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Purpose
To investigate the impact of the first transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) on health-related quality of life (HRQoL) and identify predictors for low HRQoL following TACE.Materials and Methods
HRQoL was prospectively evaluated in 79 patients with standardized questionnaires (QlQ-C30 and HCC18) pre- and 2 weeks post-TACE. Treatment response was evaluated using common tumour response criteria. Clinical parameters [e.g. Eastern Cooperative Oncology Group (ECOG) performance status, Model of End Stage Liver Disease (MELD) score], tumour load and pre-TACE HRQoL scores were tested for predicting HRQoL after TACE.Results
Patients showed a 12.1% decrease in global health score (GHS). Major decreases were observed for physical (?21.4%), role (?23.4%), and social (?21.5%) functioning and increases in symptom severity for fatigue (+30.1%), loss of appetite (+25.3%), pain (+19.4%) after TACE. ECOG performance status >1 was associated with increased nausea/vomiting (p = 0.002) and decreased GHS (p = 0.01). MELD score >10 was associated with increased fatigue (p = 0.021) and abdominal swelling (p < 0.001). Our study showed an increase in symptom severity in patients with no symptoms before TACE for pain (p = 0.005) and abdominal swelling (p < 0.001).Conclusion
The first TACE for treatment of HCC does not result in a major loss of HRQoL in general. For TACE as a palliative therapy maintaining HRQoL is of critical importance and standardized HRQoL assessment can help to detect HRQoL problems.3.
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Xing Minzhi Sakaria Sonali Dhanasekaran Renumathy Parekh Samir Spivey James Knechtle Stuart J. Zhang Di Kim Hyun S. 《Cardiovascular and interventional radiology》2017,40(3):410-420
CardioVascular and Interventional Radiology - To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT) in patients with... 相似文献
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Ahmed Gabr Nadine Abouchaleh Rehan Ali Talia Baker Juan Caicedo Nitin Katariya Michael Abecassis Ahsun Riaz Robert J. Lewandowski Riad Salem 《Journal of vascular and interventional radiology : JVIR》2018,29(11):1502-1510.e1
Purpose
To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection.Materials and Methods
TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated.Results
Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3% (IQR:10%–48%) for patients who had radiation lobectomy and 9% (IQR: 6%–25%) for patients who had radiation segmentectomy (P = .037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72% (IQR:45%–88%) in patients who had radiation lobectomy and 94% (IQR: 72%–146%) in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96% and 86%, respectively. Median recurrence-free survival was 34.2 months (95% confidence interval,18.7–34.2).Conclusions
TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control. 相似文献7.
《Journal of vascular and interventional radiology : JVIR》2020,31(2):311-314.e1
Health-related quality of life (HRQoL) measurements are important for patient care, and emerging bundles in value-based care are placing an increasing emphasis on tying reimbursement to patient surveys. A multicenter pilot study was carried out to assess the efficacy of an automated digital patient engagement (DPE) platform for collecting HRQoL measurements at baseline and at 2- to 4-week intervals through 90 days after transarterial radioembolization (TARE) with yttrium-90 (90Y) treatments for hepatocellular carcinoma (HCC). The results revealed a survey completion of 78.4% and demonstrated only 4 of 35 individual symptom instances across all time points of transient worsening relative to baseline. Most importantly, the DPE platform provided an effective means for deploying and collecting patient-reported outcome measures. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2014,25(10):1489-1496.e3
PurposeThe need for specialty devices to improve the technical outcome of endovascular interventions is dependent on the rate of early failure in such procedures. This meta-analysis assessed procedural outcomes of such interventions to elucidate the rate of early procedural failures and the need for such specialty devices.Materials and MethodsMEDLINE and EMBASE were searched for contemporary studies (2000–2012) reporting procedural or short-term outcomes for revascularization of infrapopliteal atherosclerotic lesions. A random-effects metaanalysis was performed, which included post hoc comparisons among treatment groups.ResultsA total of 42 studies with 52 treatment arms representing 3,660 unique patients were included. Technical success rates were higher with bare metal stents (BMSs; 98.6%) than with atherectomy (92.2%; P < .05) or percutaneous transluminal angioplasty (PTA; 91.2%; P = .01), and higher with drug-eluting stents (DESs) than with PTA (P < .001). DES use had higher primary