Outcomes of Patients with Hepatocellular Carcinoma Treated with Conventional Transarterial Chemoembolization Using Guidance Software

Miyayama, Shiro; Yamashiro, Masashi; Sugimori, Natsuki; Ikeda, Rie; Okimura, Kotaro; Sakuragawa, Naoko

doi:10.1016/j.jvir.2018.08.009

Cited by 30 publications

(29 citation statements)

References 24 publications

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“…TACE induces hypoxic and chemotherapeutic stress on HCC cells, and the surviving hypoxic tumors frequently change to sarcomatous or mixed hepatocholangiocellular phenotypes; in addition, it induces vascular endothelial growth factor, which further promotes tumor progression [31, 32, 34]. Moreover, when the artery is impaired, tumor cells can be fed by the collateral arteries, and infrequently by the portal vein [60]. It is speculated that these factors underlie the development of TACE refractoriness.…”

Section: Methodsmentioning

confidence: 99%

A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements

et al. 2020

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Section: Methodsmentioning

confidence: 99%

A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements

et al. 2020

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“…Hypoxia induced by TACE also stimulates vascular endothelial growth factor (VEGF) production by the residual tumor cells [12]. Intrahepatic distant recurrence also develops more frequently in patients with local tumor progression after cTACE than in patients without local tumor progression [13]. This indicates that some intrahepatic distant recurrence may be related to local tumor progression: metastases from locally progressed tumors or newly developed tumors promoted mainly by high expression of VEGF production from the residual tumor cells.…”

Section: Why Is Ultraselective Ctace Necessary?mentioning

confidence: 99%

“…3, 6). When the branch identified by AFD is agreed on a tumor-feeder, we embolize it without performing selective DSA [13]. This can reduce the procedural time and doses of radiation exposure and contrast material.…”

Section: Technical Tips For Effective Ultraselective Ctacementioning

confidence: 99%

“…This can reduce the procedural time and doses of radiation exposure and contrast material. Based on our recent data, approximately 82% of tumors can be completely embolized with an adequate safety margin without confirmation by DSA and/or CBCT.13 Another advantage of TACE guidance software is that curability and invasiveness can be controlled according to the patient-tumor condition by adjusting the target size [13,46]. The 5-year survival rate of 102 patients with 190HCCs ≤7 cm and ≤5 lesions (mean±SD maximum tumor diameter, 25.3±12.3 mm and mean±SD tumor number, 1.9±1.1 lesions) was 60%.13 This indicates that TACE guidance software can improve the therapeutic effects of ultraselective cTACE.…”

Section: Technical Tips For Effective Ultraselective Ctacementioning

confidence: 99%

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Ultraselective conventional transarterial chemoembolization: When and how?

Miyayama

2019

Clin Mol Hepatol

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Transarterial chemoembolization (TACE) is the most commonly performed therapy for inoperable hepatocellular carcinoma (HCC), although the necessity of chemotherapeutics is still controversial. 1,2 Now, two major techniques are performed: TACE using iodized oil (Lipiodol 480; Guerbet Japan, Tokyo, Japan) emulsion and gelatin sponge (GS) particles (conventional TACE; cTACE); and TACE using drug-eluting beads. The former technique has been mainly developed in Asian countries, and it is a standard treatment option for localized HCCs. However, the therapeutic effects of cTACE are strongly influenced by technical aspects. 3-5 Ultraselective cTACE is defined as cTACE at the most distal portion of the tumor-feeding subsubsegmental hepatic artery and has a strong therapeutic effect on HCCs. 5-8 Therefore, it is important to understand the rationale and techniques of ultraselective cTACE. Why Is ultrAseleCtIve ctACe neCessAry? Complete response at the first TACE is the most robust predictor of a favorable outcome. 9 It is well-known that TACE loads hypoxic and chemotherapeutic stress on HCC and the surviving tumors frequently change to sarcomatous 10 or mixed hepatocholangiocellular 11 phenotypes, which are usually more aggressive and TACEresistant. Hypoxia induced by TACE also stimulates vascular endo

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“…Second, we did not use C-arm CT or guidance software in this study. C-arm CT and guidance software can improve the recognition of EHCs supplying the tumors (35), and we probably missed unsuspected EHCs in some patients. Thus, the prevalence of EHCs in this study may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma With Different Areas of Right Retroperitoneal Space Invasion: Evaluation of Transcatheter Arterial Chemoembolization Efficacy and Blood Supply Characteristics

et al. 2020

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Purpose: To evaluate the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with different areas of right retroperitoneal space (rRPS) invasion and analyze the blood supply. Methods: This retrospective study enrolled 41 patients with HCC with different areas of rRPS invasion treated with TACE, including 22 HCCs with superior aspect of the right perirenal space (SARPS) invasion and 19 HCCs with right anterior pararenal space (RAPS) invasion. The overall response rate (ORR) and disease control rate (DCR) were analyzed. The prognostic factors for overall survival (OS) after TACE were determined. The blood supply characteristics of HCC with different areas of rRPS invasion were analyzed with arteriograms. Results: All patients underwent 2.8 ± 1.8 TACE sessions over 25.0 ± 21.9 months. The median OS was 29.0 months for patients with SARPS invasion and 12.0 months for patients with RAPS invasion (P = 0.004). Only the invaded area of the rRPS was an independent prognostic factor for OS [hazard ratio (HR), 2.833; 95% CI, 1.297-6.188; and P = 0.009). The ORR and DCR were significantly higher in the group with SARPS invasion than in the group with RAPS invasion (ORR: 63.6% vs 31.6%, P = 0.041; DCR: 77.3% vs 47.4%, P = 0.047). Initially, HCC with SARPS invasion were supplied by the hepatic artery (HA; n = 8) and both the HA and extrahepatic collateral vessels (EHCs; n = 14); HCC with RAPS invasion were supplied by the HA (n = 10) and both the HA and EHCs (n = 9); as the TACE sessions increased, the tumor-feeding vessels shifted from the HA to both the HA and EHCs, and even EHCs could be the only blood supply. Rare EHCs appeared earlier and more frequently in the RAPS group than in the SARPS group.

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Outcomes of Patients with Hepatocellular Carcinoma Treated with Conventional Transarterial Chemoembolization Using Guidance Software

Cited by 30 publications

References 24 publications

A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements

A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements

Ultraselective conventional transarterial chemoembolization: When and how?

Hepatocellular Carcinoma With Different Areas of Right Retroperitoneal Space Invasion: Evaluation of Transcatheter Arterial Chemoembolization Efficacy and Blood Supply Characteristics

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