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Ehrengut C, Schindler A, Seehofer D, Ebel S, Steinhoff K, Sabri O, Berg T, Denecke T, Bömmel FVAN, Meyer HJ. The Apparent Diffusion Coefficient of the Paraspinal and Psoas Muscles Are of Prognostic Relevance in Patients With Hepatocellular Carcinoma Undergoing Transarterial Radioembolization. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:281-287. [PMID: 38707727 PMCID: PMC11062171 DOI: 10.21873/cdp.10321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim Transarterial radioembolization (TARE) is a treatment option for early or intermediate stage hepatocellular carcinoma (HCC). Sarcopenia is defined as loss of muscle strength and quality which can be estimated by imaging modalities and has been associated with prognosis and treatment response in HCC patients. Apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) can reflect the tissue composition and might be better to determine muscle changes of sarcopenia than the standard method of computed tomography (CT). The present study sought to elucidate ADC values of the abdominal wall muscles as a prognostic factor in patients undergoing TARE. Patients and Methods A retrospective analysis was performed between 2016 and 2020. Overall, 52 patients, 9 women (17.3%) and 43 men (82.7%), with a mean age of 69±8.5 years were included into the analysis. In every case, the first pre-interventional magnetic resonance imaging (MRI) including DWI was used to measure the ADC values of paraspinal and psoas muscle. The 12-month survival after TARE was used as the primary study outcome. Results Overall, 40 patients (76.9%) of the patient cohort died within the 12-month observation period. Mean overall survival was 10.9 months after TARE for all patients. Mean ADC values for all muscles were 1.31±0.13×10-3mm2/s. The ADC values of the paraspinal muscles were statistically significantly higher compared to the ADC values of the psoas muscles (p=0.0031). A positive correlation was identified between mean ADC and the thrombocyte count (r=0.37, p=0.005) and serum bilirubin (r=-0.30, p=0.03). In the multivariate Cox regression analysis, the mean ADC values of all muscles were associated with the survival after 12 months (HR=0.98, 95% CI=0.97-0.99, p=0.04). Conclusion ADC values of the abdominal wall muscles could be used as a prognostic biomarker in patients with HCC undergoing TARE. These preliminary results should be confirmed by further studies using external validation cohorts and other treatment modalities.
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Affiliation(s)
- Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Aaron Schindler
- Department of Hepatology, University of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Department of Hepatology, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | | | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Wang H, Zhang Y, Du S. Integrated analysis of lactate-related genes identifies POLRMT as a novel marker promoting the proliferation, migration and energy metabolism of hepatocellular carcinoma via Wnt/β-Catenin signaling. Am J Cancer Res 2024; 14:1316-1337. [PMID: 38590398 PMCID: PMC10998737 DOI: 10.62347/zttg4319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a prevalent and deadly form of cancer globally with typically unfavorable outcomes. Increasing research suggests that lactate serves as an important carbon contributor to cellular metabolism and holds a crucial part in the progression, sustenance, and treatment response of tumors. However, the contribution of lactate-related genes (LRGs) in HCC is still unclear. In this study, we analyzed TCGA datasets and screened 21 differentially expressed LRGs related to long-term survivals in HCC patients. Pan-cancer assays revealed that 21 LRGs expression exhibited a dysregulated level in man types of tumors and associated with clinical prognosis of tumor patients. The analysis of 21 LRGs successfully classified HCC samples into two molecular subtypes, and these two subtypes showed significant differences in clinical information, gene expression, and immune characteristics. Subsequently, based on the aforementioned 21 LRGs, a novel prognostic signature (DTYMK, IRAK1, POLRMT, MPV17, UQCRH, PDSS1, SLC16A3, SPP1 and LDHD) was generated by LASSO-Cox regression analysis. Survival assays demonstrated that the signature performed well in predicting the overall survival of patients with HCC. The results of Gene Set Variation Analysis indicated that the high GSVA scores were associated with poor prognosis. Moreover, we also investigated the correlation between GSVA scores and various signaling pathways in HCC. Among the nine prognostic genes, our attention focused on POLRMT which was highly expressed in HCC specimens based on TCGA datasets and several HCC cell lines. In addition, functional assays indicated that POLRMT distinctly promoted the proliferation, migration and energy metabolism of HCC cells via regulating Wnt/β-Catenin signaling. Overall, through the establishment of a novel prognostic signature, we have provided potential clinical value for assessing the prognosis of HCC patients. Furthermore, our study has identified the high expression of POLRMT in HCC and demonstrated its crucial role in HCC cell proliferation. These findings hold great importance in advancing our understanding of the pathophysiology of HCC, identifying new therapeutic targets, and improving patient survival rates.
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Affiliation(s)
- Huifen Wang
- Department of Gastroenterology, China-Japan Friendship Hospital Beijing 100029, P. R. China
| | - Yanli Zhang
- Department of Gastroenterology, China-Japan Friendship Hospital Beijing 100029, P. R. China
| | - Shiyu Du
- Department of Gastroenterology, China-Japan Friendship Hospital Beijing 100029, P. R. China
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Alolyan A, Alshammari K, Arabi M, Alshehri A, Alsuhaibani H, Ibnshamsah F, Alsharm A, Mahrous M, Al Zanbagi A, Hassanain M, Bazarbashi S. Treatment Patterns and Recommendations for Improving the Management of Hepatocellular Carcinoma in Saudi Arabia. J Hepatocell Carcinoma 2024; 11:349-362. [PMID: 38385059 PMCID: PMC10879627 DOI: 10.2147/jhc.s442842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common type of cancer in the world associated with high morbidity and mortality. Despite being a significant healthcare burden there is limited information on the unmet needs and current treatment practices for intermediate and advanced-stage HCC in Saudi Arabia. This article analyzes the gaps and provides expert consensus on the management strategies for unresectable HCC in Saudi Arabia. A pre-meeting online questionnaire, comprising 20 objective questions about the treatment landscape and diagnosis of HCC in Saudi Arabia, was distributed to experts in the field of HCC management. An advisory board meeting including a panel of 13 experts was held in September 2022 where the responses to the survey questionnaire were reviewed and discussed. The survey results and experts' discussion highlighted the growing incidence of liver cancer in Saudi Arabia. HCC comprised the majority of all liver cancer cases due to rising rates of chronic viral infections and lifestyle-related risk factors. Most physicians in Saudi Arabia follow the Barcelona Clinic Liver Cancer guidelines as a prognostic tool for the detection and staging of patients with HCC. Most of the patients with HCC in Saudi Arabia are diagnosed in the intermediate or advanced stages with poor prognoses and limited therapeutic options. Establishing evidence-based surveillance techniques, a multidisciplinary approach to diagnosis, and better accessibility of treatment options is vital for the management of HCC in Saudi Arabia.
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Affiliation(s)
- Ashwaq Alolyan
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Kanan Alshammari
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Arabi
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alshehri
- Department of Oncology, King Khalid National Guard Hospital Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hamad Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fahad Ibnshamsah
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mervat Mahrous
- Department of Oncology, Prince Sultan Military Medical City Hospital, Riyadh, Saudi Arabia
- Department of Medicine, Minia University of Egypt, Faculty of Medicine, Minia, Egypt
| | - Adnan Al Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, King Saudi University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Demirtaş CK, Can M, Karadeniz Ö, Çilengiroğlu ÖV, Ertay T, Kaya GÇ. Energy window optimization in bremsstrahlung imaging after Yttrium-90 microsphere therapy. Biomed Phys Eng Express 2024; 10:025028. [PMID: 38306962 DOI: 10.1088/2057-1976/ad25ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024]
Abstract
In imaging of Yttrium-90 patients treated hepatic primary and metastatic cancers, bremsstrahlung photons produced in a wide energy range is used. However, the image quality depends on acquisition energy window. This research aimed energy window optimization for Yttrium-90 bremsstrahlung imaging and 48 patients with various types of cancer received radioembolization therapy were investigated. Patients were imaged using a GE Healthcare Optima NM/CT 640 series gamma camera system with a medium energy general-purpose (MEGP) collimator and planar images were acquired with 8 different energy windows in the 55-400 keV energy range. The data set, formed with the % FOV, contrast, and spatial resolution of image quality parameters calculated from these images, was statistically examined with ANOVA and Tukey tests. According to the visual evaluations and ANOVA/Tukey test results, it was statistically concluded that energy window of 90-110 keV is the optimal energy window while 60-400 keV energy ranges show the lowest image quality for Y-90 bremsstrahlung imaging.
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Affiliation(s)
- C Kayaş Demirtaş
- Department of Medical Physics, Institute of Health Sciences, Dokuz Eylül University, 35340, İnciraltı, İzmir, Turkey
| | - M Can
- Department of Medical Physics, Institute of Health Sciences, Dokuz Eylül University, 35340, İnciraltı, İzmir, Turkey
- Program of Nuclear Medicine Techniques, Vocational School of Health Services, Dokuz Eylül University, 35330, İnciralti, İzmir, Turkey
| | - Ö Karadeniz
- Department of Medical Physics, Institute of Health Sciences, Dokuz Eylül University, 35340, İnciraltı, İzmir, Turkey
- Department of Physics, Faculty of Sciences, Dokuz Eylül University, 35390, Tınaztepe, Izmir, Turkey
| | - Ö Vupa Çilengiroğlu
- Department of Statistics, Faculty of Sciences, Dokuz Eylül University, 35390, Tınaztepe, Izmir, Turkey
| | - T Ertay
- Department of Medical Physics, Institute of Health Sciences, Dokuz Eylül University, 35340, İnciraltı, İzmir, Turkey
- Department of Nuclear Medicine, Faculty of Medicine, Dokuz Eylül University, 35340, Inciraltı, Izmir, Turkey
| | - G Çapa Kaya
- Department of Medical Physics, Institute of Health Sciences, Dokuz Eylül University, 35340, İnciraltı, İzmir, Turkey
- Department of Nuclear Medicine, Faculty of Medicine, Dokuz Eylül University, 35340, Inciraltı, Izmir, Turkey
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Badar W, Yu Q, Patel M, Ahmed O. Transarterial Radioembolization for Management of Hepatocellular Carcinoma. Oncologist 2024; 29:117-122. [PMID: 38128565 PMCID: PMC10836303 DOI: 10.1093/oncolo/oyad327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Transarterial radioembolization (TARE) with Yttrium-90 (Y90) is a growing area of study due to its benefits in early-, intermediate-, and late-stage hepatocellular carcinoma. Treatment intent, including curative therapy, bridging to transplant, and downstaging disease, informs treatment approach and dosimetry goals. Radiation lobectomy (RL) and radiation segmentectomy (RS) are the 2 main forms of Y90 administration which have shown improved survival outcomes with the development of personalized dosimetry. RS aims to achieve complete pathological necrosis with dose escalation and RL aims for local disease control as well as induction of contralateral lobe hypertrophy to improve hepatic reserve. Furthermore, TARE has been validated in head-to-head comparison to other locoregional and systemic therapies. Lastly, early potential exists for combination therapy between TARE and immune checkpoint inhibitors for advanced stage disease.
