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1.
Medicine (Baltimore) ; 103(20): e38174, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38758900

RESUMO

Camrelizumab, donafenib, and transarterial chemoembolization (TACE) are recommended for advanced hepatocellular carcinoma (HCC), but their combined efficacy remains unclear. From July 2021 to January 2023, 20 Barcelona Clinic Liver Cancer stage C HCC patients were prospectively enrolled. Inclusion criteria were Eastern Cooperative Oncology Group performance status of 0 or 1, Child-Pugh Score ≤ 7, and Barcelona Clinic Liver Cancer B or C. Surgical candidates were excluded. The treatment included TACE, camrelizumab, and donafenib. Endpoints were median overall survival, progression-free survival, and adverse events (AEs) related to donafenib. Among 20 patients, 85% experienced AEs from targeted therapy and programmed cell death protein-1, with 40% having grade 3 AEs. No grade 4 or 5 AEs occurred. Median follow-up was 9 months, with 15% achieving complete response, 65% partial response, and 15% stable disease. Disease control rate was 90%. Median progression-free survival and overall survival were 9 and 14 months, respectively. TACE, camrelizumab, and donafenib combination therapy in Chinese advanced HCC patients show effectiveness in extending survival with low severe AEs incidence.


Assuntos
Anticorpos Monoclonais Humanizados , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Idoso , Estadiamento de Neoplasias , Adulto , Terapia Combinada , Estudos Prospectivos , Resultado do Tratamento , Intervalo Livre de Progressão
2.
World J Surg Oncol ; 22(1): 93, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38605359

RESUMO

OBJECTIVE: The clinical efficacy and safety of sorafenib in patients with advanced liver cancer (ALC) were evaluated based on transarterial chemoembolization (TACE). METHODS: 92 patients with ALC admitted to our hospital from May 2020 to August 2022 were randomly rolled into a control (Ctrl) group and an observation (Obs) group, with 46 patients in each. Patients in the Ctrl group received TACE treatment, while those in the Obs group received sorafenib molecular targeted therapy (SMTT) on the basis of the treatment strategy in the Ctrl group (400 mg/dose, twice daily, followed by a 4-week follow-up observation). Clinical efficacy, disease control rate (DCR), survival time (ST), immune indicators (CD3+, CD4+, CD4+/CD8+), and adverse reactions (ARs) (including mild fatigue, liver pain, hand-foot syndrome (HFS), diarrhea, and fever) were compared for patients in different groups after different treatments. RESULTS: the DCR in the Obs group (90%) was greatly higher to that in the Ctrl group (78%), showing an obvious difference (P < 0.05). The median ST in the Obs group was obviously longer and the median disease progression time (DPT) was shorter, exhibiting great differences with those in the Ctrl group (P < 0.05). Moreover, no great difference was observed in laboratory indicators between patients in various groups (P > 0.05). After treatment, the Obs group exhibited better levels in all indicators. Furthermore, the incidence of ARs in the Obs group was lower and exhibited a sharp difference with that in the Ctrl group (P < 0.05). CONCLUSION: SMTT had demonstrated good efficacy in patients with ALC, improving the DCR, enhancing the immune response of the body, and reducing the incidence of ARs, thereby promoting the disease outcome. Therefore, it was a treatment method worthy of promotion and application.


Assuntos
Antineoplásicos , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Sorafenibe/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Antineoplásicos/efeitos adversos , Quimioembolização Terapêutica/métodos , Niacinamida/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Resultado do Tratamento , Terapia Combinada
3.
Acta Radiol ; 65(6): 535-545, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38489805

