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1.
Hyo-jae Lee Jin Woong Kim Young Hoe Hur Sung Bum Cho Byung Chan Lee Byung Kook Lee Eu Chang Hwang Yong Soo Cho Hyun Ju Seon 《Journal of vascular and interventional radiology : JVIR》2019,30(3):284-292.e1
Purpose
To retrospectively compare long-term outcomes of conventional chemoembolization plus radiofrequency (RF) ablation vs those of surgical resection in patients with a single 3–5-cm hepatocellular carcinoma (HCC).Materials and Methods
From January 2008 to December 2017, 139 of 623 patients who underwent surgical resection and 60 of 186 patients who underwent chemoembolization/RF ablation in a single center were compared with respect to local tumor progression (LTP), intrahepatic distant recurrence (IDR), disease-free survival (DFS), overall survival (OS), major complications, and hospital stay before and after propensity-score matching.Results
Mean follow-up periods were similar in the chemoembolization/RF ablation and surgical resection groups (41.9 mo vs 48.4 mo). Three (5%) and 17 (28.3%) patients in the chemoembolization/RF ablation group and 12 (8.6%) and 57 (41.0%) patients in the surgical resection group showed LTP and IDR (P = .366 and P =.114, respectively). At 1, 3, and 5 years, respective DFS rates were 88.1%, 65.3%, and 49.0% for chemoembolization/RF ablation and 84.2%, 58.2%, and 46.5% for surgical resection (P = .294). Moreover, respective OS rates were 95.0%, 73.5%, and 54.0% for chemoembolization/RF ablation and 97.1%, 87.4%, and 75.0% for surgical resection (P = .055). After matching (n = 52), therapeutic outcomes remained similar (P = .370, P = .110, P = .230, and P = .760, respectively). Surgical resection was associated with higher complication rates (P = .015) and longer hospital stays (8.4 d ± 3.7 vs 16.9 d ± 7.0; P < .001).Conclusions
Conventional chemoembolization combined with RF ablation may be feasible for single 3–5-cm HCCs, with comparable therapeutic outcomes vs surgical resection and shorter hospital stays. 相似文献2.
Jong Eun Lee Jin Woong Kim Hyoung Ook Kim Byung Chan Lee Young Hoe Hur Sung Bum Cho Yong Soo Cho Hyun Ju Seon DongHun Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):370-379.e4
Purpose
To evaluate the effects of the degree of ethiodized oil accumulation achieved by transarterial chemoembolization followed by radiofrequency (RF) ablation on the treatment efficacy for a single intermediate-sized hepatocellular carcinoma (HCC).Materials and Methods
A total of 153 consecutive patients who underwent chemoembolization and RF ablation for a single intermediate-sized HCC (2–5 cm) were included. On the basis of the degree of ethiodized oil accumulation in HCC on cone-beam CT images, patients who underwent chemoembolization and RF ablation were classified into 2 groups: compact accumulation (≥ 75%) and noncompact accumulation (< 75%). The rates of cumulative local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between groups.Results
Of the 153 patients, 89 were classified into the compact ethiodized oil accumulation group and 64 in the noncompact ethiodized oil accumulation group. There were no significant differences in patient demographic or HCC characteristics between groups except for the incidence of liver cirrhosis (P = .038) and the tumor margin morphology (P = .008). The cumulative LTP rate was significantly lower in the compact accumulation group than in the noncompact accumulation group (P = .013). There were no significant differences in the incidences of complications, DFS rates (P = .055), or OS rates (P = .184).Conclusions
The degree of ethiodized oil accumulation does not play a role in decreasing the OS or DFS rate after chemoembolization and RF ablation for intermediate-sized HCC; however, it may contribute to reducing the rate of LTP. 相似文献3.