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Affiliation(s)
- Wali Badar
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Qian Yu
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Mikin Patel
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, IL, USA
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Karimi A, Yarmohammadi H, Erinjeri JP. Immune Effects of Intra-Arterial Liver-Directed Therapies. J Vasc Interv Radiol 2024; 35:178-184. [PMID: 38272638 DOI: 10.1016/j.jvir.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/08/2023] [Accepted: 10/21/2023] [Indexed: 01/27/2024] Open
Abstract
Image-guided intra-arterial locoregional therapies (LRTs) such as transarterial embolization, transarterial chemoembolization, and transarterial radioembolization exhibit effects on the immune system. Understanding the humoral (cytokine, chemokine, and growth factor) and cellular (T cell, neutrophil, dendritic cell, and macrophage) mechanisms underlying the immune effects of LRT is crucial to designing rational and effective combinations of immunotherapy and interventional radiology procedures. This article aims to review the immune effects of intra-arterial LRTs and provide insight into strategies to combine LRTs with systemic immunotherapy.
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Affiliation(s)
- Anita Karimi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Mirza-Aghazadeh-Attari M, Srinivas T, Kamireddy A, Kim A, Weiss CR. Radiomics Features Extracted From Pre- and Postprocedural Imaging in Early Prediction of Treatment Response in Patients Undergoing Transarterial Radioembolization of Hepatic Lesions: A Systematic Review, Meta-Analysis, and Quality Appraisal Study. J Am Coll Radiol 2024:S1546-1440(24)00002-4. [PMID: 38220040 DOI: 10.1016/j.jacr.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Transarterial radioembolization (TARE) is one of the most promising therapeutic options for hepatic masses. Radiomics features, which are quantitative numeric features extracted from medical images, are considered to have potential in predicting treatment response in TARE. This article aims to provide meta-analytic evidence and critically appraise the methodology of radiomics studies published in this regard. METHODS A systematic search was performed on PubMed, Scopus, Embase, and Web of Science. All relevant articles were retrieved, and the characteristics of the studies were extracted. The Radiomics Quality Score and Checklist for Evaluation of Radiomics Research were used to assess the methodologic quality of the studies. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve in predicting objective response were determined. RESULTS The systematic review included 15 studies. The average Radiomics Quality Score of these studies was 11.4 ± 2.1, and the average Checklist for Evaluation of Radiomics Research score was 33± 6.7. There was a notable correlation (correlation coefficient = 0.73) between the two metrics. Adherence to quality measures differed considerably among the studies and even within different components of the same studies. The pooled sensitivity and specificity of the radiomics models in predicting complete or partial response were 83.5% (95% confidence interval 76%-88.9%) and 86.7% (95% confidence interval 78%-92%), respectively. CONCLUSION Radiomics models show great potential in predicting treatment response in TARE of hepatic lesions. However, the heterogeneity seen between the methodologic quality of studies may limit the generalizability of the results. Future initiatives should aim to develop radiomics signatures using multiple external datasets and adhere to quality measures in radiomics methodology.
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Affiliation(s)
- Mohammad Mirza-Aghazadeh-Attari
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Tara Srinivas
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Arun Kamireddy
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Alan Kim
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland.
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Ingenerf M, Grawe F, Winkelmann M, Karim H, Ruebenthaler J, Fabritius MP, Ricke J, Seidensticker R, Auernhammer CJ, Zacherl MJ, Seidensticker M, Schmid-Tannwald C. Neuroendocrine liver metastases treated using transarterial radioembolization: Identification of prognostic parameters at 68Ga-DOTATATE PET/CT. Diagn Interv Imaging 2024; 105:15-25. [PMID: 37453859 DOI: 10.1016/j.diii.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To identify prognostic clinical and imaging parameters for patients with neuroendocrine liver metastases (NELMs) undergoing transarterial radioembolization (TARE). MATERIALS AND METHODS Forty-seven patients (27 men; mean age, 64 years) with NELMs who received TARE, along with pre-procedure liver MRI and 68Ga-DOTATATE positron emission tomography/computed tomography were included. Apparent diffusion coefficient and standardized uptake value (SUV) of three liver metastases, normal spleen and liver were measured. SUVmax or SUVmean were used for the calculation of tumor-to-organ ratios (tumor-to-spleen and tumor-to-liver ratios) using all possible combinations (including SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean). Clinical parameters (hepatic tumor-burden, presence of extra-hepatic metastases, chromograninA, Ki-67 and bilirubin levels) were assessed. Overall survival, progression-free survival (PFS) and hepatic progression-free survival (HPFS) were calculated using Kaplan-Meier curves. RESULTS Median overall survival, PFS and HPFS were 49.6, 13.1 and 28.3 months, respectively. In multivariable Cox regression analysis, low Ki-67 (≤ 5%), low hepatic tumor-burden (< 10%), absence of extrahepatic metastases, and increased Tmean/Lmax ratio were significant prognostic factors of longer overall survival and HPFS. High baseline chromograninA (> 1330 ng/mL) was associated with shorter HPFS. Tmean/Lmax > 1.9 yielded a median overall survival of 69 vs. 33 months (P < 0.04), and a median HPFS of 30 vs. 19 months (P = 0.09). For PFS, high baseline SUVmax of NELMs was the single significant parameter in the multivariable model. SUVmax > 28 resulted in a median PFS of 16.9 vs. 6.5 months, respectively (P = 0.001). CONCLUSION High preinterventional Tmean/Lmax ratios, and high SUVmax on 68Ga-DOTATATE positron emission tomography/computed tomography seem to have prognostic value in patients with NELMs undergoing TARE, potentially aiding patient selection and management alongside conventional variables.
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Affiliation(s)
- Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Michael Winkelmann
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Homeira Karim
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Johannes Ruebenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Christoph Josef Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Christine Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
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Elvevi A, Laffusa A, Elisei F, Morzenti S, Guerra L, Rovere A, Invernizzi P, Massironi S. Any role for transarterial radioembolization in unresectable intrahepatic cholangiocarcinoma in the era of advanced systemic therapies? World J Hepatol 2023; 15:1284-1293. [PMID: 38223418 PMCID: PMC10784807 DOI: 10.4254/wjh.v15.i12.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is recognized as the second most frequently diagnosed liver malignancy, following closely after hepatocellular carcinoma. Its incidence has seen a global upsurge in the past several years. Unfortunately, due to the lack of well-defined risk factors and limited diagnostic tools, iCCA is often diagnosed at an advanced stage, resulting in a poor prognosis. While surgery is the only potentially curative option, it is rarely feasible. Currently, there are ongoing investigations into various treatment approaches for unresectable iCCA, including conventional chemotherapies, targeted therapies, immunotherapies, and locoregional treatments. This study aims to explore the role of transarterial radioembolization (TARE) in the treatment of unresectable iCCA and provide a comprehensive review. The findings suggest that TARE is a safe and effective treatment option for unresectable iCCA, with a median overall survival (OS) of 14.9 months in the study cohort. Studies on TARE for unresectable iCCA, both as a first-line treatment (as a neo-adjuvant down-staging strategy) and as adjuvant therapy, have reported varying median response rates (ranging from 34% to 86%) and median OS (12-16 mo). These differences can be attributed to the heterogeneity of the patient population and the limited number of participants in the studies. Most studies have identified tumor burden, portal vein involvement, and the patient's performance status as key prognostic factors. Furthermore, a phase 2 trial evaluated the combination of TARE and chemotherapy (cisplatin-gemcitabine) as a first-line therapy for locally advanced unresectable iCCA. The results showed promising outcomes, including a median OS of 22 mo and a 22% achievement in down-staging the tumor. In conclusion, TARE represents a viable treatment option for unresectable iCCA, and its combination with systemic chemotherapy has shown promising results. However, it is important to consider treatment-independent factors that can influence prognosis. Further research is necessary to identify optimal treatment combinations and predictive factors for a favorable response in iCCA patients.
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Affiliation(s)
- Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Alice Laffusa
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Federica Elisei
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori University of Milano Bicocca, Monza 20900, Italy
| | - Sabrina Morzenti
- Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Luca Guerra
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori University of Milano Bicocca, Monza 20900, Italy
| | - Antonio Rovere
- Department of Radiology and Interventional Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy.
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10
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Dalzell CG, Taylor AC, White SB. New Insights on Liver-Directed Therapies in Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:5749. [PMID: 38136295 PMCID: PMC10741466 DOI: 10.3390/cancers15245749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) has been increasing over the past decades, but improvements in systemic and locoregional therapies is increasing survival. Current locoregional treatment options include ablation, transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and stereotactic body radiotherapy (SBRT). There is ongoing research regarding the combination of systemic and local therapies to maximize treatment effect as well as in new non-invasive, image-guided techniques such as histotripsy. There is also active research in optimizing the delivery of therapy to tumors via nanostructures and viral-vector-mediated gene therapies. In many cases, patients require a combination of therapies to achieve tumor control and prolong survival. This article provides an overview of the most common liver-directed therapies for HCC as well as insight into more recent advances in personalized medicine and emerging techniques.
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Affiliation(s)
- Christina G. Dalzell
- Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Amy C. Taylor
- Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Sarah B. White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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11
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Choksi EJ, Elsayed M, Kokabi N. Antitumor Activity of Metformin Combined with Locoregional Therapy for Liver Cancer: Evidence and Future Directions. Cancers (Basel) 2023; 15:4538. [PMID: 37760509 PMCID: PMC10526211 DOI: 10.3390/cancers15184538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This article aimed to examine the effect of metformin use on improving outcomes after liver-directed therapy in patients with HCC and identify future directions with the adjuvant use of and potential therapeutic agents that operate on similar mechanistic pathways. Databases were queried to identify pertinent articles on metformin's use as an anti-cancer agent in HCC. Eleven studies were included, with five pre-clinical and six clinical studies. The mean overall survival (OS) and progression-free survival were both higher in the locoregional therapy (LRT) + metformin-treated groups. The outcome variables, including local tumor recurrence rate, reduction in HCC tumor growth and size, tumor growth, proliferation, migration and invasion of HCC cells, HCC cell apoptosis, DNA damage, and cell cycle arrest, showed favorable outcomes in the LRT + metformin-treated groups compared with LRT alone. This systemic review provides a strong signal that metformin use can improve the tumor response after locoregional therapy. Well-controlled prospective trials will be needed to elucidate the potential antitumor effects of metformin and other mTOR inhibitors.
