Interventional oncology treatments for unresectable early stage HCC in patients with a high risk for intraprocedural bleeding: Is a single-step combined therapy safe and feasible?
Aged
Aged, 80 and over
Blood Loss, Surgical
/ prevention & control
Carcinoma, Hepatocellular
/ pathology
Catheter Ablation
/ adverse effects
Chemoembolization, Therapeutic
/ methods
Combined Modality Therapy
Feasibility Studies
Female
Humans
Liver Neoplasms
/ pathology
Male
Middle Aged
Precision Medicine
Prospective Studies
Treatment Outcome
Bleeding
Chemoembolization
Combined treatment
HCC
Personalized medicine
Precision medicine
Radiofrequency ablation
Journal
European journal of radiology
ISSN: 1872-7727
Titre abrégé: Eur J Radiol
Pays: Ireland
ID NLM: 8106411
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
27
09
2018
revised:
04
01
2019
accepted:
22
02
2019
entrez:
22
4
2019
pubmed:
22
4
2019
medline:
22
6
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 31005173
pii: S0720-048X(19)30084-1
doi: 10.1016/j.ejrad.2019.02.030
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-37Informations de copyright
Copyright © 2019. Published by Elsevier B.V.