patency rates than atherectomy (P < .05), BMS use (P < .001), and PTA (P < .01). The 30-day rate of target lesion revascularization was significantly higher with PTA (8.1%) than with BMSs (2.2%; P < .05) and DESs (1.1%; P < .05). Thirty-day rates of major unplanned amputation (range, 1.5%–4.4%) and mortality (range, 0.9%–3.3%) were comparable among treatment groups. Significant heterogeneity among studies was noted for most PTA outcomes. Publication bias was evident for most PTA and DES outcomes.ConclusionsEarly failure of percutaneous therapies in patients with infrapopliteal atherosclerotic lesions is device- and technique-dependent. Specialty devices designed to reduce technical failure rates may therefore be of benefit in this selected group of patients. Study results are confounded by inconsistent data reporting, heterogeneity of treatment effects, and publication bias. 相似文献
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Laila Lobo Danny Yakoub Omar Picado Caroline Ripat Fiorella Pendola Rishika Sharma Rana ElTawil Deukwoo Kwon Shree Venkat Loraine Portelance Raphael Yechieli 《Cardiovascular and interventional radiology》2016,39(11):1580-1588
Background
Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques.Methods
Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STrengthening the Reporting of OBservational studies in Epidemiology criteria. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data.Results
The search strategy yielded 172 studies, five met selection criteria and included 553 patients with unresectable HCC, 284 underwent TACE and 269 underwent TARE. Median ages were 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95 % CI 0.81–1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 0.51, 95 % CI 0.36–0.72, p < 0.01), but less subjective fatigue (RR = 1.68, 95 % CI 1.08–2.62, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever, or other complications. In addition, there was no difference in partial or complete response rates between the two groups.Conclusion
TARE appears to be a safe alternative treatment to TACE with comparable complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported outcomes and cost–benefit analysis are required to consolidate these results.10.
《Journal of vascular and interventional radiology : JVIR》2020,31(10):1612-1618.e1
PurposeTo evaluate the utility of visualizing preprocedural MR images in 3-dimensional (3D) space using augmented reality (AR) before transarterial embolization of hepatocellular carcinoma (HCC) in a preclinical model.Materials and MethodsA total of 28 rats with diethylnitrosamine-induced HCCs > 5 mm treated with embolization were included in a prospective study. In 12 rats, 3D AR visualization of preprocedural MR images was performed before embolization. Procedural metrics including catheterization time and radiation exposure were compared vs a prospective cohort of 16 rats in which embolization was performed without AR. An additional cohort of 15 retrospective cases was identified and combined with the prospective control cohort (n = 31) to improve statistical power.ResultsA 37% reduction in fluoroscopy time, from 11.7 min to 7.4 minutes, was observed with AR when compared prospectively, which did not reach statistical significance (P = .12); however, when compared with combined prospective and retrospective controls, the reduction in fluoroscopy time from 14.1 min to 7.4 minutes (48%) was significant (P = .01). A 27% reduction in total catheterization time, from 42.7 minutes to 31.0 minutes, was also observed with AR when compared prospectively, which did not reach statistical significance (P = .11). No significant differences were seen in dose–area product or air kerma prospectively.ConclusionsThree-dimensional AR visualization of preprocedural imaging may aid in the reduction of procedural metrics in a preclinical model of transarterial embolization. These data support the need for further studies to evaluate the potential of AR in endovascular oncologic interventions. 相似文献
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Leland Pung Moiz Ahmad Kerstin Mueller Jarrett Rosenberg Christopher Stave Gloria L. Hwang Rajesh Shah Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2017,28(3):334-341
Purpose
To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries.Materials and Methods
Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included “cone beam,” “CBCT,” “C-arm,” “CACT,” “cone-beam CT,” “volumetric CT,” “volume computed tomography,” “volume CT,” AND “liver,” “hepatic*,” “hepatoc*.” Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included.Results
Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%–95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%–80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%–95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%–74%).Conclusions
Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC. 相似文献12.
