The effect of lipiodol deposition in HCC after TACE on the necrosis range of PMCT

Abstract

ObjectiveTo study the impact of lipiodol deposition in the lesion of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) on the necrosis area of percutaneous microwave coagulation therapy (PMCT).Materials and methodsA total of 44 patients with HCC with 56 nodules, with a size ranging from 1.5 to 3.5 cm, was selected in our study. About 23 patients (26 nodules) underwent PMCT treatment only as Group A and 21 patients (30 nodules) were treated by PMCT-combined TACE as Group B. All patients underwent PMCT with single-electrode and one-point ablation. Paired t-test was used to analyze pre- and postoperatively the volume of tumor and the necrosis volume after PMCT. Independent t-test was used to compare the difference in the necrosis area between two groups (α=0.05).ResultsAll patients underwent PMCT or PMCT combined with TACE successfully. The tumor and necrosis size of Group A was 16.29±19.23 cm3 and 17.98±18.49 cm3 (P=0.650), and 11.95±12.78 cm3 and 16.60±11.70 cm3 of Group B (P=0.017). There was no significant difference on necrosis volume between the two groups (P=0.581). The necrosis area of Group B was larger than the size of the tumor (P=0.017), but the ablation area of the two groups was smaller than the theoretic area (P=0.001). (The theoretic area means that the necrosis area of ablation should be 1.0 cm larger than the tumor in diameter.)ConclusionPMCT combined with TACE could enlarge the ablation area, but will not lead to an ideal necrosis area than the PMCT alone. The lipiodol deposition in the tumor lesion may hinder the expansion of the heating field. Therefore, further research was needed.

Transcatheter arterial chemoembolization monotherapy vs combined transcatheter arterial chemoembolization–percutaneous microwave coagulation therapy for massive hepatocellular carcinoma (≥10 cm)

“…However, hydrothorax and peritonitis were common complications caused by PMCT. 20 In this study, the higher incidence of hydrothorax in the TACE–PMCT group was found compared to other two groups, but hydrothorax can be resolved by applying albumin and diuretic. In addition, pulmonary metastasis, peritonitis, and hepatic encephalopathy were associated with the prognosis of MHCC patients by univariate analysis.…”

“… 23 TACE could alleviate the adverse cooling effect induced by abundant blood flow on microwave thermal coagulation by blocking the tumor vascular bed. 20 , 23 Seki et al 32 reported that the combination of TACE and PMCT might result in higher rates of necrosis and longer survival times compared to treatment with TACE or PMCT alone and improve the prognosis of HCC patients. Up to date, there are limited studies on the efficacy and safety of MHCC patients treated with TACE plus PMCT.…”

“… 15 – 18 PMCT produces high temperature by electrodes inserted into tumor tissue, which can lead to rapid coagulation and necrosis of tumor tissue, so as to achieve the goal of eliminating tumor. 5 , 20 In addition, TACE can lead to ischemia and inflammatory edema of the tumor tissue, which could accelerate tumor necrosis and enhance the coagulation effect of microwaves. 16 This provides a theoretical basis for the combination of TACE and PMCT treatment for MHCC patients.…”

“…PMCT produces high temperature by electrodes inserted into tumor tissue, which can lead to rapid coagulation and necrosis of tumor tissue, so as to achieve the goal of eliminating tumor. 5 , 20 This method gradually became one of the most important treatments for HCC. 21 , 22 Importantly, TACE could reduce the cooling effect of hepatic blood flow on microwave thermal coagulation by blocking the tumor vascular bed.…”

Lipiodol Uptake and Wash-out Rate Detection on Computed Tomography as Predictors for Tumor Recurrence in Hepatocellular Carcinoma Treated by Transcatheter Arterial Chemoembolization

“…One of the treatment modalities for HCC is transcatheter arterial chemoembolization (TACE), which is appropriate for stage B HCC according to Barcelona Clinic Liver Cancer staging system (3). TACE experienced many technical developments as new drugs and delivery systems were developed, but the conventional approach, using Lipiodol emulsion mixed with doxorubicin followed by complete embolization is still one of the most used methods worldwide (4). The follow-up of TACE-treated HCC is performed by computed tomography (CT) and/or magnetic resonance imaging (MRI).…”