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Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Peter Popovic
Peter Popovic
, 
Borut Stabuc
Borut Stabuc
, 
Rado Jansa
Rado Jansa
 and 
Manca Garbajs
Manca Garbajs
   | Nov 10, 2016
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Article Category: Research Article
Published Online: Nov 10, 2016
Page range: 418 - 426
Received: Jun 10, 2015
Accepted: Aug 19, 2015
DOI: https://doi.org/10.1515/raon-2015-0045
© 2016 Radiol Oncol
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 56-year-old female with HCC. (A) Contrast-enhanced CT shows tumor (arrow) between right and left liver lobe. (B) Initial angiography shows tumor in the liver (arrow). (C) Superselective contrast injection throught microcatheter into segmental branches for eight liver segment confirmes the tumor. (D) Superselective contrast injection throught microcatheter into segmental branches for first liver segment also confirmes the tumor (arrow). (E) CBCT after contrast injection throught microcatheter into segmental branches for first liver segment confirmes that the target lesion (arrow) is dominantely suplied from this artery and superselective DEBDOX TACE was performed from both artery. (F) Two months after the DEBDOX TACE, control CT shows complete devascularization of the target lesion (arrow) (complete response).
A 56-year-old female with HCC. (A) Contrast-enhanced CT shows tumor (arrow) between right and left liver lobe. (B) Initial angiography shows tumor in the liver (arrow). (C) Superselective contrast injection throught microcatheter into segmental branches for eight liver segment confirmes the tumor. (D) Superselective contrast injection throught microcatheter into segmental branches for first liver segment also confirmes the tumor (arrow). (E) CBCT after contrast injection throught microcatheter into segmental branches for first liver segment confirmes that the target lesion (arrow) is dominantely suplied from this artery and superselective DEBDOX TACE was performed from both artery. (F) Two months after the DEBDOX TACE, control CT shows complete devascularization of the target lesion (arrow) (complete response).

A 64-year-old male with HCC. (A) Control MR after chemoembolization shows complete response of the target lesion (arrow) in fourth segment and partial response of the target lesion in eight segment. (B) Superselective contrast injection throught microcatheter into the righr phrenic artery. (C) Position of microcatheter prior CBCT. (D) CBCT shows that this artery suplied the target tumor in seventh segment. Superselective DEBDOX TACE was performed.
A 64-year-old male with HCC. (A) Control MR after chemoembolization shows complete response of the target lesion (arrow) in fourth segment and partial response of the target lesion in eight segment. (B) Superselective contrast injection throught microcatheter into the righr phrenic artery. (C) Position of microcatheter prior CBCT. (D) CBCT shows that this artery suplied the target tumor in seventh segment. Superselective DEBDOX TACE was performed.

A 66-year-old male with HCC. (A) Initial angiography shows tumor in right liver lobe (arrow). (B) Superselective contrast injection throught microcatheter into the subsegmental branches. (C) CBCT shows that this artery actually suplied the gallblader (arrow) and not the target tumor. (D) Superselective catheterisation of the tumor feeding artery with microcathter. (E) CBCT after contrast injection throught microcatheter confirmes the target lesion (arrow). Superselective DEBDOX TACE was performed.
A 66-year-old male with HCC. (A) Initial angiography shows tumor in right liver lobe (arrow). (B) Superselective contrast injection throught microcatheter into the subsegmental branches. (C) CBCT shows that this artery actually suplied the gallblader (arrow) and not the target tumor. (D) Superselective catheterisation of the tumor feeding artery with microcathter. (E) CBCT after contrast injection throught microcatheter confirmes the target lesion (arrow). Superselective DEBDOX TACE was performed.

Baseline demographic, clinical, laboratory and tumor staging characteristics of patients

CharacteristicValue
Age, [years]67.5 ± 7.8
Gender (M/F), n [%]32/3 [91.4/8.6]
Cirrhosis (yes/no), n [%]30/5 [85.7 /14.3]
Etiology of cirrhosis, n [%]:
 Ethanol13 [43.3]
 HBV4 [13.3]
 HCV4 [13.3]
 other9 [29.9]
Albumin [g/l]38.4 ± 4.6
INR1.2 ± 0.2
Total bilirubin [μmol/l]25.6 ± 17.4
Child-Pugh score (points)6.0 ± 0.7
Child-Pugh score (classes), n [%]:
 A22 [73.3]
 B8 [26.7]
Creatinine [μmol/l]81.7 ± 23.4
ASAT [μkat/l]1. 1 ± 0.7
ALAT [μkat/l]0.8 ± 0.6
γGT [μkat/l]2.3 ± 1.6
αFP [kIE/l]152.5 ± 310.2
Portal vein thrombosis (yes/no), n [%]6/29 [17.1/82.9]
Bilobar disease, n [%]11 [31.4]
Unilobar disease, n [%:]24 [68.6]
right lobe, n [%]20 [83.3]
Overall number of nodules, n97
Number of nodules per pt, n2.8 ± 2.2
Maximum diameter of HCC nodule per pt. [cm]4.7 ± 1.9

Number and type of minor complications after DEBDOX TACE.

Type of complicationNo. of complications
Post-embolization syndrome

Post-embolization syndrome was defined as elevated body temperature, pain in the abdomen, nausea and/or vomiting, leukocytosis and elevated liver enzymes.

23
Rise in blood pressure4
Gastric erosions or ulcers2
Chest pain2
Hematoma at puncture site1
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