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1.
Laura E. Moreno-Luna Ju Dong Yang William Sanchez Ricardo Paz-Fumagalli Denise M. Harnois Teresa A. Mettler Denise N. Gansen Piet C. de Groen Konstantinos N. Lazaridis K. V. Narayanan Menon Nicholas F. LaRusso Steven R. Alberts Gregory J. Gores Chad J. Fleming Seth W. Slettedahl William S. Harmsen Terry M. Therneau Gregory A. Wiseman James C. Andrews Lewis R. Roberts 《Cardiovascular and interventional radiology》2013,36(3):714-723
Purpose
Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using β-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC.Materials and Methods
Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records.Results
Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for ≥1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02).Conclusion
There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials. 相似文献2.
Suk Kyeong Ji Yun Ku Cho Yong Sik Ahn Mi Young Kim Yoon Ok Park Jae Kyun Kim Wan Tae Kim 《Korean journal of radiology》2008,9(6):534-540
Objective
While the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE.Materials and Methods
A total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model.Results
Conventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively).Conclusion
In our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE. 相似文献3.
Dongho Hyun Sung Ki Cho Sung Wook Shin Kwang Bo Park Hong Suk Park Sung Wook Choo Young Soo Do In-wook Choo Min Woo Lee Hyunchul Rhim Hyo Keun Lim 《Cardiovascular and interventional radiology》2016,39(3):417-425
Purpose
To report the results of combined therapy with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early stage hepatocellular carcinoma (HCC) considered infeasible for ultrasound (US)-guided RFA in comparison with those of TACE monotherapy.Methods
From January 2007 through December 2010, 91 patients with early or very early stage HCC infeasible for US-guided RFA received either TACE alone (TACE group; n = 54) or TACE immediately followed by RFA (TACE–RFA group; n = 37) as a first-line treatment. 1-month tumor response, time to progression (TTP), and overall survival (OS) rates were calculated. Univariate and multivariate analyses were performed to identify prognostic factors.Results
TACE–RFA group showed a better 1-month tumor response than TACE group (P < .001). The mean TTP was 29.7 ± 3.4 months (95 % confidence intervals [CIs] 23.0–36.5) in TACE group and 34.9 ± 2.8 months (95 % CIs 29.4–40.4) in TACE–RFA group. TACE–RFA group had a significantly longer TTP (P = .014). Cumulative 1-, 2-, and 3-year OS rates in the TACE and TACE–RFA groups were 91, 79, and 71 % and 100, 97, and 93 %, respectively (P = .008). Initial treatment of TACE was found to be the only significant risk factor for tumor progression and OS in multivariate analysis.Conclusion
TACE–RFA combination therapy appears superior to TACE monotherapy in terms of 1-month tumor response, TTP, and OS when performed for early stage HCC infeasible for US-guided RFA.4.
Purpose
This study was designed to evaluate the antitumorigenic efficiency of Endostar (an antiangiogenic agent) arterially administrated combined with transcatheter arterial chemoembolization (TACE) on liver tumor, and validation of perfusion CT for quantitative measurements of the results. 相似文献5.
Akihiko Seki Shinich Hori Kazuya Kobayashi Seizi Narumiya 《Cardiovascular and interventional radiology》2011,34(3):557-565
Purpose
To evaluate the safety, clinical outcomes, and hepatic artery damage after transcatheter arterial chemoembolization (TACE) with epirubicin-loaded superabsorbent polymer microspheres (ELM-TACE) in patients with hepatocellular carcinoma (HCC) in a single center in Japan. 相似文献6.
Objective
To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).Materials and Methods
Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.Results
After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.Conclusion
TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence. 相似文献7.