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Affiliation(s)
- Eshani J. Choksi
- School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, USA;
| | - Mohammad Elsayed
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nima Kokabi
- Department of Radiology, Division of Interventional Radiology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
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12
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Almaguer J, Khan A, Saleem A. Pre-transarterial Radioembolization of Tumoral Arteriovenous Fistula Associated With Recanalized Umbilical Vein Shunt in a Case of Hepatocellular Carcinoma With Hepatic Vein and Inferior Vena Cava Invasion. Cureus 2023; 15:e44784. [PMID: 37680256 PMCID: PMC10482310 DOI: 10.7759/cureus.44784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common liver cancer and has a propensity to develop arteriovenous fistulas with the surrounding vasculature, making targeted intravascular treatment more difficult. HCC can oftentimes be accompanied by portal hypertension and liver cirrhosis, which can, in turn, cause recanalization of the umbilical vein. In rare circumstances, arteriovenous fistula formation and shunting into the recanalized and enlarged umbilical vein can occur. In the following presented case of HCC, an arteriovenous shunt between the anterior division of the right hepatic artery and a recanalized umbilical vein is demonstrated. Subsequent successful endovascular coil embolization of the fistula was performed to avoid shunting and non-target embolization of the radiation particles in the umbilical vein territory. Post-embolization angiogram with DynaCT and lack of Tc-99m macroaggregated albumin deposition in the umbilical vein distribution confirmed the resolution of the shunt. The patient then received targeted Y-90 transarterial radioembolization locoregional therapy in combination with systemic therapy.
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Affiliation(s)
- Joey Almaguer
- Radiology, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Ahmed Khan
- Vascular and Interventional Radiology, University of Texas Medical Branch, Galveston, USA
| | - Arsalan Saleem
- Vascular and Interventional Radiology, University of Texas Medical Branch, Galveston, USA
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13
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Auer TA, Collettini F, Segger L, Pelzer U, Mohr R, Krenzien F, Gebauer B, Geisel D, Hosse C, Schöning W, Fehrenbach U. Interventional Treatment Strategies in Intrahepatic Cholangiocarcinoma and Perspectives for Combined Hepatocellular-Cholangiocarcinoma. Cancers (Basel) 2023; 15:cancers15092655. [PMID: 37174120 PMCID: PMC10177209 DOI: 10.3390/cancers15092655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
cHCC-CCA is an uncommon type of liver cancer that exhibits clinical and pathological characteristics of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), which are the two main forms of primary liver cancer. The similarity to HCC and CCA makes therapeutical strategies challenging. The poor prognosis of CCA in general, as well as for cHCC-CCA, is mainly attributable to the fact that diagnosis is often at an advanced stage of disease. During the last decade, locoregional therapies usually performed by interventional radiologists and its established role in HCC treatment have gained an increasing role in CCA treatment as well. These comprise a wide range of options from tumor ablation procedures such as radiofrequency ablation (RFA), microwave ablation (MWA), computed tomography high-dose rate brachytherapy (CT-HDRBT), and cryoablation to transarterial chemoembolization (TACE), including the option of intra-arterial administration of radioactive spheres (transarterial radioembolization-TARE), and much attention has focused on the potential of individual concepts in recent years. The purpose of this review is to provide an overview of current radiologic interventions for CCA (excluding options for eCCA), to review and appraise the existing literature on the topic, and to provide an outlook on whether such interventions may have a role as treatment for cHCC-CCA in the future.
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Affiliation(s)
- Timo Alexander Auer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Laura Segger
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Uwe Pelzer
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Raphael Mohr
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Felix Krenzien
- Department of Surgery-CVK/CCM, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Clarissa Hosse
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery-CVK/CCM, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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14
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Garfinkel A, Nagourney A, Larson MC. Hematoma Disguised as Cancer. Cureus 2023; 15:e39665. [PMID: 37398808 PMCID: PMC10307931 DOI: 10.7759/cureus.39665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Hematomas are often associated with benign processes such as sport-related injuries, postsurgical complications, and medications such as blood thinners. Rarely, hematomas can occur spontaneously without any identifiable cause or recollection of an inciting event. Such events can lead to inaccurately diagnosing a patient, which could delay or alter treatment and worsen the patient's prognosis. This patient reported sudden-onset abdominal pain with radiation to her back and denied any recent medication use or trauma while at home. The case highlights the key radiographic findings of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound to eventually confirm an obscure case of hepatocellular carcinoma and help guide management.
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Affiliation(s)
- Alec Garfinkel
- Radiology, California Northstate University College of Medicine, Elk Grove, USA
| | - Alex Nagourney
- Internal Medicine, California Northstate University College of Medicine, Elk Grove, USA
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15
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Kauffman N, Morrison J, O’Brien K, Fan J, Zinn KR. Intra-Arterial Delivery of Radiopharmaceuticals in Oncology: Current Trends and the Future of Alpha-Particle Therapeutics. Pharmaceutics 2023; 15:pharmaceutics15041138. [PMID: 37111624 PMCID: PMC10144492 DOI: 10.3390/pharmaceutics15041138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
A paradigm shift is underway in cancer diagnosis and therapy using radioactivity-based agents called radiopharmaceuticals. In the new strategy, diagnostic imaging measures the tumor uptake of radioactive agent “X” in a patient’s specific cancer, and if uptake metrics are realized, the patient can be selected for therapy with radioactive agent “Y”. The X and Y represent different radioisotopes that are optimized for each application. X–Y pairs are known as radiotheranostics, with the currently approved route of therapy being intravenous administration. The field is now evaluating the potential of intra-arterial dosing of radiotheranostics. In this manner, a higher initial concentration can be achieved at the cancer site, which could potentially enhance tumor-to-background targeting and lead to improved imaging and therapy. Numerous clinical trials are underway to evaluate these new therapeutic approaches that can be performed via interventional radiology. Of further interest is changing the therapeutic radioisotope that provides radiation therapy by β- emission to radioisotopes that also decay by α-particle emissions. Alpha (α)-particle emissions provide high energy transfer to the tumors and have distinct advantages. This review discusses the current landscape of intra-arterially delivered radiopharmaceuticals and the future of α-particle therapy with short-lived radioisotopes.
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Affiliation(s)
- Nathan Kauffman
- Comparative Medicine and Integrative Biology, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - James Morrison
- Advanced Radiology Services, 3264 N Evergreen Dr, Grand Rapids, MI 49525, USA
| | - Kevin O’Brien
- Department of Radiology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Jinda Fan
- Departments of Radiology and Chemistry, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Kurt R. Zinn
- Departments of Radiology, Biomedical Engineering, Small Animal Clinical Sciences, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
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16
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Wong JK, Lim HJ, Tam VC, Burak KW, Dawson LA, Chaudhury P, Abraham RJ, Meyers BM, Sapisochin G, Valenti D, Samimi S, Ramjeesingh R, Mujoomdar A, Martins I, Dixon E, Segedi M, Liu DM. Clinical consensus statement: Establishing the roles of locoregional and systemic therapies for the treatment of intermediate-stage hepatocellular carcinoma in Canada. Cancer Treat Rev 2023; 115:102526. [PMID: 36924644 DOI: 10.1016/j.ctrv.2023.102526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) a leading cause of cancer mortality worldwide and approximately one-third of patients present with intermediate-stage disease. The treatment landscape of intermediate-stage HCC is rapidly evolving due to developments in local, locoregional and systemic therapies. Treatment recommendations focused on this heterogenous disease stage and that take into account the Canadian reality are lacking. To address this gap, a pan-Canadian group of experts in hepatology, transplant, surgery, radiation therapy, nuclear medicine, interventional radiology, and medical oncology came together to develop consensus recommendations on management of intermediate-stage HCC relevant to the Canadian context. METHODS A modified Delphi framework was used to develop consensus statements with strengths of recommendation and supporting levels of evidence graded using the AHA/ACC classification system. Tentative consensus statements were drafted based on a systematic search and expert input in a series of iterative feedback cycles and were then circulated via online survey to assess the level of agreement. RESULTS & CONCLUSION The pre-defined ratification threshold of 80 % agreement was reached for all statements in the areas of multidisciplinary treatment (n = 4), intra-arterial therapy (n = 14), biologics (n = 5), radiation therapy (n = 3), surgical resection and transplantation (n = 7), and percutaneous ablative therapy (n = 4). These generally reflected an expansion in treatment options due to developments in previously established or emergent techniques, introduction of new and more active therapies and increased therapeutic flexibility. These developments have allowed for greater treatment tailoring and personalization as well as a paradigm shift toward strategies with curative intent in a wider range of disease settings.
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Affiliation(s)
- Jason K Wong
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Howard J Lim
- BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Vincent C Tam
- Tom Baker Cancer Centre, University of Calgary, 1331 29 St NW, Calgary, AB T2N 4N2, Canada.
| | - Kelly W Burak
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Laura A Dawson
- Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON M5G 2C1, Canada.
| | | | - Robert J Abraham
- Department of Diagnostic Radiology, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.
| | - Brandon M Meyers
- Juravinski Cancer Centre, 699 Concession St, Hamilton, ON L8V 5C2, Canada.
| | | | - David Valenti
- McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada.
| | - Setareh Samimi
- Hopital Sacre-Coeur de Montreal, University of Montreal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada.
| | - Ravi Ramjeesingh
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.
| | - Amol Mujoomdar
- Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada.
| | - Ilidio Martins
- Kaleidoscope Strategic, Inc. 1 King Street W, Suite 4800 - 117, Toronto, ON M5H 1A1, Canada.
| | - Elijah Dixon
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Maja Segedi
- Department of Surgery, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
| | - David M Liu
- School of Biomedical Engineering, University of British Columbia, 2329 West Mall Vancouver, BC V6T 1Z4, Canada.
