, Atlanta, GA, USA
| | - Louis Jacobs
- Division of Interventional Radiology, Piedmont Healthcare, 1984 Peachtree Road, Suite 505, Atlanta, GA, 30309, USA
| | | | - Michael Bosley
- Division of Interventional Radiology, Piedmont Healthcare, 1984 Peachtree Road, Suite 505, Atlanta, GA, 30309, USA
| | - Steve Citron
- Division of Interventional Radiology, Piedmont Healthcare, 1984 Peachtree Road, Suite 505, Atlanta, GA, 30309, USA
| | - Dean W Joelson
- Division of Pathology, Piedmont Healthcare, Atlanta, GA, USA
| | | | - Aravind Arepally
- Division of Interventional Radiology, Piedmont Healthcare, 1984 Peachtree Road, Suite 505, Atlanta, GA, 30309, USA.
| |
Collapse
|