Generic placeholder image

Current Radiopharmaceuticals

Author(s): Roberto Iezzi*, Alessandro Posa, Marco Santoro, Alessandro Tanzilli, Lucia Cerrito, Francesca Romana Ponziani, Maurizio Pompili, Antonio Grieco, Gian Ludovico Rapaccini, Antonio Gasbarrini and Riccardo Manfredi

DOI: 10.2174/1874471015666220223102426

DownloadDownload PDF Flyer Cite As
Balloon-Occluded Radiofrequency Ablation as Bridge to TACE in the Treatment of Advanced HCC with Arterioportal Shunt

Page: [194 - 198] Pages: 5

  • * (Excluding Mailing and Handling)

Abstract

Background: Transarterial chemoembolization is the most widely used palliative treatment for unresectable hepatocellular carcinoma; however, arterioportal shunt represents a contraindication to this treatment.

Objective: The study aims to assess the feasibility of balloon-occluded radiofrequency ablation in the transitory resolution of an extensive arterioportal shunt in patients with advanced hepatocellular carcinoma as a bridge to safe and effective transarterial chemoembolization.

Methods: 12 consecutive patients advanced multinodular unilobar unresectable hepatocellular carcinoma with a target lesion larger than 5 cm (mean diameter 7.7 ± 1.4 cm), not suitable to transarterial chemoembolization due to extensive arterioportal shunt, were recruited. Balloon-occluded radiofrequency ablation of the hepatic area surrounding the shunt during occlusion of the artery supplying the shunt was performed, followed by lobar conventional chemoembolization. Intra/periprocedural complications were evaluated. Technical success was defined by the result of radiofrequency ablation in terms of immediate disappearance, reduction, or persistence of the shunt. Local efficacy of chemoembolization was evaluated at 1-month computed tomography according to m-RECIST criteria.

Results: Technical success was achieved in all patients. No major complications were observed. 1- month follow-up showed a mean necrotic diameter of 6.3 cm (range: 3.8-8.7 cm), with an acceptable procedural result and persistence of the shunt. An overall response rate was obtained in all patients, with 25% complete response and 75% partial response.

Conclusion: Balloon-occluded radiofrequency ablation of an arterioportal shunt in patients with advanced hepatocellular carcinoma can temporarily reduce shunting, allowing to perform safe and therapeutically useful chemoembolization, with satisfactory control of tumor growth.

Keywords: HCC, RFA, ablation, chemoembolization, combined therapy, arterioportal shunt.

