Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided radiofrequency ablation in the treatment of solitary large hepatocellular carcinoma

Liu, Fengyong; Li, Xin; Guan, Ying; Wang, Maoqiang

doi:10.1007/s11547-018-0932-1

Cited by 25 publications

(21 citation statements)

References 23 publications

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“…Following TACE, we now use DynaCT to scan the tumor and reconstruct 3D images for the puncture site and the route planning [28]. Wang needle can accurately penetrate the target lesions of 46 patients and achieve favorable clinical results [29]. Therefore, DSA system with DynaCT allows for simultaneous combination of TACE and MWA in one intervention operation and more accurate puncture for ablation needles.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

Jiao

Han

et al. 2020

Cancer Imaging

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Purpose: To evaluate the method and effectiveness of transcatheter arterial chemoembolization (TACE) combined with simultaneous DynaCT-guided Microwave ablation (MWA) for the treatment of small hepatocellular carcinoma (SHCC). Materials and methods: From June 2015 to May 2017, a total of 28 consecutive patients with SHCC received single treatment of TACE and 23 subjects received a combination treatment of TACE with simultaneous DynaCTguided MWA. Following 1 month of treatment, the tumor response was assessed using the mRECIST criteria and the outcomes were analyzed including intervention-associated complications, changes in liver function, imaging response, and progression-free survival (PFS). Results: The technical success rate was 100%. The rates of CR (65%) in the combined TACE and MWA group were higher than those of the TACE group (46%). The rate of common adverse events, such as liver abscess, spontaneous bacterial peritonitis and liver dysfunction, in the combined TACE and MWA group (56%) was comparable to the corresponding rate of the TACE group (P > 0.411). The median and mean PFS of the TACE group were significantly lower than those of the combined TACE and MWA group (19.00 months vs. 29.00 months, 21.076 months vs. 24.693 months, p = 0.019, log-rank test). Conclusion: Stereotactic DynaCT-guided MWA is a safe and effective method for the treatment of SHCC, which usually provides an effective tumor puncture path, notably for lesions that cannot be detected following TACE. Overall, the data suggested that this treatment method could improve the clinical outcome of patients with SHCC.

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Section: Discussionmentioning

confidence: 99%

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

Jiao

Han

et al. 2020

Cancer Imaging

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“…Our findings showed that sorafenib combined with TACE followed by RFA 3 ± 2 days later is a feasible and effective method in the treatment of large HCCs complicated by types I/II PVTT. Although several studies on this approach have been performed (26,27), the optimal timing of this combined therapy remains unclear. The majority of clinicians recommend that RFA should be performed 1 week to 1 month after TACE (26); however, in this study, cTACE and RFA were performed sequentially (separated by 3 ± 2 days).…”

Section: Discussionmentioning

confidence: 99%

“…The majority of clinicians recommend that RFA should be performed 1 week to 1 month after TACE (26); however, in this study, cTACE and RFA were performed sequentially (separated by 3 ± 2 days). An advantage of this nearconcurrent treatment with TACE and RFA is the avoidance of lipiodol and chemotherapeutic clearance, which would possibly allow for the formation of new collateral vessels and vascular recanalization (27). TACE effectively inhibited the nutrient vessel supply to the tumor, and it alleviated the effectiveness of blood circulation on heat ablation.…”

Section: Discussionmentioning

confidence: 99%

“…TACE effectively inhibited the nutrient vessel supply to the tumor, and it alleviated the effectiveness of blood circulation on heat ablation. Lipiodol has a heat conduction effect; thus, RFA performed after complete lipiodol deposition improves the transduction of heat to peripheral tissues, which increases the ablation effect and reduces the risk of recurrence and metastasis (26,27). Another advantage of sequential treatment is that tumors with deposited lipiodol can be observed at high contrast in CT.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Radiofrequency Ablation Combined With Transarterial Chemoembolization Plus Sorafenib for Large Hepatocellular Carcinoma Invading the Portal Venous System: A Prospective Randomized Study

