Research Presentation Session: Interventional Radiology

RPS 209 - Advances in liver loco-regional treatment

February 28, 09:30 - 11:00 CET

7 min
Salvage therapy outcomes of degradable starch microspheres transarterial chemoembolisation (DSM-TACE) in patients with uveal melanoma liver metastases
Johannes Maximilian Ludwig, Heidelberg / Germany
Author Block: J. M. Ludwig, H. Steinberg, J. Haubold, L. Umutlu, M. Forsting, J. T. Siveke, B. M. Schaarschmidt, J. Theysohn; Essen/DE
Purpose: The aim of this study was to assess DSM-TACE as salvage therapy in patients with unresectable uveal melanoma liver metastases and to identify prognostic factors for survival.
Methods or Background: Fifty-five patients (49.1% male, median age 65 yrs) first treated between 08/2016-06/2021 were assessed retrospectively. One hundred and sixty two DSM-TACE (median of 2/patient, range: 1-12) with melphalan (in 98%) were performed. Cox Proportional Hazard Model for uni-(UVA) & multivariate (MVA) analyses (Hazard ratio;95%CI,p-value) and Kaplan-Meier analysis for determining median overall survival and time to progression (OS/TTP in months; 95%CI) were performed. Response assessment was performed according to the RECIST criteria.
Results or Findings: The median OS of the study cohort was 7.97 (6.7-9.3) months following the first DSM-TACE. UVA identified low lactate dehydrogenase (LDH <2x the upper level of normal) (0.26;0.12-0.57,p=<0.001), normal serum protein (0.32;0.2-0.7,p=0.008), hepatic tumour burden ≦25% (0.39;0.19-0.7,p=0.007), and monthly tumour growth rate ≦20% before the first DSM-TACE (0.32;0.14-0.7,p=0.005) as predictors of prolonged OS. MVA confirmed low LDH (median OS: 11.4 vs. 4.3 months, p=0.021) and low TGR (median OS: 9.9 vs. 6.4 months, p=0.005) as independent predictors. Patients with low LDH and TGR (40.9%) survived longer, with a median OS of 20.4 (8.4-1.6) months compared to patients with high LDH or high TGR (46%) with 6,4 months (4,5-8,9) or patients with high TGR and high LDH (14%) with 2.4 months (1,1-7,2). Median TTP was four months (3.1-5.7). The best response observed was PR in 14%, SD in 67%, and PD in 19%, with a median OS of 25 (13.5-31.6), 8 (7.1-.8), and 4.4 (2.1-20.4) months, respectively.
Conclusion: DSM-TACE is a promising salvage therapy for patients with unresectable uveal melanoma liver that can achieve disease control and prolong survival. Low pretreatment LDH and low prior tumor growth rate are independent predictors of prolonged survival.
Limitations: Single-centre, retrospective study is its limitation.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study is a retrospective single-centre database analysis that has been approved by the local institutional review board with waived informed consent (5: 20-9799-BO).
7 min
Percutaneous combined treatment (transarterial chemoembolisation + thermal ablation) in patients with hepatocellular carcinoma enlisted for liver transplant: pathological findings and follow-up
Federica Piccione, Turin / Italy
Author Block: F. Piccione, M. Calandri, A. Doriguzzi Breatta, P. Fonio, M. M. E. Fronda, C. Gazzera, E. Susanna; Turin/IT
Purpose: The study aimed at evaluating the efficacy of a combined thermal ablation (TA) and trans-arterial chemoembolisation (TACE) treatment as a bridge or downstaging method for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) > 3 cm in size.
Methods or Background: A retrospective review encompassed 700 consecutive patients subjected to OLT for HCC, focusing on 36 patients who underwent combined TA and TACE as bridge or downstaging. Primary objectives included assessing explanted liver pathology, emphasising necrosis of the targeted lesion, post-OLT overall survival (OS) and post-OLT recurrence free survival (RFS). A comparison in terms of post-OLT OS and RFS with 170 patients subjected to TA alone for nodules < 3 cm in size was also performed.
Results or Findings: Out of the 36 patients, 63.9% underwent the combined therapy as a bridge, while 36.1% required downstaging to meet the Milan criteria. The average treated node size was 4.25 cm (+/- DS). Half received radiofrequency (RF) treatment and the other half underwent microwave (MW) treatment. All nodes underwent drug-eluting beads (DEB) TACE. The mean necrosis percentage was 65.9% in the RF+TACE group and 83.3% in the MW+TACE group (p-value = 0.099). OS was 100% at 1 year, 100% at 3 years, and 94.7% at 5 years. RFS was 97.2% at 1 year, 94.4% at 3 years, and 90% at 5 years. Despite the different sizes of the lesions, OS and RFS did not show significant differences between the study cohort and the cohort of patients subjected to TA alone.
