Fogarty-assisted flow redirection during conventional transarterial chemoembolization for caudate lobe hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Approximately 8% of patients with HCC are not suitable candidates for curative options. Caudate lobe HCC presents technical challenges for interventional radiologists. Caudate lobe HCC has higher local recurrence and poorer survival rate than other segments. Transarterial treatments of caudate HCC are difficult due to extreme variation of arterial supply. We present a case of a caudate lobe HCC with supply from the proper hepatic artery, which underwent successful conventional transcatheter arterial chemoembolization (cTACE) by utilizing a Fogarty catheter to direct the embolic material. The patient presented 5 days following the procedure with duodenitis and pancreatitis, which were managed conservatively. Follow-up imaging at 1 month showed significant improvement of the ischemic duodenitis/pancreatitis with successful cTACE.

Gamma Knife Radiosurgery Versus Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: a Propensity Score Matching Study

BackgroundThe optimal management for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is unclear. This study aimed to investigate the efficacy of Gamma knife radiosurgery (GKR) versus transcatheter arterial chemoembolization (TACE) in HCC patients with PVTT. MethodsThis retrospective study included 572 HCC patients with PVTT (GKR, 207; TACE, 365). Propensity score matching (PSM) analysis identified 188 matched pairs of patients. The primary endpoint was overall survival (OS).ResultsBefore PSM, the GKR group demonstrated significantly median OS (mOS) than TACE group (17.4 vs. 8.0 months, p < 0.001). In the subgroup analysis, GKR was associated with significantly longer OS for patients with PVTT II-IV (17.5 vs. 8.2 months, p < 0.001; 19.3 vs. 7.4 months, p < 0.001; 14.5 vs. 6.6 months, p = 0.008, respectively) and comparable OS for patients with PVTT I. After PSM, the GKR group had also a longer OS (mOS) than TACE group (15.8 vs. 9.8 months, p < 0.001). In the subgroup analysis, the GKR group demonstrated superior mOS for patients with PVTT II-IV (all P < 0.05) and comparable OS for patients with PVTT I. ConclusionsGKR was associated better OS than TACE in HCC patients with PVTT, especially for patients with PVTT II-IV.

Efficacy and Safety of Radiotherapy Plus Anti-PD1 Versus Transcatheter Arterial Chemoembolization Plus Sorafenib For Advanced Hepatocellular Carcinoma: a Real-World Study

Background: The combination of transcatheter arterial chemoembolization (TACE) plus sorafenib prolonged progression-free survival (PFS) and overall survival (OS) than sorafenib or TACE monotherapy for patients with hepatocellular carcinoma (HCC). This study assessed the efficacy and safety of radiotherapy (RT) plus monoclonal antibody against programmed cell death 1 (anti-PD1) versus TACE plus sorafenib for patients with advanced HCC.Methods: Patients with advanced HCC who treated with RT plus anti-PD1 and TACE plus sorafenib were enrolled. Objective response rate (ORR), PFS, disease control rate (DCR) and OS were calculated to assess the antitumor response and the treatment-related adverse events to the safety.Results: Between January 2018 to March 2021, 37 patients underwent RT plus anti-PD1 and 41 patients underwent TACE plus sorafenib. The baseline characteristics between the two groups were comparable. The ORR and DCR were significantly higher in the RT+PD1 group than the TACE plus sorafenib group according to RECIST 1.1 (54.05% vs 12.20%, P < 0.001; 70.27% vs 46.37%, P = 0.041; respectively) and according to mRECIST (56.76% vs 31.71%, P = 0.039; 70.27% vs 46.37%, P = 0.041; respectively). RT plus anti-PD1 provided significantly better PFS (HR, 0.51; 95% CI 0.30-0.86; p=0.017) than TACE plus sorafenib. Moreover, patients with RT plus anti-PD1 had significantly higher 3-, 6-, and 9-month OS rates than those with TACE plus sorafenib(97.3% vs 92.30%, P < 0.001; 91.89% vs 68.60%, P < 0.001; 75.5% vs 60.60%, P < 0.001; respectively). The median OS was more favorable 17.4 months for the RT+PD1 group and 11.9 months for the TACE plus sorafenib group. No treatment-related death was observed. Grade 3 or more treatment-related adverse events (TRAEs) occurred significantly less in patients in the RT+PD1 group than the TACE plus sorafenib group (29.7% vs 75.6%, p < 0.001), and all TRAEs were manageable.Conclusions: In this real-world study, RT plus anti-PD1 showed significantly promising efficacy and manageable safety than TACE plus sorafenib in patients with advanced HCC. Toxicities were manageable, with no unexpected safety signals. The study provides evidence on a new therapeutic method in the treatment of advanced HCC.

