共查询到20条相似文献，搜索用时 31 毫秒
1.
Siddharth A. Padia Guy E. Johnson Kathryn J. Horton Christopher R. Ingraham Matthew J. Kogut Sharon Kwan Sandeep Vaidya Wayne L. Monsky James O. Park Renuka Bhattacharya Daniel S. Hippe William P. Harris 《Journal of vascular and interventional radiology : JVIR》2017,28(6):777-785.e1
Purpose
To compare segmental radioembolization with segmental chemoembolization for localized, unresectable hepatocellular carcinoma (HCC) not amenable to ablation.Materials and Methods
In a single-center, retrospective study (2010–2015), 101 patients with 132 tumors underwent segmental radioembolization, and 77 patients with 103 tumors underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Patients receiving chemoembolization had worse performance status (Eastern Cooperative Oncology Group 0, 76% vs 56%; P = .003) and Child-Pugh class (class A, 65% vs 52%; P = .053); patients receiving radioembolization had larger tumors (32 mm vs 26 mm; P < .001), more infiltrative tumors (23% vs 9%; P = .01), and more vascular invasion (18% vs 1%; P < .001). Toxicity, tumor response, tumor progression, and survival were compared. Analyses were weighted using a propensity score (PS).Results
Toxicity rates were low, without significant differences. Index and overall complete response rates were 92% and 84% for radioembolization and 74% and 58% for chemoembolization (P = .001 and P < .001). Index tumor progression at 1 and 2 years was 8% and 15% in the radioembolization group and 30% and 42% in the chemoembolization group (P < .001). Median progression-free and overall survival were 564 days and 1,198 days in the radioembolization group and 271 days and 1,043 days in the chemoembolization group (PS-adjusted P = .002 and P = .35; censored by transplant PS-adjusted P < .001 and P = .064).Conclusions
Segmental radioembolization demonstrates higher complete response rates and local tumor control compared with segmental chemoembolization for HCC, with similar toxicity profiles. Superior progression-free survival was achieved. 相似文献2.
Yu-Kai Su Rosewell V. Mackey Ahsun Riaz Vanessa L. Gates Al B. Benson Frank H. Miller Vahid Yaghmai Ahmed Gabr Riad Salem Robert J. Lewandowski 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1520-1526
Purpose
To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms.Materials and Methods
Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function.Results
Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P = .023) and lower albumin levels (P = .0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity.Conclusions
Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients. 相似文献3.
Amar Karalli Ramin Ghaffarpour Rimma Axelsson Lars Lundell Bela Bozoki Torkel Brismar Ove Gustafsson 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1664-1672
Purpose
To prospectively assess feasibility, safety, and cytoreductive effect of transarterial chemoembolization on renal cell carcinoma (RCC) using drug-eluting embolic agent (DEE) saturated with doxorubicin compared with transarterial embolization (TAE).Materials and Methods
Between 2012 and 2015, 12 patients (male/female = 5/7, age 66 y ± 9.8) with biopsy-verified RCC eligible for nephron-sparing surgery or radical nephrectomy were recruited. Mean tumor size was 3.2 cm ± 0.62. Patients were randomized at 1:1 ratio to receive either DEE transarterial chemoembolization or TAE before planned surgery. A microcatheter was used to inject particles selectively into arteries feeding the tumors. Response was evaluated by CT according to modified Response Evaluation Criteria In Solid Tumors and by microscopy of excised tumors. Complications were scored according to the Society of Interventional Radiology classification.Results
DEE transarterial chemoembolization (n = 6) resulted in a significantly (P = .018) higher degree of necrosis with an average of 88.3% (range, 70%–100%) compared with TAE (n = 5), which resulted in an average of 29.4% (range, 0–77%), as evaluated by CT. Histopathologic evaluation showed similar results (P = .016) with an average necrosis of 87.5% (range, 80%–95%) for DEE transarterial chemoembolization (n = 4) versus 26% (range, 0–70%) for TAE (n = 5). Percentage of necrosis seen on microscopy correlated significantly (P = .0005) with radiologic findings, as 4 tumors in each arm were evaluated by both CT and microscopy. No major complications were observed in either group.Conclusions
DEE transarterial chemoembolization is safe for treating localized RCC and has a significantly superior cytoreductive effect compared with TAE. 相似文献4.