RESUMO

BACKGROUND: Transcatheter arterial chemoembolization (TACE) is a mainstay treatment for intermediate and advanced hepatocellular carcinoma (HCC), with the potential to enhance patient survival. Preoperative prediction of postoperative response to TACE in patients with HCC is crucial. PURPOSE: To develop a deep neural network (DNN)-based nomogram for the non-invasive and precise prediction of TACE response in patients with HCC. MATERIAL AND METHODS: We retrospectively collected clinical and imaging data from 110 patients with HCC who underwent TACE surgery. Radiomics features were extracted from specific imaging methods. We employed conventional machine-learning algorithms and a DNN-based model to construct predictive probabilities (RScore). Logistic regression helped identify independent clinical risk factors, which were integrated with RScore to create a nomogram. We evaluated diagnostic performance using various metrics. RESULTS: Among the radiomics models, the DNN_LASSO-based one demonstrated the highest predictive accuracy (area under the curve [AUC] = 0.847, sensitivity = 0.892, specificity = 0.791). Peritumoral enhancement and alkaline phosphatase were identified as independent risk factors. Combining RScore with these clinical factors, a DNN-based nomogram exhibited superior predictive performance (AUC = 0.871, sensitivity = 0.844, specificity = 0.873). CONCLUSION: In this study, we successfully developed a deep learning-based nomogram that can noninvasively and accurately predict TACE response in patients with HCC, offering significant potential for improving the clinical management of HCC.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Redes Neurais de Computação , Nomogramas , Humanos , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Quimioembolização Terapêutica/métodos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Adulto , Tomografia Computadorizada por Raios X/métodos , Aprendizado Profundo , Radiômica
4.
Cardiovasc Intervent Radiol ; 46(7): 870-879, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37217649

RESUMO

BACKGROUND: Examine the association of metformin use and overall survival (OS) in patients with HCC undergoing image-guided liver-directed therapy (LDT): ablation, transarterial chemoembolization (TACE), or Yttrium-90 radioembolization (Y90 RE). METHODS: Using National Cancer Institute Surveillance, Epidemiology, and End Results registry and Medicare claims databases between 2007 and 2016, we identified patients ≥ 66 years who underwent LDT within 30 days of HCC diagnosis. Patients with liver transplant, surgical resection, and other malignancies were excluded. Metformin use was identified by at least two prescription claims within 6 months before LDT. OS was measured by time between first LDT and death or last Medicare observation. Comparisons were performed between both all and diabetic patients on and not on metformin. RESULTS: Of 2746 Medicare beneficiaries with HCC undergoing LDT, 1315 (47.9%) had diabetes or diabetes-related complications. Among all and diabetic patients, 433(15.8%) and 402 (30.6%) were on metformin respectively. Median OS was greater for patients on metformin (19.6 months, 95% CI 17.1-23.0) vs those not (16.0 months, 15.0-16.9; p = 0.0238). Patients on metformin had lower risk of death undergoing ablation (HR 0.70; 0.51-0.95; p = 0.0239) and TACE (HR 0.76, 0.66-0.87; p = 0.0001), but not Y90 RE (HR1.22, 0.89-1.69; p = 0.2231). Among diabetics, OS was greater for those on metformin vs those not (HR 0.77, 0.68-0.88; p < 0.0001). Diabetic patients on metformin had longer OS undergoing TACE (HR 0.71, 0.61-0.83; p < 0.0001), but not ablation (HR 0.74, 0.52-1.04; p = 0.0886) or Y90 RE (HR 1.26, 0.87-1.85; p = 0.2217). CONCLUSION: Metformin use is associated with improved survival in HCC patients undergoing TACE and ablation.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Idoso , Humanos , Estados Unidos/epidemiologia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Quimioembolização Terapêutica/métodos , Resultado do Tratamento , Medicare , Sistema de Registros , Estudos Retrospectivos
5.
Ultrasound Med Biol ; 49(5): 1318-1326, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36868958