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Dr. Michael Pinkawa Karin Fischedick Marc D. Piroth Bernd Gagel Holger Borchers Gerhard Jakse Michael J. Eble 《Strahlentherapie und Onkologie》2006,182(11):660-665
PURPOSE: To determine dosimetric risk factors for increased toxicity after permanent interstitial brachytherapy for prostate cancer. PATIENTS AND METHODS: Quality of life questionnaires (Expanded Prostate Cancer Index Composite) of 60 and 56 patients were analyzed after a median posttreatment time of 6 weeks (A-acute) and 16 months (L-late). The corresponding CT scans were performed 30 days after the implant. The prostate, rectal wall, and base of seminal vesicles were contoured. Prostate volume, number of seeds and needles as well as dosimetric parameters were correlated with the morbidity scores. RESULTS: For a prostate volume of 38 +/- 12 cm(3) (mean +/- standard deviation), 54 +/- 7 (125)I sources (Rapid Strands), activity of 22.6 +/- 3.0 MBq [0.61 +/- 0.08 mCi]) were implanted using 20 +/- 6 needles. Improved late urinary function scores resulted from a higher number of sources per cm(3) (> or = 1.35). A prostate D(90) < 170 Gy (A)/< 185 Gy (L) and base of seminal vesicle D(10) < 190 Gy (A and L) were associated with higher urinary function scores. Late rectal function scores were significantly higher for patients with a prostate V(200) < 50% and V(150) < 75%. Patients with a prostate volume < 40 cm(3) reached better sexual function scores (A and L). A higher number of needles per cm(3) (> or = 0.5) resulted in improved late urinary, bowel and sexual function scores. CONCLUSION: Quality of life after a permanent implant can be improved by using an adequate amount of sources and needles. With an increasing number of seeds per cm(3), dose homogeneity is improving. A prostate D(90) < 170 Gy and a base of seminal vesicle D(10) < 190 Gy (as an indicator of the dose to the bladder neck and urethral sphincter) can be recommended to maintain a satisfactory urinary function. 相似文献
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Peiman Habibollahi Sara Pourhassan Shamchi John M. Choi Terence P. Gade S. William Stavropoulos Stephen J. Hunt Mandeep Dagli Deepak Sudheendra Jeffery I. Mondschein Michael C. Soulen Gregory J. Nadolski 《Journal of vascular and interventional radiology : JVIR》2019,30(3):323-329
Purpose
To evaluate long-term outcomes of patients with hepatocellular carcinoma (HCC) who show a complete response (CR) vs non-CR on pretransplantation imaging studies or pathologic evaluation of liver explants after locoregional therapy (LRT) before liver transplantation.Materials and Methods
Patients listed for liver transplantation for HCC (March 1998 to December 2010) undergoing LRT with available multiphase MR/CT imaging before transplantation were included. Pathologic response was evaluated based on liver explant pathology. A total of 108 patients (17 women; 16%) met the inclusion criteria.Results
Radiologic CR was achieved in 65 patients (60%) vs non-CR in 43 (40%), and pathologic CR was achieved in 36 patients (33%) vs non-CR in 72 (67%). Mean 5-year overall survival (OS) from the time of listing and recurrence-free survival (RFS) after liver transplantation were significantly better for patients with pathologic CR vs non-CR on explant pathology (OS, 83.3% vs 65.2% [28% difference; P = .046]; RFS, 80.6% vs 62.5% [29% difference; P = .045]). Mean 5-y OS and RFS were not significantly different between patients with radiologic CR or non-CR on pretransplantation imaging (OS, 75.4% vs 65.1% [P = .12]; RFS, 74% vs 62.8% [P = .17]).Conclusions
Achievement of a pathologic CR vs non-CR in response to LRT before liver transplantation for HCC is associated with improved OS from time of listing and improved RFS after liver transplantation. However, current imaging paradigms fall short of accurate delineation of response to LRT, resulting in poor correlation of outcomes between pathologic and radiologic CR. 相似文献15.
