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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

  • Technical Note
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose To evaluate the feasibility, safety and efficacy of a combined single-step therapy in patients with unresectable single large (> 5 cm) hepatocellular carcinoma (HCC), with balloon-occluded microwave ablation (b-MWA) plus transcatheter arterial balloon-occluded chemoembolization (b-TACE).

Materials & Methods

Five consecutive Child A patients (mean age: 71.4 ± 3.2 yo; range 68–76 yo) with an unresectable single large HCC (> 5 cm) (mean size: 5.7 ± 0.6 cm; range 5.1–6.5 cm) were enrolled in our pilot study. The schedule consisted of percutaneous microwave ablation of the lesion during balloon occlusion of the hepatic artery supplying the tumor (b-MWA), followed by TACE under the occlusion of feeding arteries by a microballoon catheter (b-TACE). Adverse events and intra- and peri-procedural complications were clinically assessed. Early local efficacy was evaluated on 1- and 6-month follow-up multiphasic computed tomography (CT) on the basis of m-RECIST criteria.

Results

Technical success was obtained in all procedures. No major complications occurred. A mean necrotic area of 6.8 ± 0.47 cm (range 6.3–7.4 cm) was obtained, with a complete response at 1-month follow-up obtained in 4 out of 5 lesions, with 1 partial response (less than 30% of residual tumor), successfully treated with a single TACE treatment. No residual tumor or local recurrence was registered at 6-month CT follow-up.

Conclusions

Our preliminary experience seems to demonstrate that b-MWA plus b-TACE could be a safe and effective combined therapy for unresectable large HCC lesions, allowing a high rate of local response also in lesion exceeding 5 cm in size.

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Funding

This study was not supported by any funding

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli—IRCCS, Istituto di Radiologia, Universita’ Cattolica del Sacro Cuore, L. go A. Gemelli 8, 00168, Rome, Italy

    Roberto Iezzi, Alessandro Posa, Alessandro Tanzilli, Francesca Carchesio & Riccardo Manfredi

  2. Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario A Gemelli—IRCCS, Universita’ Cattolica del Sacro Cuore, L. go A. Gemelli 8, 00168, Rome, Italy

    Maurizio Pompili

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  1. Roberto Iezzi
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  2. Alessandro Posa
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  3. Alessandro Tanzilli
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  4. Francesca Carchesio
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  5. Maurizio Pompili
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Correspondence to Roberto Iezzi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) approved this study.

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Iezzi, R., Posa, A., Tanzilli, A. et al. 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 43, 1702–1707 (2020). https://doi.org/10.1007/s00270-020-02583-6

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