Conclusion: Combined therapy (TA and TACE) is effective for HCC > 3 cm, particularly for bridging and downstaging to OLT, achieving OS and RFS rates exceeding 80% at 1, 3, and 5 years.
Limitations: Retrospective single-centre study limits the scope of this study.
Funding for this study: No funds were received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Waiting for a response.
7 min
Two-dimensional perfusion-angiography permits direct visualisation of redistribution of flow in hepatocellular carcinoma during balloon-occluded TACE
Paolo Vetri, Rome / Italy
Author Block: P. Lucatelli, P. Vetri, S. Ciaglia, B. Rocco, E. Damato, M. G. Travaglini, P. Ricci, C. Catalano; Rome/IT
Purpose: The purpose of this study was to demonstrate in vivo redistribution of the blood flow towards HCC’s lesions by utilizing two-dimensional perfusion-angiography in balloon occluded-TACE procedures.
Methods or Background: Thirty patients with 35 HCC nodules treated in the period between January 2019 and November 2021. For each patient, a post-processing software leading to a two-dimensional perfusion-angiography was applied on each angiography performed via balloon microcatheter, before and after inflation. On the color map obtained, reflecting the evolution of contrast intensity change over time, five regions of interests (ROIs) were assessed: one on the tumour (ROI-t), two in the immediate peritumoural healthy liver parenchyma (ROI-ihl) and two in the peripheral healthy liver parenchyma (ROI-phl). The results have been interpreted with a novel in-silico model that simulates the haemodynamics of the hepatic arterial system.
Results or Findings: Among the ROIs drawn inside the same segment of target lesion, the time-to-peak of the ROI-t and of the ROI-ihl have a significantly higher mean value when the balloon was inflated compared with the ROIs obtained with deflated balloon (10.33 ± 3.66s vs 8.87 ± 2.60s (p=0.015) for ROI-t; 10.50 ± 3.65s vs 9.23 ± 2.70s (p=0.047) for ROI-ihl). The in-silico model prediction time-to-peak delays when balloon was inflated, matches with those observed in vivo. The numerical flow analysis shows how time-to-peak delays are caused by the obstruction of the balloon-occluded artery and the opening of intra-hepatic collateral.
Conclusion: The measurements identify predictively the flow redistribution in the hepatic arteries during b-TACE, supporting a proper positioning of the balloon microcatheter, in order to provide the operator with an advantageous flow distribution for chemoembolization.
Limitations: Limitations to the study are the fact that it is a retrospective analysis and that it is monocentric.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable for this study.
7 min
Interventional treatment of unresectable or recurrent hepatic cholangiocarcinoma: transarterial chemoembolisation (TACE) with combined thermal ablation vs TACE alone
Andreas Michael Bucher, Frankfurt am Main / Germany
Author Block: T. J. Vogl, M. H. H. Albrecht, N-E. A. N-E. Mohammed; Frankfurt a. Main/DE
Purpose: The purpose of this study was to retrospectively evaluate local tumour control and survival rates after targeted local therapy using transarterial chemoembolisation (TACE) with or without local thermal ablation in patients with unresectable or recurrent hepatic cholangiocarcinoma (CCC).
Methods or Background: From 01/07 to 12/17, 152 patients (69 males/83 females; mean: 58.7 years) with CCC were retrospectively evaluated. The study included patients with both unresectable (80.2%) and recurrent lesions (19.8%). Patients were treated with at least three cycles of TACE (range; 3-26). 32 patients received combined TACE and local thermal ablation. Local tumour response was assessed by contrast-enhanced MRI (CE-MRI) based on the modified RECIST criteria (mRECIST) and the survival evaluated using the Kaplan-Meier method.
Results or Findings: The mean survival for all patients was 28.7 months (range:21.8-35.7). Patients with additional thermal ablation showed significantly longer survival vs. those with TACE as monotherapy (median: 27 vs. 18 months). Tumour response after three cycles of TACE was either stable (35.5%), partial response (41.4%), progressive (23%), or complete response (0%) and the response at the last follow-up was 25.7%, 15.2%, 59.2%, and 3.5%, respectively. Significant prognostic factors were found: nodal and/or systemic metastases, pre-therapeutic tumour load, initial local tumour response and associated application of local thermal ablation.
Conclusion: Targeted therapy of unresectable or recurrent CCC using TACE with an added value of thermal ablation may provide a therapeutic option for local tumour control and may improve patient's survival.
