Aim
To retrospectively compare the initial response, local recurrence, and complication rates of radiofrequency ablation (RFA) vs microwave ablation (MWA) when combined with neoadjuvant bland transarterial embolization (TAE) or drug eluting microsphere chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC).
Methods
A total of 35 subjects with BCLC very early and early stage HCC (range 1.2 – 4.1 cm) underwent TAE (23) or TACE (12) with RFA (15) or MWA (20) from 1/2009–6/2015 as either definitive therapy or a bridge to transplant. TAE and TACE were performed with 40–400 μm particles and 30–100 μm plus either Doxorubicin or Epirubicin eluting microspheres respectively. Initial response and local progression were evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Complications were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Results
Complete response (CR) rates were 80% (12/15) for RFA + TAE/TACE and 95% (19/20) for MWA + TAE/TACE (p value 0.29). Local recurrence (LR) was 30% (4/12) for RFA + TAE/TACE and 0% (0/19) for MWA + TAE/TACE. Durability of response (DR), defined as local disease control for duration of the study, demonstrated a significant difference in favor of MWA (p value 0.0091). There was no statistical difference in complication rates (3 vs 2).
Conclusions
MWA and RFA when combined with neoadjuvant TAE or TACE have similar safety and efficacy in the treatment of early stage HCC. MWA provided more durable disease control in this study, however, prospective data remains necessary to evaluate superiority of either modality.
To compare the outcomes of radiation segmentectomy for early-stage hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease (NAFLD) versus hepatitis C virus (HCV). Materials and Methods: A retrospective analysis of consecutive patients with NAFLD-or HCV-related HCC treated with radiation segmentectomy from 01/2017-06/2022 was performed. Eligibility criteria included solitary tumor ≤8 cm or up to 3 HCC ≤3 cm, ECOG 0-1, and absence of vascular invasion or extrahepatic spread. Imaging best response was assessed per modified Response Evaluation Criteria in Solid Tumors. Target tumor and overall progression, time-to-progression (TTP), and overall survival (OS) were calculated. All outcomes were censored for liver transplantation (LT). Complete pathologic response (CPN) was assessed in patients who underwent LT. Results: Of 142 patients included (NAFLD: 61; HCV: 81), most had cirrhosis (NAFLD: 87%; HCV: 86%) and small tumors (median size NAFLD: 2.3 cm; HCV: 2.5 cm). Patients with NAFLD had higher BMI (p<0.001) and worse ALBI scores (p=0.003). Patients with HCV were younger (p<0.001) and had higher AFP levels (p=0.034). Median radiation dose (NAFLD: 508 Gy; HCV: 452 Gy) and specific activity (NAFLD: 700 Bq; HCV: 698 Bq) were similar between cohorts. Objective response was 100% and 97% in the NAFLD and HCV cohorts, respectively. Target tumor progression occurred in 1 (2%) NAFLD and 8 (10%) HCV patients. Target tumor TTP was not met for either cohort. Overall progression occurred in 23 (38%) NAFLD and 39 (48%) HCV patients. Overall TTP was 17.4 months (95% CI 13.5-22.2) in NAFLD and 13.5 months (95% CI 0.4-26.6) in HCV patients (p=0.86). LT was performed in 27 (44%) NAFLD and 33 (41%) HCV patients, with a CPN rate of 63% and 54%, respectively. OS was not met in the NAFLD cohort and was 53.9 months (95% CI 32.1-75.7) in the HCV cohort (p=0.15). Conclusion: Although NAFLD and HCV are associated with different mechanisms of liver injury, patients with early-stage HCC treated with radiation segmentectomy achieve comparable outcomes.
transarterial chemoembolization (cTACE) vs. yttrium-90 radioembolization (Y90) for Hepatocellular Carcinoma (HCC). Materials: With IRB approval, 45 patients with unresectable HCC were prospectively randomized to cTACE vs. Y90 [PREMIERE TRIAL (1)]. From this cohort, the fluoroscopy times and doses were recorded for all of these patients' procedures. Statistical comparison between both cohorts was conducted using independent sample t-test assuming unequal variances. Statistical significance was set at po0.05. Results: Twenty-one patients received cTACE (32 treatment sessions) and 24 patients received Y90 (29 treatment sessions) with glass microspheres. All Y90 patients had a separate planning angiogram prior to radioembolization. Mean fluoroscopic time (95%CI) for the planning angiography prior to Y90 was 11.6 minutes (9.3-14) and mean fluoroscopic dose was 1611 mGy (969-2253). Mean fluoroscopy time (95%CI) for Y90 treatment procedures was 13.3 minutes (10-16.5) and 18.3 minutes (15.5-21) for cTACE procedures (P ¼ 0.021). Mean fluoroscopic dose (95%CI) for Y90 treatment was 1154 mGy (712-1596) and 1834 mGy (1356-2312) for cTACE (P ¼ 0.035). Mean accumulative fluoroscopic time/dose for Y90 included the dose administered on planning angiography and on treatment day. Mean accumulative fluoroscopy time (95%CI) for cTACE patients after multiple treatments was 29 minutes (21-38) and 28 minutes for Y90 patients (24-33) (P ¼ 0.8213). Mean fluoroscopic dose (95%CI) for Y90 patients was 2978 mGy and 3941 mGy (1830-6053) for cTACE patients (P ¼ 0.4). Conclusions: Y90 radioembolization exposes patients to significantly less fluoroscopy time and dose compared to cTACE per treatment session. When combined with planning angiography, there is no statistically significant difference in fluoroscopy time and dose between Y90 and cTACE.
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