Antonio Saviano Roberto Iezzi Felice Giuliante Lucia Salvatore Caterina Mele Alessandro Posa Francesco Ardito Anna Maria De Gaetano Maurizio Pompili 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1512-1519
Purpose
To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm.Materials and Methods
From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0–6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0–7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P = .017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates.Results
One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P = .463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P = .034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P = .005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P = .016; LTP 16.0% vs 55.7%, P = .013).Conclusions
LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR. 相似文献5.
Enxin Wang Lei Liu Dongdong Xia Wenjun Wang Wei Bai Qiuhe Wang Jie Yuan Xiaomei Li Lei Zhang Jing Niu Zhanxin Yin Jielai Xia Hongwei Cai Daiming Fan Guohong Han 《Journal of vascular and interventional radiology : JVIR》2017,28(7):956-962
Purpose
To investigate treatment outcome, prognostic factors for overall survival, and appropriate candidates for transarterial chemoembolization among patients with hepatocellular carcinoma (HCC) and extrahepatic spread (EHS).Materials and Methods
From January 2010 to June 2014, 111 consecutive patients with HCC and EHS treated by transarterial chemoembolization alone were evaluated. Factors associated with overall survival were evaluated using Cox regression analysis, and a scoring equation was established to subgroup patients with EHS.Results
Median follow-up was 3.8 months, and median overall survival was 3.8 months (95% confidence interval [CI], 2.9–4.7 months). Multivariate analysis demonstrated maximum tumor size ≥ 10 cm (hazard ratio [HR] 1.58; 95% CI, 1.02–2.46; P = .041), multifocal intrahepatic tumors (HR 1.55; 95% CI, 1.03–2.33; P = .037), and portal vein tumor thrombosis (PVTT) (HR 1.81; 95% CI, 1.12–2.91; P = .015) as significant predictors of overall survival. Based on these factors, a scoring equation was developed to predict treatment outcome of transarterial chemoembolization, with an area under the receiver operating characteristic curve of 0.76 in predicting 6-month survival. Using a cutoff score of 5.5, patients with HCC and EHS were divided into 2 groups with significantly different overall survival (8.1 months for EHS1 and 2.4 months for EHS2; P < .001). The described method of subgrouping remained discriminatory regardless of baseline characteristics.Conclusions
Maximum tumor size, intrahepatic tumor distribution, and presence of PVTT were significant determinants of overall survival for patients with HCC and EHS. Transarterial chemoembolization may be appropriate for patients with EHS but lower intrahepatic tumor burden. 相似文献6.
Camillo Aliberti Riccardo Carandina Sara Lonardi Vincenzo Dadduzio Alessandro Vitale Enrico Gringeri Giacomo Zanus Umberto Cillo 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1495-1502
Purpose
To assess the safety, tolerability, and efficacy of small drug-eluting embolic (DEE) agents (70–150 μm) for chemoembolization of hepatocellular carcinoma (HCC).Materials and Methods
This single-center, single-arm, retrospective study involved 421 patients (mean age, 66.1 y ± 9.8 [standard deviation]) with Barcelona Clinic Liver Cancer (BCLC) stage A (n = 88), B (n = 140), or C (n = 193) HCC and Child–Pugh class A (n = 233) or B (n = 188) cirrhosis. Patients had a mean of 7.2 lesions ± 4.8 (range, 1–21; mean diameter of target lesion, 21.4 cm ± 8.1; unilobar, n = 132; bilobar, n = 289; portal vein involvement, n = 193). One (n = 320) or 2 (n = 101) vials of small DEEs loaded with doxorubicin 50 mg per vial were delivered selectively (ie, segmentally) or superselectively (ie, directly into the tumor-feeding vessel) until complete delivery or stasis/near-stasis. Treatment was repeated in patients with partial response or stable disease at 1- or 3-month follow-up (mean, 2.0 cycles ± 0.9). Adverse events within 30 days of chemoembolization, response per modified Response Evaluation Criteria In Solid Tumors (mRECIST), and survival were assessed.Results
Within 30 days after treatment, no deaths or bleeding events occurred, but all patients had at least 1 episode of postembolization syndrome (pain, fever, and/or nausea/vomiting; 27.1% grade 3/4 per National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0) and increased bilirubin and liver aminotransferase levels (0.2% and 5.9% grade 3/4, respectively). Overall response rates were 94.5% at 3 months and 99.5% at 6 months. Median overall survival was 42.0 months (95% confidence interval, 38.0–43.0 mo).Conclusions
Chemoembolization with small DEE agents is well tolerated and an effective treatment for a broad range of patients with liver-confined HCC. 相似文献7.