RESUMO

OBJECTIVE: Hepatocellular carcinoma (HCC) is a highly prevalent form of liver cancer diagnosed annually in 600,000 people worldwide. A common treatment is transarterial chemoembolization (TACE), which interrupts the blood supply of oxygen and nutrients to the tumor mass. The need for repeat TACE treatments may be assessed in the weeks after therapy with contrast-enhanced ultrasound (CEUS) imaging. Although the spatial resolution of traditional CEUS has been restricted by the diffraction limit of ultrasound (US), this physical barrier has been overcome by a recent innovation known as super-resolution US (SRUS) imaging. In short, SRUS enhances the visible details of smaller microvascular structures on the 10 to 100 µm scale, which unlocks a host of new clinical opportunities for US. METHODS: In this study, a rat model of orthotopic HCC is introduced and TACE treatment response (to a doxorubicin-lipiodol emulsion) is assessed using longitudinal SRUS and magnetic resonance imaging (MRI) performed at 0, 7 and 14 d. Animals were euthanized at 14 d for histological analysis of excised tumor tissue and determination of TACE response, that is, control, partial response or complete response. CEUS imaging was performed using a pre-clinical US system (Vevo 3100, FUJIFILM VisualSonics Inc.) equipped with an MX201 linear array transducer. After administration of a microbubble contrast agent (Definity, Lantheus Medical Imaging), a series of CEUS images were collected at each tissue cross-section as the transducer was mechanically stepped at 100 µm increments. SRUS images were formed at each spatial position, and a microvascular density metric was calculated. Microscale computed tomography (microCT, OI/CT, MILabs) was used to confirm TACE procedure success, and tumor size was monitored using a small animal MRI system (BioSpec 3T, Bruker Corp.). RESULTS: Although there were no differences at baseline (p > 0.15), both microvascular density levels and tumor size measures from the complete responder cases at 14 d were considerably lower and smaller, respectively, than those in the partial responder or control group animals. Histological analysis revealed tumor-to-necrosis levels of 8.4%, 51.1% and 100%, for the control, partial responder and complete responder groups, respectively (p < 0.005). CONCLUSION: SRUS imaging is a promising modality for assessing early changes in microvascular networks in response to tissue perfusion-altering interventions such as TACE treatment of HCC.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Animais , Ratos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Quimioembolização Terapêutica/métodos , Meios de Contraste/química , Ultrassonografia/métodos , Resultado do Tratamento
6.
J Vasc Interv Radiol ; 34(7): 1237-1246.e3, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36804296

RESUMO

PURPOSE: To assess the cost effectiveness of 3 main locoregional therapies (LRTs) (transarterial chemoembolization [TACE], transarterial radioembolization [TARE], and percutaneous ablation) as bridging therapy. MATERIALS AND METHODS: A cost-effectiveness analysis was performed comparing the 3 LRTs for patients with a single hepatocellular carcinoma (HCC) with a diameter of 3 cm or less over a 5-year time horizon from a payer's perspective. The clinical courses, including transplantation, decompensation resulting in delisting, and the need for a second LRT, were based on data from the United Network for Organ Sharing (2016-2019). Costs and effectiveness were measured in U.S. dollars and quality-adjusted life-years, respectively. Probabilistic and deterministic sensitivity analyses were performed. RESULTS: A total of 2,594, 1,576, and 903 patients underwent TACE, ablation, and TARE, respectively. Ablation was the dominant strategy, with the lowest expected cost and highest effectiveness. The probabilistic sensitivity analysis demonstrated that ablation was the most cost-effective strategy in 93.9% of simulations. A subgroup analysis was performed for different wait times, with ablation remaining the most cost-effective strategy. The sensitivity analysis showed that ablation was most effective if the risk of waitlist dropout was less than 2.00% and the rate of transplantation was more than 15.1% quarterly. TARE was most effective if the risk of dropout was less than 1.19% and the rate of transplantation was more than 24.0%. TACE was most effective if the risk of dropout was less than 1.01% and the rate of transplantation was more than 45.7%. Ablation remained the most cost-effective modality until its procedural cost was more than $34,843. CONCLUSIONS: Ablation is the most cost-effective bridging strategy for patients with a single, small (≤3 cm) HCC prior to liver transplantation. The conclusion remained robust in multiple sensitivity analyses.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Transplante de Fígado , Humanos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Análise de Custo-Efetividade , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/métodos , Resultado do Tratamento
7.
Cardiovasc Intervent Radiol ; 46(3): 319-326, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36599950

