Terapia loco-regionale multimodale dell'epatocarcinoma non resecabile con approccio single-step: termoablazione a radiofrequenza durante occlusione temporanea dell'arteria epatica con catetere da PTA (BO-RFA) plus chemioembolizzazione arteriosa transcatetere (TACE)

Translated title of the contribution: Single-step multimodal locoregional treatment for unresectable hepatocellular carcinoma: Balloon-occluded percutaneous radiofrequency thermal ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE)

R. Iezzi, V. Cesario, L. Siciliani, M. Campanale, A. M. De Gaetano, M. Siciliano, S. Agnes, F. Giuliante, A. Grieco, M. Pompili, G. L. Rapaccini, A. Gasbarrini, L. Bonomo

Research output: Contribution to journalArticle

Abstract

Purpose: This study was undertaken to evaluate the feasibility, safety and efficacy of a new combined single-step therapy in patients with unresectable multinodular unilobar hepatocellular carcinoma (HCC), with at least one lesion >3 cm, with balloon-occluded radiofrequency ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) of the main lesion and TACE of the other lesions. The second purpose of our study was to compare the initial effects in terms of tumour necrosis of this new combined therapy with those obtained in a matched population treated with TACE alone in a singlestep treatment in our centre in the previous year. Methods and materials: This pilot study was approved by the institutional review board, and informed consent was obtained from all patients. Ten consecutive patients with multinodular (two to six nodules) unilobar unresectable HCC and with a main target lesion >3 cm (range, 3.5-6 cm) not suitable for curative therapy were enrolled in our single-centre multidisciplinary pilot study. The schedule consisted of percutaneous RFA (single 3-cm monopolar needle insertion) of the target lesion during occlusion of the hepatic artery supplying the tumour, followed by selective TACE, plus lobar TACE for other lesions (450-mg carboplatin and lipiodol plus temporary embolisation with SPONGOSTAN). Adverse events and intra- and periprocedural complications were clinically assessed. Early local efficacy was evaluated on 1-month follow-up multiphasic computed tomography (CT) on the basis of the Modified Response Evaluation Criteria in Solid Tumors (m-RECIST). A separate evaluation of target lesions in terms of enhancement, necrotic diameter and presence and distribution of lipiodol uptake was also performed. Results: No major complications occurred. Overall technical success, defined as complete devascularisation of all nodules during the arterial phase, was achieved in seven of 10 patients, with three cases of partial response (persistence of small hypervascular nodules). When considering only target lesions, technical success was obtained in all patients, with a nonenhancing area corresponding in shape to the previously identified HCC (necrotic diameter, 3.5-5 cm) and with circumferential peripheral lipiodol uptake (safety margin) of at least 0.5 cm (0.5-1.3cm). Conclusions: TACE and BO-RFA, plus TACE in a singlestep approach seems to be a safe and effective combined therapy for treating advanced, unresectable HCC lesions, allowing a high rate of complete local response to be achieved in large lesions also.

Original languageItalian
Pages (from-to)555-569
Number of pages15
JournalRadiologia Medica
Volume118
Issue number4
DOIs
Publication statusPublished - Jun 2013

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Combined Modality Therapy
Hepatocellular Carcinoma
Ethiodized Oil
Hot Temperature
Therapeutics
Safety
Research Ethics Committees
Hepatic Artery
Carboplatin
Informed Consent
Needles
Neoplasms
Appointments and Schedules
Necrosis
Tomography
Population

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Terapia loco-regionale multimodale dell'epatocarcinoma non resecabile con approccio single-step : termoablazione a radiofrequenza durante occlusione temporanea dell'arteria epatica con catetere da PTA (BO-RFA) plus chemioembolizzazione arteriosa transcatetere (TACE). / Iezzi, R.; Cesario, V.; Siciliani, L.; Campanale, M.; De Gaetano, A. M.; Siciliano, M.; Agnes, S.; Giuliante, F.; Grieco, A.; Pompili, M.; Rapaccini, G. L.; Gasbarrini, A.; Bonomo, L.

In: Radiologia Medica, Vol. 118, No. 4, 06.2013, p. 555-569.

Research output: Contribution to journalArticle

Iezzi, R. ; Cesario, V. ; Siciliani, L. ; Campanale, M. ; De Gaetano, A. M. ; Siciliano, M. ; Agnes, S. ; Giuliante, F. ; Grieco, A. ; Pompili, M. ; Rapaccini, G. L. ; Gasbarrini, A. ; Bonomo, L. / Terapia loco-regionale multimodale dell'epatocarcinoma non resecabile con approccio single-step : termoablazione a radiofrequenza durante occlusione temporanea dell'arteria epatica con catetere da PTA (BO-RFA) plus chemioembolizzazione arteriosa transcatetere (TACE). In: Radiologia Medica. 2013 ; Vol. 118, No. 4. pp. 555-569.
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T1 - Terapia loco-regionale multimodale dell'epatocarcinoma non resecabile con approccio single-step

T2 - termoablazione a radiofrequenza durante occlusione temporanea dell'arteria epatica con catetere da PTA (BO-RFA) plus chemioembolizzazione arteriosa transcatetere (TACE)

AU - Iezzi, R.

