Intraprocedural cone-beam CT with parenchymal blood volume assessment for transarterial chemoembolization guidance: Impact on the effectiveness of the individual TACE sessions compared to DSA guidance alone. Issue 140 (July 2021)

• Record Type: Journal Article
• Authors: Peisen, Felix; Maurer, Michael; Grosse, Ulrich; Nikolaou, Konstantin; Syha, Roland; Artzner, Christoph; Bitzer, Michael; Horger, Marius; Grözinger, Gerd
• Is Part Of: European journal of radiology. Issue 140(2021)
• Publication Date: 2021-07
• Subjects: Carcinoma -- Hepatocellular -- Chemoembolization -- Therapeutic -- Cone-beam computed tomography -- Matched-pair analysis -- Retrospective studies; AFP alpha-fetoprotein -- ANOVA analysis of variance -- AP alkaline phosphatase -- BCLC Barcelona Clinic Liver Cancer Staging System -- BSC best supportive care -- CBCT cone-beam CT -- CI confidence interval -- CR complete response -- CT computer tomography -- DEB drug-eluting bead -- DSA digital subtraction angiography -- EASL European Association for the Study of the Liver -- ECOG Eastern Cooperative Oncology Group -- HBV hepatitis B virus -- HCC hepatocellular carcinoma -- HCV hepatitis C virus -- IQR interquartile range -- LTX liver transplantation -- mRECIST modified response evaluation criteria in solid tumours -- MRI magnet resonance imaging -- NASH non-alcoholic steatohepatitis -- OS overall survival -- PD progressive disease -- PBV(I) parenchymal blood volume (imaging) -- PR partial response -- PS performance status -- RFA radiofrequency ablation -- SD standard deviation/stable disease -- TACE transarterial chemoembolization; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109768
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The study findings support the use of PBV-CBCT for DEB-TACE guidance. PBV-CBCT leads to a considerable increase of the treatment efficiency. PBV-CBCT guidance has no negative effects on tumour response and overall survival. PBV-CBCT helps to avoid unnecessary re-interventions. Abstract: Purpose: The objective of this retrospective single centre study was to evaluate the impact of intraprocedural cone-beam CT with parenchymal blood volume assessment (PBV-CBCT) for guidance of transarterial chemoembolization with drug-eluting beads (DEB-TACE) in HCC patients on the effectiveness (local tumour response, survival and number of individual TACE sessions) compared to guidance solely by digital subtraction angiography (DSA). Method: n = 179 HCC patients (mean age, 77.4 y) undergoing DEB-TACE, with (n = 28) and without (n = 151) PBV-CBCT, using 100−300 μm microspheres loaded with epirubicin were retrospectively analysed. Tumour response according to mRECIST, overall survival and number of TACE interventions as well as laboratory parameters for liver function and inflammation were recorded. The analysis of the influence of intraprocedural PBV-CBCT was based on matched pair analysis (CBCT n = 28 vs. DSA n = 28). Gender, tumour number, tumour size and HCC risk factors were equally distributed between both groups. Results: Response rates according to mRECIST: CBCT : PD: 7%, SD: 28 %, PR: 46 %, CR: 18 %; DSA : PD: 7 %, SD: 32 %, PR: 39 %, CR: 21 % (p = 0.174). Median OS: CBCT : 44.1 months; DSA : 28.8 months (p = 0.815). Median TACE number: CBCT : 2.0; DSA : 3.0 (p = 0.046). Conclusions: The use of intraprocedural PBV-CBCT for TACE guidance reduced the number of re-interventions, with no negative effects on tumour response and overall survival. The study findings support the use of PBV-CBCT for DEB-TACE guidance as the improved immediate feedback leads to a considerable increase of the treatment efficiency and helps to avoid unnecessary re-interventions.