RESUMO

PURPOSE: To assess the cost-utility of initial treatment with drug-eluting microspheres (DEM) transarterial chemoembolization (TACE) versus conventional (C)-TACE in patients with hepatocellular carcinoma considering the perspective of a Local Healthcare Authority in Italy. MATERIALS AND METHODS: The economic evaluation is based on a retrospective single-center study and individual patients' data whose details have been previously reported. The impact of initial treatment with DEM-TACE or C-TACE on disease progression, mortality, and direct health costs over a lifetime horizon were simulated and compared in terms of incremental cost-utility ratio expressed as costs per quality adjusted life years (QALY). Costs included direct health costs related to the first chemoembolization procedure and all subsequent follow-up costs associated with health care resources used for disease management. Probabilistic (PSA) sensitivity analysis was used to assess the robustness of the results. RESULTS: A total of 101 patients in each treatment group were considered. All over the time-horizon median costs were €3,145.14 and €2,158.32 in the DEM-TACE and C-TACE group, respectively (p < 0.001); while mean costs were € 24,619 and € 17,001, respectively (p < 0.001). The ICUR was 6,461.86 €/QALY when using median costs derived from the study population as input for the health-economic evaluation and 49,932.15 €/QALY when the mean costs were considered. Results from PSA highlighted that using median costs DEM-TACE was always cost-effective, while using mean costs, it was preferable only 24.7% of times. CONCLUSIONS: The higher prices of DEMs are counterbalanced by the positive impact on QALY.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patologia , Análise Custo-Benefício , Neoplasias Hepáticas/patologia , Estudos Retrospectivos , Microesferas , Quimioembolização Terapêutica/métodos , Resultado do Tratamento
8.
Front Public Health ; 10: 963058, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388345

RESUMO

Objective: To conduct a cost-effectiveness analysis of drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) and conventional transcatheter arterial chemoembolization (cTACE) for first-line treatment of hepatocellular carcinoma (HCC) from the perspective of the Chinese healthcare system. Methods: Based on the real-world clinical data of HCC patients receiving interventional therapy, a partitioned survival model was constructed for cost-effectiveness analysis. The model period is 1 month, and the research time limit is 10 years. The incremental cost-effectiveness ratio (ICER) is used as the evaluation index. One-way sensitivity analysis and probabilistic sensitivity analysis were used to analyze the uncertainty of parameters to test the stability of the model results. Results: The ICER of the DEB-TACE group was 11,875.62 $/QALYs, which was lower than the willingness to pay threshold (WTP) of 31,499.23 $/QALYs. One-way sensitivity analysis suggested that the utility value of progression-free survival (PFS) in the DEB-TACE group had the greatest impact. Probabilistic sensitivity analysis showed that at the level of WTP of 31,499.23 $/QALYs, DEB-TACE had a cost-effective probability of 92%. Conclusion: Under the current economic level in my country, DEB-TACE is more cost-effective than cTACE in the treatment of HCC patients.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Análise Custo-Benefício , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Microesferas , Resultado do Tratamento
9.
Clin Imaging ; 89: 112-119, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35777239

RESUMO

PURPOSE: This study assessed the response to conventional transarterial chemoembolization (cTACE) in patients with liver metastases from rare tumor primaries using one-dimensional (1D) and three-dimensional (3D) quantitative response assessment methods, and investigate the relationship of lipiodol deposition in predicting response. MATERIALS AND METHODS: This retrospective bicentric study included 16 patients with hepatic metastases from rare tumors treated with cTACE between 2002 and 2017. Multi-phasic MR imaging obtained before and after cTACE was used for assessment of response. Response evaluation criteria in solid tumors (RECIST) and modified-RECIST (mRECIST) were utilized for 1D response assessment, and volumetric RECIST (vRECIST) and enhancement-based quantitative European Association for Study of the Liver EASL (qEASL) were used for 3D response assessment. The same day post-cTACE CT scan was analyzed to quantify intratumoral lipiodol deposition (%). RESULTS: The mean and standard deviation (SD) of diameter of treated lesions per targeted area was 7.5 ± 5.4 cm, and the mean and SD of number of metastases in each targeted area was 4.2 ± 4.6. cTACE was technically successful in all patients, without major complications. While RECIST and vRECIST methods did not allocate patients with partial response, mRECIST and qEASL identified patients with partial response. Intratumoral lipiodol deposition significantly predicted treatment response according qEASL (R2 = 0.470, p < 0.01), while no association was shown between lipiodol deposition within treated tumor area and RECIST or mRECIST (p > 0.212). CONCLUSION: 3D quantitative volumetric response analysis can be used for stratification of response to cTACE in patients with hepatic metastases originating from rare primary tumors. Lipiodol deposition could potentially be used as an early surrogate to predict response to cTACE.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Óleo Etiodado , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Estudos Retrospectivos , Resultado do Tratamento
10.
Expert Rev Gastroenterol Hepatol ; 16(7): 673-680, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35709813