Hyun Yang Jein Seon Pil Soo Sung Jung Suk Oh Hae Lim Lee Bohyun Jang Ho Jong Chun Jeong Won Jang Si Hyun Bae Jong Young Choi Seung Kew Yoon 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1503-1511.e2
Purpose
To test the hypothesis that prophylactic administration of dexamethasone alleviates postembolization syndrome (PES) after transarterial chemoembolization for the treatment of hepatocellular carcinoma (HCC).Materials and Methods
This prospective, randomized, double-blinded, placebo-controlled trial was conducted in a single center from August 2015 to June 2016. A total of 88 patients with intermediate-stage HCC were enrolled. After randomization, 44 patients were assigned to the dexamethasone group and the other 44 to the control group. In the dexamethasone group, 12 mg of intravenous dexamethasone was administered before chemoembolization. Nausea, vomiting, fever, pain, and alanine aminotransferase level elevation were evaluated after chemoembolization had been performed with the use of Lipiodol and doxorubicin.Results
The incidences of PES were 78.0% in the dexamethasone group and 97.5% in the control group (P = .008). Mean hospitalization times after chemoembolization were 2.7 days ± 1.44 in the dexamethasone group and 2.9 days ± 1.83 in the control group (P = .553). Mean doses of antiemetic and analgesic agents were lower in the dexamethasone group than the control group (0.2 ± 0.58 vs 1.0 ± 1.89 [P = .029] and 0.6 ± 0.97 vs 1.92 ± 2.54 [P = .006], respectively). Prophylactic administration of dexamethasone was a significant factor that influences PES occurrence after chemoembolization (odds ratio = 10.969, P = .027).Conclusions
This study demonstrates that the prophylactic administration of dexamethasone before chemoembolization is an effective way to reduce PES. 相似文献8.
9.
Jan Hansmann Maximilian J. Evers James T. Bui R. Peter Lokken Andrew J. Lipnik Ron C. Gaba Charles E. Ray 《Journal of vascular and interventional radiology : JVIR》2017,28(9):1224-1231.e2
Purpose
To evaluate albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades in predicting overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma (HCC).Materials and Methods
This single-center retrospective study included 180 high-risk patients (142 men, 59 y ± 9) between April 2007 and January 2015. Patients were considered high-risk based on laboratory abnormalities before the procedure (bilirubin > 2.0 mg/dL, albumin < 3.5 mg/dL, platelet count < 60,000/mL, creatinine > 1.2 mg/dL); presence of ascites, encephalopathy, portal vein thrombus, or transjugular intrahepatic portosystemic shunt; or Model for End-Stage Liver Disease score > 15. Serum albumin, bilirubin, and platelet values were used to determine ALBI and PALBI grades. Overall survival was stratified by ALBI and PALBI grades with substratification by Child-Pugh class (CPC) and Barcelona Liver Clinic Cancer (BCLC) stage using Kaplan-Meier analysis. C-index was used to determine discriminatory ability and survival prediction accuracy.Results
Median survival for 79 ALBI grade 2 patients and 101 ALBI grade 3 patients was 20.3 and 10.7 months, respectively (P < .0001). Median survival for 30 PALBI grade 2 and 144 PALBI grade 3 patients was 20.3 and 12.9 months, respectively (P = .0667). Substratification yielded distinct ALBI grade survival curves for CPC B (P = .0022, C-index 0.892), BCLC A (P = .0308, C-index 0.887), and BCLC C (P = .0287, C-index 0.839). PALBI grade demonstrated distinct survival curves for BCLC A (P = 0.0229, C-index 0.869). CPC yielded distinct survival curves for the entire cohort (P = .0019) but not when substratified by BCLC stage (all P > .05).Conclusions
ALBI and PALBI grades are accurate survival metrics in high-risk patients undergoing conventional transarterial chemoembolization for HCC. Use of these scores allows for more refined survival stratification within CPC and BCLC stage. 相似文献10.