Chunyu Jiang Jianbo Wang Yonggang Wang Jungong Zhao Yueqi Zhu Xu Ma Jia Zhou Xuebing Yan 《Cardiovascular and interventional radiology》2016,39(10):1420-1428
Purpose
Transarterial chemoembolization (TACE) is used to treat unresectable bone and soft tissue sarcoma (STS) and as a pre-surgical adjuvant treatment. However, its efficiency for advanced STS is undetermined. This study evaluated TACE’s efficiency in treating advanced STS and prognostic factors for patient survival.Materials and Methods
We enrolled 39 patients with unresectable STS who underwent TACE as an alternative treatment during 2010–2014, with overall survival (OS) as the primary end point. Cancer pain was evaluated by visual analogue scores (VAS) before and after TACE procedures. Factors that affect survival were evaluated by multivariate analyses (Cox proportional hazard model).Results
Mean OS after TACE was 23.7 ± 2.1 months, with 1-year OS 71.5 %, 2-year OS 45.8 %, and 3-year OS 32.5 %. Lesion number and tumor stage were key predictors of survival. TACE was found to decrease cancer pain VAS and increase relapse interval. Size of polyvinyl alcohol (PVA) particle diameter (P = 0.03) and imaging response (P = 0.044) were also found to affect relapse interval.Conclusion
TACE was an effective treatment for advanced STS, with a 32.5 % 3-year OS rate, and led to lower cancer pain VAS and longer relapse intervals than chemoinfusion only. Smaller PVA particles are preferable during the TACE procedure.8.
Yuo-Chen Kuo Maureen P. Kohi David M. Naeger Ricky T. Tong K. Pallav Kolli Andrew G. Taylor Jeanne M. Laberge Robert K. Kerlan Jr. Nicholas Fidelman 《Cardiovascular and interventional radiology》2013,36(5):1336-1343
Purpose
To compare treatment response after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS).Materials and Methods
A retrospective review of patients who underwent conventional TACE for HCC between January 2005 and December 2009 identified 10 patients with patent TIPS. From the same time period, 23 patients without TIPS were selected to control for comparable Model for End-Stage Liver Disease and Child–Pugh–Turcotte scores. The two groups showed similar distribution of Barcelona Clinic Liver Cancer and United Network of Organ Sharing stages. Target HCC lesions were evaluated according to the modified response evaluation criteria in solid tumors (mRECIST) guidelines. Transplantation rate, time to tumor progression, and overall survival (OS) were documented.Results
After TACE, the rate of complete response was significantly greater in non-TIPS patients compared with TIPS patients (74 vs. 30 %, p = 0.03). Objective response rate (complete and partial response) trended greater in the non-TIPS group (83 vs. 50 %, p = 0.09). The liver transplantation rate was 80 and 74 % in the TIPS and non-TIPS groups, respectively (p = 1.0). Time to tumor progression was similar (p = 0.47) between the two groups. OS favored the non-TIPS group (p = 0.01) when censored for liver transplantation.Conclusion
TACE is less effective in achieving complete or partial response using mRECIST criteria in TIPS patients compared with those without a TIPS. Nevertheless, similar clinical outcomes may be achieved, particularly in TIPS patients who are liver-transplantation candidates. 相似文献9.
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.10.
Peter Huppert Thorsten Wenzel Hubertus Wietholtz 《Cardiovascular and interventional radiology》2014,37(1):154-164
Purpose
This prospective study evaluated the effectiveness and safety of TACE using irinotecan loaded superabsorbent polymer (SAP) microspheres for treatment of colorectal cancer liver metastases (CCLM) in a salvage setting of patients.Methods
A total of 71 TACE procedures were performed in 29 patients with liver only or liver-dominant CCLM. In all patients, systemic chemotherapy before TACE had failed. Two hundred milligrams of irinotecan were loaded into 50–100 mg of SAP microspheres (HepaSphere? Microspheres) considering tumor size and vascularization. TACE was performed selectively with respect to tumor distribution. Response was evaluated following RECIST and EASL criteria, respectively. Median follow-up after last TACE was 8 (range 1–54) months. All patients had died at time of analysis.Results
All TACE procedures were performed successfully; 35–400 mg (mean 168.3 mg) of irinotecan loaded in 13–100 mg (mean 48.3 mg) SAP microspheres were injected during individual sessions. No major complications occurred. Three, 6, and 12 months after first TACE complete and partial response was present in 72, 32 %, 0 of patients by EASL criteria and stable disease was seen in 86, 48, and 8 % with no complete and no partial response by RECIST criteria. Median overall survival after first TACE was 8 months, and median time to progression was 5 months. Median overall survival was longer in patients with limited (<25 %) compared with extensive (>50 %) intrahepatic disease (21 vs. 5 months, p < 0.005).Conclusions
TACE using irinotecan loaded SAP microspheres is safe and effective in terms of tumor necrosis. Survival benefit in a salvage setting seems to be limited in patients with advanced intrahepatic tumor load. 相似文献11.