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17
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Guven DC, Yildirim HC, Chalabiyev E, Kus F, Yilmaz F, Yasar S, Akyildiz A, Aktas BY, Yalcin S, Dizdar O. Emerging treatment strategies in hepatobiliary cancer. Expert Rev Anticancer Ther 2023; 23:243-256. [PMID: 36803258 DOI: 10.1080/14737140.2023.2183844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION There have been significant advances in the treatment of hepatobiliary cancers, especially for advanced-stage disease. However, data is limited for optimal therapy selection in the first line and sequencing of available options. AREAS COVERED This review covers the systemic treatment of hepatobiliary cancers with an emphasis on the advanced stage. The previously published and ongoing trials will be discussed to create an algorithm for the current practice and to give future perspectives on how the field could go forward. EXPERT OPINION While there is no standard-of-care option in the adjuvant treatment of hepatocellular cancer, capecitabine is the standard of care for biliary tract cancer. The efficacy of adjuvant gemcitabine and cisplatin and the added benefit of radiotherapy to chemotherapy are yet to be defined. For the advanced stage, immunotherapy-based combinations became the standard of care for both hepatocellular and biliary tract cancers. The molecularly targeted therapy has profoundly changed the second-line and later treatment for biliary tract cancers, while the optimal second-line treatment for advanced hepatocellular cancer is yet to be defined due to rapid advances in the first-line setting.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Elvin Chalabiyev
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Fatih Kus
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Feride Yilmaz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Serkan Yasar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Burak Yasin Aktas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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18
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Srinivas S, Rose SC, Al Jammal O, Hsieh LJ, Rockwell HD, Duncan DP, Minocha J, Berman ZT. Boosted-Dose Yttrium-90 Radiation Segmentectomy or Lobectomy for Hepatocellular Carcinoma Refractory to Prior Transarterial Embolization or Chemoembolization: A Single Institution Retrospective Case Series. Cardiovasc Intervent Radiol 2023; 46:460-469. [PMID: 36854903 DOI: 10.1007/s00270-023-03388-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE To assess the tumor response rates and liver toxicity of boosted-dose transarterial radioembolization (TARE) for treatment of hepatocellular carcinoma (HCC) refractory to previous transarterial embolization (TAE) and/or chemoembolization (TACE). MATERIALS AND METHODS All patients were identified who had HCC treated between 2017 and 2020 that had been refractory to prior TAE or TACE, then treated with boosted-dose segmental or lobar TARE. Tumor response was assessed by multiphasic CT or MRI using localized mRECIST imaging criteria and serological alpha-fetoprotein levels at three and six months after TARE, if available. Liver toxicity was evaluated using serial serological liver function tests, platelet counts, and clinical Child-Pugh and MELD scores. RESULTS Twenty-four patients met inclusion criteria. Mean age was 68.7 years (54-89); 8 were females. Three (12.5%) patients had Barcelona Clinical Liver Cancer stage A, 4 (16.7%) stage B, and 17 (70.8%) stage C disease. Three months after TARE, 52% of patients had a complete response and 33% had a partial response. Mean AFP decreased from 33.2 ng/mL at baseline to 17 ng/mL at 3 months (p = 0.782). The median MELD-Na score increased from 11 at baseline to 16 at 6 months post-TARE (p = 0.044); the mean Child-Pugh score rose from 5 at baseline to 6 at 3 months post-TARE (p < 0.01). CONCLUSION Boosted-dose TARE resulted in statistically significant favorable tumor responses by imaging criteria in 85% of patients previously refractory to TAE or TACE. TARE resulted in transient but acceptable deterioration of liver function and clinical scores.
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Affiliation(s)
- Shanmukha Srinivas
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 92095, USA
| | - Steven C Rose
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Omar Al Jammal
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Lee J Hsieh
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Helena D Rockwell
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - David P Duncan
- Department of Radiology, Vanderbilt University, 1161 21st Avenue, South Nashville, TN, 37232, USA
| | - Jeet Minocha
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Zachary T Berman
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
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19
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Kim HC, Kim GM. Radiation pneumonitis following Yttrium-90 radioembolization: A Korean multicenter study. Front Oncol 2023; 13:977160. [PMID: 36726383 PMCID: PMC9885146 DOI: 10.3389/fonc.2023.977160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
Objective To report the incidence of radiation pneumonitis after radioembolization. Methods In this retrospective study, from May 2009 to July 2021, 782 consecutive patients underwent radioembolization in two institutes. Medical internal radiation dose dosimetry and partition dosimetry were used for glass and resin Yttrium-90-labeled microspheres (90Y-microspheres), respectively. Medical records and radiological findings were retrospectively evaluated with emphasis on the symptomatic radiation pneumonitis. Results Of the 732 patients with lung shunt study and follow-up, 13 (1.8%) had symptomatic radiation pneumonitis and six patients died due to radiation pneumonitis. Of the 721 patients whose lung doses were calculated, 10 patients who were treated with glass (n = 5) and resin (n = 5) 90Y-microspheres had radiation pneumonitis. No significant statistical difference between glass and resin 90Y-microspheres (p = 0.304) was noted in terms of radiation pneumonitis incidence. Among the patients with radiation pneumonitis, all five patients treated with glass 90Y-microspheres had estimated lung doses > 29 Gy, whereas five patients treated with resin 90Y-microspheres had relatively wide range of lung dose reaching much lower value (13.21Gy). Conclusion The present study suggests that radiation pneumonitis after radioembolization may occur even though the manufacturer's instructions are followed.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea,*Correspondence: Gyoung Min Kim,
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20
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Chung SW, Cho H, Shin H, Park J, Kim JY, Hong JH, Hur MH, Park MK, Lee YB, Yu SJ, Lee M, Kim YJ, Paeng JC, Yoon JH, Chung JW, Lee JH, Kim HC. Transarterial chemoembolization as an alternative to radioembolization is associated with earlier tumor recurrence than in radioembolization-eligible patients. Front Oncol 2023; 13:1081479. [PMID: 36925930 PMCID: PMC10013818 DOI: 10.3389/fonc.2023.1081479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Although transarterial radioembolization (TARE) using yttrium-90 (90Y) is a treatment option for large hepatocellular carcinoma (HCC), a fraction of patients are ineligible for TARE due to high lung shunt fraction (LSF). Methods We evaluated if treatment with transarterial chemoembolization (TACE), owing to TARE ineligibility was associated with early HCC progression. Consecutive patients with HCC who were initially TARE candidates were included. Patients with vascular invasion or metastasis were excluded. Primary endpoints were time-to-progression (TTP) and overall survival (OS). The secondary endpoint was objective response rate. Results In total, 175 patients were included: 144 underwent TARE (TARE-eligible group) and 31 underwent TACE due to high LSF (TARE-ineligible group). This latter group had larger tumors (13.8 cm vs. 7.8 cm, P<0.001) and higher MoRAL scores (1,385.8 vs. 413.3, P=0.002) than the TARE-eligible group. After balancing baseline characteristics with an inverse probability of treatment weighting (IPTW), the TARE-ineligible group showed shorter TTP [adjusted hazard ratio (aHR)=2.16, 95% confidence interval (CI)=1.14-4.07, P=0.02] and OS (aHR=1.80, 95% CI=0.85-3.80, P=0.12), although the latter was not statistically significant. The TARE-ineligible group had a significantly lower objective response rate than the TARE-eligible group (9.7% vs. 56.9%, P<0.001). Conclusion TARE-ineligible patients had larger tumors and higher MoRAL scores than TARE-eligible patients. Treatment with TACE, owing to high LSF, was associated with a shorter TTP even after balancing tumor size and MoRAL scores.
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Affiliation(s)
- Sung Won Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heejin Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyunjae Shin
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeayeon Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon Haeng Hur
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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21
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Pal K, Sheth RA. Engineering the Tumor Immune Microenvironment through Minimally Invasive Interventions. Cancers (Basel) 2022; 15:cancers15010196. [PMID: 36612192 PMCID: PMC9818918 DOI: 10.3390/cancers15010196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
The tumor microenvironment (TME) is a unique landscape that poses several physical, biochemical, and immune barriers to anti-cancer therapies. The rapidly evolving field of immuno-engineering provides new opportunities to dismantle the tumor immune microenvironment by efficient tumor destruction. Systemic delivery of such treatments can often have limited local effects, leading to unwanted offsite effects such as systemic toxicity and tumor resistance. Interventional radiologists use contemporary image-guided techniques to locally deliver these therapies to modulate the immunosuppressive TME, further accelerating tumor death and invoking a better anti-tumor response. These involve local therapies such as intratumoral drug delivery, nanorobots, nanoparticles, and implantable microdevices. Physical therapies such as photodynamic therapy, electroporation, hyperthermia, hypothermia, ultrasound therapy, histotripsy, and radiotherapy are also available for local tumor destruction. While the interventional radiologist can only locally manipulate the TME, there are systemic offsite recruitments of the immune response. This is known as the abscopal effect, which leads to more significant anti-tumoral downstream effects. Local delivery of modern immunoengineering methods such as locoregional CAR-T therapy combined with immune checkpoint inhibitors efficaciously modulates the immunosuppressive TME. This review highlights the various advances and technologies available now to change the TME and revolutionize oncology from a minimally invasive viewpoint.
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Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids. Pol J Radiol 2022; 87:e672-e677. [PMID: 36643011 PMCID: PMC9834067 DOI: 10.5114/pjr.2022.123790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/06/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. Material and methods A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups. Results All cases were technically successful without major complications. The average peak skin dose was 2281 mGy,with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. Conclusions With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids.