Hee Ho Chu Jin Hyoung Kim Hyun-Ki Yoon Heung-Kyu Ko Dong Il Gwon Pyo Nyun Kim Kyu-Bo Sung Gi-Young Ko So Yeon Kim Seong Ho Park 《Journal of vascular and interventional radiology : JVIR》2019,30(10):1533-1543
PurposeTo compare survival outcomes of patients with single medium-sized hepatocellular carcinomas (HCCs) who underwent treatment with transarterial chemoembolization, radiofrequency (RF) ablation, or a combination of the 2 therapies.Materials and MethodsBetween 2000 and 2016, 538 patients underwent combined chemoembolization and RF ablation (n = 109), chemoembolization alone (n = 314), or RF ablation alone (n = 115) as first-line treatment for a single medium-sized (3.1–5.0 cm) HCC. Baseline demographic data (age, sex, etiology, Eastern Cooperative Oncology Group performance status, presence of liver cirrhosis, and serum bilirubin, albumin, and α-fetoprotein levels) were similar among groups except for Child–Pugh class, albumin level, and tumor size. Propensity-score analysis with inverse probability weighting (IPW) was used to reduce any bias in treatment selection and other potential confounding factors.ResultsMedian follow-up time was 46.2 months. Before IPW, overall survival (OS) durations were significantly different among the 3 groups (median, 85 months for combined therapy, 56.5 months for chemoembolization alone, and 52.1 months for RF ablation alone; P = .01). The 10-year OS rates were 40.1%, 25.5%, and 19.5% for the combined, chemoembolization-only, and RF ablation–only groups, respectively. After IPW, OS remained superior in the combined chemoembolization/RF ablation group compared with the monotherapy groups (10-y OS, 41.8% with combined therapy, 28.4% with chemoembolization alone, and 11.9% with RF ablation alone; P = .022).ConclusionsChemoembolization plus RF ablation may provide better survival outcomes than chemoembolization or RF ablation monotherapy, and can be considered a viable alternative treatment for unresectable single medium-sized HCCs. 相似文献
4.
Peiman Habibollahi Sara P. Shamchi Rashmi Tondon Brett L. Ecker Terence P. Gade Stephen Hunt Michael C. Soulen Emma E. Furth Matthew H. Levine Gregory Nadolski 《Journal of vascular and interventional radiology : JVIR》2018,29(2):237-243
Purpose
To examine differences in outcome and response of cirrhotomimetic (CMM) hepatocellular carcinoma (HCC) to a combination of bridging transcatheter arterial chemoembolization and orthotopic liver transplantation (OLT) compared with non-CMM HCC.Materials and Methods
All patients with pathologically proven CMM HCC who underwent bridging transcatheter arterial chemoembolization before OLT between 2007 and 2013 (n = 23) were retrospectively compared with a control group of patients with pathologically proven non-CMM HCC (n = 46).Results
There were 29 tumors in the CMM HCC group and 64 tumors in the non-CMM group identified and treated. Objective response rate on MR imaging at 1 and 3 months after transcatheter arterial chemoembolization for CMM HCC tumors (including patients with complete and partial response) was 93.1% and 86.4% compared with 85.2% and 93.2% for non-CMM tumors without statistically significant difference (P = .54 and P = .09, respectively). Pathologic study of liver explants showed complete tumor necrosis in 62.3% of non-CMM tumors (38/61) compared with 10.3% of CMM tumors (3/29) (P < .0001). Overall 2-year survival after transcatheter arterial chemoembolization and OLT was significantly lower for patients with CMM HCC compared with patients non-CMM HCC (65.2% vs 87%, P = .03). Patients with CMM HCC with extranodular tumor extension involving > 50% of liver parenchyma had worse survival with mean 2-year survival of 402 days ± 102 vs 656 days ± 39 for the remaining patients with CMM HCC (P = .02).Conclusions
Despite similar early imaging response rates, CMM HCC tumors had markedly lower rates of complete pathologic necrosis on liver explants and were associated with reduced survival after OLT compared with conventional HCCs. 相似文献5.