Limitations: Retrospective non-randomised study design limits the scope of this study.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional review board approval was obtained prior to commencing this retrospective study.
7 min
Cone beam-assisted transarterial chemoembolisation in malignant liver tumours: evaluation of parenchymal blood volume
Andreas Michael Bucher, Frankfurt am Main / Germany
Author Block: T. J. Vogl, E. Emrich, S. Bernatz, T. Gruber-Rouh; Frankfurt a. Main/DE
Purpose: The study was aimed to assess the prognostic value of parenchymal blood volume (PBV) after transarterial chemoembolisation (TACE).
Methods or Background: One hundred and thirty seven patients (60 females/77 males; median age 61; range 22–86) with malignant liver tumours of hepatocellular carcinoma (HCC) (n=27), colorectal cancer (CRC) (n=30) or other primaries (n=80) treated with TACE between 07/2016 and 07/2018 were retrospectively evaluated. Examinations were performed using Artis Pheno- and/or Artis Zeego-Dyna CT. CTs were reworked at a dedicated workstation to create a PBV map, which was overlapped with the associated MRI to determine tumour diameter and PBV. Patients were divided into 2 groups: PBV<50 or >50ml/1000 ml and subdivided regarding the primaries. Median survival was calculated using Kaplan-Meier and compared using the log‐rank test.
Results or Findings: One hundred and eleven patients with 2-6 TACEs (average: 3) were included for measuring reduction PBV and tumor size: In 27/111 patients with initial PBV <50 ml/1000 ml, tumour volume, independent of the primary, was reduced by 13.26%, PBV by 23.11%. In 84/111 patients with PBV>50 ml/1000 ml, tumour volume was reduced by 24.01%, PBV by 44.69%. In the overall study population (n=137) patients with PBV>50 ml/1000 ml (n=101) survived on average 15.05 months, patients with PBV<50 ml/1000 ml (n=36) 10.01 months (p<0.002). The subgroup analysis showed a longer median survival in the HCC group at PBV>50 ml/1000 ml of 18.09 months. For CRC and other primaries survival time for high and low PBV is almost identical with 11.64 months for CRC and 12.03 months for other primaries.
Conclusion: High initial PBV values in the HCC group showed a prolonged survival time. In the other subgroups (CRC, other primaries) there was no effect on survival time regarding the initial PBV value.
Limitations: Retrospective study design, preparation and analysis of PBV cards is very time-consuming, different pretreatments of the primary tumours, partly no longer traceable, all these are the limitations of this study.
Funding for this study: There was no funding for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: A consenting ethics vote was issued by the Frankfurt Ethics Committee on January 17, 2019 (business no: 376 / 18).
7 min
Long-term outcome of transarterial radioembolisation for patients with hepatocellular carcinoma
Riccardo Muglia, Bergamo / Italy
Author Block: R. Muglia, P. Marra, C. Prussia, M. De Giorgio, M. Viganò, A. Gerali, G. L. Poli, S. Fagiuoli, S. Sironi; Bergamo/IT
Purpose: Transarterial radioembolisation (TARE) is a treatment indicated across many stages of hepatocellular carcinoma (HCC). We aimed to assess radiological response, safety and overall survival (OS) of TARE for HCC, identifying predictors of OS.
Methods or Background: We included consecutive patients treated with TARE from 2012 to 2021 in a single centre with following criteria: presence of at least 1 measurable HCC without extrahepatic metastases, Child-Pugh score (CPS) A/B, ECOG performance status 0/1. Only the first TARE was considered in those patients who received >1 procedure. The radiological response by mRECIST criteria was evaluated 3/4 months after TARE. Uni- and multivariable analyses were used to explore the features at time of TARE and post-TARE radiological evaluation.
Results or Findings: Among the 142 patients (median age 67 years, 85% males, 92% cirrhotics, BCLC-A 29%, BCLC-B 35%, BCLC-C 36%, HCV+ 46%, CPS-A 85%, median alpha-fetoprotein 27 ng/mL) the median OS was 16.7 months with a 3-yrs cumulative survival rate of 28%. 31%, 39%, 9% and 21% of patients had complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), respectively. BCLC stage and alpha-fetoprotein levels at time of TARE, delta alpha-fetoprotein (from TARE to post-TARE evaluation) and radiological response were statistically related to OS. Alpha-fetoprotein >21.4 ng/mL and BCLC-C at time of TARE were significantly related with death [HR 1.48 (95%CI 1.00-2.18, p=0.048) and 1.71 (95%CI 1.05-2.79, p=0.031),respectively] although only radiological incomplete response (PR, SD, PD) had higher HR for death (3.34, 95%CI 2.03-5.79, p<0.0001), at multivariate analysis. Adverse events occurred in 27% of patients (1 severe).
