Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy.
Cardiovasc Intervent Radiol. 2022 May;45(5):665-676. doi: 10.1007/s00270-022-03117-y. Epub 2022 Mar 30.
To report the multicenter retrospective experience on combination of balloon-occluded MWA(b-MWA) followed by balloon-occluded TACE(b-TACE) in patients with liver malignancies > 3 cm, focusing on appearance and volume of necrotic area, safety profile and oncological results.
Twenty-three patients with liver primary malignancies (hepatocellular carcinoma,HCC = 18; intrahepatic cholangiocarcinoma,iCC = 2) and metastasis (colorectal cancer metastasis = 1;sarcoma metastasis = 1;breast metastasis = 1) were treated. Maximum mean diameter of lesions was 4.4 cm (± 1 cm). Treatments were performed using a single-step approach:b-MWA was performed after balloon-microcatheter inflation, followed by b-TACE (with epirubicin or irinotecan). Necrotic area shape and discrepancy with the expected volume of necrosis suggested by vendor's ablation chart were assessed at post-procedural CT. Complications were categorized according to CIRSE classification. Oncological results at 1 and 3-6 months were evaluated using m-RECIST(HCC) and RECISTv1.1(metastasis/iCC).
Mean volume of necrotic area was 75 cm (± 36). Discrepancy with vendor chart consisted in a medium percentage of volumetric incrementation of necrotic area of 103.2% (± 99.8). Non-spherical shape was observed in 22/23 patients (95.7%). No complications occurred; Post-embolization syndrome occurred in 12/23patients. Complete response and partial response were, respectively, 91, 3% (21/23) and 8.7% (2/23) at 1 month, 85.7% (18/21) and 9.5% (2/21) at 3-6 months. Progression of disease was 4.7% (1/21) at 3-6 months for extra-hepatic progression. Among partial responders, average percentage of tumor volume debulking was 78.8% (± 9.8%).
b-MWA followed by b-TACE in a single-step procedure led to larger necrotic areas than the proposed by vendors ablation chart, non-spherical in shape and corresponded to the vascular segment occluded during ablation. This permitted to safely achieve promising oncological results in patients with > 3 cm tumors.
报告在直径大于 3cm 的肝脏恶性肿瘤患者中应用球囊阻断式微波消融（b-MWA）序贯球囊阻断式 TACE（b-TACE）的多中心回顾性经验，重点关注坏死区域的外观和体积、安全性及肿瘤学结果。
共纳入 23 例肝脏原发性恶性肿瘤（肝细胞癌 [HCC]18 例，肝内胆管细胞癌 [iCC]2 例）和转移瘤（结直肠癌转移 1 例，肉瘤转移 1 例，乳腺癌转移 1 例）患者。病变最大平均直径为 4.4cm（±1cm）。采用单步治疗方案：球囊微导管扩张后置入球囊阻断行 MWA，随后行 b-TACE（顺铂或伊立替康）。术后 CT 评估坏死区域形状与供应商消融图预计坏死体积的差异。根据 CIRSE 分类评估并发症。采用 m-RECIST（HCC）和 RECISTv1.1（转移瘤/iCC）评估治疗后 1 个月和 3-6 个月的肿瘤学结果。
坏死区域平均体积为 75cm（±36cm）。与供应商消融图相比，坏死区域体积增加比例中等，为 103.2%（±99.8%）。23 例患者中有 22 例（95.7%）为非球形。23 例患者中有 12 例（52.2%）发生栓塞后综合征。治疗后 1 个月完全缓解和部分缓解率分别为 91.3%（21/23）和 8.7%（2/23），3-6 个月时分别为 85.7%（18/21）和 9.5%（2/21）。3-6 个月时，肝外进展疾病进展率为 4.7%（1/21）。在部分缓解患者中，肿瘤体积减瘤率平均为 78.8%（±9.8%）。
单步序贯 b-MWA 联合 b-TACE 治疗可导致比供应商消融图建议的更大的坏死区域，形状为非球形，与消融过程中闭塞的血管节段相对应。这可以安全地为直径大于 3cm 的肿瘤患者带来有前景的肿瘤学结果。