et al. 2020

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Background: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) portends a worse prognosis. The objective of this study was to compare the efficacy of percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) plus sorafenib to that of the most commonly utilized regimen of TACE plus sorafenib in large HCCs with type I/II PVTT. Methods: An open-label, single-center, prospective, randomized trial of participants with tumors ≥5 cm and type I/II PVTT was performed. Participants with previously untreated HCCs were divided into two groups: RFA + cTACE + sorafenib (study group, n = 40) and cTACE + sorafenib (control group, n = 40). The primary endpoint was the objective response rate (ORR), the secondary endpoints included the overall survival (OS); time to progression (TTP); and toxicity. Prognostic factors were analyzed using cox-regression analysis. Results: 80 patients were enrolled into this study with integrated clinical data. Under a median follow-up of 506 days, the median age was 57.5 years (range: 28-80 years). The ORR of study group was higher than control group (70% vs 22.5%, p<0.001). Furthermore, the median OS of study group was superior to that of control group (468 days vs 219 days, HR: 0.44 [95% CI: 0.25-0.78], P = 0.005). Adverse events occurred with 100% probability in both groups (p>0.99), but no treatment-related deaths were recorded. Tumor encapsulation and attaining treatment response predict favorable OS in a multivariate Cox model. The rates of adverse events in both groups were 100% (p>0.99). There were no treatment-related deaths.

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“…[6][7][8][9] With the development of cone-beam CT and angio-CT, a single-session combination of TACE and RFA has become a new and effective choice for the treatment of solitary large HCCs with satisfactory outcomes. [10][11][12][13] In solitary large HCCs, as in many other cancers, identifying potential predictors of locoregional therapy response remains important.…”

Section: Introductionmentioning

confidence: 99%

<p>Pretreatment Apparent Diffusion Coefficient as a Predictor of Response to Transcatheter Arterial Chemoembolization Immediately Combined with Radiofrequency Ablation for Treatment of Solitary Large Hepatocellular Carcinoma</p>

Tang¹,

Liu²,

Li³

et al. 2020

CMAR

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Purpose: To evaluate whether the pretreatment apparent diffusion coefficient (ADC) measured with diffusion weighted imaging (DWI) of tumor can be used as an imaging biomarker for predicting prognosis in solitary large hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE) immediately combined with radiofrequency ablation (RFA). Patients and Methods: In this single institution retrospective study, 40 solitary large HCCs that underwent treatment with TACE immediately combined with RFA were analyzed. All patients underwent abdominal dynamic contrast-enhanced magnetic resonance imaging within one month before treatment with DWI, and ADC values in the lesions were measured by two independent radiologists. Associations among patients' preoperative ADC values and objective response (OR), progression-free survival (PFS) and overall survival (OS) were examined. Survival curves were drawn with the Kaplan-Meier method, and differences were determined with the Log rank test. The Cox proportional-hazards model was used for univariate and multivariate analyses of PFS and OS. Results: Forty solitary large HCCs (mean 9.54 cm, range 5.04-16.06 cm) were successfully treated with TACE in immediate combination with RFA (OR 75%). The ADC values were significantly higher in the response group than the non-response group (1.51±0.32×10 −3 mm 2 /s vs 1.09±0.17×10 −3 mm 2 /s; P<0.001). As predicted on the basis of the ADC values, the optimal cutoff value for the efficacy of TACE combined with RFA was 1.32×10 −3 mm 2 /s, with a predictive sensitivity of 0.63 and a specificity of 1.00. Patients with high ADC had longer PFS than those with low ADC (14.9 months vs 5.3 months; P<0.001) and had significantly longer survival rates (22.6 months vs 12.1 months; P=0.004). Conclusion: Preoperative ADC values <1.32×10 −3 mm 2 /s are an independent predictor of poorer prognosis in patients with solitary large HCCs who have undergone TACE immediately combined with RFA.

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Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided radiofrequency ablation in the treatment of solitary large hepatocellular carcinoma

Abstract: DynaCT-guided TACE + RFA is safe and feasible for the treatment of solitary large HCCS. TACE combined with simultaneous RFA provides a new treatment option for solitary large HCCs in which DynaCT has important clinical value.

Cited by 25 publications

References 23 publications

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

Percutaneous Radiofrequency Ablation Combined With Transarterial Chemoembolization Plus Sorafenib for Large Hepatocellular Carcinoma Invading the Portal Venous System: A Prospective Randomized Study

<p>Pretreatment Apparent Diffusion Coefficient as a Predictor of Response to Transcatheter Arterial Chemoembolization Immediately Combined with Radiofrequency Ablation for Treatment of Solitary Large Hepatocellular Carcinoma</p>

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