Conclusion: TARE is effective for HCC patients across different disease stages, and response to treatment remains the most important predictor of OS.
Limitations: Possible biases in patients selection leading to cohort inomogeneity limit this study.
Funding for this study: This study was not supported by any funding.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
7 min
Percutaneous thermal segmentectomy for liver malignancies over 3 cm: retrospective multicentric study of mid-term oncological performance and predictors of sustained complete response
Bianca Rocco, Rome / Italy
Author Block: B. Rocco1, R. Argirò1, V. Semeraro1, Q. Lai1, C. Catalano1, R. Lezzi1, L. Crocetti2, P. Lucatelli1; 1Rome/IT, 2Pisa/IT
Purpose: Report the mid-term oncological results of a multicenter retrospective experience on percutaneous thermal segmentectomy (single-step combination of balloon-occluded MWA -bMWA- followed by balloon-occluded TACE -bTACE-) in patients with liver malignancies >3 cm and to identify risk factors for the loss of sustained complete response in the target lesion.
Methods or Background: Sixty-three patients (40/23, male/female) with liver primary malignancies (hepatocellular carcinoma,HCC=49; intra-hepatic cholangiocarcinoma,iCC=4) and metastasis (n=10) were treated. Median diameter of the target lesion was 4.5 cm (range: 3-7 cm). bMWA was performed, in a single-step procedure, after balloon-microcatheter inflation, followed eventually by bTACE (with epirubicin or irinotecan). Oncological results at 1 month and at 3 months interval until 12-15 months, were evaluated using m-RECIST (HCC) and RECISTv1.1 (metastasis/iCC).
Results or Findings: Median follow-up was 9.2 months. At one month follow-up 79.4% of patients presented a complete response and the remaining 20.6% of patients were partial responders. The 3-6 months follow up was reached by 59/63 patients: 83.3%(48/59) of patients showed a sustained complete response, while 10.2%(6/59) and 8.5%(5/59) of patients had respectively a partial response and a progressive disease. At the last available follow-up, the global median time of sustained complete response was 9 months, with 65.9% of cases showing a complete response. While, no relevant risk factors were identified for obtaining a complete response after the bMWA-bTACE, an initial diameter of the target lesion ≥ 5cm showed to be the unique independent variable for the risk of failure in maintaining a complete response at 6 months (OR=8.58, 95%CI=1.38-53.43; P=0.02).
Conclusion: Percutaneous thermal segmentectomy allows to achieve promising oncological results in patients with >3 cm tumors, with tumour dimension ≥5 cm being the only risk factor associated with the failure of a sustained complete response.
Limitations: Retrospective nature
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Sapienza ethics committee approved of this study.
7 min
Radiomics analysis of pre-treatment imaging in hepatocellular carcinoma (HCC) undergoing trans-arterial chemoembolisation (TACE): correlations with treatment response and survival
Elio Damato, Rome / Italy
Author Block: P. Lucatelli, E. Damato, E. P. Perrone, B. Rocco, M. Forlino, A. De Santis, C. Catalano; Rome/IT
Purpose: Radiomics uses radiological imaging to generate multi-dimensional data, defined as features. The novelty of radiomics is the possible correlation with clinical endpoints, mostly in oncological diseases. This a retrospective study investigate correlations between pre-treatment imaging radiomics and clinical outcomes in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolisation (TACE).
Methods or Background: We selected pretreatment data (clinical, CT scan and laboratory) of 64 HCC Patients treated with TACE. With an open-source software we extract 68 features. Therapeutic outcome was divided in "response" (complete and partial response) and "non-response" (stable disease). Response to TACE was assessed with mRECIST criteria. Primary endpoint was correlation with clinical response to treatment. Secondary endpoint was overall survival.
Results or Findings: Primary endpoint: clinical data related to response (Chi-Square test) were age (upper median, p=0.027), Child-Pugh Score (A vs B, P=0.009) and albumin (upper median, P=0.009). Twelve radiomics features were related with response (Mann-Whitney test, p<0.05), namely: CONVENTIONAL, SHAPE, GLRLM, NGLDM, GLZLM family. Secondary endpoint: clinical data related to survival (Cox regression model) were: age, number of HCC nodules, albumin, history of ascites and hepatic encephalopathy. Kaplan Meier curve showed that Patients that had at least two of the aforementioned clinical variable experienced inferior survival, Log Rank: p<0,01. Radiomic parameters related to survival were: GLCM_Entropy_median, GLZLM_SZHGE_median. Kaplan Meier curve showed that Patients with high median scores of GLCM_entropy and GLZLM_SZHGE experienced inferior survival, Log Rank: p=0.022.
