Pescatori Lorenzo Carlo, Galletto Pregliasco Athena, Derbel Haytham, Saccenti Laetitia, Ghosn Mario, Blain Maxime, Chalayea Julia, Luciani Alain, Mulé Sebastien, Amaddeo Giuliana, Kobeiter Hicham, Tacher Vania
Department of Interventional Radiology, hôpital Avicenne (AP-HP), Bobigny, France.
Department of Radiology, hôpital Henri-Mondor (AP-HP), Créteil, France.
Res Diagn Interv Imaging. 2024 Mar 10;9:100042. doi: 10.1016/j.redii.2024.100042. eCollection 2024 Mar.
The aim of this study was to report the safety and tumor response rate of combined transarterial radioembolization (TARE) through the intrahepatic arteries and transarterial chemoembolization (TACE) through the extrahepatic feeding arteries (EHFA) in patients with hepatocellular carcinoma (HCC).
Patients with HCC, who had both intrahepatic and extrahepatic arterial supply visible on preinterventional multiphase CT and were treated between 2016 and 2021 with a combination of TACE and TARE on the same nodule, were retrospectively included. Epidemiological, clinical, biological, and radiological characteristics were recorded. Safety and tumor response were assessed at 6 months.
Nine patients (8 men, median age 62 years [IQR: 54-72 years]) were included. Seven patients had previous treatments on the target nodule (TARE: 5; TACE: 2). The median longest axis (LA) of the lesion was 70 mm (IQR: 60-79 mm). Three patients had portal vein invasion (VP3). The EHFA originated from the right diaphragmatic artery ( = 6), the right adrenal artery ( = 2), and the left gastric artery ( = 1). The LA of the tumor portion treated with TACE was 47 mm (range: 35-64 mm). The ratio between the LA of the entire lesion and the LA treated with TACE was 1.44 (range: 1.27-1.7). One major complication occurred: acute on chronic liver failure. Median follow-up was 23 months (range: 16-29 months). Seven patients underwent further treatment: on the same lesion ( = 2), on newly appeared nodules ( = 2), and systemic treatment ( = 3). At 6-month follow-up, seven patients showed a local objective response. Time-to-progression was 13 (3.5-19) months.
The combination of TARE and extrahepatic TACE for HCC with both intrahepatic and extrahepatic arterial supplies seems feasible and safe. Further studies are needed to validate the effectiveness of these preliminary results.
本研究旨在报告经肝内动脉的联合经动脉放射性栓塞术（TARE）和经肝外供血动脉（EHFA）的经动脉化疗栓塞术（TACE）在肝细胞癌（HCC）患者中的安全性和肿瘤反应率。
回顾性纳入2016年至2021年间接受TACE和TARE联合治疗同一结节、且在介入前多期CT上可见肝内和肝外动脉供血的HCC患者。记录流行病学、临床、生物学和放射学特征。在6个月时评估安全性和肿瘤反应。
纳入9例患者（8例男性，中位年龄62岁[四分位间距：54 - 72岁]）。7例患者曾对目标结节进行过治疗（TARE：5例；TACE：2例）。病变的中位最长径（LA）为70 mm（四分位间距：60 - 79 mm）。3例患者有门静脉侵犯（VP3）。EHFA起源于右膈动脉（n = 6）、右肾上腺动脉（n = 2）和胃左动脉（n = 1）。TACE治疗的肿瘤部分的LA为47 mm（范围：35 - 64 mm）。整个病变的LA与TACE治疗的LA之比为1.44（范围：1.27 - 1.7）。发生1例主要并发症：慢性肝衰竭急性发作。中位随访时间为23个月（范围：16 - 29个月）。7例患者接受了进一步治疗：同一病变（n = 2）、新出现的结节（n = 2）和全身治疗（n = 3）。在6个月随访时，7例患者显示局部客观反应。疾病进展时间为13（3.5 - 19）个月。
对于具有肝内和肝外动脉供血的HCC，TARE与肝外TACE联合应用似乎可行且安全。需要进一步研究来验证这些初步结果的有效性。
