Combined conventional transarterial chemoembolization with Mitomycin and percutaneous ablation for unresectable hepatocellular carcinoma.

BACKGROUND: Conventional transarterial chemoembolization (cTACE) has been the standard treatment for intermediate stage hepatocellular carcinoma (HCC). For early stage HCC, percutaneous ablation is a curative option. There is growing evidence to support combined therapy to improve tumor response and overall survival (OS) in patients with unresectable HCC. The goal of this study is to retrospectively review a single institution patient population who underwent the combined approach to determine its efficacy and safety, and possible predictive factors for OS and tumor response. METHODS: Retrospective analysis identified all patients that underwent c-TACE with Mitomycin followed by percutaneous ablation from 2011 to 2016 at our institution. Efficacy was assessed by OS, time to progression (TTP), and tumor response according to mRECIST criteria. Initial imaging was obtained 1 month after each treatment and after complete response was achieved, every 3 months for 2 years. Percentage of Lipiodol uptake was determined at 30-day follow-up with contrasted abdominal CT. Safety was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Multiple linear regressions were conducted to predict OS and number of progression-free survival days based on potential predictive factors. RESULTS: A total of 50 patients were identified. At 1-month follow-up, objective response (CR + PR) was achieved in 44 patients (88%). The median OS was 26.6 months and median TTP was 9.7 months (n=50). There was no statistically significant difference in median OS between patients with different lesion size (P=0.95), BCLC stage (P=0.84) or Lipiodol uptake (P=0.36). Higher albumin/bilirubin ratio was significantly correlated with improved OS (P=0.024). CONCLUSIONS: Combined c-TACE and PTA is a safe and effective approach for patients with unresectable HCC. Elevated albumin/bilirubin ratio was a predictor for improved OS.

Radiofrequency wire technique and image fusion in the creation of an endovascular bypass to treat chronic central venous occlusion.

The goal of this case report was to demonstrate the feasibility, safety, and efficacy of image fusion software to treat symptomatic central venous occlusion with radiofrequency wire after failure of conventional endovascular techniques. The complex and chronic central venous occlusion was successfully treated without complications. The combination of these techniques provided an endovascular solution and could be considered in select cases.

Long-term follow-up after conventional transarterial chemoembolization (c-TACE) with mitomycin for hepatocellular carcinoma (HCC).

BACKGROUND: Conventional transarterial chemoembolization (c-TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). It is associated with increased overall survival (OS) when compared to conservative management. The purpose of this study is to analyze all c-TACE with mitomycin in patients with HCC at a single institution to determine safety, efficacy, and prognostic factors in a long-term follow-up. METHODS: Retrospective analysis of patients with HCC treated only with c-TACE with Mitomycin between 2007 and 2012. Efficacy was determined by OS at 1, 3, and 5 years, censored by date of death or last known follow-up. Treatment response was assessed according to mRECIST criteria and the degree of lipiodol uptake by the lesions was assessed by CT at 1-month follow-up. Prognostic factors were analyzed by multiple linear regression analysis, significance levels set at 0.05. RESULTS: A total of 60 patients were identified. OS rate at 1, 3 and 5 years was 72.1%, 47.8% and 39.3%, respectively. Median OS was 15 months. Tumor response by mRECIST criteria was complete; objective response, defined as combination of complete response (CR) and partial response (PR) patients, was 76%. When stratified by tumor response, risk of death in patients with progressive disease in 5 years was significantly higher compared to patients with objective response [hazard ratio (HR): 2.531, 95% confidence interval (CI): 1.110-5.778, P=0.0273]. Lipiodol uptake analysis was available in 51 patients; there was no statistically significant difference in OS in patients with higher lipiodol uptake compared to less uptake (<50% versus >50% uptake; HR: 0.713, 95% CI: 0.316-1.611, P=0.4161]. CONCLUSIONS: c-TACE with mitomycin was effective and safe in this long-term follow-up study. Risk of death was significantly higher in patients without objective tumor response.

Safety and Efficacy of Combined Transarterial Embolization and Percutaneous Radiofrequency Ablation for Liver Tumors Using Cone-Beam CT and Needle Navigation Software in a Single Session.

PURPOSE: To assess the safety and efficacy of single-session transarterial embolization and radiofrequency (RF) ablation for hepatic tumors with the use of needle navigation software. MATERIALS AND METHODS: Retrospective analysis was conducted of 24 patients with liver cancer undergoing embolization followed by RF ablation between May 2014 and August 2017. Twelve patients each underwent (i) embolization and computed tomography (CT)-guided RF ablation during different sessions (group 1) and (ii) embolization followed by RF ablation with cone-beam CT and Needle Assist software in 1 session (group 2). Median age (70.5 y [range, 58-78 y] vs 70.5 y [range, 50-82 y]; P = .76) and performance status (0/1) were comparable between groups. Median tumor size was significantly larger in group 2 (2 cm [range, 1.0-7.3 cm] vs 3.2 cm [range, 1.1-9.6 cm]; P < .03). Procedure time, effective dose, and number of scans were examined. Efficacy was assessed by modified Response Evaluation Criteria In Solid Tumors after 1 month. Safety was assessed by Society of Interventional Radiology adverse event classification. RESULTS: Group 1 had a mean of 8.5 CT scans, vs a mean of 5.0 cone-beam CT scans in group 2 (P < .001). Median procedure times were 110 min in group 1 and 199.5 min in group 2 (P < .001). Median effective doses were 68.8 mSv in group 1 and 55.4 mSv in group 2 (P = .38). There was no difference in complete response between groups (66.7% vs 63.6%; P = 1). CONCLUSIONS: Transarterial embolization followed by RF ablation with cone-beam CT and needle guidance software in a single session seems to be safe and effective.

Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction.

PURPOSE: To determine whether transradial access (TRA) or transfemoral access (TFA) provides better patient satisfaction during intra-arterial therapy (IAT) for liver cancer. MATERIALS AND METHODS: This randomized, prospective, intra- and interpatient controlled trial compared TRA vs TFA accesses in patients with primary or metastatic liver cancer undergoing IAT. After having one of each type of access (1 TRA and 1 TFA), all patients selected their preferred access regardless of whether a third intervention was indicated. The primary endpoint was patient access preference; secondary endpoints were access-related complications, procedure time, contrast agent volume, and radiation doses to the patient and operator. Patients were evaluated on postprocedure days 1 and 30. RESULTS: Fifty-five patients with liver cancer (31 hepatocellular carcinoma, 24 metastatic disease) were enrolled, and 124 IAT procedures were performed. A total of 36 patients underwent at least 1 intervention each with TRA and TFA. Of those, 29 patients (81%) preferred TRA and 7 (19%) preferred TFA (ratio, 4:1; P < .001). Median radiation exposure to the operator was significantly lower for TRA (5.5 mrem) vs TFA (13 mrem; P = .01). Incidences of complications, procedure time, contrast agent volume, and radiation exposure to patients were similar between groups. CONCLUSIONS: TRA was the preferred access for the majority of patients and was associated with less radiation exposure to the operator. No differences were detected in incidence of adverse events, procedure time, contrast agent volume, or patient radiation exposure.