Orapin Chansanti Younes Jahangiri Yusuke Matsui Akira Adachi Yindee Geeratikun John A. Kaufman Kenneth J. Kolbeck Jeffrey S. Stevens Khashayar Farsad 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1528-1535
Purpose
To evaluate dose-response relationship in yttrium-90 (90Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (99mTc MAA) single photon emission computed tomography (SPECT)-CT.Materials and Methods
Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0.Results
Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P = .0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P = .0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas < 72.8 Gy predicted nonresponse with 100% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P = .007).Conclusions
Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity. 相似文献11.
Hyo-jae Lee Jin Woong Kim Young Hoe Hur Sang Soo Shin Suk Hee Heo Sung Bum Cho Yang Joon Kang Hyo Soon Lim Hyun Ju Seon Yong Yeon Jeong 《Journal of vascular and interventional radiology : JVIR》2017,28(9):1240-1247.e3
Purpose
To compare therapeutic outcomes of radiofrequency (RF) ablation combined with transcatheter arterial chemoembolization vs surgical resection (SR) for single 2–3 cm hepatocellular carcinoma (HCC).Materials and Methods
Seventy patients underwent combined chemoembolization/RF ablation therapy and 84 underwent SR. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), disease-free survival (DFS), and overall survival (OS) rates, as well as major complications and duration of hospital stay, were compared between groups before and after propensity-score matching.Results
LTP and IDR had developed in 9 (12.9%) and 24 (34.3%) patients in the combined treatment group and in 7 (8.3%) and 24 (28.6%) patients in the SR group (P = .262 and P = .252, respectively). The 1-, 3-, 4-, and 5-year DFS rates were similar between groups (82.6%, 53.2%, 53.2%, and 37.6%, respectively, vs 84.5%, 63.6%, 59.2%, and 52.1%, respectively; P = .278), and 1-, 3-, 4-, and 5-year OS rates were also comparable (94.2%, 81.2%, 74.1%, and 59.4%, respectively, vs 95.2%, 86.3%, 84.0%, and 80.3%, respectively; P = .081). After matching (n = 98), LTP, IDR, DFS, and OS rates were still similar (P = .725, P = .826, P = .484, and P = .578, respectively). Major complication rate was not significantly different (2.9% vs. 6.0%; P = .596); however, after matching, major complication rate was higher in SR group (2.0% vs. 6.1%; P < .001). Hospital stays were significantly longer in the SR group (16.6 ± 6.7 d vs 8.5 ± 4.1 d; P < .001).Conclusions
Before and after matching, there were no significant differences in long-term therapeutic outcomes between combined chemoembolization/RF ablation and SR groups. Therefore, combined chemoembolization/RF ablation therapy may be an alternative treatment for single 2–3 cm HCCs. 相似文献12.
Martin Jonczyk Julius Chapiro Federico Collettini Dominik Geisel Dirk Schnapauff Florian Streitparth Thomas Schmidt Bernd Hamm Bernhard Gebauer Gero Wieners 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1378-1385
Purpose
To evaluate detectability of hepatocellular carcinoma (HCC) using split-bolus cone-beam CT in intraindividual comparison between cone-beam CT and contrast-enhanced MR imaging.Materials and Methods
In a retrospective, single-center study, 28 patients with 85 HCC tumors were treated with transarterial chemoembolization between May 2015 and June 2016. All patients underwent arterial and hepatobiliary phase (HBP) MR imaging within 1 month before transarterial chemoembolization. Cone-beam CT images were acquired using a split-bolus contrast injection with 2 contrast injections and 1 cone-beam CT acquisition. Statistical analyses included Friedman 2-way analysis, Kendall coefficient of concordance, and Wilcoxon test. Tumor detectability was scored using a 5-point system (1 = best; 5 = worst) by 2 independent readers resulting in 170 evaluated tumors. Quantitative analysis included signal-to-noise and contrast-to-noise ratio and contrast measurements. P values < .05 were considered significant.Results
Better tumor detection was provided with split-bolus cone-beam CT (2.91/2.73) and HBP MR imaging (2.93/2.21) compared with arterial MR imaging (3.72/3.05; P < .001) without statistical difference between cone-beam CT and HBP MR imaging in terms of detectability (P = .154) and sensitivity for hypervascularized tumors. More tumors were identified on cone-beam CT (n = 121/170) than on arterial MR imaging (n = 94/170). Average contrast-to-noise ratio values of arterial and HBP MR imaging were higher than for cone-beam CT (7.79, 8.58, 4.43), whereas contrast values were higher for cone-beam CT than for MR imaging (0.11, 0.13, 0.97).Conclusions
Split-bolus cone-beam CT showed excellent detectability of HCC. Sensitivity is comparable to HBP MR imaging and better than arterial phase MR imaging. 相似文献13.