RESUMO

OBJECTIVE: To explore the clinical efficacy and prognostic factors of the use of Gelfoam for drug-eluting bead (DEB) transarterial chemoembolization (GMD-TACE) in patients with unresectable large hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). METHODS: A retrospective analysis was conducted using the mRECIST standard to evaluate tumor response after GMD-TACE. Overall survival time, median survival time, time to progression (TTP) after the first intervention, and other treatment methods were recorded. RESULTS: The follow-up time was 2-110 months (mean 17.97 + 19.12 months), the median follow-up time was 12.5 months, and the first TTP after the first GMD-TACE was 4 months (95% CI 3.020-4.980). The median overall survival (OS) time was 14 months (95% CI 9.801-18.199). The 1-, 3-, and 5-year survival rates were 53.6%, 32.3%, and 8.9%, respectively. Multivariate analysis showed that the type of tumor thrombus was an independent factors affecting prognosis, and combination therapy was a protective factor affecting prognosis. CONCLUSIONS: GMD-TACE can be used as the core treatment for unresectable large HCC combined with a PVTT. This can improve the quality of life and further improve the median OS, and is worthy of clinical promotion and application.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Trombose , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Esponja de Gelatina Absorvível , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Veia Porta/diagnóstico por imagem , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
11.
Spectrochim Acta A Mol Biomol Spectrosc ; 278: 121314, 2022 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-35525180

RESUMO

In clinical practice, the transcatheter arterial chemoembolization (TACE) has been widely accepted as the first option for non-surgical hepatocellular carcinoma (HCC) treatment. However, patients with HCC often suffer from poor response to TACE therapy. This can be prevented if the chemotherapeutic response can be early and accurately assessed, which is essential to guide timely and rational management. In this study, the serum SERS technique was for the first time investigated as a potential prognostic tool for early assessment of HCC chemotherapeutic response. According to the SERS spectral analysis results, it is newly found that not only the absolute circulating nucleic acids and collagen levels in pre-therapeutic serum but also the changes in circulating nucleic acids and amino acids between pre-therapeutic and post-therapeutic serum are expected to be potential serum markers for HCC prognosis. By further applying chemometrics methods to establish prognostic models, excellent prognostic accuracies were achieved within only 3 days after TACE therapy. Thus, the proposed method is expected to provide guidance on timely and rational management of HCC to improve its survival rate.


Assuntos
Carcinoma Hepatocelular , Ácidos Nucleicos Livres , Quimioembolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica/métodos , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/metabolismo , Análise Espectral Raman
12.
Drug Deliv ; 28(1): 1356-1362, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34180755

RESUMO

This study aimed to compare efficacy and safety of HepaSpheres and CalliSpheres in unresectable large hepatocellular carcinoma (HCC) patients. One hundred and twenty-seven unresectable large HCC patients receiving drug-eluting bead transarterial chemoembolization (DEB-TACE) treatment with CalliSpheres or HepaSpheres microspheres were analyzed. Treatment response, Karnofsky performance status (KPS) score, adverse events, main liver function indexes, time to progression (TTP), and overall survival (OS) were analyzed. Objective response rate (82.7% vs. 63.8%, p=.030) and disease control rate (100.0% vs. 91.5%, p=.030) were increased in CalliSpheres group compared to HepaSpheres group at 1 month after treatment, while no difference was found between the two groups regarding treatment response at 3 or 6 months post treatment (all p>.05). The KPS score at 1, 3, and 6 months was similar between the two groups (all p>.05). As for the liver function, the ALT, AST, ALB, and TBIL levels at 7 and 30 days were of no difference between the two groups (all p>.05). In addition, the adverse events including nausea/vomiting, pain, fever, myelosuppression, biloma, and abscess were of no difference between the two groups, either (all p>.05). In terms of survival profile, there was no difference regarding TTP (6.3 months (95%CI: 5.9-6.6 months) vs. 6.0 months (95%CI: 5.6-6.4 months), p=.082) or OS (23.0 months (95%CI: 20.1-25.9 months) vs. 22.0 months (95%CI: 20.2-23.8 months), p=.571) between the two groups. In conclusion, CalliSpheres seems to be superior in short-term efficacy and equal in long-term efficacy as well as safety compared to HepaSpheres for DEB-TACE treatment in unresectable large HCC patients.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Doxorrubicina/análogos & derivados , Neoplasias Hepáticas/terapia , Microesferas , Fatores Etários , Idoso , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/patologia , Química Farmacêutica , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Portadores de Fármacos , Feminino , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Carga Tumoral
13.
BMC Cancer ; 20(1): 504, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487089