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Reinders MT, van Erpecum KJ, Smits ML, Braat AJ, de Bruijne J, Bruijnen R, Sprengers D, de Man RA, Vegt E, IJzermans JN, Moelker A, Lam MG. Safety and Efficacy of 166Ho Radioembolization in Hepatocellular Carcinoma: The HEPAR Primary Study. J Nucl Med 2022; 63:1891-1898. [PMID: 35589409 PMCID: PMC9730925 DOI: 10.2967/jnumed.122.263823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/18/2022] [Indexed: 01/11/2023] Open
Abstract
The safety and efficacy of 166Ho radioembolization was first determined in the HEPAR and HEPAR II studies, which, however, excluded patients with hepatocellular carcinoma (HCC). The aim of this prospective clinical early phase II study was to establish the toxicity profile of 166Ho radioembolization in patients with measurable, liver-dominant HCC; Barcelona clinic liver cancer stage B or C; a Child-Pugh score of no more than B7; and an Eastern Cooperative Oncology Group performance status of 0-1 without curative treatment options. Methods: The primary endpoint was a rate of unacceptable toxicity defined as grade 3 hyperbilirubinemia (Common Terminology Cancer Adverse Events, version 4.03) in combination with a low albumin or ascites level in the absence of disease progression or treatment-related serious adverse events. Secondary endpoints included overall toxicity, response, survival, change in α-fetoprotein, and quality of life. Thirty-one patients with Barcelona clinic liver cancer stage B (71%) or C (29%) HCC were included, mostly multifocal (87%) or bilobar (55%) disease. Results: Common grade 1 or 2 clinical toxicity included fatigue (71%), back pain (55%), ascites (32%), dyspnea (23%), nausea (23%), and abdominal pain (23%), with no more than 10% grade 3-5 toxicity. Grade 3 laboratory toxicity (>10%) included an aspartate transaminase and γ-glutamyltransferase increase (16%), hyperglycemia (19%), and lymphopenia (29%). Treatment-related unacceptable toxicity occurred in 3 of 31 patients. At 3 mo, 54% of target lesions showed a complete or partial response according to modified RECIST. Median overall survival was 14.9 mo (95% CI, 10.4-24.9 mo). No significant changes in quality of life or pain were observed. Conclusion: The safety of 166Ho radioembolization was confirmed in HCC, with less than 10% unacceptable toxicity. Efficacy data support further evaluation.
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Affiliation(s)
- Margot T.M. Reinders
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Maarten L.J. Smits
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Arthur J.A.T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Rutger Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Robert A. de Man
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Jan N.M. IJzermans
- Department of Surgery, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Marnix G.E.H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
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Locoregional Approaches in Cholangiocarcinoma Treatment. Cancers (Basel) 2022; 14:cancers14235853. [PMID: 36497334 PMCID: PMC9740081 DOI: 10.3390/cancers14235853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a rare hepatic malignant tumor with poor prognosis due to late detection and anatomic factors limiting the applicability of surgical resection. Without surgical resection, palliation is the most common approach. In non-surgical cases contained within the liver, locoregional therapies provide the best chance for increased survival and disease control. The most common methods, transarterial chemoembolization and transarterial radioembolization, target tumors by embolizing their blood supply and limiting the tumor's ability to metabolize. Other treatments induce direct damage via thermal ablation to tumor tissue to mediate their anti-tumor efficacy. Recent studies have begun to explore roles for these therapies outside their previous role of palliation. This review will outline the mechanisms of each of these treatments, along with their effects on overall survival, while comparing these to non-locoregional therapies.
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Shetty VV, Kellarai A. Comprehensive Review of Hepatocellular Carcinoma in India: Current Challenges and Future Directions. JCO Glob Oncol 2022; 8:e2200118. [PMID: 36198133 PMCID: PMC9812497 DOI: 10.1200/go.22.00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is not much information on hepatocellular carcinoma (HCC) in India. Here, we review the existing data, available treatment choices, and future directions in HCC management. An extensive search was conducted through PubMed and MEDLINE for studies published between January 2000 and June 2022 on the epidemiology of HCC in India using the following key words: atezolizumab, BCLC staging, hepatocellular carcinoma, immune checkpoint inhibitors, immunotherapy, and programmed cell death ligand-1, with the filters humans and English language. The most frequent risk factors for the development of HCC in India include nonalcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infection, liver cirrhosis, and alcohol intake. On the basis of new findings, the Barcelona Clinic Liver Cancer (BCLC) Staging Criteria need to be revised. As most cases in India are discovered at a later stage, curative treatments such as surgical resection, ablation, or liver transplantation may not be an option. Clinical trials are underway for a number of immune checkpoint drugs that target cytotoxic T-cell lymphocyte-4 and programmed cell death-1/programmed cell death-ligand 1. In India, phase III trials of atezolizumab in combination with other drugs are underway for the treatment of various malignancies. Renin angiotensin system inhibitors, antivirals, primary hepatocyte transplantation, and bioartificial liver devices are among the future options for the management of HCC. In developing countries like India, HCC is often diagnosed at an advanced stage because of a delay in routine testing or screening. Therefore, developing effective treatment regimens for such stages is critical. Immunotherapy is a promising treatment option that has the potential to increase overall response and survival rate.
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Affiliation(s)
- Vijith Vittal Shetty
- K.S Hegde Medical Academy, Mangalore, India,Vijith Vittal Shetty, MD, DM, Medical Oncology, K.S Hegde Medical Academy, University Rd, Deralakatte, Mangalore, Dakshina Kannada, Karnataka 575018, India; e-mail:
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Gupta P, Kalra N, Chaluvashetty SB, Gamangatti S, Mukund A, Abdul R, Shyam VS, Baijal SS, Mohan C. Indian College of Radiology and Imaging Guidelines on Interventions in Hepatocellular Carcinoma. Indian J Radiol Imaging 2022; 32:540-554. [DOI: 10.1055/s-0042-1754361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractHepatocellular carcinoma (HCC) is one of the most common malignancies and a significant cause of cancer-related death. Treatment of HCC depends on the stage of the tumor. As many patients with HCC are not deemed fit for surgical resection or liver transplantation, locoregional therapies play an essential role in the management. Image-guided locoregional treatments include percutaneous ablative therapies and endovascular therapies. The choice of an individual or a combination of therapies is guided by the tumor and patient characteristics. As the outcomes of image-guided locoregional treatments depend on the ability to achieve necrosis of the entire tumor along with a safety margin around it, it is mandatory to follow standard guidelines. In this manuscript, we discuss in detail the various aspects of image-guided locoregional therapies to guide interventional radiologists involved in the care of patients with HCC.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Amar Mukund
- Department of Interventional Radiology, ILBS, New Delhi, India
| | - Razik Abdul
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - VS Shyam
- Department of Interventional Radiology, ILBS, New Delhi, India
| | | | - Chander Mohan
- Department of Interventional Radiology, BLK Superspeciality Hospital, New Delhi, India
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Jokar N, Moradhaseli F, Ahmadzadehfar H, Jafari E, Nikeghbalian S, Rasekhi AR, Assadi M. Theranostic approach in liver cancer: an emerging paradigm to optimize personalized medicine. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Choi TW, Joo I, Kim HC. Association of dysmorphic intratumoral vessel with high lung shunt fraction in patients with hepatocellular carcinoma. Sci Rep 2022; 12:14248. [PMID: 35989374 PMCID: PMC9393166 DOI: 10.1038/s41598-022-18697-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractTo evaluate the role of dysmorphic intratumoral vessels as imaging marker for the prediction of high lung shunt fraction (LSF) in patients with hepatocellular carcinoma (HCC). This retrospective study included 403 patients with HCC who underwent a planning arteriography for transarterial radioembolization with administration of 99mTc-macroaggregated albumin to calculate LSF. The LSF was measured by using planar body scans. Two radiologists evaluated the pre-treatment contrast-enhanced CT findings, including tumor number, size, margin, distribution, tumor burden, portal and hepatic vein invasion, early hepatic vein enhancement, and dysmorphic intratumoral vessels. The logistic regression analysis was performed to determine significant predictors for high LSF > 20%. Using the identified predictors, diagnostic criteria for high LSF were proposed. Among 403 patients, 52 (13%) patients had high LSF > 20%, and dysmorphic tumor vessels were present in 115 (28.5%) patients. Predictors for LSF > 20% were tumor size > 11 cm, hepatic vein invasion, early hepatic vein enhancement, and dysmorphic intratumoral vessel. If the patient had three or more of the four predictors for LSF > 20% on imaging, the accuracy and specificity for diagnosing LSF > 20% were 88.8% and 96.3% respectively. Dysmorphic intratumoral vessel in HCC is an imaging marker suggesting a high LSF, which may be applicable to treatment modification or patient exclusion for radioembolization with combined interpretation of tumor size and hepatic vein abnormality.
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Raja J, Madoff DC. Oncopharmacology in Interventional Radiology. Semin Intervent Radiol 2022; 39:411-415. [PMID: 36406031 PMCID: PMC9671678 DOI: 10.1055/s-0042-1758076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The broad scope of malignancies treated in interventional oncology is mirrored by the breadth of oncotherapeutics, drugs used to treat cancer. Many of these treatments are administered endovascularly, though a group of therapies can be delivered percutaneously. Perhaps the best taxonomy of oncotherapeutics is based on their biological inactivity or activity and the mechanism by which they interact with treated and targeted tissues. As the fields of interventional oncology and oncotherapeutics continue to grow and expand, this framework may provide a more organized approach in helping distinguish and select the best therapy for patients.
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Affiliation(s)
- Junaid Raja
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David C. Madoff
- Division of Interventional Radiology, Yale New Haven Hospital, New Haven, Connecticut
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Embolization therapy with microspheres for the treatment of liver cancer: State-of-the-art of clinical translation. Acta Biomater 2022; 149:1-15. [PMID: 35842035 DOI: 10.1016/j.actbio.2022.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023]
Abstract
Embolization with microspheres is a therapeutic strategy based on the selective occlusion of the blood vessels feeding a tumor. This procedure is intraarterially performed in the clinical setting for the treatment of liver cancer. The practice has evolved over the last decade through the incorporation of drug loading ability, biodegradability and imageability with the subsequent added functionality for the physicians and improved clinical outcomes for the patients. This review highlights the evolution of the embolization systems developed through the analysis of the marketed embolic microspheres for the treatment of malignant hepatocellular carcinoma, namely the most predominant form of liver cancer. Embolic microspheres for the distinct modalities of embolization (i.e., bland embolization, chemoembolization and radioembolization) are here comprehensively compiled with emphasis on material characteristics and their impact on microsphere performance. Moreover, the future application of the embolics under clinical investigation is discussed along with the scientific and regulatory challenges ahead in the field. STATEMENT OF SIGNIFICANCE: Embolization therapy with microspheres is currently used in the clinical setting for the treatment of most liver cancer conditions. The progressive development of added functionalities on embolic microspheres (such as biodegradability, imageability or drug and radiopharmaceutical loading capability) provides further benefit to patients and widens the therapeutic armamentarium for physicians towards truly personalized therapies. Therefore, it is important to analyze the possibilities that advanced biomaterials offer in the field from a clinical translational perspective to outline the future trends in therapeutic embolization.