Norifumi Kennoki Shinichi Hori Takeo Yuki Atsushi Hori 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1386-1394
Purpose
To evaluate safety and feasibility of transcatheter arterial chemoembolization with superabsorbent polymer microspheres (SAP-MS) for patients with pulmonary or mediastinal metastasis from breast cancer.Methods
Between November 2002 and January 2015, 14 patients with 29 unresectable pulmonary or mediastinal breast cancer metastases underwent transcatheter arterial chemoembolization using SAP-MS (50–100 μm) after injection of a combination of 2–4 types of anticancer drugs (eg, cisplatin [30 mg] + fluorouracil [500 mg], or epirubicin [40 mg] + mitomycin C [4 mg] + fluorouracil [500 mg]). As a primary endpoint, local tumor response and adverse events were evaluated 1 month after the first transcatheter arterial chemoembolization, according to Response Evaluation Criteria In Solid Tumors Version 1.1 and Common Terminology Criteria for Adverse Events Version 4 criteria. Transcatheter arterial chemoembolization was repeated as needed. Overall survival was analyzed as a secondary endpoint.Results
Response rate was 28.6% (partial response, 4 patients; stable disease, 10 patients). Median progression rate was ?12.7%. No cases of hematologic toxicity of grade 3 or higher were observed. A grade 3 maculopapular rash was observed in 1 patient. After the first transcatheter arterial chemoembolization sessions, 63 additional transcatheter arterial chemoembolization sessions were performed (average, 5.5 sessions per patient; range, 2–10 sessions). The median overall survival time after the first session was 29 months, and the 5-year survival rate was 49.5%.Conclusions
Transcatheter arterial chemoembolization with SAP-MS is a well-tolerated and feasible palliative treatment option for patients with pulmonary or mediastinal metastasis from breast cancer. 相似文献14.
Ryan M. Kiefer Stephen J. Hunt Santiago Pulido Stephen Pickup Emma E. Furth Michael C. Soulen Gregory J. Nadolski Terence P. Gade 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1043-1050.e2
Purpose
To test the hypotheses that (i) heavier rats demonstrate improved survival with diminished fibrosis in a diethylnitrosamine (DEN)-induced model of hepatocellular carcinoma (HCC) and (ii) transarterial embolization via femoral artery access decreases procedure times versus carotid access.Materials and Methods
One hundred thirty-eight male Wistar rats ingested 0.01% DEN in water ad libitum for 12 weeks. T2-weighted magnetic resonance imaging was used for tumor surveillance. Rats underwent selective embolization of ≥ 5 mm tumors via carotid or femoral artery catheterization under fluoroscopic guidance. Rats were retrospectively categorized into 3 groups by initial weight (< 300, 300–400, > 400 g) for analyses of survival, tumor latency, and fibrosis. Access site was compared relative to procedural success, mortality, and time.Results
No significant differences in tumor latency were related to weight group (P = .310). Rats weighing < 300 g had shorter survival than both heavier groups (mean, 88 vs 108 d; P < .0001), and more severe fibrosis (< 300 g median, 4.0; 300–400 g median, 1.5; > 400 g median, 1.0; P = .015). No significant difference was found in periprocedural mortality based on access site; however, procedure times were shorter via femoral approach (mean, 71 ± 23 vs 127 ± 24 min; P < .0001).Conclusions
Greater initial body weight resulted in improved survival without prolonged tumor latency for rats with DEN-induced HCCs and was associated with less severe fibrosis. A femoral approach for embolization resulted in decreased procedure time. These modifications provide a translational animal model of HCC and transarterial embolization that may be suited for short-term survival studies. 相似文献15.
