Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

Ching Charoenvisal; Toshihiro Tanaka; Hideyuki Nishiofuku; Hiroshi Anai; Takeshi Sato; Takeshi Matsumoto; Nagaaki Marugami; Kimihiko Kichikawa

doi:10.1159/000512337

Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

Liver Cancer. 2021 Feb;10(1):63-71. doi: 10.1159/000512337. Epub 2021 Jan 12.

Authors

Ching Charoenvisal^{1

2}, Toshihiro Tanaka¹, Hideyuki Nishiofuku¹, Hiroshi Anai³, Takeshi Sato¹, Takeshi Matsumoto¹, Nagaaki Marugami¹, Kimihiko Kichikawa¹

Affiliations

¹ Department of Radiology, Nara Medical University, Kashihara, Japan.
² King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
³ Department of Radiology, Nara City Hospital, Nara, Japan.

Abstract

Introduction: The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC).

Methods: Consecutive 48 HCC nodules (diameter, 1-3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated.

Result: Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3-4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed.

Conclusion: Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.

Keywords: Hepatocelluar carcinoma; Lipiodol; Transarterial chemoembolization.