6.
Yuqian Huang Qin Shen Harrison X. Bai Jing Wu Cong Ma Quanliang Shang Steven J. Hunt Giorgos Karakousis Paul J. Zhang Zishu Zhang 《Journal of vascular and interventional radiology : JVIR》2018,29(9):1218-1225.e2
Purpose
To compare survival outcome of radiofrequency (RF) ablation and surgical resection (SR) for treatment of hepatocellular carcinoma (HCC) ≤ 2 cm.Materials and Methods
In this retrospective study, patients from the US National Cancer Database with HCC ≤ 2 cm received RF ablation or SR as sole treatment. Overall survival (OS) was compared using log-rank test, multivariable Cox proportional hazard regression, and propensity score matched analysis.Results
Of 833 patients included, 620 received RF ablation and 213 received SR. The 1-, 3-, and 5-year OS rates were 90%, 64%, and 47% for RF ablation and 89%, 75%, and 62% for SR. On univariate analyses, patients who received SR had longer OS than patients who received RF ablation, but this did not achieve statistical significance (P = .113). On multivariate analyses, female sex (HR = 0.700; 95% CI, 0.501–0.979; P = .037), African American (HR = 0.611; 95% CI, 0.398–0.938; P = .024) and Asian ethnicity (HR = 0.427; 95% CI, 0.230–0.790; P = .007), and median income ≥ $48,000 (HR = 0.695; 95% CI, 0.518–0.932; P = .015) were associated with longer OS, whereas higher Model for End-stage Liver Disease (MELD) scores (HR = 1.023; 95% CI, 1.009–1.037; P = .001) were associated with shorter OS. After matching on age, sex, ethnicity, MELD score, and income, there was no significant difference in OS between the 2 treatment groups (log-rank P = .646).Conclusions
There was no significant difference in OS between RF ablation and SR in treatment of HCC measuring ≤ 2 cm. 相似文献7.
Erica M. Knavel Chelsey M. Green Annette Gendron-Fitzpatrick Christopher L. Brace Paul F. Laeseke 《Journal of vascular and interventional radiology : JVIR》2018,29(7):1050-1056
Purpose
To quantify the effect of transarterial embolization on microwave (MW) ablations in an in vivo porcine liver model.Materials and Methods
Hepatic arteriography and cone-beam computed tomography (CT) scans were performed in 6 female domestic swine. Two lobes were embolized to an endpoint of substasis with 100–300-μm microspheres. MW ablations (65 W, 5 min) were created in embolized (n = 15) and nonembolized (n = 12) liver by using a 2.45-GHz system and single antenna. Cone-beam CT scans were obtained to monitor the ablations, document gas formation, and characterize arterial flow. Ablation zones were excised and sectioned. A mixed-effects model was used to compare ablation zone diameter, length, area, and circularity.Results
Combined transarterial embolization and MW ablation zones had significantly greater area (mean ± standard deviation, 11.8 cm2 ± 2.5), length (4.8 cm ± 0.5), and diameter (3.1 cm ± 0.6) compared with MW only (7.1 cm2 ± 1.9, 3.7 cm ± 0.6, and 2.4 cm ± 0.3, respectively; P = .0085, P = .0077, and P = .0267, respectively). Ablation zone circularity was similar between groups (P = .9291). The larger size of the combined ablation zones was predominantly the result of an increase in size of the peripheral noncharred zone of coagulation (1.3 cm ± 0.4 vs 0.8 cm ± 0.2; P = .0104). Cone-beam CT scans demonstrated greater gas formation during combined ablations (1.8 cm vs 1.1 cm, respectively). Mean maximum temperatures 1 cm from the MW antennas were 86.6°C and 68.7°C for the combined embolization/ablation and MW-only groups, respectively.Conclusions
Combining transarterial embolization and MW ablation increased ablation zone diameter and area by approximately 27% and 66%, respectively, in an in vivo non–tumor-bearing porcine liver model. This is largely the result of an increase in the size of the peripheral ablation zone, which is most susceptible to local blood flow. 相似文献8.
