scholarly journals Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6370
Author(s):  
Shiro Miyayama ◽  
Masashi Yamashiro ◽  
Rie Ikeda ◽  
Junichi Matsumoto ◽  
Kiyotaka Takeuchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Survival Rates ◽  
Safety Margin ◽  
Complete Response ◽  
Hepatic Arteriography ◽  
Conventional Tace ◽  
Dual Blood Supply ◽  
Lost To Follow Up

The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan sau nút mạch hóa chất (TACE) theo mRECIST

2021 ◽  
Author(s):  
Trong Binh Le
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Treatment Response ◽  
Portal Vein Thrombosis ◽  
Transarterial Chemoembolization ◽  
Complete Response ◽  
Vein Thrombosis ◽  
The Mean ◽  
Keywords Hepatocellular Carcinoma

TÓM TẮT Mục tiêu: Đánh giá đáp ứng điều trị ung thư biểu mô tế bào gan (UTBMTBG) sau nút mạch hoá chất (TACE) theo tiêu chuẩn mRECIST. Phương pháp: Nghiên cứu tiến cứu.Chẩn đoán UTBMTBG theo EASL 2018. Đánh giá đáp ứng sau TACE theo thang điểm mRECIST tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng. Kết quả: 46 bệnh nhân (nam/nữ: 39/7), tuổi trung bình 61,5 ± 11,2 tuổi thỏa mãn tiêu chuẩn chọn bệnh. Thời gian theo dõi trung bình: 223 ngày (42 - 723 ngày). Đường kính lớn nhất trung bình của u: 62 mm (10 - 153 mm). 23,9% bệnh nhân có huyết khối tĩnh mạch cửa (HKTMC). Tỉ lệ đáp ứng hoàn toàn đối với tổn thương đích tại các thời điểm < 3 tháng, 3 - 6 tháng, 6 - 12 tháng, > 12 tháng lần lượt là 33,3%; 33,3%; 35,3% và 33,3%. Có 16,7% u tiến triển sau lần TACE thứ nhất. U thâm nhiễm, kích thước > 10cm, ở cả 2 thùy và có HKTMC là những yếu tố dự báo tái phát sau TACE. Kết luận: TACE có hiệu quả kiểm soát u ngắn hạn khi đánh giá bằng mRECIST. ABSTRACT EVALUATION OF TREATMENT RESPONSE OF HEPATOCELLULAR CARCINOMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION USING mRECIST CRITERIA Nguyen Thi Thuy Linh1, Hoang Anh Dung1, Huyen Ton Nu Hong Hanh2, Ngo Dac Hong An1, Le Minh Tuan1, Dang Quang Hung2, Le Hoang Huy2, Le Trong Binh1* Purpose: To evaluate the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using mRECIST. Methods: Diagnosis of HCC was based on EASL 2018, and an indication of TACE was based on SIR practice guideline. Treatment responses were evaluated at < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month intervals. Results: Forty - sixpatients (male/female 39/7) with the mean age 61.5 ± 11.2 years were enrolled in the present study. The mean follow - up duration was 223 days (range, 42 - 723 days). The mean of maximal HCC diameter was 62mm (range, 10 - 153mm). 23.9% of patients had portal vein thrombosis (PVT). The rates of complete response of the target lesions at the < 3 - month, 3 - 6 - month, 6 - 12 - month and > 12 - month were 33.3%; 33.3%; 35.3% and 33.3%, respectively. Progression disease was seen in 16.7%. Infiltrative type, diameter > 10cm, bilobar HCC, and portal vein thrombosis were predictors for recurrence. Conclusion: TACE offered short - term therapeutic control of HCC when using mRECIST. Keywords: Hepatocellular carcinoma, transarterial chemoembolization, mRECIST.

scholarly journals Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20–40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm

Life ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 358
Author(s):  
Su Min Cho ◽  
Hee Ho Chu ◽  
Jong Woo Kim ◽  
Jin Hyung Kim ◽  
Dong Il Gwon
Keyword(s):  
Hepatocellular Carcinoma ◽  
Median Time ◽  
Transarterial Chemoembolization ◽  
Median Overall Survival ◽  
Progressive Disease ◽  
Complete Response ◽  
Treatment Method ◽  
Local Tumor Recurrence ◽  
Drug Eluting

Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20–40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm. Materials and Methods: This study included 39 consecutive patients (34 men, 5 women; mean age, 63.5 years; range, 39–80 years) who underwent DEB-TACE using HepaSpheres 20–40 µm as first-line treatment for HCC > 5 cm (mean diameter, 8.2 cm; range, 5.1–13 cm) between September 2018 and August 2019. Patients with new tumors, residual tumors, or tumor growth after initial DEB-TACE underwent subsequent Cis-TACE. Results: All 39 patients underwent initial DEB-TACE successfully, with 35 (89.7%) and three (7.7%) patients experiencing minor and major complications, respectively. After initial DEB-TACE, one patient (2.6%) achieved complete response (CR), 35 (89.7%) achieved partial response (PR), and three (7.7%) experienced progressive disease (PD). During a median follow-up period of 14.4 months (range, 0.6–23 months), 23 patients underwent Cis-TACE, with 11, three, and nine achieving CR, PR, and PD, respectively. The median overall survival time was 20.9 months (95% confidence interval (CI), 18.6–23.2 months), the median time to progression was 8.8 months (95% CI, 6.5–11.1 months), and the median time to local tumor recurrence was 16 months (95% CI, 7.4–24.6 months). Conclusions: DEB-TACE using HepaSpheres 20–40 µm in diameter can be a safe and effective initial treatment method in patients with HCC > 5 cm. Subsequent Cis-TACE constitutes a good adjuvant method to enhance tumor response after initial DEB-TACE.

scholarly journals Treatment Response, Survival, and Safety of Transarterial Chemoembolization With CalliSpheres® Microspheres Versus Conventional Transarterial Chemoembolization in Hepatocellular Carcinoma: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Bin Liang ◽  
Joyman Makamure ◽  
Shenglei Shu ◽  
Lijie Zhang ◽  
Tao Sun ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Response ◽  
Transarterial Chemoembolization ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Objective Response ◽  
Progression Free Survival ◽  
Complete Response ◽  
Conventional Tace ◽  
Drug Eluting

BackgroundDrug-eluting embolic transarterial chemoembolization (DEE-TACE) is an advance in TACE technique. However, at present there is insufficient evidence to support that DEE-TACE is superior to conventional TACE (cTACE) for hepatocellular carcinoma (HCC). The aim of this meta-analysis is to evaluate the efficacy and safety of TACE with CalliSpheres® microspheres (CSM-TACE) compared with cTACE in patients with HCC.Data SourcesPubMed, Embase, Web of Science, CNKI and Wanfang Databases were searched to identify relevant articles published before March 26, 2020. The data regarding treatment response, survival profile, adverse events and liver function indexes were retrieved.ResultsA total of 16 studies with 1454 HCC patients (722 treated with CSM-TACE and 732 with cTACE) were included. Patients receiving CSM-TACE had higher 1-month complete response (CR), objective response rate (ORR), disease control rate (DCR) (odds ratio (OR): 2.00, 95% confidence interval (95% CI): 1.29–3.09; OR: 2.87, 95% CI: 2.15–3.83; OR: 2.01, 95% CI: 1.37–2.95, respectively), 3-month CR, ORR, DCR (OR: 4.04, 95%CI: 2.46–6.64; OR: 3.39, 95%CI: 2.45–4.70; OR: 1.71, 95%CI: 1.14–2.55 respectively), and 6-month CR, ORR, DCR (OR: 4.02, 95%CI: 2.26–7.16; OR: 3.00, 95%CI: 2.05–4.38; OR: 2.66, 95%CI: 1.70–4.16 respectively) than those treated with cTACE. Furthermore, CSM-TACE exhibited a trend toward improved progression free survival (hazard ratio (HR): 0.86, 95%CI: 0.67–1.11) and overall survival (HR: 0.79, 95%CI: 0.59–1.07) over cTACE although these differences did not reach statistical significance. In terms of safety, the two TACE treatments showed similar post-treatment pain (OR: 0.84, 95%CI: 0.55–1.28), fever (OR: 0.99, 95%CI: 0.60–1.63), nausea/vomiting (OR: 0.84, 95% CI: 0.60–1.17), as well as 1-month follow-up alanine aminotransferase (Mean difference (MD): −3.66, 95%CI: −10.38–3.07), aspartate aminotransferase (MD: −2.30, 95%CI: −8.91–4.31) and total bilirubin (MD: −0.15, 95%CI: −2.26–1.96).ConclusionCSM-TACE displays superior treatment response, non-inferior survival profile and safety over cTACE in HCC patients.