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Stella M, van Rooij R, Lam MGEH, de Jong HWAM, Braat AJAT. Lung Dose Measured on Postradioembolization 90Y PET/CT and Incidence of Radiation Pneumonitis. J Nucl Med 2022; 63:1075-1080. [PMID: 34772794 PMCID: PMC9258566 DOI: 10.2967/jnumed.121.263143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
Radiation pneumonitis is a rare but possibly fatal side effect of 90Y radioembolization. It may occur 1-6 mo after therapy, if a significant part of the 90Y microspheres shunts to the lungs. In current clinical practice, a predicted lung dose greater than 30 Gy is considered a criterion to exclude patients from treatment. However, contrasting findings regarding the occurrence of radiation pneumonitis and lung dose were previously reported in the literature. In this study, the relationship between the lung dose and the eventual occurrence of radiation pneumonitis after 90Y radioembolization was investigated. Methods: We retrospectively analyzed 317 90Y liver radioembolization procedures performed during an 8-y period (February 2012 to September 2020). We calculated the predicted lung mean dose (LMD) using 99mTc-MAA planar scintigraphy (LMDMAA) acquired during the planning phase and left LMD (LMDY-90) using the 90Y PET/CT acquired after the treatment. For the lung dose computation, we used the left lung as the representative lung volume, to compensate for scatter from the liver moving in the craniocaudal direction because of breathing and mainly affecting the right lung. Results: In total, 272 patients underwent 90Y procedures, of which 63% were performed with glass microspheres and 37% with resin microspheres. The median injected activity was 1,974 MBq (range, 242-9,538 MBq). The median LMDMAA was 3.5 Gy (range, 0.2-89.0 Gy). For 14 procedures, LMDMAA was more than 30 Gy. Median LMDY-90 was 1 Gy (range, 0.0-22.1 Gy). No patients had an LMDY-90 of more than 30 Gy. Of the 3 patients with an LMDY-90 of more than 12 Gy, 2 patients (one with an LMDY-90 of 22.1 Gy and an LMDMAA of 89 Gy; the other with an LMDY-90 of 17.7 Gy and an LMDMAA of 34.1 Gy) developed radiation pneumonitis and consequently died. The third patient, with an LMDY-90 of 18.4 Gy (LMDMAA, 29.1 Gy), died 2 mo after treatment, before the imaging evaluation, because of progressive disease. Conclusion: The occurrence of radiation pneumonitis as a consequence of a lung shunt after 90Y radioembolization is rare (<1%). No radiation pneumonitis developed in patients with a measured LMDY-90 lower than 12 Gy.
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Affiliation(s)
- Martina Stella
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob van Rooij
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Cisneros-Garza L, González-Huezo M, Moctezuma-Velázquez C, Ladrón de Guevara-Cetina L, Vilatobá M, García-Juárez I, Alvarado-Reyes R, Álvarez-Treviño G, Allende-Pérez S, Bornstein-Quevedo L, Calderillo-Ruiz G, Carrillo-Martínez M, Castillo-Barradas M, Cerda-Reyes E, Félix-Leyva J, Gabutti-Thomas J, Guerrero-Ixtlahuac J, Higuera-de la Tijera F, Huitzil-Melendez D, Kimura-Hayama E, López-Hernández P, Malé-Velázquez R, Méndez-Sánchez N, Morales-Ruiz M, Ruíz-García E, Sánchez-Ávila J, Torrecillas-Torres L. The second Mexican consensus on hepatocellular carcinoma. Part II: Treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:362-379. [DOI: 10.1016/j.rgmxen.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 10/25/2022] Open
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Zane KE, Nagib PB, Jalil S, Mumtaz K, Makary MS. Emerging curative-intent minimally-invasive therapies for hepatocellular carcinoma. World J Hepatol 2022; 14:885-895. [PMID: 35721283 PMCID: PMC9157708 DOI: 10.4254/wjh.v14.i5.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/20/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally. Cure can be achieved for early stage HCC, which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0. Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation (LT) also achieve curative outcomes. Traditionally, surgical resection, LT, and ablation are considered curative therapies for early HCC. However, results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC, leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC. This review is based on current evidence for curative-intent loco-regional therapies including radioembolization for early-stage HCC.
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Affiliation(s)
- Kylie E Zane
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Paul B Nagib
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Sajid Jalil
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Hatzidakis A, Müller L, Krokidis M, Kloeckner R. Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations. Cancers (Basel) 2022; 14:cancers14102469. [PMID: 35626073 PMCID: PMC9139740 DOI: 10.3390/cancers14102469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Percutaneous interventional radiological techniques offer many alternatives for treatment of Hepatocellular Carcinoma (HCC) using local anesthesia and sedation. These methods aim to destroy the malignant tumors locally without affecting the non-malignant liver. In this way, complications are kept low and patient recovery is quick. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. In recent years, a lot of research has been made in combining such approaches with immune therapy, but there is still much work to be done. This manuscript tries to analyze where we stand today and explain, using a comprehensive algorithm, the treatment options for each different clinical condition. Abstract Background: Hepatocellular carcinoma (HCC) can be treated by local and regional methods of percutaneous interventional radiological techniques. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. According to international classification systems such as Barcelona Clinic Liver Cancer (BCLC) classification, very early, early or intermediate staged tumors can be treated either with ablative methods or with transarterial chemoembolization (TACE), depending on tumor characteristics. The combination of both allows for individualized forms of treatment with the ultimate goal of improving response and survival. In recent years, a lot of research has been carried out in combining locoregional approaches with immune therapy. Although recent developments in systemic treatment, especially immunotherapy, seem quite promising and have expanded possible combined treatment options, there is still not enough evidence in their favor. The aim of this review is to provide a comprehensive up-to-date overview of all these techniques, explaining indications, contraindications, technical problems, outcomes, results and complications. Moreover, combinations of percutaneous treatment with each other or with immunotherapy and future options will be discussed. Use of all those methods as down-staging or bridging solutions until surgery or transplantation are taken into consideration will also be reviewed. Conclusion: Local and regional therapies remain a mainstay of curative and palliative treatment of patients with HCC. Currently, evidence on potential combination of the local and regional treatment options with each other as well as with other treatment modalities is growing and has the potential to further individualize HCC therapy. To identify the most suitable treatment option out of these new various options, a repeated interdisciplinary discussion of each case by the tumor board is of utmost importance.
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Affiliation(s)
- Adam Hatzidakis
- Department of Radiology, AHEPA University Hospital of Thessaloniki, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
| | - Miltiadis Krokidis
- 1st Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
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Ghosh A, Zhang J, Akhter NM. Transradial versus transfemoral arterial access in Yttrium-90 microspheres radioembolization for hepatocellular carcinoma. J Clin Imaging Sci 2022; 12:27. [PMID: 35673590 PMCID: PMC9168346 DOI: 10.25259/jcis_213_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE
Transradial access has become more popular in body intervention procedures but has not been ubiquitously adapted. This study assesses the efficacy of this approach in Yttrium-90 labeled microspheres radioembolization. To compare transradial to transfemoral access in hepatocellular carcinoma patients who underwent Yttrium-90 radioembolization.
MATERIALS AND METHODS
A total of 244 hepatocellular carcinoma patients underwent 337 radioembolization procedures at our institute from May 2014 to May 2020. The transradial access-group included 188 patients (252 procedures) while the transfemoral access group had 63 patients (85 procedures). The recovery time, fluoroscopy time, contrast volume, peak radiation dose, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the two groups.
RESULTS
The transradial cohort recorded a significantly shorter (P < 0.01) mean recovery time (from the end of the procedure to discharge) and had a significantly shorter (P < 0.05) use of contrast volume versus the transfemoral group. In addition, the radiation dose and fluoroscopy time were lower in the transradial subset, although not statistically different. Furthermore, the overall cost for procedural equipment was significantly less (P < 0.01) in the transradial cohort than in the transfemoral. No major complications were reported in the transradial group, while one pseudoaneurysm was noted in the transfemoral group.
CONCLUSION
With respect to many pertinent parameters, transradial access was evaluated as being more advantageous than transfemoral access. The results of this study suggest that transradial access should be considered more often, whenever feasible, as an option in the Yttrium-90 treatment of hepatocellular carcinoma patients.
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Affiliation(s)
- Abheek Ghosh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
| | - Jian Zhang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
| | - Nabeel Mohsin Akhter
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
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Mahmoud K, Swidan S, El-Nabarawi M, Teaima M. Lipid based nanoparticles as a novel treatment modality for hepatocellular carcinoma: a comprehensive review on targeting and recent advances. J Nanobiotechnology 2022; 20:109. [PMID: 35248080 PMCID: PMC8898455 DOI: 10.1186/s12951-022-01309-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/12/2022] [Indexed: 12/12/2022] Open
Abstract
Liver cancer is considered one of the deadliest diseases with one of the highest disease burdens worldwide. Among the different types of liver cancer, hepatocellular carcinoma is considered to be the most common type. Multiple conventional approaches are being used in treating hepatocellular carcinoma. Focusing on drug treatment, regular agents in conventional forms fail to achieve the intended clinical outcomes. In order to improve the treatment outcomes, utilizing nanoparticles-specifically lipid based nanoparticles-are considered to be one of the most promising approaches being set in motion. Multiple forms of lipid based nanoparticles exist including liposomes, solid lipid nanoparticles, nanostructured lipid carriers, microemulsion, nanoemulsion, phytosomes, lipid coated nanoparticles, and nanoassemblies. Multiple approaches are used to enhance the tumor uptake as well tumor specificity such as intratumoral injection, passive targeting, active targeting, and stimuli responsive nanoparticles. In this review, the effect of utilizing lipidic nanoparticles is being discussed as well as the different tumor uptake enhancement techniques used.
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Affiliation(s)
- Khaled Mahmoud
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, 11837, Egypt
- The Center for Drug Research and Development (CDRD), Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, 11837, Egypt
| | - Shady Swidan
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, 11837, Egypt.
- The Center for Drug Research and Development (CDRD), Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, 11837, Egypt.
| | - Mohamed El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt.
| | - Mahmoud Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
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Balli HT, Aikimbaev K, Guney IB, Piskin FC, Yagci-Kupeli B, Kupeli S, Kanmaz T. Trans-Arterial Radioembolization with Yttrium-90 of Unresectable and Systemic Chemotherapy Resistant Hepatoblastoma in Three Toddlers. Cardiovasc Intervent Radiol 2022; 45:344-348. [PMID: 35034139 DOI: 10.1007/s00270-021-03026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
The aim of this short communication was to report the results of transarterial radioembolization (TARE) with Yttrium-90 (Y90) loaded resin microspheres in three toddlers with unresectable and systemic chemotherapy-resistant HB hepatoblastoma (HB). Six TARE procedures were performed on the patients. The dose required for treatment was calculated using partition model. Administered doses of Y90 were 1.369, 0.851, and 1.147 GBq. Complete radiological response in two patients and partial response enabling liver resection in one patient were achieved. Neither life-threatening nor minor complications developed after the treatment. These results demonstrates that HB is a radiosensitive neoplasm, and TARE-Y90 can be used as the primary, neoadjuvant and palliative treatment method in patients with unresectable and systemic chemotherapy-resistant HBs. However, studies with higher number of patients and long-term results are required.