Shiro Miyayama Masashi Yamashiro Natsuki Sugimori Rie Ikeda Kotaro Okimura Naoko Sakuragawa 《Journal of vascular and interventional radiology : JVIR》2019,30(1):10-18
Purpose
To evaluate the outcomes of conventional transarterial chemoembolization using guidance software for hepatocellular carcinoma (HCC) patients.Materials and Methods
One hundred two patients with treatment-naïve HCC with ≤ 7-cm and ≤ 5 lesions treated with conventional transarterial chemoembolization using guidance software were selected. Technical success was classified into 3 grades by computed tomography performed 1 week after transarterial chemoembolization: (i) A, complete embolization with a safety margin; (ii) B, entire tumor embolization without a safety margin; and (iii) C, incomplete embolization. Intrahepatic tumor recurrence was classified into 2 categories: local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Overall survival (OS) and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, the incidences of LTP between grade A and B tumors, IDR with/without LTP, and OS with/without LTP were compared by the log-rank test.Results
One hundred fifty-six (82.1%) tumors were determined to be grade A, 26 (13.7%) were determined to be grade B, and 8 (4.2%) were determined to be grade C. The 1-, 3-, and 5-year LTP and IDR rates were 31.7%, 49.4%, and 59.4% and 33.9%, 58.2%, and 73.3%, respectively. LTP developed more frequently in grade B tumors than grade A tumors (P = .0016). IDR developed more frequently in patients with LTP than without LTP (P = .0004). The 1-, 3-, and 5-year OS rates were 96.1%, 71.1%, and 60%, respectively; the 1-, 3-, and 5-year OS rates in patients with/without LTP were 95.7%, 69.8%, and 59.3% and 96.2%, 71.6%, and 59.4%, respectively (P = .9984).Conclusions
Transarterial chemoembolization guidance software promotes the technical success of transarterial chemoembolization and excellent OS in HCC patients. 相似文献9.
手术切除与经皮射频消融在小肝癌治疗中的价值探讨 总被引：2，自引：0，他引：2
目的评价手术切除与经皮射频消融（PRFA）在小肝癌治疗中的价值。方法我院小肝癌患者99例分为两组,分别给于手术切除和PRFA,对两组术后不良反应、术后1年复发率进行比较。结果两组患者术后不良反应,包括术后体温恢复时间,ALT升高例数,胆红素升高例数,经比较无差异;对于直径≤3cm的肿瘤,手术治疗与PRFA治疗组患者术后1年的肿瘤复发率差异没有显著性;但是直径3～5cm的肿瘤,手术治疗组在术后1年的肿瘤复发率明显低于PRFA治疗组。结论手术治疗与PRFA均是一种创伤小、恢复快、安全性高的治疗方法 ,对于肿瘤直径≤3cm的,两者疗效等同;对于肿瘤直径3～5cm的,以手术治疗为宜。 相似文献
10.
肝动脉化疗栓塞对肝癌肿瘤新生血管生成的影响 总被引：12，自引：3，他引：9
目的 研究肝细胞癌 (hepatocellularcarcinoma ,HCC)经导管动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)后残癌组织微血管密度 (microvesseldensity ,MVD)、微血管直径的情况及其意义。方法 经病理证实的HCC 63例 ,包括单纯手术切除42例 (对照组 ) ,TACE术后行Ⅱ期手术切除 2 1例 (TACE组 ) ,TACE组患者手术前接受 1～ 2次不等的TACE术治疗 ,均按统一规范标准给予化疗药物灌注 栓塞治疗。对手术切除标本进行免疫组化染色 ,其中TACE组取病灶边缘残存肿瘤部分 ,检测肿瘤组织的MVD、微血管直径。结果 对照组MVD值为 5 1.69± 18.17,TACE组MVD值为 5 8.5 7± 15 .75 ,二者之间比较无显著性差异 (t=1.48,P >0 .0 5 ) ;对照组微血管直径为 ( 17.62± 10 .5 4) μm ,TACE组微血管直径为 ( 15 .79± 7.65 ) μm ,二者之间比较无显著性差异 (t =0 .71,P >0 .0 5 )。结论 TACE术很难彻底消除肿瘤血供 ,术后残癌组织可通过各种途径重新生成丰富血供 相似文献
11.