AU - Cesario, V.

AU - Siciliani, L.

AU - Campanale, M.

AU - De Gaetano, A. M.

AU - Siciliano, M.

AU - Agnes, S.

AU - Giuliante, F.

AU - Grieco, A.

AU - Pompili, M.

AU - Rapaccini, G. L.

AU - Gasbarrini, A.

AU - Bonomo, L.

PY - 2013/6

Y1 - 2013/6

N2 - Purpose: This study was undertaken to evaluate the feasibility, safety and efficacy of a new combined single-step therapy in patients with unresectable multinodular unilobar hepatocellular carcinoma (HCC), with at least one lesion >3 cm, with balloon-occluded radiofrequency ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) of the main lesion and TACE of the other lesions. The second purpose of our study was to compare the initial effects in terms of tumour necrosis of this new combined therapy with those obtained in a matched population treated with TACE alone in a singlestep treatment in our centre in the previous year. Methods and materials: This pilot study was approved by the institutional review board, and informed consent was obtained from all patients. Ten consecutive patients with multinodular (two to six nodules) unilobar unresectable HCC and with a main target lesion >3 cm (range, 3.5-6 cm) not suitable for curative therapy were enrolled in our single-centre multidisciplinary pilot study. The schedule consisted of percutaneous RFA (single 3-cm monopolar needle insertion) of the target lesion during occlusion of the hepatic artery supplying the tumour, followed by selective TACE, plus lobar TACE for other lesions (450-mg carboplatin and lipiodol plus temporary embolisation with SPONGOSTAN). Adverse events and intra- and periprocedural complications were clinically assessed. Early local efficacy was evaluated on 1-month follow-up multiphasic computed tomography (CT) on the basis of the Modified Response Evaluation Criteria in Solid Tumors (m-RECIST). A separate evaluation of target lesions in terms of enhancement, necrotic diameter and presence and distribution of lipiodol uptake was also performed. Results: No major complications occurred. Overall technical success, defined as complete devascularisation of all nodules during the arterial phase, was achieved in seven of 10 patients, with three cases of partial response (persistence of small hypervascular nodules). When considering only target lesions, technical success was obtained in all patients, with a nonenhancing area corresponding in shape to the previously identified HCC (necrotic diameter, 3.5-5 cm) and with circumferential peripheral lipiodol uptake (safety margin) of at least 0.5 cm (0.5-1.3cm). Conclusions: TACE and BO-RFA, plus TACE in a singlestep approach seems to be a safe and effective combined therapy for treating advanced, unresectable HCC lesions, allowing a high rate of complete local response to be achieved in large lesions also.

AB - Purpose: This study was undertaken to evaluate the feasibility, safety and efficacy of a new combined single-step therapy in patients with unresectable multinodular unilobar hepatocellular carcinoma (HCC), with at least one lesion >3 cm, with balloon-occluded radiofrequency ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) of the main lesion and TACE of the other lesions. The second purpose of our study was to compare the initial effects in terms of tumour necrosis of this new combined therapy with those obtained in a matched population treated with TACE alone in a singlestep treatment in our centre in the previous year. Methods and materials: This pilot study was approved by the institutional review board, and informed consent was obtained from all patients. Ten consecutive patients with multinodular (two to six nodules) unilobar unresectable HCC and with a main target lesion >3 cm (range, 3.5-6 cm) not suitable for curative therapy were enrolled in our single-centre multidisciplinary pilot study. The schedule consisted of percutaneous RFA (single 3-cm monopolar needle insertion) of the target lesion during occlusion of the hepatic artery supplying the tumour, followed by selective TACE, plus lobar TACE for other lesions (450-mg carboplatin and lipiodol plus temporary embolisation with SPONGOSTAN). Adverse events and intra- and periprocedural complications were clinically assessed. Early local efficacy was evaluated on 1-month follow-up multiphasic computed tomography (CT) on the basis of the Modified Response Evaluation Criteria in Solid Tumors (m-RECIST). A separate evaluation of target lesions in terms of enhancement, necrotic diameter and presence and distribution of lipiodol uptake was also performed. Results: No major complications occurred. Overall technical success, defined as complete devascularisation of all nodules during the arterial phase, was achieved in seven of 10 patients, with three cases of partial response (persistence of small hypervascular nodules). When considering only target lesions, technical success was obtained in all patients, with a nonenhancing area corresponding in shape to the previously identified HCC (necrotic diameter, 3.5-5 cm) and with circumferential peripheral lipiodol uptake (safety margin) of at least 0.5 cm (0.5-1.3cm). Conclusions: TACE and BO-RFA, plus TACE in a singlestep approach seems to be a safe and effective combined therapy for treating advanced, unresectable HCC lesions, allowing a high rate of complete local response to be achieved in large lesions also.

KW - Chemoembolization

KW - Combined therapy

KW - Hepatocellular carcinoma

KW - Radiofrequency ablation

KW - Treatment algorithm

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