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Affiliation(s)
- Huseyin Tugsan Balli
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Isa Burak Guney
- Department of Nuclear Medicine, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Ferhat Can Piskin
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey.
| | - Begul Yagci-Kupeli
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Adana Education and Research Center, Adana, Turkey
| | - Serhan Kupeli
- Department of Pediatric Oncology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Turan Kanmaz
- Department of Pediatric Surgery, Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
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Jia G, Van Valkenburgh J, Chen AZ, Chen Q, Li J, Zuo C, Chen K. Recent advances and applications of microspheres and nanoparticles in transarterial chemoembolization for hepatocellular carcinoma. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1749. [PMID: 34405552 PMCID: PMC8850537 DOI: 10.1002/wnan.1749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
Transarterial chemoembolization (TACE) is a recommended treatment for patients suffering from intermediate and advanced hepatocellular carcinoma (HCC). As compared to the conventional TACE, drug-eluting bead TACE demonstrates several advantages in terms of survival, treatment response, and adverse effects. The selection of embolic agents is critical to the success of TACE. Many studies have been performed on the modification of the structure, size, homogeneity, biocompatibility, and biodegradability of embolic agents. Continuing efforts are focused on efficient loading of versatile chemotherapeutics, controlled sizes for sufficient occlusion, real-time detection intra- and post-procedure, and multimodality imaging-guided precise treatment. Here, we summarize recent advances and applications of microspheres and nanoparticles in TACE for HCC. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Guorong Jia
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China
| | - Juno Van Valkenburgh
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Austin Z. Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Quan Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jindian Li
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
| | - Kai Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
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Choi JW, Kim HC. Radioembolization for hepatocellular carcinoma: what clinicians need to know. JOURNAL OF LIVER CANCER 2022; 22:4-13. [PMID: 37383534 PMCID: PMC10035707 DOI: 10.17998/jlc.2022.01.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/24/2021] [Accepted: 01/16/2022] [Indexed: 06/30/2023]
Abstract
Transarterial radioembolization (TARE) with yttrium 90 (90Y) has been used in the management of hepatocellular carcinoma (HCC) for more than 10 years in Korea. There are two types of 90Y radioactive microspheres available, namely, glass and resin microspheres, with comparable clinical outcomes. In general, TARE outperforms transarterial chemoembolization regarding post-embolization syndrome, time to progression, tumor downsizing for liver transplantation, and hospitalization stay. Although TARE is commonly recommended for patients with unresectable large HCCs, it can be an alternative to or performed in combination with ablation, surgical resection, and systemic treatment. This review aimed to address 90Y radioactive microspheres, patient selection, clinical outcomes, simulation tests, radioembolization procedures, follow-up imaging, and complications.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Yttrium-90 radioembolization for unresectable hepatocellular carcinoma: predictive modeling strategies to anticipate tumor response and improve patient selection. Eur Radiol 2022; 32:4687-4698. [PMID: 35230518 PMCID: PMC9213379 DOI: 10.1007/s00330-022-08585-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022]
Abstract
Objectives This study aims to better characterize potential responders of Y-90-radioembolization at baseline through analysis of clinical variables and contrast enhanced (CE) MRI tumor volumetry in order to adjust therapeutic regimens early on and to improve treatment outcomes. Methods Fifty-eight HCC patients who underwent Y-90-radioembolization at our center between 10/2008 and 02/2017 were retrospectively included. Pre- and post-treatment target lesion volumes were measured as total tumor volume (TTV) and enhancing tumor volume (ETV). Survival analysis was performed with Cox regression models to evaluate 65% ETV reduction as surrogate endpoint for treatment efficacy. Univariable and multivariable logistic regression analyses were used to evaluate the combination of baseline clinical variables and tumor volumetry as predictors of ≥ 65% ETV reduction. Results Mean patients’ age was 66 (SD 8.7) years, and 12 were female (21%). Sixty-seven percent of patients suffered from liver cirrhosis. Median survival was 11 months. A threshold of ≥ 65% in ETV reduction allowed for a significant (p = 0.04) separation of the survival curves with a median survival of 11 months in non-responders and 17 months in responders. Administered activity per tumor volume did predict neither survival nor ETV reduction. A baseline ETV/TTV ratio greater than 50% was the most important predictor of arterial devascularization (odds ratio 6.3) in a statistically significant (p = 0.001) multivariable logistic regression model. The effect size was strong with a Cohen’s f of 0.89. Conclusion We present a novel approach to identify promising candidates for Y-90 radioembolization at pre-treatment baseline MRI using tumor volumetry and clinical baseline variables. Key Points • A decrease of 65% enhancing tumor volume (ETV) on follow-up imaging 2–3 months after Y-90 radioembolization of HCC enables the early prediction of significantly improved median overall survival (11 months vs. 17 months, p = 0.04). • Said decrease in vascularization is predictable at baseline: an ETV greater than 50% is the most important variable in a multivariable logistic regression model that predicts responders at a high level of significance (p = 0.001) with an area under the curve of 87%. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08585-x.
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Tong VJW, Shelat VG, Chao YK. Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma. J Clin Transl Res 2021; 7:811-833. [PMID: 34988334 PMCID: PMC8715712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Hepatocellular carcinoma (HCC) management has evolved over the past two decades, with the development of newer treatment modalities. While various options are available, unmet needs are reflected through the mixed treatment outcome for intermediate-stage HCC. As HCC is radiosensitive, radiation therapies have a significant role in management. Radiation therapies offer local control for unresectable lesions and for patients who are not surgical candidates. Radiotherapy also provides palliation in metastatic disease, and acts as a bridge to resection and transplantation in selected patients. Advancements in radiotherapy modalities offer improved dose planning and targeted delivery, allowing for better tumor response and safer dose escalations while minimizing the risks of radiation-induced liver damage. Radiotherapy modalities are broadly classified into external beam radiation therapy and selective internal radiation therapy. With emerging modalities, radiotherapy plays a complementary role in the multidisciplinary care of HCC patients. Aim: We aim to provide an overview of the role and clinical application of radiation therapies in HCC management. Relevance for Patients: The continuous evolution of radiotherapy techniques allows for improved therapeutic outcomes while mitigating unwanted adverse effects, making it an attractive modality in HCC management. Rigorous clinical studies, quality research and comprehensive datasets will further its application in the present era of evidence-based practice in Medicine.
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Affiliation(s)
- Valerie J W Tong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Yew Kuo Chao
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 308433, Singapore
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Le Fur M, Fougère O, Lepareur N, Rousseaux O, Tripier R, Beyler M. Tuning the lipophilic nature of pyclen-based 90Y3+ radiopharmaceuticals for β-radiotherapy. Metallomics 2021; 13:6445036. [PMID: 34850060 DOI: 10.1093/mtomcs/mfab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/16/2021] [Indexed: 01/31/2023]
Abstract
Pyclen-dipicolinate chelates proved to be very efficient chelators for the radiolabeling with β--emitters such as 90Y. In this study, a pyclen-dipicolinate ligand functionalized with additional C12 alkyl chains was synthesized. The radiolabeling with 90Y proved that the addition of saturated carbon chains does not affect the efficiency of the radiolabeling, whereas a notable increase in lipophilicity of the resulting 90Y radiocomplex was observed. As a result, the compound could be extracted in Lipiodol® and encapsulated in biodegrable pegylated poly(malic acid) nanoparticles demonstrating the potential of lipophilic pyclen-dipicolinate derivatives as platforms for the design of radiopharmaceuticals for the treatment of liver or brain cancers by internal radiotherapy.
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Affiliation(s)
- Mariane Le Fur
- Univ Brest, UMR-CNRS 6521 CEMCA, 6 avenue Victor le Gorgeu, 29238 Brest, France
| | - Olivier Fougère
- Guerbet group, Centre de Recherche d'Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - Nicolas Lepareur
- Univ Rennes, Centre Eugène Marquis, Inrae, Inserm, Institut NUMECAN [(Nutrition, Métabolismes et Cancer)]-UMR_A 1341, UMR_S 1241, Avenue de la Bataille Flandres, Dunkerque CS 44229, 35042 Rennes Cedex, France
| | - Olivier Rousseaux
- Guerbet group, Centre de Recherche d'Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - Raphaël Tripier
- Univ Brest, UMR-CNRS 6521 CEMCA, 6 avenue Victor le Gorgeu, 29238 Brest, France
| | - Maryline Beyler
- Univ Brest, UMR-CNRS 6521 CEMCA, 6 avenue Victor le Gorgeu, 29238 Brest, France
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Subramanian S, Mallia MB, Shinto AS, Mathew AS. Clinical Management of Liver Cancer in India and Other Developing Nations: A Focus on Radiation Based Strategies. Oncol Ther 2021; 9:273-295. [PMID: 34046873 PMCID: PMC8593115 DOI: 10.1007/s40487-021-00154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global killer with preponderance in Asian and African countries. It poses a challenge for successful management in less affluent or developing nations like India, with large populations and limited infrastructures. This review aims to assess the available options and future directions for management of HCC applicable to such countries. While summarizing current and emerging clinical strategies for detection, staging and therapy of the disease, it highlights radioisotope- and radioactivity-based strategies as part of an overall program. Using the widely accepted Barcelona Clinic Liver Cancer (BCLC) staging system as a base, it evaluates the applicability of different therapeutic approaches and their synergistic combination(s) in the context of a patient-specific dynamic results-based strategy. It distills the conclusions of multiple HCC management-focused consensus recommendations to provide a picture of clinical strategies, especially radiation-related approaches. Additionally, it discusses the logistical and economic feasibility of these approaches in the context of the limitations of the burdened public health infrastructure in India (and like nations) and highlights possible strategies both at the clinical level and in terms of an administrative health policy on HCC to provide the maximum possible benefit to the widest swathe of the affected population.