Diaphragmatic weakness after transcatheter arterial chemoembolization of the right inferior phrenic artery for treatment of hepatocellular carcinoma: a comparison of outcomes after N-butyl cyanoacrylate versus gelatin sponge embolization

2020 ◽  
pp. 028418512098177
Author(s):  
Seung Yeon Noh ◽  
Dong Il Gwon ◽  
Suyoung Park ◽  
Woo Jin Yang ◽  
Hee Ho Chu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Complete Response ◽  
Gelatin Sponge ◽  
Inferior Phrenic Artery ◽  
Gelatin Sponge Particles ◽  
Phrenic Artery ◽  
The Right ◽  
Diaphragmatic Weakness ◽  
Arterial Chemoembolization

Background The inferior phrenic artery (IPA) is the most common extrahepatic feeder for hepatocellular carcinoma (HCC) during transhepatic arterial chemoembolization (TACE). Purpose To compare the incidence of diaphragmatic weakness in patients with HCC after TACE of the right IPA conducted using either N-butyl cyanoacrylate (NBCA) or gelatin sponge particles. Material and Methods Medical records of 111 patients who underwent TACE of the right IPA using NBCA were retrospectively reviewed and compared with data from 135 patients with IPA embolization using gelatin sponge particles. Results The incidence of diaphragmatic weakness after the initial TACE procedure did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 20.7%; P = 0.458). Five patients in the NBCA group and 11 in the gelatin sponge group showed spontaneous resolution of diaphragmatic weakness after a mean period of 3.5 months. Diaphragmatic weakness developed after the initial follow-up visit in 17 patients from the gelatin sponge group due to repeated TACE of the right IPA (mean 2.4 sessions; range 2–4 sessions), while it spontaneously developed without additional TACE procedures in one patient from the NBCA group. Permanent diaphragmatic weakness was less common in the NBCA than in the gelatin sponge group (12.6% and 25.2%, respectively; P = 0.017). The complete response rate did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 25.9%; P = 0.065). Conclusion Use of NBCA rather than gelatin sponge particles for TACE of the right IPA resulted in a lower incidence of permanent diaphragmatic weakness.

Lessons from pathological analysis of recurrent early esophageal squamous cell neoplasia after complete endoscopic radiofrequency ablation

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 743-750 ◽  
Author(s):  
Wen-Lun Wang ◽  
I-Wei Chang ◽  
Chien-Chuan Chen ◽  
Chi-Yang Chang ◽  
Cheng-Hao Tseng ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Local Recurrence ◽  
Endoscopic Resection ◽  
Squamous Cell ◽  
Complete Response ◽  
Primary Treatment ◽  
Long Term Follow Up ◽  
Endoscopic Radiofrequency Ablation ◽  
Lost To Follow Up

Abstract Background Endoscopic radiofrequency ablation (RFA) is a treatment option for early esophageal squamous cell neoplasia (ESCN); however, long-term follow-up studies are lacking. The risks of local recurrence and “buried cancer” are also uncertain. Methods Patients with flat-type ESCN who were treated with balloon-type ± focal-type RFA were consecutively enrolled. Follow-up endoscopy was performed at 1, 3, and 6 months, and then every 6 months thereafter. Endoscopic resection was performed for persistent and recurrent ESCN, and the histopathology of resected specimens was assessed. Results A total of 35 patients were treated with RFA, of whom 30 (86 %) achieved a complete response, three were lost to follow-up, and five (14 %) developed post-RFA stenosis. Two patients had persistent ESCN and received further endoscopic resection, in which the resected specimens all revealed superficial submucosal invasive cancer. Six of the 30 patients with successful RFA (20 %) developed a total of seven episodes of local recurrence (mean size 1.4 cm) during the follow-up period (mean 40.1 months), all of which were successfully resected endoscopically without adverse events. Histological analysis of the resected specimens revealed that six (86 %) had esophageal glandular ductal involvement, all of which extended deeper than the muscularis mucosae layer. Immunohistochemistry staining for P53 and Ki67 suggested a clonal relationship between the ductal involvement and epithelial cells. None of the tumors extended out of the ductal structure; no cases of cancer buried beneath the normal neosquamous epithelium were found. Conclusions Because ductal involvement is not uncommon and may be related to recurrence, the use of RFA should be conservative and may not be the preferred primary treatment for early ESCN.

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