TY - JOUR
T1 - Interventional oncology treatments for unresectable early stage HCC in patients with a high risk for intraprocedural bleeding
T2 - Is a single-step combined therapy safe and feasible?
AU - HepatoCATT Study Group for the Multidisciplinary Management of HCC
AU - Iezzi, Roberto
AU - Pompili, Maurizio
AU - Posa, Alessandro
AU - Carchesio, Francesca
AU - Siciliano, Massimo
AU - Annicchiarico, Brigida Eleonora
AU - Agnes, Salvatore
AU - Giuliante, Felice
AU - Garcovich, Matteo
AU - Cerrito, Lucia
AU - Ponziani, Francesca Romana
AU - Basso, Michele
AU - Cassano, Alessandra
AU - Rapaccini, Gian Lodovico
AU - De Gaetano, Anna Maria
AU - Gasbarrini, Antonio
AU - Manfredi, Riccardo
N1 - Copyright © 2019. Published by Elsevier B.V.
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - Blood Loss, Surgical/prevention & control
KW - Carcinoma, Hepatocellular/pathology
KW - Catheter Ablation/adverse effects
KW - Chemoembolization, Therapeutic/methods
KW - Combined Modality Therapy
KW - Feasibility Studies
KW - Female
KW - Humans
KW - Liver Neoplasms/pathology
KW - Male
KW - Middle Aged
KW - Precision Medicine
KW - Prospective Studies
KW - Treatment Outcome
U2 - 10.1016/j.ejrad.2019.02.030
DO - 10.1016/j.ejrad.2019.02.030
M3 - Article
C2 - 31005173
SN - 0720-048X
VL - 114
SP - 32
EP - 37
JO - European Journal of Radiology
JF - European Journal of Radiology
ER -