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Affiliation(s)
- Suresh Subramanian
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India.
| | - Madhava B Mallia
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India
| | - Ajit S Shinto
- Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
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Akarca US, Akhan O, Bilgiç S, Bozkurt MF, Cantaşdemir M, Çermik TF, Çakaloğlu Y, Er Ö, Ilgıt E, Çapa Kaya G, Küçük NÖ, Numan F, Parıldar M, Türkmen C. The position of transarterial chemoembolization with drug-eluting beads and yttrium-90 transarterial radioembolization in patients with hepatocellular carcinoma: Consensus statements from a Delphi-method expert panel in Turkey. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:732-739. [PMID: 34792027 DOI: 10.5152/dir.2021.201089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Clinical studies conducted in different geographic regions using different methods to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression and a higher downstaging effect with TARE treatment. In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE. However, relevant literature indicates that TARE is more advantageous compared to TACE regarding the need for repeat procedures, costs of complication management, total hospital stay and quality of life. Heterogeneity of hepatocellular carcinoma (HCC) patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field. As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey. METHODS The present expert panel used two round modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for drug-eluting beads (DEB)-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level. RESULTS The panelists stated that they most commonly use the BCLC staging system for the management of HCC patients in Turkey. However, they did not find any of the staging systems or treatment guidelines sufficient enough for their clinical practice in terms of covering the down-staging intent of treatments. Since living donor transplant preference is higher in Turkey than the rest of the Western countries, down-staging treatments are thought to be more prioritized in Turkey than that in other Western countries. The panelists reached a consensus that TARE may provide improved OS and reduce the number of repeat procedures compared to DEB-TACE in intermediate-stage patients with a single tumor spanning a diameter above 5 cm who experience recurrence after previous treatment with TACE and most TACE-naïve patient groups in intermediate stage. CONCLUSION Based on the consensus on OS and the number of procedures, the panelists assumed that TARE would be more cost-effective than DEB-TACE in most groups of TACE-naïve patients in intermediate stage and in those with a single tumor spanning a diameter above 5 cm. It was also stated that the predicted cost-effectiveness advantage of TARE could be more pronounced in patients with a tumor diameter greater than 7 cm.
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Affiliation(s)
- Ulus Salih Akarca
- From the Department of Gastroenterology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Okan Akhan
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sadık Bilgiç
- Department of Radiology Ankara University Medical School, Ankara, Turkey
| | - Murat Fani Bozkurt
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Cantaşdemir
- Department of Nuclear Medicine , Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Fikret Çermik
- Department of Radiology, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul
| | - Yılmaz Çakaloğlu
- Department of Gastroenterology and Hepatology, Memorial Şişli Hastanesi, İstanbul, Turkey
| | - Özlem Er
- Department of Oncology, Acibadem Maslak Hospital, İstanbul, Turkey
| | - Erhan Ilgıt
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
| | - Gamze Çapa Kaya
- Department of Nuclear Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Nuriye Özlem Küçük
- Department of Nuclear Medicine ,İstanbul University Cerrahpasa Faculty of Medicine, İstanbul
| | - Furuzan Numan
- Department of Radiology, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul
| | - Mustafa Parıldar
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Cüneyt Türkmen
- Department of Radiology, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul
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Whitlock RS, Loo C, Patel K, Bista R, Goss JA, Heczey A, Khan O, Lopez-Terrada D, Masand P, Nguyen H, Mahvash A, Vasudevan SA, Kukreja K. Transarterial Radioembolization Treatment as a Bridge to Surgical Resection in Pediatric Hepatocellular Carcinoma. J Pediatr Hematol Oncol 2021; 43:e1181-e1185. [PMID: 33769387 DOI: 10.1097/mph.0000000000002089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with unresectable hepatocellular carcinoma (HCC) have a poor prognosis and limited treatment options. Transarterial radioembolization (TARE) using Yttrium-90 (Y90) has emerged as a potential bridge therapy to hepatic resection or transplantation for HCC with very limited studies in children. OBSERVATIONS Here we present the clinical course of 2 children successfully treated with TARE Y90 for initially unresectable fibrolamellar HCC (FL-HCC) and bridged to partial hemihepatectomy with >1-year overall survival post-TARE. CONCLUSION Although there have been prior published reports of pediatric patients with HCC being treated with TARE Y90 and some being able to undergo subsequent orthotopic liver transplantation, this is the first report of pediatric HCC patients treated with TARE Y90 as a bridge to nontransplant resections and going on to have >1-year overall survival.
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Affiliation(s)
- Richard S Whitlock
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Texas Children's Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Caitlyn Loo
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kalyani Patel
- Department of Pathology and Immunology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Ranjan Bista
- Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX
| | - John A Goss
- E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Michael Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Andras Heczey
- Department of Pediatrics, Texas Children's Cancer Center, Center for Cell and Gene Therapy, Texas Children's Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Osman Khan
- Division of Hematology and Oncology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Dolores Lopez-Terrada
- Department of Pathology and Immunology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Prakash Masand
- Singleton Department of Pediatric Radiology, Texas Children's Hospital Liver Tumor Program, Baylor College of Medicine
| | - HaiThuy Nguyen
- Singleton Department of Pediatric Radiology, Texas Children's Hospital Liver Tumor Program, Baylor College of Medicine
| | - Armeen Mahvash
- Department of Interventional Radiology, MD Anderson Cancer Center
| | - Sanjeev A Vasudevan
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Texas Children's Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine
| | - Kamlesh Kukreja
- Singleton Department of Pediatric Radiology, Division of Interventional Radiology, Texas Children's Hospital Liver Tumor Program, Baylor College of Medicine, Houston
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Commander CW, Mauro DM. Current Approach to Planning Angiography and MAA Administration. Semin Intervent Radiol 2021; 38:397-404. [PMID: 34629705 DOI: 10.1055/s-0041-1735616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.
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Affiliation(s)
- Clayton W Commander
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Tovar-Felice G, García-Gámez A, Benito-Santamaría V, Balaguer-Paniagua D, Villalba-Auñón J, Sampere-Moragues J. Unresectable hepatocellular carcinoma treatment with doxorubicin-eluting polyethylene glycol microspheres: a single-center experience. Hepat Oncol 2021; 8:HEP38. [PMID: 34408848 PMCID: PMC8369521 DOI: 10.2217/hep-2020-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Transarterial chemoembolization (TACE) is indicated for unresectable hepatocellular carcinoma. Methods This was a retrospective study of 50 hepatocellular carcinoma patients treated with TACE using doxorubicin-loaded LifePearl™ to investigate the safety and efficacy of TACE. Results There was no 30-day mortality, and limited adverse events were reported. At best tumor response, complete response and disease control were 58% and 94%, respectively, with a median of 4.5 months of follow-up. Median overall survival was 33.8 months. Patients with Barcelona Clinic Liver Cancer stage 0 and stage A at best tumor response showed a higher complete response rate (83%) than patients with Barcelona Clinic Liver Cancer stage B (complete response: 50%; p = 0.0414). Conclusion Doxorubicin-loaded LifePearl™ TACE might be an effective treatment, with a good safety profile, for patients with early/intermediate-stage hepatocellular carcinoma. Further prospective data, especially with a small cohort of selected patients, are required to confirm these results.
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Affiliation(s)
- Gerardo Tovar-Felice
- Germans Trias I Pujol (Can Ruti) University Hospital, Carretera de Canyet, Badalona, 08916, Spain
| | - Andrés García-Gámez
- Germans Trias I Pujol (Can Ruti) University Hospital, Carretera de Canyet, Badalona, 08916, Spain
| | | | - David Balaguer-Paniagua
- Germans Trias I Pujol (Can Ruti) University Hospital, Carretera de Canyet, Badalona, 08916, Spain
| | - Jordi Villalba-Auñón
- Germans Trias I Pujol (Can Ruti) University Hospital, Carretera de Canyet, Badalona, 08916, Spain
| | - Jaume Sampere-Moragues
- Germans Trias I Pujol (Can Ruti) University Hospital, Carretera de Canyet, Badalona, 08916, Spain
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48
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Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3596-3614. [PMID: 33909092 DOI: 10.1007/s00261-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/17/2022]
Abstract
Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.
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Clinical outcome of Yttrium-90 selective internal radiation therapy (Y-90 SIRT) in unresectable hepatocellular carcinoma: Experience from a tertiary care center. LIVER RESEARCH 2021. [DOI: 10.1016/j.livres.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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50
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Koulouris A, Tsagkaris C, Spyrou V, Pappa E, Troullinou A, Nikolaou M. Hepatocellular Carcinoma: An Overview of the Changing Landscape of Treatment Options. J Hepatocell Carcinoma 2021; 8:387-401. [PMID: 34012929 PMCID: PMC8128500 DOI: 10.2147/jhc.s300182] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022] Open
Abstract
The last three years have seen remarkable progress in comprehending predisposing factors and upgrading our treatment arsenal concerning hepatocellular carcinoma (HCC). Until recently, there were no means to withstand the progression of viral hepatitis-associated liver cirrhosis to HCC. A deeper understanding of the molecular mechanism of the disease, the use of biomarkers, and the follow-up, allowed us to realize that conventional chemotherapy failing to increase survival in patients with advanced HCC tends to be exiled from clinical practice. Multi-kinase inhibitors (TKIs) such as sorafenib, lenvatinib targeting mainly the vascular endothelial growth factor receptors 1–3 VEGFRs 1–3 provided until recently the standard of care for these patients, as first- or second-line treatment. Since May 2020, the atezolizumab plus bevacizumab combination (immunotherapy plus anti-VEGF) has become the new reference standard in first-line HCC treatment. Additionally, anti-programmed cell death protein 1 (anti-PD-1) immunotherapy can be used as a second-line treatment following first-line treatment’s failure. Phase III clinical trials have recently suggested the efficacy of novel anti-angiogenic factors such as cabozantinib and ramucirumab as a second-line treatment option. With considerations about toxicity arising, clinical trials are investigating combinations of the aforementioned targeted therapies with immunotherapy as first-line treatment. This paper aims to perform a systematic review describing the evolving treatment options for HCC over the last decades, ranging from neoadjuvant treatment to systemic therapy of advanced-stage HCC. With the landscape of HCC treatment shifting towards novel agents the forming of a new therapeutic algorithm for HCC seems to be imperative.
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Affiliation(s)
- Andreas Koulouris
- Resident of Medical Oncology, University General Hospital of Heraklion, University of Crete, Crete, Greece
| | | | | | - Eleni Pappa
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michail Nikolaou
- 1st Oncology Department, "Saint Savas" Anticancer - Oncology Hospital, Athens, Greece
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