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VIII) Interventional Oncology in Digestive Medicine
Symposium (VIII)
INTERVENTIONAL ONCOLOGY IN DIGESTIVE MEDICINE
LEGACY: LOCAL RADIOEMBOLIZATION USING GLASS MICROSPHERES FOR THE ASSESSMENT OF TUMOUR CONTROL WITH Y-90
Vivian Bishay Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
The LEGACY Study is the first multicenter study to report a high median perfused volume absorbed dose of 410 Gy with TheraSphere, which resulted in an 88% best response (84% complete response), durable tumor control and high overall survival rate in patients with early and advanced HCC. At three years the overall survival rate for patients was 93% in patients with transplant or resection following TheraSphere and 84% for patients who had TheraSphere as a primary treatment, with 96.8% of patients responding to treatment following one TheraSphere treatment and 100% response with two treatments.
Symposium (VIII)
INTERVENTIONAL ONCOLOGY IN DIGESTIVE MEDICINE
Y90 FOR CURATIVE INTENT IN HCC
Rheun-Chuan Lee Division of Abdominal Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
Radioembolization has historically been employed in the salvage setting for the treatment of unresectable HCC. However, application of segmental, high dose radioembolization or radiation segmentectomy higher radiation doses can be safely delivered, translating to robust and consistent response rates. The focused delivery also minimizes risk of collateral parenchymal damage. This approach could be considered potentially curative based on the same rationale as resection, radiofrequency ablation, and transplantation in recent studies. For those who exceed surgical criteria, radioembolization can be used to reduce the tumor burden and increase sufficient future liver remnant thereby enabling patients to meet the conditions for hepatectomy or liver transplantation. It provides the possibility of long-term survival in a substantial although selected subgroup of patients with otherwise limited treatment options.
Symposium (VIII)
INTERVENTIONAL ONCOLOGY IN DIGESTIVE MEDICINE
Toshihiro Tanaka Department of Radiology, IVR Center, Nara Medical University, Nara, Japan
Due to recent development of molecular targeted agents and immunotherapies for HCC, the role of TACE has changed from palliative treatment to curative treatment in patients with preserved liver function. Previous reports indicated that selective TACE could be a curative treatment option.[1,2] A recent randomized controlled trial in Japan demonstrated the higher curability of selective cTACE compared with DEB-TACE.[3] The mechanism of action for TACE is a combination of selective vascular occlusion of tumor feeding arteries, which induce ischemic necrosis, and cytotoxic effect by chemotherapeutic agents. Our experimental study using a rat HCC model showed advantage of embolic effect of lipiodol emulsion compared with small microspheres in ultrasonography and histology examinations. [4] Recently developed pumping emulsification device with a microporous glass membrane can create nearly 100% W/O emulsion, which could increase antitumor effect of selective cTACE.[5-7] Several techniques were reported to enhance the therapeutic effect in selective TACE. 3D-saftymargin is one of the important factors to obtain curability.[8] On the other hand, presently, due to an increase in life expectancy of the aged, treatments for elderly patients with HCC are a critical issue. Year by year, the average age of HCC patients has been increasing. Currently, approximately 12,000 patients with HCC over 80 years old have been newly diagnosed and approximately 13,000 patients over 80 years old died due to HCC in Japan.[9] For extremely aged patients, current molecular targeted agents and immunotherapies might not be always acceptable due to their tolerability. Also, basically, poor liver function is contraindication. Several previous studies revealed some advantages of DEB-TACE in cases with bilobar multiple HCC or poor liver function.
The learning objective of this lecture is to understand the basic principle and clinical evidence in DEB-TAE and cTACE for HCC.
Reference:
1. Miyayama. Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma. Appl. Sci 2020,10,7337. 2. Saito N, Tanaka T, et al. Transarterial- chemoembolization remains an effective therapy for intermediate-stage hepatocellular carcinoma with preserved liver function. Hepatol Res 2020;50:1176-1185. 3. Ikeda M, et al. A prospective randomized controlled trial of selective transarterial chemoembolization using drug-eluting beads loaded with epirubicin versus selective conventional transarterial chemoembolization using epirubicin-Lipiodol for hepatocellular carcinoma: the JIVROSG-1302 PRESIDENT study. J Clin Oncol 2020;38:(15 Suppl); abstract 4518. 4. Minamiguchi K, Tanaka T, et al. Comparison of embolic effect between water-in-oil
emulsion and microspheres in transarterial embolization for rat hepatocellular carcinoma model. Hepatol Res 2020;50:1297-1305. 5. Masada T, Tanaka T, et al. Use of a Glass Membrane Pumping Emulsification Device Improves Systemic and Tumor
Pharmacokinetics in Rabbit VX2 Liver Tumor in Transarterial Chemoembolization. J Vasc
Interv Radiol. 2020;31:347-351. 6. Tanaka T, et al. Efficacy of a glass membrane emulsification device to form mixture of cisplatin powder with lipiodol on transarterial therapy for hepatocellular carcinoma.
Cardiovasc Intervent Radiol accepted in Dec.2020. 7. Tanaka T, et al. Drug Release Property of Lipiodol Emulsion Formed by Glass Membrane Emulsification Device for Transarterial Chemoembolization. Cardiovasc Intervent
Radiol. 2020;43:135-139. 8. Charoenvisal C, Tanaka T, et al. 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;10:63-71. 9. Cheng HM, Tanaka T, et al. Safety and Prognosis of Transarterial Chemoembolization for Octogenarians with Hepatocellular
Carcinoma. Cardiovasc Intervent Radiol. 2019;42:1413-1419.
Symposium (VIII)
INTERVENTIONAL ONCOLOGY IN DIGESTIVE MEDICINE
Yi-Sheng Liu Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan Division of Interventional Radiology, Department of Medical Imaging, National Cheng Kung University Hospital, Tainan, Taiwan
Transarterial chemoembolization (TACE) is a major treatment for intermediate hepatocellar carcinoma (HCC). Conventional TACE (cTACE) is developed for over 30 years, and drug-eluting bead TACE (DEB-TACE) is developed for more than 10 years. More and more expertise opinions and research data are pubished, but the demographics of HCC patients highly vary in different regions. So the perspectives of different regions may be different. In Taiwan, the survival rates of TACE-naïve patients treated with cTACE and DEB-TACE during 5-year follow-up were 23.9% and 33.3% (p = 0.045). The median time to disease progression in the cTACE and the DEB-TACE groups were 11.0 months and 16.0 months (p = 0.019). And for TACE-naïve patients with large HCC, the 3-year survival rates in the cTACE and DEB-TACE groups were no difference (HR = 0.95, 95% confidence interval: 0.51 - 1.78; p = 0.880). However, the patients treated with DEB-TACE showed longer time to disease progression in the first 2 years. Other Taiwan’s perspectives will be shared in the meeting.