Sylvain Favelier Mathieu Boulin Samia Hamza Jean-Pierre Cercueil Violaine Cherblanc Côme Lepage Patrick Hillon Bruno Chauffert Denis Krausé Boris Guiu 《Cardiovascular and interventional radiology》2013,36(4):1039-1046
Background
There is still no consensus about the best chemotherapeutic agent for transarterial chemoembolization (TACE). A recent in vitro study demonstrated that idarubicin, an anthracycline, was by far the most cytotoxic drug on human hepatocellular carcinoma (HCC) cell lines. Idarubicin is much more lipophilic than doxorubicin, leading to higher cell penetration through lipidic membranes and greater accumulation of the drug in the lipiodol. Furthermore, idarubicin has the ability to overcome multidrug resistance. Therefore, we designed this pilot human study to evaluate the safety and efficacy of lipiodol TACE using idarubicin.Methods
In 21 consecutive patients treated by lipiodol TACE with idarubicin (10 mg) for HCC, safety data, tumor response (Response Evaluation Criteria in Solid Tumors, mRECIST), time to treatment failure (TTTF), and overall survival were evaluated.Results
Postembolization syndrome was observed after 30.9 % (17 of 55) of sessions. No patient died from a TACE-related complication. No hematological grade 3–5 adverse event was observed. At least one grade 3 or higher adverse event occurred in 19 % (4 of 21) of patients. On imaging, no progression was encountered; four patients (24 %) exhibited stable disease, 12 (57 %) exhibited a partial response, and five (19 %) exhibited a complete response. Median TTTF was 16.7 months (Kaplan–Meier analysis). At 6 months, 94.7 % (95 % confidence interval [CI] 68.1–99.2) of patients did not reach treatment failure, whereas treatment failure was not reached in 50.6 % (95 % CI 21.6–73.9) of patients at 1 year. Overall survival was 83.5 % (95 % CI 57–94.4) at 1 year.Conclusion
Idarubicin seems safe and effective in lipiodol TACE of HCC. This warrants further study to determine the potential of this drug to replace doxorubicin for TACE. 相似文献12.
Nikhil Bhagat Diane K. Reyes Mingde Lin Ihab Kamel Timothy M. Pawlik Constantine Frangakis J. F. Geschwind 《Cardiovascular and interventional radiology》2013,36(2):449-459
Purpose
To evaluate safety in an interim analysis of transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEB) in 13 patients with hepatic metastases from neuroendocrine tumors (NETs) as part of a phase II trial.Methods
Institutional Review Board approval and informed consent were obtained. Thirteen patients completed preliminary safety analysis. Their mean age was 65 years, Eastern Cooperative Oncology Group status was 0/1, tumor burden range was 4–75 %, and mean targeted tumor size was 5.9 cm. Up to four DEB-TACE sessions (100–300 μm beads loaded with ≤100 mg doxorubicin) within 6 months were allowed. Tumor response was assessed by magnetic resonance imaging 1 month after treatment using contrast-enhancement [European Association for the Study of the Liver (EASL) and size Response Evaluation Criteria in Solid Tumors (RECIST)] criteria. Safety was assessed by National Cancer Institute Common Terminology Criteria.Results:
DEB-TACE was successfully performed in all 13 patients. At 1 month follow-up, there was a mean 12 % decrease in tumor size (p < 0.0003) and a 56 % decrease in tumor enhancement (p < 0.0001). By EASL criteria, the targeted lesion objective response rate was 78 %. Grade 3 to 4 toxicities were fatigue (23 %), increased alanine amino transferase (15 %), hyperglycemia (15 %), and abdominal pain (8 %). Seven patients developed bilomas (54 %); all of these patients had multiple small (<4 cm) lesions. Subsequently, four underwent percutaneous drainage, three for abscess formation and one for symptoms related to mass effect.Conclusions
Although biloma and liver abscess are known risks after TACE, the high incidence in our study population was unexpected and forced interruption of the trial. Although this occurred in a small group of patients, we have changed our technique and patient selection as a result of these findings, thus allowing resumption of the trial. 相似文献13.