Ohmoto K Yoshioka N Tomiyama Y Shibata N Kawase T Yoshida K Kuboki M Yamamoto S 《Cardiovascular and interventional radiology》2006,29(6):1111-1113
A 73-year-old man with hepatitis-C-related cirrhosis and an elevated alpha-fetoprotein level and tumor in segment 3 of his
liver was referred for interventional radiologic treatment. He was not a candidate for surgical resection due to impaired
liver function and his personal preferences. On conventional ultrasonography no lesion could be detected, but the tumor was
clearly depicted by intra-arterial carbon-dioxide-enhanced ultrasonography. Radiofrequency ablation was performed safely and
accurately under the guidance of carbon-dioxide-enhanced ultrasonography. By concomitant performance of transcatheter arterial
chemoembolization with radiofrequency ablation, extensive necrosis was obtained and adequate tumor volume reduction achieved
with only one treatment session. 相似文献
12.
Reto Bale Michael Richter Martina Dünser Elliot Levy Wolfgang Buchberger Peter Schullian 《Journal of vascular and interventional radiology : JVIR》2018,29(2):262-267
Purpose
To evaluate outcomes in patients with liver metastases from breast cancer treated with stereotactic radiofrequency (RF) ablation.Materials and Methods
A retrospective analysis of 29 stereotactic RF ablation treatment sessions in 26 consecutive patients with 64 biopsy-proven breast cancer liver metastases (BCLMs) was conducted. Patients were included only if systemic treatment failed and all visible BCLMs were treatable.Results
Primary and secondary technical success rates were 96.9% (62 of 64) and 100%, respectively. There were no perioperative mortalities. Local recurrence was identified in 5 tumors (7.8%), with no significant differences among tumor sizes (P = .662): < 3 cm (9.3%), 3–5 cm (0%), and > 5 cm (8.3%). Median estimated overall survival (OS) from first stereotactic ablation treatment was 29.3 months ± 8.9 (95% confidence interval [CI], 11.9–46.8 mo; mean, 28.7 mo) after a median follow-up of 23.1 months (mean, 31.3 mo; range, 0.1–100.8 mo). No significant differences in OS (P = .223) were observed among tumor volumes < 50 cm3 (median, 84.9 mo ± 53.1; mean, 58.4 mo), 50–100 cm3 (median, 37.8 mo ± 5.7; mean, 36.3 mo), and > 100 cm3 (median, 17.1 mo ± 3.5; mean, 21.8 mo). Numbers of metastases did not affect estimated OS, with a median OS of 32.7 months ± 10.4 (mean, 35.8 mo) for single lesions vs 17.7 months ± 3.2 (mean, 25.9 mo) for 2/3 lesions and a mean of 68.4 months ± 17.23 for > 3 lesions (P = .113).Conclusions
Multiple-electrode stereotactic RF ablation proved to be a safe minimally invasive alternative to surgical liver resection in selected patients with BCLMs. 相似文献13.
Shibata T Shibata T Maetani Y Kubo T Nishida N Itoh K 《Cardiovascular and interventional radiology》2006,29(3):479-481
Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular
carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml
of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery.
The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was
noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor
seeding after radiofrequency ablation for hepatocellular carcinoma. 相似文献
14.