Conclusion: Our study showed that some radiomic features have predictive or prognostic value in HCC Pts undergoing TACE. Clinical and laboratory data are always essential. Integration of the two models can help management of HCC patients.
Limitations: Limited sample size. Further studies are needed to develop standardised models for performing radiomic analysis.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable for this study.
7 min
European multicentre retrospective study of balloon-occluded transarterial chemoembolisation (B-TACE) for hepatocellular carcinoma (HCC) long term (31 months) follow-up
Elio Damato, Rome / Italy
Author Block: P. Lucatelli1, E. Damato1, B. Rocco1, T. Debaere2, G. Verset3, F. Fucilli4, A. Paccapelo5, C. Catalano1, C. Mosconi5; 1Rome/IT, 2Villejuif/FR, 3Brussels/BE, 4Triggiano/IT, 5Bologna/IT
Purpose: The aim of this retrospective multicentric European study was to evaluate the long-term tumor response rates of balloon-occluded transarterial chemoembolisation (B-TACE) in HCC patients.
Methods or Background: B-TACE procedures response were evaluated according to m-RECIST criteria with multiphasic CT/MRI imaging at 1 months after the procedure and then every 3-6 months. Data were collected from six European centers from 2015 to 2022. Values assessed at latest available follow-up were disease control (DC), progressive disease (PD) and Progression free survival (PFS), for both target lesions and patient overall.
Results or Findings: Of the 91 patients of the original cohort, 19 patients were lost at follow-up, resulting in a final cohort of 72 patients. Mean maximum diameter of target lesion was 36.5±19.4 mm, with a median follow-up of 31.6 months. Overall Response was DC 33.3% (24 patients) and PD 66.7% (48 patients). Target lesion long-term response was DC 69.4% (50 patients) and PD 30.6% (22 patients). Median Progression-Free Survival was 9.3 months for Overall Response and not Reached for Target Lesion Response (Local Recurrence-Free), among the 22 patients with local recurrence the mean time observed for PD was 9.8±19.4 months (median 7.7, range 1-31).
Conclusion: The study proves that B-TACE permits to achieve an high sustained disease control rate of the target lesion whereas progression occurred within first 7 months from initial treatment.
Limitations: Small sample size
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable for this study.
7 min
MRI-based investigation of dynamic changes in viable hepatocellular carcinoma following transarterial chemoembolisation
Shu-Hang Zhang, Jiangsu / China
Author Block: W. Wang, Y-C. Wang, S-H. Zhang; Nanjing/CN
Purpose: The aim of this study was to analyse the dynamic changes in MRI radiological features of viable tumours at different follow-up times after the initial Tanscatheter arterial chemoembolisation (TACE) treatment for hepatocellular carcinoma (HCC) to improve the understanding and diagnostic accuracy of viable tumours.
Methods or Background: The study analysed a prospective, single-arm, multicentre clinical trial data set (NCT03113955) and another three centres of clinically diagnosed patients with intermediate-stage HCC who received TACE as their first treatment. Viable tumours in two follow-up MRI were evaluated according to the Liver Imaging Reporting and Data System (LI-RADS). Radioligical features were evaluated including signal characteristics of T1WI, T2WI, and DWI, the presence or absence of wash in and wash out, as well as the size, location, and shape of the viable tumours.
Results or Findings: There were 157 HCCs in multicentre data set and 297 HCCs in another three centers met inclusion criteria. After exclusion, there were total 160 viable tumours on both follow-up MRI. Compared with the radiological features of the baseline, the T2WI hyperintensity (P= .002), wash out (P< .001) and the tumour short diameter (P< .001) of the first follow-up viable tumours significantly decreased. Compared with the radiological features of the first follow-up viable tumours, only the DWI hyperintensity of the second follow-up viable tumours increased (P= .009). For the shape features, both follow-ups showed mostly regular shapes (66.9%, 60.6%). Another location feature, the first follow up viable tumour showed mostly internal location (51.3%), but the second follow up viable tumour showed mostly non-internal location (66.9%).
Conclusion: The radiological features of viable tumours at early follow up post-TACE showed more variability compared to the baseline HCC, while those at second follow-up remained variable but less than the first follow up.
Limitations: Not applicable for this study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable for this study.

This session will not be streamed, nor will it be available on-demand!