Graphical Abstract

[1]
Bray, F.; Ferlay, J.; Soerjomataram, I.; Siegel, R.L.; Torre, L.A.; Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of inci-dence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin., 2018, 68(6), 394-424.
[http://dx.doi.org/10.3322/caac.21492] [PMID: 30207593]
[2]
Llovet, J.M.; Burroughs, A.; Bruix, J. Hepatocellular carcinoma. Lancet, 2003, 362(9399), 1907-1917.
[http://dx.doi.org/10.1016/S0140-6736(03)14964-1] [PMID: 14667750]
[3]
Llovet, J.M.; Brú, C.; Bruix, J. Prognosis of hepatocellular carcinoma: The BCLC staging classification. Semin. Liver Dis., 1999, 19(3), 329-338.
[http://dx.doi.org/10.1055/s-2007-1007122] [PMID: 10518312]
[4]
Sugano, S.; Miyoshi, K.; Suzuki, T.; Kawafune, T.; Kubota, M. Intrahepatic arteriovenous shunting due to hepatocellular carcinoma and cirrhosis, and its change by transcatheter arterial embolization. Am. J. Gastroenterol., 1994, 89(2), 184-188.
[PMID: 8304300]
[5]
Velázquez, R.F.; Rodríguez, M.; Navascués, C.A.; Linares, A.; Pérez, R.; Sotorríos, N.G.; Martínez, I.; Rodrigo, L. Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology, 2003, 37(3), 520-527.
[http://dx.doi.org/10.1053/jhep.2003.50093] [PMID: 12601348]
[6]
Escudier, B.; Worden, F.; Kudo, M. Sorafenib: Key lessons from over 10 years of experience. Expert Rev. Anticancer Ther., 2019, 19(2), 177-189.
[http://dx.doi.org/10.1080/14737140.2019.1559058] [PMID: 30575405]
[7]
Moore, C.G.; Carter, R.E.; Nietert, P.J.; Stewart, P.W. Recommendations for planning pilot studies in clinical and translational research. Clin. Transl. Sci., 2011, 4(5), 332-337.
[http://dx.doi.org/10.1111/j.1752-8062.2011.00347.x] [PMID: 22029804]
[8]
Steven, A.J. Sample size of 12 per group rule of thumb for a pilot study. Pharm. Stat., 2005, 4(4), 287-291.
[http://dx.doi.org/10.1002/pst.185]
[9]
Malagari, K.; Iezzi, R.; Goldberg, S.N.; Bilbao, J.I.; Sami, A.; Akhan, O.; Giuliante, F.; Pompili, M.; Crocetti, L.; Valentini, V.; Gasbarrini, A.; Colosimo, C.; Manfredi, R. The ten commandments of chemoembolization: Expert discussion and report from Mediterranean Inter-ventional Oncology (MIOLive) congress 2017. Eur. Rev. Med. Pharmacol. Sci., 2018, 22(2), 372-381.
[http://dx.doi.org/10.26355/eurrev_201801_14184] [PMID: 29424893]
[10]
Tarazov, P.G. Intrahepatic arterioportal fistulae: Role of transcatheter embolization. Cardiovasc. Intervent. Radiol., 1993, 16(6), 368-373.
[http://dx.doi.org/10.1007/BF02603142] [PMID: 8131168]
[11]
Furuse, J.; Iwasaki, M.; Yoshino, M.; Konishi, M.; Kawano, N.; Kinoshita, T.; Ryu, M.; Satake, M.; Moriyama, N. Hepatocellular carci-noma with portal vein tumor thrombus: Embolization of arterioportal shunts. Radiology, 1997, 204(3), 787-790.
[http://dx.doi.org/10.1148/radiology.204.3.9280260] [PMID: 9280260]
[12]
Murata, S.; Tajima, H.; Nakazawa, K.; Onozawa, S.; Kumita, S.; Nomura, K. Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts. Eur. Radiol., 2009, 19(8), 2016-2023.
[http://dx.doi.org/10.1007/s00330-009-1349-y] [PMID: 19238387]
[13]
Murata, S.; Mine, T.; Sugihara, F.; Yasui, D.; Yamaguchi, H.; Ueda, T.; Onozawa, S.; Kumita, S. Interventional treatment for unresectable hepatocellular carcinoma. World J. Gastroenterol., 2014, 20(37), 13453-13465.
[http://dx.doi.org/10.3748/wjg.v20.i37.13453] [PMID: 25309076]
[14]
Liao, G.S.; Yu, C.Y.; Shih, M.L.; Chan, D.C.; Liu, Y.C.; Yu, J.C.; Chen, T.W.; Hsieh, C.B. Radiofrequency ablation after transarterial em-bolization as therapy for patients with unresectable hepatocellular carcinoma. Eur. J. Surg. Oncol., 2008, 34(1), 61-66.
[http://dx.doi.org/10.1016/j.ejso.2007.02.006] [PMID: 17434711]
[15]
Iezzi, R.; Pompili, M.; Posa, A.; Coppola, G.; Gasbarrini, A.; Bonomo, L. Combined locoregional treatment of patients with hepatocellular carcinoma: State of the art. World J. Gastroenterol., 2016, 22(6), 1935-1942.
[http://dx.doi.org/10.3748/wjg.v22.i6.1935] [PMID: 26877601]
[16]
Iezzi, R.; Posa, A.; Tanzilli, A.; Carchesio, F.; Pompili, M.; Manfredi, R. Balloon-Occluded MWA (b-MWA) Followed by Balloon-Occluded TACE (b-TACE): Technical Note on a New Combined Single-Step Therapy for Single Large HCC. Cardiovasc. Intervent. Radiol., 2020, 43(11), 1702-1707.
[http://dx.doi.org/10.1007/s00270-020-02583-6] [PMID: 32676963]
[17]
Veltri, A.; Moretto, P.; Doriguzzi, A.; Pagano, E.; Carrara, G.; Gandini, G. Radiofrequency thermal ablation (RFA) after transarterial che-moembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur. Radiol., 2006, 16(3), 661-669.
[http://dx.doi.org/10.1007/s00330-005-0029-9] [PMID: 16228211]
[18]
Takaki, H.; Yamakado, K.; Uraki, J.; Nakatsuka, A.; Fuke, H.; Yamamoto, N.; Shiraki, K.; Yamada, T.; Takeda, K. Radiofrequency abla-tion combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J. Vasc. Interv. Radiol., 2009, 20(2), 217-224.
[http://dx.doi.org/10.1016/j.jvir.2008.10.019] [PMID: 19097810]
[19]
Iezzi, R.; Pompili, M.; La Torre, M.F.; Campanale, M.C.; Montagna, M.; Saviano, A.; Cesario, V.; Siciliano, M.; Annicchiarico, E.; Agnes, S.; Giuliante, F.; Grieco, A.; Rapaccini, G.L.; De Gaetano, A.M.; Gasbarrini, A.; Bonomo, L. Radiofrequency ablation plus drug-eluting beads transcatheter arterial chemoembolization for the treatment of single large hepatocellular carcinoma. Dig. Liver Dis., 2015, 47(3), 242-248.
[http://dx.doi.org/10.1016/j.dld.2014.12.007] [PMID: 25577299]