RPS 909 - Interventional management of malignant liver lesions

Author Block: R. Schmidt, B. Gebauer, C. Roderburg, G. Ardila Pardo, E. Can, F. Tacke, L. Hammerich, B. Hamm, L. J. Savic; Berlin/DE
Purpose or Learning Objective: To characterize immune cell profiles in patients with hepatocellular carcinoma (HCC) and alterations induced by conventional transarterial chemoembolization (cTACE).
Methods or Background: This interim report of an ongoing prospective clinical trial included 31 patients with HCC, who received 58 cTACE procedures between 09/2020-08/2021. Peripheral blood was sampled before, 24h, and 8 weeks after cTACE for fluorescence-activated cell sorting (FACS) analysis. A 24-color multiplex staining panel was employed to quantify lymphoid cells and checkpoint-molecule expression including CD3, CD4, CD8, CD45 and PD-1 staining. Baseline MRI and post-cTACE non-contrast CT were registered and Hounsfield units (HU) in a segmented tumour mask were quantified. The mean HU of the entire cohort was defined as a threshold for tumoural Lipiodol uptake. Statistics included normality and paired mixed-effects with post-hoc testing.
Results or Findings: Compared to baseline (CD4+: 69.7% of CD45+CD3+ T cells (TC); CD8+: 23.3% of TC), CD4+ helper TC decreased (64.6%, p=0.001), whereas CD8+ effector TC increased (26.9%, p=0.01) 24h post-cTACE. A greater increase of CD8+ TC 24h post-cTACE was observed in patients with below threshold tumoural Lipiodol uptake (p=0.001) but values returned to baseline levels at 8 weeks (p<0.001), as compared to patients with above Lipiodol uptake (p=0.043), where levels remained increased 8 weeks post-cTACE (p>0.999). However, in patients with below threshold Lipiodol uptake at 24h, CD8+ TC expressing the exhaustion marker PD1 were higher than in patients with above threshold Lipiodol uptake (p=0.019), but not 8 weeks post-cTACE (p=0.293).
Conclusion: These preliminary results demonstrate possibly favorable cTACE-induced antitumoural T cell response, suggesting Lipiodol as an imaging biomarker for the functional TC status. The findings may help exploit cTACE-induced immune-activation to guide personalized treatments using combinations with immuno-oncological therapies.
Limitations: Single-site.
Ethics committee approval: Obtained.
Funding for this study: Guerbet (project-related funding).

Author Block: A. De Cinque, C. Mosconi, A. Cucchetti, A. Cappelli, G. Vara, C. Pettinato, L. Strigari, R. Golfieri; Bologna/IT
Purpose or Learning Objective: Transarterial Radioembolisation (TARE) requires multidisciplinary experience and skill to be effective. The aim of this study was to identify the determinants of survival in patients with hepatocellular carcinoma (HCC), focusing on the learning curve, technical advancements, patient selection and role of subsequent therapies. Thus, TARE results achieved in the initial period (2005-2012) were compared to those obtained in recent years (2012-2020).
Methods or Background: From 2005 to 2020, 253 patients were treated with TARE. From 2005 to 2012, delivered activity was calculated using body surface area (BSA) formula while, after 2012, partition model was used and, for the most part, selective treatments were performed.
Results or Findings: Of 253 patients, 68 were treated before January 2012 and 185 after 2012. In the second period, patients had an ECOGPS score of 1 (p=0.025) less frequently, less liver involvement (p=0.006) and a less advanced degree of vascular invasion (p=0.019). The median overall survival (OS) of patients treated before 2012 was 11.2 months and that of patients treated beginning in 2012 was 25.7 months. After reweighting to isolate the effect of the treatment period, the median OS of patients before 2012 increased to 16 months. The median OS of patients with an adsorbed dose <120Gy was 15.7 months and that of patients with an adsorbed dose ≥120Gy was 26.0 months. Of subsequent therapies, only surgery provided a survival advantage.
Conclusion: Better patient selection, refinement of technique and adoption of personalized dosimetry improved survival after TARE. Conversely, the addition of sorafenib after TARE did not impact life expectancy.
Limitations: Limitations intrinsic to retrospective studies.
Ethics committee approval: The study conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of the centre. All patients provided informed written consent.
Funding for this study: No funding received.

Author Block: L. Dulcetta, P. Marra, F. S. Carbone, P. A. Bonaffini, R. Muglia, L. D'Antiga, S. Sironi; Bergamo/IT
Purpose or Learning Objective: Cholestasis due to benign biliary strictures is the most common biliary complication after paediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management is lacking. Percutaneous transhepatic cholangiography (PTC), bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post SLT biliary strictures.
Methods or Background: In addition to the standard treatment, 6 paediatric patients (4 males; median age 8 years, interquartile range 6.25-9.75) with SLT underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile. To our knowledge the device is unique and the first to be CE-marked for the use in this indication.
Results or Findings: Percutaneous stent implantation was technically successful in all 6 patients. In the first case, early stent dislodgement and migration in the bowel was demonstrated with X-rays after 72 hours, without sequelae. No complications occurred during a 6-month follow-up.
Conclusion: Preliminary data suggest that implantation of a new biodegradable biliary stent is feasible and safe, to be considered in the management of post SLT cholestasis in paediatric patients. Some technical considerations must be done during implantation. This device may prolong biliary drainage and may relieve the discomfort of long-term IEBD.
Limitations: Small cohort study.
Ethics committee approval: The Human Investigation Committee (IRB) of Bergamo approved this study.
Funding for this study: Not applicable.