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.14.
Kichang Han Jin Hyoung Kim Hee Mang Yoon Eun-Joung Kim Dong Il Gwon Gi-Young Ko Hyun-Ki Yoon Heung Kyu Ko 《Korean journal of radiology》2014,15(4):464-471
Objective
To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) in patients with infiltrative hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with patient survival.Materials and Methods
Fifty two patients who underwent TACE for infiltrative HCC were evaluated between 2007 and 2010. The maximum diameter of the tumors ranged from 7 cm to 22 cm (median 15 cm). Of 46 infiltrative HCC patients with portal vein tumor thrombosis, 32 patients received adjuvant radiation therapy for portal vein tumor thrombosis after TACE.Results
The tumor response by European Association for the Study of the Liver criteria was partial in 18%, stable in 47%, and progressive in 35% of the patients. The median survival time was 5.7 months (Kaplan-Meier analysis). The survival rates were 48% at six months, 25% at one year, and 12% at two years. In the multivariable Cox regression analysis, Child-Pugh class (p = 0.02), adjuvant radiotherapy (p = 0.003) and tumor response after TACE (p = 0.004) were significant factors associated with patient survival. Major complications occurred in nine patients. The major complication rate was significantly higher in patients with Child-Pugh B than in patients with Child-Pugh A (p = 0.049, χ2 test).Conclusion
Transcatheter arterial chemoembolization can be a safe treatment option in infiltrative HCC patients with Child Pugh class A. Child Pugh class A, radiotherapy for portal vein tumor thrombosis after TACE and tumor response are good prognostic factors for an increased survival after TACE in patients with infiltrative HCCs. 相似文献15.
Purpose
There is no consensus on switching anticancer agents loaded onto drug carriers in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study aimed to evaluate the safety and clinical outcomes of TACE with cisplatin-loaded microspheres (CLM-TACE) in HCC patients refractory to TACE with epirubicin-loaded microspheres (ELM-TACE).Methods
Between February 2008 and June 2010, 85 patients with unresectable HCC refractory to ELM-TACE were enrolled to undergo CLM-TACE. The number of ELM-TACE sessions until judgment of resistance ranged from 1 to 4 (median, 2.1). CLM-TACE was performed using 50?C100-??m superabsorbent polymer microspheres loaded with 1?mg cisplatin/1?mg microspheres together with hepatic arterial infusion of 25?mg cisplatin and 500?mg 5-fluorouracil per patient. Tumor responses were evaluated by computed tomography according to the European Association for the Study of the Liver criteria.Results
The median number of CLM-TACE treatment sessions was 1.8 (range, 1?C5), and the mean total dose of cisplatin per session was 42.8?mg (range, 30.0?C59.0). After 6?months, 3 (3.5%) patients achieved complete response, 31 (36.5%) had partial response, 15 (17.6%) had stable disease, and 36 (42.4%) had progressive disease. The median overall survival and time to treatment failure after initial CLM-TACE were 13.3 and 7.2?months, respectively. Overall, 9.4% of patients experienced grade 3/4 adverse events.Conclusion
Switching the loaded agent from epirubicin to cisplatin is a safe, well-tolerated, and efficacious treatment strategy for salvage TACE with drug-eluting microspheres in HCC patients refractory to ELM-TACE. 相似文献16.