RESUMO

BACKGROUND: The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. METHODS: A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). RESULTS: Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001). CONCLUSIONS: ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/terapia , Idoso , Bilirrubina/análise , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/fisiopatologia , Tomada de Decisão Clínica/métodos , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Humanos , Fígado/patologia , Fígado/fisiopatologia , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Testes de Função Hepática , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Critérios de Avaliação de Resposta em Tumores Sólidos , Medição de Risco/métodos , Fatores de Risco , Albumina Sérica/análise , Índice de Gravidade de Doença , Análise de Sobrevida
14.
Phys Med ; 72: 7-15, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32179407

RESUMO

Conversion factors used to estimate effective (E) and organ doses (HT) from air Kerma area product (KAP) are required to estimate population doses in percutaneous transhepatic biliary drainage (PTBD) and trans arterial chemoembolization (TACE) interventional procedures. In this study, E and HT for ten critical organs/tissues, were derived in 64 PTBD and 48 TACE procedures and in 14,540 irradiation events from dosimetric, technical and geometrical information included in the radiation dose structured report using the PCXMC Monte Carlo model, and the ICRP 103 organ weighting factors. Conversion factors of: 0.13; 0.19; 0.26 and 0.32 mSv Gy-1 cm-2 were established for irradiation events characterized by a Cu filtration of 0.0; 0.1; 0.4 and 0.9 mm, respectively. While a single coefficient of conversion is not able to provide estimates of E with enough accuracy, a high agreement is obtained between E estimated through Monte Carlo methods and E estimated through E/KAP conversion factors accounting separately for the different modes of fluoroscopy and the fluorography component of the procedures. An algorithm for the estimation of effective and organ doses from KAP has been established in biliary procedures which considers the Cu filtration in the X-ray irradiation events. A similar algorithm could be easily extended to other interventional procedures and incorporated in radiation dose monitoring systems to provide dosimetric estimates automatically with enough accuracy to assess population doses.


Assuntos
Artérias , Quimioembolização Terapêutica/métodos , Drenagem/métodos , Doses de Radiação , Idoso , Feminino , Humanos , Masculino , Método de Monte Carlo
15.
Sci Rep ; 9(1): 13020, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506503

RESUMO

Trans-arterial chemoembolization (TACE) is an important yet variably effective treatment for management of hepatic malignancies. Lack of response can be in part due to inability to assess treatment adequacy in real-time. Gold-standard contrast enhanced computed tomography and magnetic resonance imaging, although effective, suffer from treatment-induced artifacts that prevent early treatment evaluation. Non-contrast ultrasound is a potential solution but has historically been ineffective at detecting treatment response. Here, we propose non-contrast ultrasound with recent perfusion-focused advancements as a tool for immediate evaluation of TACE. We demonstrate initial feasibility in an 11-subject pilot study. Treatment-induced changes in tumor perfusion are detected best when combining adaptive demodulation (AD) and singular value decomposition (SVD) techniques. Using a 0.5 s (300-sample) ensemble size, AD + SVD resulted in a 7.42 dB median decrease in tumor power after TACE compared to only a 0.06 dB median decrease with conventional methods.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Ultrassonografia Doppler/métodos , Humanos , Resultado do Tratamento
16.
PET Clin ; 14(4): 477-485, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472745

RESUMO

Interventional oncology treatments have profound effects on tumor immunity. Quantitative molecular imaging with FDG-PET has the potential to aid in understanding baseline tumor characteristics that can predict response to interventional oncology treatments and immunotherapy. This review highlights some of the evidence for immune activation in the setting of locoregional therapies, and the patterns of treatment response that may be expected in the setting of immune induction. Also presented is an argument for measuring global disease metabolic activity over conventional methods of PET quantitation to circumvent challenges in correlating conventional methods of PET quantification to overall disease activity.