Bin-Yan Zhong Cai-Fang Ni Jian-Song Ji Guo-Wen Yin Li Chen Hai-Dong Zhu Jin-He Guo Shi-Cheng He Gang Deng Qi Zhang Pei-Cheng Li Hui Yu Jing-Jing Song Gao-Jun Teng 《Journal of vascular and interventional radiology : JVIR》2019,30(3):330-338
Purpose
To construct the albumin-bilirubin (ALBI) grade and the Child-Turcotte-Pugh (CTP) score based on nomograms, as well as to develop an artificial neural network (ANN) to compare the prognostic performance of the 2 scores for hepatocellular carcinoma (HCC) that has undergone transarterial chemoembolization.Materials and Methods
This multicentric retrospective study included patients with HCC who underwent transarterial chemoembolization monotherapy as an initial treatment at 4 institutions between January 2008 and December 2016. In the training cohort, significant risk factors associated with overall survival (OS) were identified by univariate and multivariate analyses. The prognostic nomograms and ANN were established and then validated in 2 validation cohorts.Results
A total of 838 patients (548, 115, and 175 in the training cohort and validation cohorts 1 and 2, respectively) were included. The median OS was 10.4, 15.7, and 9.2 months in the training cohort and validation cohorts 1 and 2, respectively. In the training cohort, both ALBI grade and CTP score were identified as significant risk factors. The ALBI grade and CTP score based on nomograms were established separately and showed similar prognostic performance when assessed externally in validation cohorts (C-index in validation cohort 1: 0.823 vs 0.802, P = .417; in validation cohort 2: 0.716 vs 0.729, P = .793). ANN showed that ALBI grade had higher importance on survival prediction than CTP score.Conclusions
ALBI grade performs at least no worse than CTP score regarding survival prediction for HCC receiving transarterial chemoembolization. Considering the easy application, ALBI grade has the potential to be regarded as an alternative to CTP score. 相似文献15.
Jin Woong Kim Sang Soo Shin Jae Kyu Kim Sung Kyu Choi Suk Hee Heo Hyo Soon Lim Young Hoe Hur Chol Kyoon Cho Yong Yeon Jeong Heoung Keun Kang 《Korean journal of radiology》2013,14(4):626-635
Objective
To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm.Materials and Methods
The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival.Results
Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test).Conclusion
When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates. 相似文献16.
Sakamoto N Monzawa S Nagano H Nishizaki H Arai Y Sugimura K 《Cardiovascular and interventional radiology》2007,30(3):508-511
Acute tumor lysis syndrome results from a sudden and rapid release of products of cellular breakdown after anticancer therapy.
Severe alterations of metabolic profile might occur and result in acute renal failure. We present a patient with a large hepatocellular
carcinoma who received transcatheter oily chemoembolization and died subsequently of this syndrome. To our knowledge, there
has been only one report of this syndrome induced by chemoembolization for hepatocellular carcinoma. This case illustrates
the need to anticipate the development of acute tumor lysis syndrome when chemoembolization is planned for a large hepatocellular
carcinoma. 相似文献
17.
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18.
Murakami T Ishimaru H Sakamoto I Uetani M Matsuoka Y Daikoku M Honda S Koshiishi T Fujimoto T 《Cardiovascular and interventional radiology》2007,30(4):696-704
PURPOSE: To analyze local recurrence-free rates and risk factors for recurrence following percutaneous radiofrequency ablation (RFA) or transcatheter arterial chemoembolization (TACE) for hypervascular hepatocellular carcinoma (HCC). METHODS: One hundred and nine nodules treated by RFA and 173 nodules treated by TACE were included. Hypovascular nodules were excluded from this study. Overall local recurrence-free rates of each treatment group were calculated using the Kaplan-Meier method. The independent risk factors of local recurrence and the hazard ratios were analyzed using Cox's proportional-hazards regression model. Based on the results of multivariate analyses, we classified HCC nodules into four subgroups: central nodules < or =2 cm or >2 cm and peripheral nodules < or =2 cm or >2 cm. The local recurrence-free rates of these subgroups for each treatment were also calculated. RESULTS: The overall local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p = 0.013). The 24-month local recurrence-free rates in the RFA and TACE groups were 60.0% and 48.9%, respectively. In the RFA group, the only significant risk factor for recurrence was tumor size >2 cm in greatest dimension. In the TACE group, a central location was the only significant risk factor for recurrence. In central nodules that were < or =2 cm, the local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p < 0.001). In the remaining three groups, there was no significant difference in local recurrence-free rate between the two treatment methods. CONCLUSION: A tumor diameter of >2 cm was the only independent risk factor for local recurrence in RFA treatment, and a central location was the only independent risk factor in TACE treatment. Central lesions measuring < or =2 cm should be treated by RFA. 相似文献
19.