A Novel Blood Index-Based Model to Predict Hepatitis B Virus-Associated Hepatocellular Carcinoma Recurrence After Curative Hepatectomy: Guidance on Adjuvant Transcatheter Arterial Chemoembolization Choice

BackgroundPostoperative recurrence is a significant obstacle in hepatocellular carcinoma (HCC) treatment. This study aimed to construct a blood index-based model to predict hepatitis B virus-associated HCC (HBV-HCC) recurrence after curative hepatectomy.MethodsA total of 370 patients who received initially curative hepatectomy for HBV-HCC were included in this study. A novel blood index signature (BIS) was identified and systematically analyzed for its recurrence predictive value. Following this, multivariate Cox regression analysis was performed to build a blood index-based nomogram.ResultsA BIS based on the aminotransferase-to-platelet ratio index and a systemic inflammatory response index was used to construct a nomogram. The model showed good clinical applicability and reliability. Notably, the patients in the high recurrence risk group tended to benefit from adjuvant transcatheter arterial chemoembolization (TACE).ConclusionA reliable model was constructed to predict the HBV-HCC recurrence after curative hepatectomy. This model can guide the surgeons in selecting patients with high recurrence risk patients who may benefit from adjuvant TACE.

Comparison of local recurrence in transcatheter arterial chemoembolization of hepatocellular carcinoma with or without accumulation of iodized oil beyond corona enhancement area: Short-term results

Background Local tumor recurrence of hepatocellular carcinoma (HCC) often occurs in blood drainage areas. Corona enhancement is determined by computed tomography during hepatic arteriography (CTHA) and is considered to represent the blood drainage area. This study aimed to investigate the relationship between embolization of corona enhancement area and local tumor recurrence of patients with HCC who underwent transcatheter arterial chemoembolization (TACE). Patients and methods The study retrospectively selected 53 patients with 60 HCC nodules that showed corona enhancement area on late-phase CTHA and showed homogenous accumulation of iodized oil throughout the nodule on non-contrast-enhanced CT performed immediately after TACE. We divided the nodules into two groups, according to whether the accumulation of iodized oil covered the entire corona enhancement area (group A) or not (group B). Local tumor recurrence was compared between the two groups. Results The cumulative local tumor recurrence rates for group A (n = 36) were 2.8%, 2.8%, 8.3% at 3, 6, and 12 months, respectively, whereas the recurrence rates for group B (n = 24) were 20.8%, 45.8%, 75% at 3, 6, and 12 months, respectively. The cumulative local tumor recurrence rates for group A were significantly lower than those for group B (hazard ratio, 0.079; 95% confidence interval, 0.026–0.24; p < 0.001). Conclusions The results of the study suggest that the corona enhancement area may be an accurate safety margin in TACE which should be performed until the embolic area covers the entire corona enhancement area.

LI-RADS Classification and Outcomes of Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation

PurposeThe aim of this study was to clarify the usefulness of the Liver Imaging Reporting and Data System (LI-RADS) to predict the patients’ prognosis after transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (TACE-RFA) for hepatocellular carcinoma (HCC) of Barcelona-Clinic Liver Cancer Stage (BCLC) 0 or A.Materials and MethodsWe retrospectively analyzed cases of HCC patients who underwent TACE-RFA (Jan 2005 to Dec 2015). Patients’ nodules were categorized based on their LI-RADS v2018 core. The LI-RADS category was assigned to each nodule using dynamic contrast-enhanced CT. LR-3, LR-4 and LR-5 nodules were extracted. We assessed the overall survival (OS) and recurrence-free survival (RFS) among BCLC 0 and BCLC A patients.ResultsOf the 64 nodules extracted, 22 were LR-3 or -4 (14.8±6.7 mm) and 42 were LR-5 (17.1±6.9 mm). Regarding OS, there was no significant difference between LR-3 or -4 and LR-5 (p=0.278). In terms of RFS, there was a significant difference between LR-3 or -4 and LR-5 (p=0.03). In particular, patients with BCLC A with LR-5 nodules showed significantly poorer RFS than those with LR-3 or -4 (p=0.016) nodules. ConclusionsFor patients with BCLC A, LR-3 or -4 are associated with a better prognosis than LR-5 nodules.

Conventional Transarterial Chemoembolization Versus Drug-Eluting Beads in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Hepatocellular carcinoma (HCC) occurs in nearly three-quarters of all primary liver cancers, with the majority not amenable to curative therapies. We therefore aimed to re-evaluate the safety, efficacy, and survival benefits of treating patients with drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) compared to the conventional transcatheter arterial chemoembolization (C-TACE). Several databases were searched with a strict eligibility criterion for studies reporting on adult patients with unresectable or recurrent HCC. The pooled analysis included 34 studies involving 4841 HCC patients with a median follow-up of 1.5 to 18 months. There were no significant differences between DEB-TACE and C-TACE with regard to complete response, partial response and disease stability. However, disease control (OR: 1.42 (95% CI (1.03,1.96) and objective response (OR: 1.33 (95% CI (0.99, 1.79) were significantly more effective for DEB-TACE treatment with fewer severe complications and all-cause mortality. The pooled-analysis did not find superiority of DEB-TACE in complete or partial response, disease stability, controlling disease progression, and 30 day or end-mortality. However, results showed that DEB-TACE is associated with a better objective response, disease control, and lower all-cause mortality with severe complications compared to C-TACE treatment. Given that the safety outcomes are based on limited studies with a potential for bias, there was no clear improvement of DEB-TACE over C-TACE treatment.