Clinical management of vascular lake during transarterial chemoembolization with CalliSpheres drug-eluting beads (DEBs) for the treatment of hepatocellular carcinoma

Abstract

Background To summarize the incidence and management strategy of vascular lake (VL) during the treatment of hepatocellular carcinoma (HCC) using transarterial chemoembolization (TACE) with CalliSpheres drug-eluting beads (DEBs), and to analyze its relationship with tumor response rate (RR). The etiology and clinical significance of VL were also analyzed based on the available literature. Methods The clinical data of 92 HCC patients who were treated with chemoembolization using CalliSpheres DEBs (DEB-TACE) in two centers were retrospectively analyzed. All 92 patients were treatment-naïve and treated by DEB-TACE. The incidence of VL and its clinical treatment during the first embolization session were summarized. The lesions were divided into a VL group and a non-VL group to analyze the relationship between VL and tumor RR. Results The embolization was successful in 98.9% of patients (91/92). A total of 33 VLs (18.4%; including 15 stable and 18 unstable VLs) were found among the 179 nodules treated. The unstable VLs were further embolized with embolic agent. One patient with unstable VL developed bleeding due to hepatic rupture and died. During the follow-up, residual tumors were found around 2 stable VLs, 2 lesions in 2 patients were treated with CT-guided radiofrequency ablation. The tumor RR was 84.4% in VL group, which was significantly higher than that (58.9%) in the non-VL group (P=0.007). Conclusions VL is a unique phenomenon during DEB-TACE. It may be accompanied by residual tumors and bleeding due to rupture. Therefore, VL should be cautiously managed in clinical practice.

Prediction of initial objective response to drug-eluting beads transcatheter arterial chemoembolization for hepatocellular carcinoma using CT radiomics-based machine learning model

“…The SACE IV classification indicates the absence of arterial blood flow or tumor blush. (ii) Vascular lakes (Kong et al, 2020) were defined as localized accumulations of contrast agents in the tumor during embolization persisting to the venous phase without dissipation, similar to extravasation but different from tumor blush.…”

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association

“…Bland embolization using large gelatin sponge particles or cyanoacrylate should be considered when tumor parenchymal staining disappears and only vascular a lake is visible, as embolization of vascular lakes can potentially enhance treatment outcomes. 104 , 105 In particular, if serial hepatic arteriography shows an increase in the size of a vascular lake, it must be embolized as the finding suggests a high risk of tumor rupture.…”

Transarterial Chemoembolization for Hepatocellular Carcinoma: 2023 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association

“…Therefore, an angiographic evaluation should be performed when vascular lake is identified. Bland embolization using large gelatin sponge particles or cyanoacrylate should be considered when tumor parenchymal staining disappears and only vascular a lake is visible, as embolization of vascular lakes can potentially enhance treatment outcomes [ 104 105 ]. In particular, if serial hepatic arteriography shows an increase in the size of a vascular lake, it must be embolized as the finding suggests a high risk of tumor rupture.…”