Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm

Abstract

The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

Robotics in Interventional Radiology: Review of Current and Future Applications

“…Many studies have demonstrated efficacy in terms of visualization of artery feeders and reduction of radiation dose in TACE using AFD softwares. 71–73…”

“…71 Many studies have demonstrated efficacy in terms of visualization of artery feeders and reduction of radiation dose in TACE using AFD softwares. [71][72][73] AI and specifically radiomics, with the extraction of quantitative features from radiological images and the combination of these with clinical and genetic/molecular models, have been improving the prognostic assessment prior to perform both percutaneous and endovascular procedures. [74][75][76][77][78][79] In conclusion, robotic-guidance in IR has demonstrated important benefits for its use, with wide applications in endovascular and percutaneous procedures using CT-, MR-, US-imaging and imaging.…”

“…Many studies have been demonstrated the efficacy in term of visualization of artery feeders and in term of reduction of radiation dose of transcatheter arterial chemoembolization (TACE) using AFD softwares. [71][72][73]…”

Comparative effectiveness of interventional therapeutic modalities for unresectable hepatocellular carcinoma: A systematic review and network meta‑analysis

“…The REFLECT trial established the first-line status of lenvatinib ( 45 ), and Ding et al ( 46 ) demonstrated its superior efficacy compared with sorafenib in HCC combination therapy. Regorafenib and cabozantinib, which are the second-line drugs for advanced HCC, were also approved following the RESORCE and CELESTIAL trials ( 47 , 48 ), With the development of drug-eluting beads and the advancement of super-selective TACE ( 2 , 49 ), further studies are recommended to investigate the efficacy of these new oral drugs in combination with interventional modalities for advanced HCC.…”

Investigating Up-to-Seven Criteria and APRI (AST Platelet Ratio) as Prognostic Factors in Intermediate-Stage Hepatocellular Carcinoma Patients Who Received Transarterial Chemoembolization

“…First, it was a retrospectively study. Second, the detail of TACE technique and sequencing were not explored, which could be another factor affecting lower survival outcome (Miyayama et al, 2021). Third, our study was done in one healthcare center.…”