The treatment of unresectable "non-early" (according to the BCLC classification) hepatocellular carcinoma (HCC) in cirrhotic patients with transcatheter arterial chemoembolization (TACE) followed by radiofrequency ablation (RFA) is retrospectively evaluated and possible prognostic factors of this combined therapy are investigated. Forty-six consecutive cirrhotic patients (Child-Pugh class A or B) with solitary or oligonodular HCC underwent RFA after TACE. The treated lesions were 51 overall (size 30-80 mm, mean 48.9). RFA was performed by a multitined expandable electrodes device after one TACE administration. Local efficacy was evaluated with multiphasic computed tomography (CT) performed an average of 2 months after treatment and then during follow-up. Patient survival rate was also evaluated (follow-up time 1-51 months, mean 15 months). Technical success (defined as complete devascularization during the arterial phase) was achieved in 34/51 lesions (66.7%) at the first CT check and in 29/51 (56.9%) during the succeeding follow-up. Among the considered prognostic factors, only lesion diameter (< or > = 50 mm) was statistically significant in the Fisher's exact test in terms of local control (85.2 vs. 45.8% at first CT, p=.0065; 70.4 vs. 41.7% during follow-up, p=.051). There were two major complications (6.5%): one hepatic failure and one death. A Kaplan-Meier analysis showed survival rates of 89.7% at 12 months and 67.1% at 24 months. Combined therapy for non-early HCC shows a relatively high complete local response (especially in lesions less than 5 cm in diameter) and promising mid-term clinical success. Its overall usefulness has yet to be established by a larger series and risk-benefit analysis.

Purpose. This study was undertaken to evaluate patient dose in paediatric liver transplant recipients treated by percutaneous biliary drainage and bilioplasty procedures. Materials and methods. Effective dose rates and entrance skin-dose (ESD) rates per minute of fluoroscopy were measured by using a plexiglas phantom (thickness 10 cm) simulating the patient and by varying the exposure parameters (type of pulsed fluoroscopy, image intensifier diameter, presence of diaphragms) to identify the technique delivering the lowest patient dose. In vivo measurements were performed during three interventional procedures. Results. The effective dose rate proved to be lowest for a particular type of pulsed fluoroscopy, with maximum magnification and with field-limiting diaphragms. The in vivo measurements showed a maximum ESD value of around 50 mGy (the threshold for transient erythema is 2,000 mGy, ICRP 60). The effective dose values were in the range of 0.9-1.5 mSv. Conclusions. We established exposure parameters providing the desired image quality with the lowest dose for the equipment used and for a specific type of interventional procedure. The measured ESD values allow us to exclude the risk of deterministic effects on the skin. The effective dose values and considerations regarding the likelihood of radiation-induced cancer led to the conclusion that the radiological risk for the patient is largely justified by the benefits of these kinds of procedure. Riassunto

AimsTo perform a cost-effectiveness analysis (CEA) comparing personalised dosimetry with standard dosimetry in the context of selective internal radiation therapy (SIRT) with TheraSphere for the management of adult patients with locally advanced hepatocellular carcinoma (HCC) from the Italian Healthcare Service perspective.Materials and methodsA partition survival model was developed to project costs and the quality-adjusted life years (QALYs) over a lifetime horizon. Clinical inputs were retrieved from a published randomised controlled trial. Health resource utilisation inputs were extracted from the questionnaires administered to clinicians in three oncology centres in Italy, respectively. Cost parameters were based on Italian official tariffs.ResultsOver a lifetime horizon, the model estimated the average QALYs of 1.292 and 0.578, respectively, for patients undergoing personalised and standard dosimetry approaches. The estimated mean costs per patient were €23,487 and €19,877, respectively. The incremental cost-utility ratio (ICUR) of personalised versus standard dosimetry approaches was €5,056/QALY.ConclusionsPersonalised dosimetry may be considered a cost-effective option compared to standard dosimetry for patients undergoing SIRT for HCC in Italy. These findings provide evidence for clinicians and payers on the value of personalised dosimetry as a treatment option for patients with HCC.

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