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CardioVascular and Interventional Radiology

, Volume 37, Issue 2, pp 388–395 | Cite as

Comparison of Local Control in Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma ≤6 cm With or Without Intraprocedural Monitoring of the Embolized Area Using Cone-Beam Computed Tomography

  • Shiro MiyayamaEmail author
  • Masashi Yamashiro
  • Masahiro Hashimoto
  • Nanako Hashimoto
  • Masaya Ikuno
  • Kenichiro Okumura
  • Miki Yoshida
  • Osamu Matsui
Clinical Investigation

Abstract

Purpose

This study was designed to compare technical success and local recurrence rates of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with/without monitoring of embolized areas using cone-beam computed tomography (CBCT).

Methods

A total of 207 HCCs ≤6 cm were treated with superselective TACE using digital subtraction angiography (DSA) alone (DSA group, 98 tumors of 70 patients) or plus CBCT monitoring (CBCT group, 109 tumors of 79 patients). Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5-mm wide for tumors <25 mm, and 10-mm wide for tumors 25≥ and ≤60 mm; grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Technical success and local recurrence rates in the DSA and CBCT groups were compared. Local recurrence rates of grade A and B tumors were also compared.

Results

The grade A/B/C tumors in the DSA and CBCT groups were 64 (65.3 %)/25 (25.5 %)/9 (9.2 %) and 95 (87.2 %)/11 (10.1 %)/3 (2.8 %), respectively. Local recurrence developed in 46/158 (29.1 %) grade A tumors and 24/36 (66.7 %) grade B. There were significant differences in technical success between the DSA and CBCT groups (p < 0.001) and local recurrence rates between grade A and B tumors (p < 0.001). The 1-, 2-, and 3-year local recurrence rates in the DSA and CBCT groups were 33.3 and 22.3 %, 41.3 and 26.8 %, and 48 and 30.6 %, respectively (p = 0.0217).

Conclusion

Intraprocedural CBCT monitoring of embolized areas reduces the local tumor recurrence.

Keywords

Hepatocellular carcinoma Transcatheter arterial chemoembolization Monitoring of the embolized area Cone-beam computed tomography Local recurrence 

Notes

Conflict of interest

None.