Myungsu Lee Jin Wook Chung Kwang-Hun Lee Jong Yun Won Ho Jong Chun Han Chu Lee Jin Hyoung Kim In Joon Lee Saebeom Hur Hyo-Cheol Kim Yoon Jun Kim Gyoung Min Kim Seung-Moon Joo Jung Suk Oh 《Journal of vascular and interventional radiology : JVIR》2017,28(4):502-512
Purpose
To assess the efficacy and safety of transcatheter arterial chemoembolization with drug-eluting embolic (DEE) agents for nodular hepatocellular carcinoma (HCC).Materials and Methods
The study design was a prospective multicenter registry-based, single-arm clinical trial that included 152 patients. One hundred three (67.8%) had a Child–Pugh class/score of A5, 114 (75.0%) had a performance status of 0, and 77 (50.7%) had Barcelona Clinic Liver Cancer (BCLC) stage A disease. The DEE chemoembolization procedures were performed with DC Bead particles loaded with doxorubicin solution. The primary endpoint of the study was 6-month tumor response assessed per modified Response Evaluation Criteria In Solid Tumors. Secondary endpoints were treatment safety and overall survival.Results
At 1-month posttreatment assessment, complete response (CR) and objective response (OR; ie, CR or partial response) rates were 40.1% and 91.4%, respectively. At 6-month assessment, 121 patients remained for analysis, and CR and OR rates were 43.0% and 55.4%, respectively. The cumulative progression-free survival (PFS) rate at 6 months was 65.0%. Child–Pugh score, tumor multiplicity, and tumor size were independent predictors of PFS (P = .020, P = .029, and P = .001, respectively). There was no 30-day mortality. The overall 6-month survival rate was 97.4%. There were no grade 4 adverse events or laboratory changes. Serious adverse events were reported in 7.2% of patients, and persistent deterioration of liver function was observed in 3.9%. Prominent biliary injury was demonstrated in 19.7% of patients. No liver abscess was observed.Conclusions
DEE chemoembolization for nodular HCC had an acceptable safety profile and acceptable 6-month tumor response and survival rates. 相似文献16.
Edwin A. Takahashi David F. Kallmes Chad J. Fleming Robert J. McDonald Michael A. McKusick Haraldur Bjarnason William S. Harmsen Sanjay Misra 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1687-1692
Purpose
To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis.Materials and Methods
This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis; 437 patients with follow-up data were included. Mean age was 73.6 years ± 8.3. PC-AKI was defined as absolute serum creatinine increase ≥ 0.3 mg/dL or percentage increase in serum creatinine ≥ 50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis.Results
Mean follow-up was 71.1 months ± 68.4. PC-AKI developed in 26 patients (5.9%). Patients with PC-AKI had significantly higher levels of baseline proteinuria compared with patients without PC-AKI (odds ratio = 1.38; 95% confidence interval, 1.11–1.72; P = .004). Hydration before intervention, chronic kidney disease stage, baseline glomerular filtration rate, statin medications, contrast volume, and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P = .50 and P = .17, respectively).Conclusions
Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death. 相似文献17.
Eduardo A. Lacayo Danielle L. Richman Michael R. Acord Darcy J. Wolfman Theresa M. Caridi Sameer Y. Desale James B. Spies 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1003-1010
Purpose
To study the factors that might impact infarction of individual uterine leiomyomas and total tumor burden after uterine artery embolization (UAE).Materials and Methods
This retrospective study included 91 patients (mean age, 44 y [range, 34–54 y]) who underwent UAE with tris-acryl gelatin microspheres (TAGMs) or nonspherical polyvinyl alcohol (PVA) particles. Twenty-one patients were treated with PVA (23%) and 70 were treated with TAGMs (77%). A total of 356 uterine leiomyomas were assessed, with a median uterine volume of 533 cm3 (range, 321–848 cm3). A reader masked to demographic and technical details reviewed contrast-enhanced magnetic resonance images before and 3 months after UAE to estimate the extent of tumor infarction.Results
There was no significant difference in global or individual tumor infarction rate between embolizations with TAGMs and PVA particles (P = .73 and P = .3, respectively). Global infarction was not affected by age (P = .53), race (P = .12), number of leiomyomas (P = .72), or uterine volume (P = .74). Leiomyoma size did not influence individual tumor infarction (P = .41). Leiomyoma location was the sole factor that influenced individual tumor infarction rates, with pedunculated serosal tumors significantly less likely to show complete infarction than transmural tumors (odds ratio, 0.24; P = .01).Conclusions
Nonspherical PVA particles and TAGMs produce similar rates of uterine leiomyoma infarction. Complete infarction of individual tumors is less likely in serosal and pedunculated serosal tumors. 相似文献18.
