Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

Abstract

Purpose: To evaluate the method and effectiveness of transcatheter arterial chemoembolization (TACE) combined with simultaneous DynaCT-guided Microwave ablation (MWA) for the treatment of small hepatocellular carcinoma (SHCC). Materials and methods: From June 2015 to May 2017, a total of 28 consecutive patients with SHCC received single treatment of TACE and 23 subjects received a combination treatment of TACE with simultaneous DynaCTguided MWA. Following 1 month of treatment, the tumor response was assessed using the mRECIST criteria and the outcomes were analyzed including intervention-associated complications, changes in liver function, imaging response, and progression-free survival (PFS). Results: The technical success rate was 100%. The rates of CR (65%) in the combined TACE and MWA group were higher than those of the TACE group (46%). The rate of common adverse events, such as liver abscess, spontaneous bacterial peritonitis and liver dysfunction, in the combined TACE and MWA group (56%) was comparable to the corresponding rate of the TACE group (P > 0.411). The median and mean PFS of the TACE group were significantly lower than those of the combined TACE and MWA group (19.00 months vs. 29.00 months, 21.076 months vs. 24.693 months, p = 0.019, log-rank test). Conclusion: Stereotactic DynaCT-guided MWA is a safe and effective method for the treatment of SHCC, which usually provides an effective tumor puncture path, notably for lesions that cannot be detected following TACE. Overall, the data suggested that this treatment method could improve the clinical outcome of patients with SHCC.

Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3–<5 cm

“…The mean PFS was significantly higher in the combined group than TACE and MWA groups (p < 0.001). These results are concurrent with the previous studies [4,12,13,22,4,27,28], which showed improved overall and recurrence-free survival and significantly longer time of tumor progression in patients treated with TACE þ MWA compared with TACE alone. In contrast, Chen et al [19] reported that the combined group (TACE þ MWA) had a better time of tumor progression (p ¼ 0.001); however, no significant difference in overall survival (p ¼ 0.317) was observed.…”

“…Regarding the safety of the procedure, in keeping with the literature [4,16,22,25,28,29], the current study demonstrated that the combined therapy was well-tolerated and did not significantly increase the risk of AEs compared with TACE and MWA alone. Although minor AEs were commonly seen in the combined therapy group, they were transient with prompt recovery.…”

The chemical tool-kit for molecular imaging with radionuclides in the age of targeted and immune therapy

“…In addition, its covalent bond with carbon generally has high in vivo kinetic stability. These chemical features, alongside its growing availability, make 18 F an important and attractive radiolabel for an enormous range of potential small molecular radiopharmaceuticals, such as FLT ([ 18 F]-3′-fluoro-3′-deoxythymidine, a nucleoside analogue and cell proliferation marker) [ 21 ]; F-DOPA ([ 18 F]dihydroxyphenylalanine, a dopamine precursor analogue used in neuroendocrine and brain tumours) [ 22 ]; F-MISO ([ 18 F]fluoromisonidazole, a nitroimidazole hypoxia imaging agent) and related nitroimidazole derivatives [ 23 ]; [ 18 F]DCFPyL (a prostate-specific membrane antigen (PSMA) ligand used for prostate cancer imaging) and other 18 F-labelled PSMA ligands [ 24 ]; [ 18 F]fluoroethylcholine [ 25 ] and related tracers for prostate and other tumours; and amino acid analogues such as FET ([ 18 F]fluoroethyltyrosine), [ 26 ] FSPG (3-[ 18 F]fluoropropyl)-L-glutamic acid (glutamate analogue taken up by cells through the system x C− transporter) [ 27 ] and [ 18 F]fluciclovine [ 28 ]; to name but a few (Fig. 4 ).…”

Image-guided microwave ablation of hepatocellular carcinoma (≤5.0 cm): is MR guidance more effective than CT guidance?

“…Of note, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) also use local ablation as first-line treatment for patients with early HCC who are not eligible for surgical treatments or as a bridge to transplantation. At present, computed tomography (CT)-guided thermal ablation is generally accepted by most clinical centers [ 6 – 9 ]. However, unenhanced CT cannot clearly demonstrate the boundary of ablated lesions during the ablation process, and multiple uses of contrast agents will undoubtedly increase the burden on the kidneys.…”