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Safety and efficacy of dem-tace performed with drug-eluting microspheres smaller than 300μm in patients with HCC and TIPS

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Hepatoma Research 2022年第1期8卷 193-206页

作者： Pierleone Lucatelli Simone Zilahi De Gyurgyokai Gianluca De Rubeis Renato Argirò Simone Ciaglia Bianca Rocco Flaminia Ferri Simona Parisse Mariana Forlino Alessandro Cannavale FabrizioBasilico Pier Giorgio Nardis Mario Corona Vito Cantisani Carlo Catalano Vascular and Interventional Radiology Unit Department of Radiological Oncological and Anatomo-Pathological SciencesPoliclinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of Interventional Radiology San Camillo Forlanini HospitalCirconvallazione Gianicolense 87Rome 00152Italy Department of Imaging and Interventional Radiology Azienda Ospedaliera Universitaria Policlinico Tor VergataViale Oxford 81Rome 00133Italy Department of Translational and Precision Medicine Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of Radiology Policlinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy

Aim:Safety and efficacy evidence of drug-eluting-microspheres trans-arterial chemoembolization(dem-tace)in patients with hepatocellular carcinoma(HCC)and trans-jugular intrahepatic portosystemic shunt(TIPS)is lacking.The aim of this retrospective study was to report the safety and efficacy of dem-tace procedures performed with microspheres smaller than 300μm in patients with HCC and TIPS in a high-volume transplant center.Methods:Embolization was standardized by initiating dem-tace with microspheres smaller than 100μm,and if stasis was not achieved,adjunctive embolization with 100-300 or 200μm microspheres was administered.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria at 1,3-6,9-12,and 15-18 months.Reporting the safety profile,detailed laboratory analysis was performed before,at 36-48 h,and 30-60 days after the procedure.Adverse events(AEs)were recorded;post-embolic syndrome was defined as the onset of fever/nausea/pain after the procedure.Late onset hepatobiliary complications were evaluated by follow-up imaging with computed tomography or magnetic resonance(CT/MR).Results:From December 2007 to November 2020,17 HCC patients(25 HCC nodules)with patent TIPS underwent 20 dem-tace.Embolization was performed only with microspheres smaller than 100μm in 3/20 dem-tace(15%);adjunctive embolization with 100-300 or 200μm microspheres was required in 17/20 demtace(85%).Reported early AEs were post-embolic syndrome(9/20;45%)all of grade 1-2,late AEs were asymptomatic acute liver bile duct injury(2/20;10%),and in one case we observed hepatic abscess(1/20;5%)resulting in death due to sepsis.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria.Complete response(CR)at 1,3-6,9-12,and 15-18 months was 52%,50%,50%,and 50%,respectively.Objective response(CR+partial response)at 1,3-6,9-12,and 15-18 months was 95%,71%,70%,and 50%,respectively.Conclusion:dem-tace with drug-eluting-microspheres smaller than 300μm can

关键词： HCC TIPS dem-tace CT MR

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