Christer Ruff Gerd Grözinger Roland Syha Stefanie Elser Sasan Partovi Michael Bitzer Marius Horger Konstantin Nikolaou Ulrich Grosse 《Journal of vascular and interventional radiology : JVIR》2019,30(3):380-389.e4
Purpose
To compare different imaging techniques (volume perfusion CT, cone-beam CT, and dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid–enhanced dynamic contrast–enhanced MR imaging with golden-angle radial sparse parallel MR imaging) in evaluation of transarterial chemoembolization of hepatocellular carcinoma (HCC) using radiopaque drug-eluting embolics (DEE).Materials and Methods
MR imaging and CT phantom investigation of radiopaque DEE was performed. In the clinical portion of the study, 13 patients (22 HCCs) were prospectively enrolled. All patients underwent cross-sectional imaging before and after transarterial chemoembolization using 100–300 μm radiopaque DEE. Qualitative assessment of images using a Likert scale was performed.Results
In the phantom study, CT-related beam-hardening artifacts were markedly visible at a concentration of 12% (v/v) radiopaque DEE; MR imaging demonstrated no significant detectable signal intensity changes. Imaging obtained before transarterial chemoembolization showed no significant difference regarding tumor depiction. Visualization of tumor feeding arteries was significantly improved with volume perfusion CT (P < .001) and cone-beam CT (P = .002) compared with MR imaging. Radiopaque DEE led to significant decrease in tumor depiction (P = .001) and significant increase of beam-hardening artifacts (P = .012) using volume perfusion CT before versus after transarterial chemoembolization. Greater residual arterial tumor enhancement was detected with MR imaging (10 HCCs) compared with volume perfusion CT (8 HCCs) and cone-beam CT (6 HCCs).Conclusions
Using radiopaque DEE, the imaging modalities provided comparable early treatment assessment. In HCCs with dense accumulation of radiopaque DEE, treatment assessment using volume perfusion CT or cone-beam CT may be impaired owing to resulting beam-hardening artifacts and contrast stasis. Dynamic contrast–enhanced MR imaging may add value in detection of residual arterial tumor enhancement. 相似文献19.
Stephen H. Gray Jared A. White Peng Li Meredith L. Kilgore David T. Redden Ahmed K. Abdel Aal Heather N. Simpson Brendan McGuire Devin E. Eckhoff Derek A. Dubay 《Journal of vascular and interventional radiology : JVIR》2017,28(2):231-237.e2
Purpose
To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population.Materials and Methods
A retrospective study identified 37,832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan–Meier method and compared by log-rank test. Propensity-score matching was used to address an imbalance of covariates.Results
More than 75% of patients with HCC did not receive any HCC-directed treatment. Transarterial chemoembolization was the most common initial therapy (15.9%). Factors associated with the use of chemoembolization included younger age, more HCC risk factors, more comorbidities, higher socioeconomic status, intrahepatic tumor, unifocal tumor, vascular invasion, and smaller tumor size (all P < .001). Median survival was improved in patients treated with chemoembolization compared with those not treated with chemoembolization (20.1 vs 4.3 mo; P < .0001). Similar findings were demonstrated in propensity-scoring analysis (14.5 vs 4.2 mo; P < .0001) and immortal time bias sensitivity analysis (9.5 vs 3.6 mo; P < .0001). There was a significantly improved survival hazard ratio (HR) in patients treated with chemoembolization (HR, 0.42; 95% confidence interval, 0.39–0.45).Conclusions
Patients with HCC treated with transarterial chemoembolization experienced a significant survival advantage compared with those not treated with transarterial chemoembolization. More than 75% of SEER/Medicare patients diagnosed with HCC received no identifiable oncologic treatment. There is a significant public health need to increase awareness of efficacious HCC treatments such as transarterial chemoembolization. 相似文献20.
Sangik Park Ji Hoon Shin Dong-Il Gwon Hyoung Jung Kim Kyu-Bo Sung Hyun-Ki Yoon Gi-Young Ko Heung Kyu Ko 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1012-1021