Zi-Han Zhang Wen Zhang Jun-Ying Gu Qing-Xin Liu Jing-Qin Ma Ling-Xiao Liu Jian-Hua Wang Jian-Jun Luo Zhi-Ping Yan 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1085-1093
Purpose
To evaluate the safety and efficacy of iodine-125 (125I) seed strand implantation in combination with transarterial chemoembolization for the treatment of hepatitis B–related unresectable hepatocellular carcinoma (HCC) with portal vein invasion.Materials and Methods
From January 2013 to June 2016, 76 HCC patients with type II tumor thrombus were included in this single-center retrospective study. Twenty patients underwent 125I seed strand implantation combined with transarterial chemoembolization (group A; n = 20), while 56 patients underwent transarterial chemoembolization alone (group B; n = 56). The procedure-related and radiation complications were assessed. Overall survivals were compared by propensity-score analysis.Results
The technique was successfully performed in all patients. The mean intended dose (r = 10 mm; z = 0; 240 days) was 62.6 ± 1.8 Gy. No grade 3 or 4 adverse events related to the procedure occurred in either group. After propensity-score-matching analysis, 19 patients were selected into each group, respectively. In the propensity-matching cohort, the median overall survival time was significantly longer in group A than in the group B (19 pairs; 28.0 ± 2.4 vs 8.7 ± 0.4 mo; P = .001). Treatment strategy, arterioportal shunt, and number of transarterial chemoembolization sessions were significant predictors of favorable overall survival time.Conclusions
125I seed strand implantation combined with transarterial chemoembolization is a safe and effective treatment for HCC patients with portal vein invasion. 相似文献20.
PET-CT同机融合显像在肝癌TACE治疗后的应用价值 总被引：1，自引：0，他引：1
目的探讨18F脱氧葡萄糖(FDG)PET-CT同机融合显像在肝动脉化疗栓塞(TACE)治疗原发性肝癌后的应用价值。方法15例原发性肝癌患者,肿瘤直径4~10cm,经TACE后3个月内完成18F-FDGPET-CT检查,与DSA和临床随访结果对照。结果15例患者TACE后PET显像均可见放射性缺损区,有11例肝内可见18F-FDG放射性增高灶,4例患者PET显像肝内未见明显18F-FDG放射性增高灶。18F-FDG放射性增高灶主要位于放射性缺损区周边,融合显像显示18F-FDG摄取增高灶与碘油沉积无对应关系。临床随访证实,11例18F-FDG摄取增高灶为残存肿瘤灶;经过再次TACE治疗或利用融合显像结果制定计划进行三维适形放疗后,18F-FDGPET-CT显像显示原18F-FDG浓聚灶范围缩小或消失。4例肝内未见明显18F-FDG放射性增高患者DSA显示肿瘤边缘仍有肿瘤染色。结论中晚期肝癌栓塞化疗后病灶边缘部分仍有肿瘤存活或残留,18F-FDGPET-CT显像可对大部分残存肿瘤定性定位,指导进一步治疗并监测疗效,但部分患者残存病灶18F-FDGPET-CT显像不能检出。 相似文献