Journal of vascular and interventional radiology : JVIR · 2026
Radiation Segmentectomy versus Combined Chemoembolization plus Microwave Ablation: Histopathologic Tumor Necrosis in Hepatocellular Carcinoma Measuring up to 5 cm.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yu Qian, Tran Patrick, Storozuk Tanner, Steiner Joseph, Ungchusri Ethan, Wang Yating, Navuluri Rakesh, Zangan Steven, Millis J Michael, Hart John, Te Helen, Van Ha Thuong
Аннотация
PURPOSE: To evaluate treatment effectiveness of radiation segmentectomy (RS) using yttrium-90 and combined transarterial chemoembolization (TACE) plus thermoablation (TACE-microwave ablation [MWA]) for treatment of hepatocellular carcinoma (HCC) by evaluating tumor necrosis (TN) on liver explant among patients bridged to transplant with HCC measuring up to 5 cm.
MATERIALS AND METHODS: A single-institution retrospective review was performed from October 2010 to February 2024 to include consecutive patients who underwent TACE-MWA or RS using glass microspheres for treatment-naive HCC measuring up to 5 cm and then liver transplant. All treatments and liver transplant were performed at the same institution. No crossover treatment was allowed. TACE and ablation were performed sequentially during the same admission. RS was defined as target dose greater than 200 Gy to up to 2 segments, performed in 2 outpatient settings for mapping and administration, respectively. Radiologic response (RR) was evaluated with contrast-enhanced computed tomography (CT) and/or magnetic resonance (MR) imaging prior to transplant. The percentage of TN was determined on liver explant. Complete pathologic necrosis (CPN) was defined as 100% TN.
RESULTS: A total of 25 and 28 patients underwent TACE-ablation and RS, respectively, with 40 tumors in each group. The mean segmental dose of the RS group was 284.5 Gy (SD ± 67.1). Tumor sizes were comparable between TACE-ablation and RS groups (mean, 2.1 cm [SD ± 0.9] vs 2.4 cm [SD ± 0.8]; P = .239). No significant difference was observed between 2 groups regarding percentage of TN on pathology (mean, 79.0% [SD ± 29.0] vs 83.6% [SD ± 29.6]; P = .484). The rate of CPN was also similar between 2 groups (mean, 45.0% vs 61.5%; P = .141) between tumors treated with TACE-ablation and RS, respectively. Tumor size of ≤3 cm was independently associated with CPN (odds ratio, 18.3; 95% CI, 2.14-156.48; P = .008) but not treatment modality. Tumors with complete RR demonstrated a higher degree of TN on liver explant than those did not (42.7% vs 26.6%, P = .0071).
CONCLUSIONS: For tumor measuring up to 5 cm, TACE-ablation and RS were equivalent in achieving TN among patients bridged to transplant based on data from liver explant.
MATERIALS AND METHODS: A single-institution retrospective review was performed from October 2010 to February 2024 to include consecutive patients who underwent TACE-MWA or RS using glass microspheres for treatment-naive HCC measuring up to 5 cm and then liver transplant. All treatments and liver transplant were performed at the same institution. No crossover treatment was allowed. TACE and ablation were performed sequentially during the same admission. RS was defined as target dose greater than 200 Gy to up to 2 segments, performed in 2 outpatient settings for mapping and administration, respectively. Radiologic response (RR) was evaluated with contrast-enhanced computed tomography (CT) and/or magnetic resonance (MR) imaging prior to transplant. The percentage of TN was determined on liver explant. Complete pathologic necrosis (CPN) was defined as 100% TN.
RESULTS: A total of 25 and 28 patients underwent TACE-ablation and RS, respectively, with 40 tumors in each group. The mean segmental dose of the RS group was 284.5 Gy (SD ± 67.1). Tumor sizes were comparable between TACE-ablation and RS groups (mean, 2.1 cm [SD ± 0.9] vs 2.4 cm [SD ± 0.8]; P = .239). No significant difference was observed between 2 groups regarding percentage of TN on pathology (mean, 79.0% [SD ± 29.0] vs 83.6% [SD ± 29.6]; P = .484). The rate of CPN was also similar between 2 groups (mean, 45.0% vs 61.5%; P = .141) between tumors treated with TACE-ablation and RS, respectively. Tumor size of ≤3 cm was independently associated with CPN (odds ratio, 18.3; 95% CI, 2.14-156.48; P = .008) but not treatment modality. Tumors with complete RR demonstrated a higher degree of TN on liver explant than those did not (42.7% vs 26.6%, P = .0071).
CONCLUSIONS: For tumor measuring up to 5 cm, TACE-ablation and RS were equivalent in achieving TN among patients bridged to transplant based on data from liver explant.
Предметные рубрики MeSH
HumansLiver NeoplasmsCarcinoma, HepatocellularRetrospective StudiesNecrosisChemoembolization, TherapeuticMaleFemaleTreatment OutcomeMiddle AgedMicrowavesTumor BurdenLiver TransplantationAgedYttrium RadioisotopesAblation TechniquesRadioembolization, TherapeuticRadiopharmaceuticalsBridge TherapyTime Factors