Guiu B Deschamps F Boulin M Boige V Malka D Ducreux M Hillon P de Baère T 《Cardiovascular and interventional radiology》2012,35(5):1102-1108
Purpose
An Asian study showed that gamma glutamyl transpeptidase (GGT) can predict survival after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). This study was designed to validate in a European population this biomarker as an independent predictor of outcome after TACE of HCC and to determine a threshold value for clinical use.Methods
In 88 consecutive patients treated by TACE for HCC, the optimal threshold for GGT serum level was determined by a ROC analysis. Endpoints were time-to-treatment failure (TTTF) and overall survival (OS). All multivariate models were internally validated using bootstrapping (90 replications).Results
Median follow-up lasted 373?days, and median overall survival was 748?days. The optimal threshold for GGT was 165 U/L (sensitivity: 89.3%; specificity: 56.7%; area under the ROC curve: 0.7515). Median TTTF was shorter when GGT was ≥165 U/L (281?days vs. 850?days; P?0.001). GGT?≥165 U/L (hazard ratio (HR)?=?2.06; P?=?0.02), WHO PS of 2 (HR?=?5.4; P?=?0.002), and tumor size (HR?=?1.12; P?=?0.014) were independently associated with shorter TTTF. Median OS was shorter when GGT was?≥165 U/L (508?days vs. not reached; P?0.001). GGT?≥?165 U/L (HR?=?3.05; P?=?0.029), WHO PS of 2 (HR?=?12.95; P?0.001), alfa-fetoprotein (HR?=?2.9; P?=?0.01), and tumor size (HR?=?1.096; P?=?0.013) were independently associated with shorter OS. The results were confirmed by bootstrapping.Conclusions
Our results provide in a European population the external validation of GGT as an independent predictor of outcome after TACE of HCC. A serum level of GGT?≥?165 U/L is independently associated with both shorter TTTF and OS. 相似文献17.
Hippocrates Moschouris Katerina Malagari Ioannis Kornezos Marina Georgiou Papadaki Panagiotis Gkoutzios Dimitrios Matsaidonis 《Cardiovascular and interventional radiology》2010,33(6):1215-1222
The purpose of this study was to describe and evaluate the findings of unenhanced ultrasonography (US) and contrast-enhanced
ultrasonography (CEUS) when these modalities are applied during transarterial embolization (TAE) or transarterial chemoembolization
(TACE) of liver tumors. Sixteen tumors (9 hepatocellular carcinomas, 5 metastases from colorectal cancer, and 2 hemangiomas)
were treated with TAE with microspheres and/or TACE with drug-eluting beads. All of these lesions were studied with intraprocedural
unenhanced US and 12 were studied with intraprocedural CEUS. For the latter, a second-generation echo-enhancer (SonoVue; Bracco,
Milan, Italy) and a low mechanical index technique were used. Intraprocedural findings were classified according to an arbitrary
scale and were compared with pretreatment imaging (CEUS and computed tomography or CEUS and magnetic resonance imaging), with
postembolization angiography, and with follow-up results. On unenhanced intraprocedural US, 13 of 16 tumors demonstrated intralesional
high-level echoes of varying extent. These feature correlated poorly (r = 0.33, p = 0.097) with and generally underestimated the actual extent of necrosis. Exceptionally, high-level echoes that occupied
the largest part of the treated lesions were associated with >50% tumor necrosis. Intraprocedural CEUS clearly depicted immediate
partial or complete disappearance of tumor enhancement as a result of TAE/TACE. Three of 6 tumors with complete devascularization
on postembolization angiogram showed residual enhancement on intraprocedural CEUS. Intraprocedural CEUS findings correlated
closely (r = 0.91, p = 0.002) with follow-up findings. Intraprocedural sonography, particularly with echo-enhancers, could be used for intraprocedural
monitoring in selected cases of liver tumors that undergo TAE or TACE. 相似文献
18.
Ji Hye Min Min Woo Lee Dong Ik Cha Yong Hwan Jeon Sung Wook Shin Sung Ki Cho Hyunchul Rhim Hyo K. Lim 《Korean journal of radiology》2013,14(2):248-258
Objective
To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US).Materials and Methods
Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method.Results
Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively.Conclusion
RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment. 相似文献19.
Miyayama S Yamashiro M Shibata Y Hashimoto M Yoshida M Tsuji K Toshima F Matsui O 《Japanese journal of radiology》2012,30(3):263-270
Purpose
To compare local control effects of superselective transcatheter arterial chemoembolization (TACE) using epirubicin (EPI) plus mitomycin C (M) and miriplatin (MPT) for hepatocellular carcinoma (HCC). 相似文献20.
Yeo Ju Kim Hae Giu Lee Jeong Mi Park Yeon Soo Lim Myung Hee Chung Mi Sook Sung Won Jong Yoo Hyun Wook Lim 《Korean journal of radiology》2007,8(4):311-319