Joshua L. Weintraub Riad Salem 《Journal of vascular and interventional radiology : JVIR》2013,24(8):1123-1134
The potential for increased efficacy with combined transarterial chemoembolization and sorafenib is a topic of increased interest to specialists who care for patients with unresectable hepatocellular carcinoma. There is strong scientific rationale for combination therapy: transarterial chemoembolization produces ischemia and stimulates hypoxia-inducible factor–1α, resulting in a local and systemic upregulation of vascular endothelial growth factor (VEGF), which can increase tumor angiogenesis. This upregulation can theoretically be counteracted with the multikinase inhibitor sorafenib, which is thought to act directly on platelet-derived growth factor, Raf kinase, and VEGF receptors. The potential of this approach has not yet been fully realized in clinical trials, and many unanswered questions remain. This review article discusses the state of the science of arterial locoregional therapies and sorafenib. 相似文献
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《Journal of the American College of Radiology》2021,18(8):1095-1105
PurposeTo use time-drive activity-based costing (TDABC) to characterize and compare costs of transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and ablation.MethodsThis three-part study involved (1) prospective observation to record resources used during TACE, TARE, and ablation and statistical evaluation of interobserver and interprocedure variability; (2) Bland-Altman analysis of prospective measurements and medical record time stamps to establish practicality of using retrospective data in place of direct observation; (3) retrospective time stamp assessment for 117 ablations, 61 TACE procedures, and 61 TARE procedures to reveal variability drivers.ResultsAblation costs were lowest ($3,744), which were 74% of TACE costs ($5,089) and 18% of TARE costs ($20,818). Consumables were the greatest cost contributor, accounting for 65% of ablation, 58% of TACE, and 90% of TARE costs. A single consumable contributed to most of the overall costs: the ablation probe (42%), ethiodized oil for TACE (30%), and yttrium-90 microspheres for TARE (80%). Bland-Altman analysis showed agreement between retrospective time stamps and prospective measurements. Ablation costs increased from $3,288 to $4,245 to $4,461 for one, two, or three tumors treated. TACE cost increased from $5,051 to $5,296 for lobar versus selective approaches.ConclusionA bottom-up costing approach using TDABC is feasible to assess true costs of hepatocellular carcinoma treatments and demonstrates ablation costs are significantly less than those of TACE and TARE. Replication of these methods at other institutions can facilitate development of a bundled payment model to promote utilization of locoregional therapies for hepatocellular carcinoma. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2023,34(7):1237-1246.e3
PurposeTo assess the cost effectiveness of 3 main locoregional therapies (LRTs) (transarterial chemoembolization [TACE], transarterial radioembolization [TARE], and percutaneous ablation) as bridging therapy.Materials and MethodsA 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.ResultsA 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.ConclusionsAblation 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. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2023,34(1):4-10.e3
PurposeTo evaluate the racial and ethnic representation of transarterial therapy for hepatocellular carcinoma (HCC) clinical trials in the United States.Materials and MethodsThe ClinicalTrials.gov database was examined to identify all completed studies with transarterial therapies for the management of HCC in the United States and extract information about the observed number of participants for each racial and ethnic group (based on the Office of Management and Budget definitions). The expected number of participants was calculated by multiplying the total number of participants in a trial with the U.S.-population HCC-based proportion for each group. The effects of the study phase, funding source, number of centers involved in the study, and the location of the participating center on racial and ethnic distribution were explored.ResultsSeventy-nine relevant studies were identified, of which 27 (34.2%) and 18 (22.8%) reported ethnic and race characteristics, respectively. Most study participants were White (81%, 1,591/1,964) by ethnicity and not Hispanic or Latino (93%, 937/1,008) by race. In terms of the observed-to-expected ratios by race and ethnicity in all trials, White and not Hispanic or Latino participants were overrepresented with a ratio of 1.22 (1.10–1.37) and 1.33 (1.26–1.41), respectively, and all other racial and ethnic groups were underrepresented. The enrollment of African Americans and Asian Americans varied by the study phase, and a higher enrollment of African Americans was noted in the National Institutes of Health–funded and multicenter studies (P < .05).ConclusionsThis cross-sectional study demonstrates that in HCC transarterial therapy clinical trials, racial and ethnic minorities were underrepresented and the majority of the studies identified failed to report this demographic information. 相似文献