Clinical Outcomes of Radiofrequency Ablation Combined with Transarterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Non-hepatocellular Carcinoma Malignant Liver Tumors

Abstract

Purpose: To retrospectively evaluate the outcomes of radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres for non-hepatocellular carcinoma malignant liver tumors. Material and Methods: A total of 15 patients (13 men, 2 women; median age, 67 years) who underwent radiofrequency ablation immediately after transarterial chemoembolization using degradable starch microspheres for liver tumors between July 2011 and September 2020 were included in this study. Thirteen patients had liver metastases from colorectal cancer (n = 6), esophageal cancer (n = 2), lung cancer (n = 2), and other tumors (n = 3), and 2 patients had primary liver tumor of cholangiocellular carcinoma (n = 1) and gastrinoma (n = 1). Twenty tumors (median size, 16 mm) were treated in 17 sessions. Technical success, safety, local tumor progression, and overall survival were evaluated. Safety was assessed according to the clinical practice guideline of the Society of Interventional Radiology. Results: All treatment procedures were successfully completed. There were no major complications. Grade-B complications of self-limiting pneumothorax (n = 1), vomiting (n = 1), and fever (n = 1) occurred in 1 session each. Local tumor progression developed in two tumors (local tumor progression rate, 10%, 2/20). The local tumor progression rates were 5% and 11% at 1 year and at 3 and 5 years, respectively. Tumor size of more than 20 mm (P = 0.0003) and contact with major vessels (P = 0.03) were significant risk factors for local tumor progression. The patients were treated with repeat radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres. During median follow-up of 48 months (range, 4-77 months), 5 patients died (33%, 5/15). The overall survival rates were 100%, 85%, and 57% at 1, 3, and 5 years, respectively. The median overall survival time was 69 months. Conclusions: Radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres was safe and showed favorable local control for non-hepatocellular carcinoma malignant liver tumors.

Biodegradable Microspheres for Transarterial Chemoembolization in Malignant Liver Disease

“…Combining radiofrequency ablation (RFA) with DMS-TACE has been described as a promising approach for the treatment of CRLM [38], and more recently, it has been explored for other non-HCC primary or metastatic malignant liver lesions [39]. This combined therapy offers the advantages of both modalities, while studies have demonstrated encouraging results, with high rates of tumor control and the possibility of managing local tumor progression with repeated sessions, as well as prolonged overall survival [39]. Moreover, the synergistic effects of ablation and TACE may facilitate complete tumor eradication and reduce the likelihood of tumor recurrence, particularly in cases where lesions are larger or located in challenging anatomical locations [40,41].…”

“…Moreover, the synergistic effects of ablation and TACE may facilitate complete tumor eradication and reduce the likelihood of tumor recurrence, particularly in cases where lesions are larger or located in challenging anatomical locations [40,41]. Additionally, the degradable nature of DMS allows for repeated treatment if necessary, enabling the adaptation of therapeutic approaches based on tumor response and disease progression [39], exemplified in the case illustrated in Figure 1. (c) Initial DSA prior to the 2nd DMS-TACE session (1 month after the 1st session), demonstrating complete viability of the right-lobe arterial supply, including the feeding vessels of the target HCC lesions.…”