Assuntos
Imunoterapia/métodos , Oncologia/métodos , Neoplasias/diagnóstico por imagem , Neoplasias/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Microambiente Tumoral/imunologia , Ablação por Cateter/métodos , Quimioembolização Terapêutica/métodos , Criocirurgia/métodos , Feminino , Humanos , Masculino , Micro-Ondas , Neoplasias/imunologia , Neoplasias/mortalidade , Prognóstico , Terapia por Radiofrequência , Radiologia Intervencionista/métodos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
17.
Int J Gynaecol Obstet ; 147(1): 29-35, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31206641

RESUMO

OBJECTIVE: To investigate the short-term efficacy and safety of transarterial chemoembolization with drug-eluting beads (DEB-TACE) versus synchronous radiochemotherapy among women with cervical cancer. METHODS: A retrospective cohort study of women treated by synchronous radiochemotherapy (n=20) and DEB-TACE (n=20) at a single center in China between November 2015 and September 2017. Inclusion criteria were pathologic diagnosis of cervical cancer, age at least 18 years, and complete clinicopathologic information. Hospital stay, direct medical cost, resection frequency, adverse events, treatment responses, progression-free survival (PFS) and overall survival (OS) were compared between treatments. RESULTS: There was no difference in treatment responses, PFS, or OS between the two groups. Hospital stay was shorter, direct medical costs were lower, and resection rate was higher in the DEB-TACE group than in the radiochemotherapy group (all P<0.05). In univariate and multivariate logistic regression analysis, no factor was associated with complete response. No predictive factor for PFS or OS was identified by Cox proportional regression analysis. Fewer adverse advents were recorded in the DEB-TACE group than in the synchronous radiochemotherapy group. CONCLUSION: Among women with cervical cancer, DEB-TACE achieved equal short-term efficacy, better tolerance, less hospital stay and medical costs, and higher resection rates as compared with synchronous radiochemotherapy.


Assuntos
Quimioembolização Terapêutica/métodos , Quimiorradioterapia/métodos , Neoplasias do Colo do Útero/terapia , Idoso , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/economia , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/economia , China , Análise Custo-Benefício , Doxorrubicina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
18.
Invest Radiol ; 54(12): 737-743, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31206392

RESUMO

PURPOSE: The aim of this study was to demonstrate the feasibility of hepatic perfusion imaging using dynamic contrast-enhanced (DCE) golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) for characterizing liver parenchyma and hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) as a potential alternative to volume perfusion computed tomography (VPCT). METHODS AND MATERIALS: Between November 2017 and September 2018, 10 patients (male = 8; mean age, 66.5 ± 8.6 years) with HCC were included in this prospective, institutional review board-approved study. All patients underwent DCE GRASP MRI with high spatiotemporal resolution after injection of liver-specific MR contrast agent before and after TACE. In addition, VPCT was acquired before TACE serving as standard of reference. From the dynamic imaging data of DCE MRI and VPCT, perfusion maps (arterial liver perfusion [mL/100 mL/min], portal liver perfusion [mL/100 mL/min], hepatic perfusion index [%]) were calculated using a dual-input maximum slope model and compared with assess perfusion measures, lesion characteristics, and treatment response using Wilcoxon signed-rank test. To evaluate interreader agreement for measurement repeatability, the interclass correlation coefficient (ICC) was calculated. RESULTS: Perfusion maps could be successfully generated from all DCE MRI and VPCT data. The ICC was excellent for all perfusion maps (ICC ≥ 0.88; P ≤ 0.001). Image analyses revealed perfusion parameters for DCE MRI and VPCT within the same absolute range for tumor and liver tissue. Dynamic contrast-enhanced MRI further enabled quantitative assessment of treatment response showing a significant decrease (P ≤ 0.01) of arterial liver perfusion and hepatic perfusion index in the target lesion after TACE. CONCLUSIONS: Dynamic contrast-enhanced GRASP MRI allows for a reliable and robust assessment of hepatic perfusion parameters providing quantitative results comparable to VPCT and enables characterization of HCC before and after TACE, thus posing the potential to serve as an alternative to VPCT.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Idoso , Algoritmos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Estudos de Viabilidade , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Masculino , Imagem de Perfusão/métodos , Estudos Prospectivos
19.
Eur Radiol ; 29(11): 5804-5812, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31073860

