In Vivo Comparison of Micro-Balloon Interventions (MBI) Advantage: A Retrospective Cohort Study of DEB-TACE Versus b-TACE and of SIRT Versus b-SIRT

Pierleone Lucatelli; Gianluca De Rubeis; Claudio Trobiani; Sara Ungania; Bianca Rocco; Simone Zilahi De Gyurgyokai; Marica Masi; Irene Pecorella; Federico Cappelli; Quirino Lai; Carlo Catalano; Giulio Vallati

doi:10.1007/s00270-021-03035-5

In Vivo Comparison of Micro-Balloon Interventions (MBI) Advantage: A Retrospective Cohort Study of DEB-TACE Versus b-TACE and of SIRT Versus b-SIRT

Cardiovasc Intervent Radiol. 2022 Mar;45(3):306-314. doi: 10.1007/s00270-021-03035-5. Epub 2022 Jan 17.

Authors

Affiliations

¹ Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. pierleone.lucatelli@gmail.com.
² Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
³ Department of Diagnostic Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
⁴ Physics Department of "Istituto Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico", Rome, Italy.
⁵ Department of Radiological Sciences, Oncology and Anatomical Pathology, Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy.
⁶ Interventional Radiology Unit of "Istituto Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico", Rome, Italy.
⁷ Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Rome, Italy.

PMID: 35037086
DOI: 10.1007/s00270-021-03035-5

Abstract

Purpose: The purpose of this study was to evaluate in vivo the role of the micro-balloon by comparing trans-arterial chemoembolization (DEB-TACE) and selective internal radiotherapy (SIRT) procedures performed with and without balloon micro-catheter (b-DEB-TACE and DEB-TACE/SIRT and b-SIRT) for the treatment of hepatocellular carcinoma (HCC).

Methods: The impact of a balloon micro-catheter on trans-arterial loco-regional treatment was analyzed using non-enhanced post-procedural cone-beam CT (Ne-CBCT) by comparing the attenuation values in the embolized area and the surrounding liver tissue before and after DEB-TACE versus b-DEB-TACE and by comparing 2D/3D dosimetry in single-photon emission computed tomography after SIRT versus b-SIRT, and by comparing the histological count of the beads following orthotopic liver transplantation in the DEB-TACE versus b-DEB-TACE subgroup.

Results: We treated 84 HCC patients using trans-arterial loco-regional therapy. Fifty-three patients (26 DEB-TACE and 27 b-DEB-TACE) were analyzed in the TACE group. Contrast, signal-to-noise ratio, and contrast-to-noise ratio were all significantly higher in b-DEB-TACE subgroup than DEB-TACE (182.33 HU [CI95% 160.3-273.5] vs. 124 HU [CI95% 80.6-163.6]; 8.3 [CI95% 5.7-10.1] vs. 4.5 [CI95% 3.7-6.0]; 6.9 [CI95% 4.3-7.8] vs. 3.1 [CI95% 2.2-5.0] p < 0.05). Thirty-one patients (24 SIRT and 7 b-SIRT) were analyzed in the SIRT group. 2D dosimetry profile evaluation showed an activity intensity peak significantly higher in the b-SIRT than in the SIRT subgroup (987.5 ± 393.8 vs. 567.7 ± 302.2, p = 0.005). Regarding 3D dose analysis, the mean dose administered to the treated lesions was significantly higher in the b-SIRT than in the SIRT group (151.6 Gy ± 53.2 vs. 100.1 Gy ± 43.4, p = 0.01). In histological explanted liver analysis, there was a trend for higher intra-tumoral localization of embolic microspheres for b-DEB-TACE in comparison with DEB-TACE.

Conclusions: Due to the use of three different methods, the results of this study demonstrate in vivo, a better embolization profile of oncological intra-arterial interventions performed with balloon micro-catheter regardless of the embolic agent employed.

Keywords: DEB-TACE; SIRT; SPECT; b-DEB-TACE; b-SIRT.

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / therapy
Chemoembolization, Therapeutic* / methods
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / pathology
Liver Neoplasms* / therapy
Retrospective Studies
Treatment Outcome