Interventional oncology treatments for unresectable early stage HCC in patients with a high risk for intraprocedural bleeding: Is a single-step combined therapy safe and feasible?

HepatoCATT Study Group for the Multidisciplinary Management of HCC

Research output: Contribution to journalArticle

Abstract

PURPOSE: This study was designed to assess the feasibility and safety of a single-step combined therapy using radiofrequency ablation and transarterial chemoembolization (RFA + TACE) in patients with hepatocellular carcinoma (HCC) and uncontrolled coagulopathy. The study also aimed to compare the effectiveness of this approach with TACE alone, performed in a control group.

MATERIAL AND METHODS: One hundred and forty-three consecutive cirrhotic patients having a single HCC < 8 cm were enrolled in this observational prospective single-center study from January 2010 to June 2017 and were divided, according to coagulation tests, into three groups (A: low risk; B: intermediate risk and C: high risk of bleeding). The feasibility and safety of a single-step combined treatment (RFA followed by TACE) were evaluated in terms of technical success rate, periprocedural complications, and laboratory values variations. Tumor response obtained at 1-month CT follow-up for group C was compared with that of control group, composed by 16 matched patients with severe coagulopathy and single HCC < 8 cm, who underwent only TACE in a previous period, performed by the same operator.

RESULTS: Technical success was achieved in all patients, without any major complications. Minor complications rate was significantly higher in group C after RFA; however, the patients were successfully treated with subsequent TACE therapy, without any differences between pre- and post-procedural laboratory values. One-month complete response rates were similar in all the three groups; however, the response rates of group C were significantly higher as compared to that of the control TACE Group (p < .001).

CONCLUSION: The single-step RFA plus TACE therapy allows expansion of the indication for percutaneous thermal ablation, allowing to also include cases previously contraindicated due to the procedural high-risk of complications associated with bleeding, thus improving short-term patient outcome.

Original languageEnglish
Pages (from-to)32-37
Number of pages6
JournalEuropean Journal of Radiology
Volume114
DOIs
Publication statusPublished - May 2019

Keywords

  • Aged
  • Aged, 80 and over
  • Blood Loss, Surgical/prevention & control
  • Carcinoma, Hepatocellular/pathology
  • Catheter Ablation/adverse effects
  • Chemoembolization, Therapeutic/methods
  • Combined Modality Therapy
  • Feasibility Studies
  • Female
  • Humans
  • Liver Neoplasms/pathology
  • Male
  • Middle Aged
  • Precision Medicine
  • Prospective Studies
  • Treatment Outcome

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