RESUMO

OBJECTIVES: To evaluate the accuracy and reproducibility of semi-quantitative visual assessment of hepatic tumor burden (HTB) on MRI and to investigate its prognostic value in predicting overall survival (OS) in neuroendocrine liver metastases (NELMs) treated with transarterial chemoembolization (TACE). METHODS: Three independent readers blinded to the quantitative HTB measurement reviewed baseline MRI in 111 NELM patients treated with TACE. Readers visually assessed and semi-quantitatively categorized HTB using the European Neuroendocrine Tumor Society (ENETS) guidelines. Quantitative HTB measured by manual segmentation was used as the reference standard. Agreements between quantitative and semi-quantitative measurement of HTB, as well as intra- and inter-reader reproducibility, were evaluated using weighted kappa coefficient and intraclass correlation coefficient (ICC). Survival analysis included the Kaplan-Meier curves and Cox regression. Harrell C-index was calculated to evaluate the prognostic value of semi-quantitative HTB for predicting OS. RESULTS: According to quantitative HTB, 41, 29, 25, and 16 patients were categorized into ≤ 10%, 11-25%, 26-50%, and > 50% groups, respectively. Agreements between quantitative and semi-quantitative measurement of HTB by each reader (weighted kappa, 0.82-0.96), intra-reader agreement (weighted kappa, 0.95), and inter-reader agreements (weighted kappa, 0.84-0.91; ICC, 0.98) were at least substantial to almost perfect. Semi-quantitative HTB was an independent prognostic factor in NELMs treated with TACE (multivariate Cox regression, p < 0.001), with prognostic value comparable to that of quantitative HTB (Harrell C-index, 0.735 for both semi-quantitative and quantitative HTB in multivariate regression). CONCLUSION: Semi-quantitative visual assessment of HTB using MRI is accurate and reproducible and could reliably predict OS in NELMs treated with TACE. KEY POINTS: • Semi-quantitative visual assessment of HTB using MR imaging is considerably accurate, reproducible, and efficient. • Visually assessed semi-quantitative HTB serves as an independent predictor of OS in NELMs treated with TACE.


Assuntos
Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/secundário , Adulto , Idoso , Algoritmos , Feminino , Humanos , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Sobrevida , Carga Tumoral
20.
BMC Cancer ; 19(1): 363, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991968

RESUMO

BACKGROUND: Hepatoma arterial-embolization prognostic (HAP) score and its modifications (modified HAP [mHAP] and mHAP-II), consisting of some or all of the following factors of tumor size, number, alpha-fetoprotein, bilirubin, and serum albumin, have been found to predict outcomes after trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We investigated the feasibility of using HAP-related risk scores for dynamic risk assessment during repeated TACE. METHODS: A total of 619 HCC patients treated with TACE from two institutions between 2003 and 2010 were included. RESULTS: Patients with A-B class risk scores showed significantly better survival than those with C-D class risk scores at the first (median 43.7 vs. 21.5 months for mHAP-II, 35.2 vs. 10.2 months for mHAP, and 39.8 vs. 18.6 months for HAP; all P < 0.001) and the second rounds of TACE (38.6 vs. 17.2 months for mHAP-II, 30.0 vs. 8.5 months for mHAP, and 32.6 vs. 17.3 months for HAP; all P < 0.001). Sequential assessment of risk scores at the second TACE round was applied for patients with A-B class risk scores at the first TACE round, which further identified two subgroups of A-B and C-D class risk scores with different outcomes (median survival 40.6 vs. 19.6 months for mHAP-II, 31.2 vs. 16.9 months for mHAP, and 35.8 vs. 21.0 months for HAP; all P < 0.001). Compared with mHAP and HAP, mHAP-II showed the highest likelihood ratio (22.61 vs. 14.67 and 13.97, respectively), highest linear trend (24.43 vs. 19.67 and 14.19, respectively), and lowest Akaike information criteria value (1432.51 vs. 3412.29 and 2296.98, respectively). CONCLUSIONS: All HAP-related risk scores dynamically predicted outcomes during repeated TACE. Sequential risk assessment using mHAP-II best identified optimal candidates for repeated TACE.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Idoso , Biomarcadores Tumorais , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/métodos , Gerenciamento Clínico , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/mortalidade , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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