References

  1. 1.
    Yamada R, Sato M, Kawabata M et al (1983) Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 148:397–401PubMedGoogle Scholar
  2. 2.
    Uchida H, Ohishi H, Matsuo N et al (1990) Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and Gelfoam particles for hepatocellular carcinoma. Cardiovasc Intervent Radiol 13:140–145PubMedCrossRefGoogle Scholar
  3. 3.
    Matsui O, Kadoya M, Yoshikawa J et al (1993) Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 188:79–83PubMedGoogle Scholar
  4. 4.
    Takayasu K, Muramatsu Y, Maeda T et al (2001) Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentogenol 176:681–688CrossRefGoogle Scholar
  5. 5.
    Ishijima H, Koyama Y, Aoki J et al (1999) Use of a combined CT-angiography system for demonstration of correlative anatomy during embolotherapy for hepatocellular carcinoma. J Vasc Interv Radiol 10:811–815PubMedCrossRefGoogle Scholar
  6. 6.
    Miyayama S, Matsui O, Yamashiro M et al (2007) Ultraselective transcatheter arterial chemoembolization with a 2-F tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 18:365–376PubMedCrossRefGoogle Scholar
  7. 7.
    Morimoto M, Numata K, Sugimori K et al (2007) Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma. World J Gastroenterol 13:1003–1009PubMedGoogle Scholar
  8. 8.
    Miyayama S, Yamashiro M, Okuda M et al (2009) Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol 32:255–264PubMedCrossRefGoogle Scholar
  9. 9.
    Hirota S, Nakao N, Yamamoto S et al (2006) Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol 29:1034–1038PubMedCrossRefGoogle Scholar
  10. 10.
    Virmani S, Ryu RK, Sato KT et al (2007) Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol 18:1305–1309PubMedCrossRefGoogle Scholar
  11. 11.
    Wallace MJ, Murthy R, Kamat PP et al (2007) Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol 18:1500–1507PubMedCrossRefGoogle Scholar
  12. 12.
    Kakeda S, Korogi Y, Ohnari N et al (2007) Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol 18:1508–1516PubMedCrossRefGoogle Scholar
  13. 13.
    Miyayama S, Matsui O, Yamashiro M et al (2009) Detection of hepatocellular carcinoma by CT during arterial portography using a cone-beam CT technology: comparison with conventional CTAP. Abdom Imaging 34:502–506PubMedCrossRefGoogle Scholar
  14. 14.
    Miyayama S, Yamashiro M, Hattori Y et al (2011) Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma. Jpn J Radiol 29:371–377PubMedCrossRefGoogle Scholar
  15. 15.
    Iwazawa J, Ohue S, Hashimoto N et al (2012) Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma. Eur J Radiol 81:3985–3992PubMedCrossRefGoogle Scholar
  16. 16.
    Mori H, Saida Y, Wanatane Y et al (2000) Rapid production of gelatin sponge particles for transcatheter arterial embolization: pumping method. Nippon Acta Radiol 60:702–704 (in Japanese)PubMedGoogle Scholar
  17. 17.
    Sasaki A, Kai S, Iwashita Y et al (2005) Microsatellite distribution and indication for locoregional therapy in small hepatocellular carcinoma. Cancer 103:299–306PubMedCrossRefGoogle Scholar
  18. 18.
    Higashihara H, Okazaki M (2002) Transcatheter arterial chemoembolization of hepatocellular carcinoma: a Japanese experience. Hepatogastroenterology 49:72–78PubMedGoogle Scholar
  19. 19.
    Nakazawa T, Kokubu S, Shibuya A et al (2007) Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 188:480–488PubMedCrossRefGoogle Scholar
  20. 20.
    Kim YS, Lee WJ, Rhim H et al (2010) The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentogenol 195:758–765CrossRefGoogle Scholar
  21. 21.
    Ueda K, Saito K, Terada T et al (1991) Selective necrosis of encapsulated malignant lesion within atypical adenomatous hyperplasia of the liver following transarterial embolization. a report of two autopsy cases. J Clin Gastroenterol 13:709–714PubMedCrossRefGoogle Scholar
  22. 22.
    Takayasu K, Wakao F, Moriyama N et al (1993) Response of early-stage hepatocellular carcinoma and borderline lesions to therapeutic arterial embolization. AJR Am J Roentogenol 160:301–306CrossRefGoogle Scholar
  23. 23.
    Miyayama S, Matsui O, Yamashiro M et al (2007) Iodized oil accumulation in the hypovascular tumor portion of early-stage hepatocellular carcinoma after ultraselective transcatheter arterial chemoembolization. Hepatol Int 1:451–459PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Iwazawa J, Ohue S, Kitayama T et al (2011) C-arm CT for assessing initial failure of iodized oil accumulation in chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol 197:W337–W342PubMedCrossRefGoogle Scholar
  25. 25.
    Terayama N, Matsui O, Gabata T et al (2001) Accumulation of iodized oil within the nonneoplastic liver adjacent to hepatocellular carcinoma via the drainage routes of the tumor after transcatheter arterial embolization. Cardiovasc Intervent Radiol 24:383–387PubMedCrossRefGoogle Scholar
  26. 26.
    Miyayama S, Mitsui T, Zen Y et al (2009) Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma. Hepatol Res 39:374–381PubMedCrossRefGoogle Scholar
  27. 27.
    Yamanaka K, Hatano E, Kitamura K et al (2012) Early evaluation of transcatheter arterial chemoembolization-refractory hepatocellular carcinoma. J Gastroenterol 47:343–346PubMedCrossRefGoogle Scholar
  28. 28.
    Miyayama S, Yamashiro M, Hashimoto M et al (2013) Identification of small hepatocellular carcinoma and tumor-feeding branches with cone-beam CT guidance technology during transcatheter arterial chemoembolization. J Vasc Interv Radiol 24:501–508PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Shiro Miyayama
    • 1
    Email author
  • Masashi Yamashiro
    • 1
  • Masahiro Hashimoto
    • 1
  • Nanako Hashimoto
    • 1
  • Masaya Ikuno
    • 1
  • Kenichiro Okumura
    • 1
  • Miki Yoshida
    • 1
  • Osamu Matsui
    • 2
  1. 1.Department of Diagnostic RadiologyFukuiken Saiseikai HospitalFukuiJapan
  2. 2.Department of RadiologyKanazawa University Graduate School of Medical ScienceKanazawaJapan

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