naa a22 4500 51074771X CHVBK 20180411083052.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s11547-012-0914-7 doi (NATIONALLICENCE)springer-10.1007/s11547-012-0914-7 Single-step multimodal locoregional treatment for unresectable hepatocellular carcinoma: balloon-occluded percutaneous radiofrequency thermal ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) [Elektronische Daten] [R. Iezzi, V. Cesario, L. Siciliani, M. Campanale, A. De Gaetano, M. Siciliano, S. Agnes, F. Giuliante, A. Grieco, M. Pompili, G. Rapaccini, A. Gasbarrini, L. Bonomo] Terapia loco-regionale multimodale dell'epatocarcinoma non resecabile con approccio single-step: termoablazione a radiofrequenza durante occlusione temporanea dell'arteria epatica con catetere da PTA (BO-RFA) plus chemioembolizzazione arteriosa transcatetere (TACE) Purpose: This study was undertaken to evaluate the feasibility, safety and efficacy of a new combined single-step therapy in patients with unresectable multinodular unilobar hepatocellular carcinoma (HCC), with at least one lesion >3 cm, with balloon-occluded radiofrequency ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) of the main lesion and TACE of the other lesions. The second purpose of our study was to compare the initial effects in terms of tumour necrosis of this new combined therapy with those obtained in a matched population treated with TACE alone in a singlestep treatment in our centre in the previous year. Methods and materials: This pilot study was approved by the institutional review board, and informed consent was obtained from all patients. Ten consecutive patients with multinodular (two to six nodules) unilobar unresectable HCC and with a main target lesion >3 cm (range, 3.5-6 cm) not suitable for curative therapy were enrolled in our single-centre multidisciplinary pilot study. The schedule consisted of percutaneous RFA (single 3-cm monopolar needle insertion) of the target lesion during occlusion of the hepatic artery supplying the tumour, followed by selective TACE, plus lobar TACE for other lesions (450-mg carboplatin and lipiodol plus temporary embolisation with SPONGOSTAN). Adverse events and intra- and periprocedural complications were clinically assessed. Early local efficacy was evaluated on 1-month follow-up multiphasic computed tomography (CT) on the basis of the Modified Response Evaluation Criteria in Solid Tumors (m-RECIST). A separate evaluation of target lesions in terms of enhancement, necrotic diameter and presence and distribution of lipiodol uptake was also performed. Results: No major complications occurred. Overall technical success, defined as complete devascularisation of all nodules during the arterial phase, was achieved in seven of 10 patients, with three cases of partial response (persistence of small hypervascular nodules). When considering only target lesions, technical success was obtained in all patients, with a nonenhancing area corresponding in shape to the previously identified HCC (necrotic diameter, 3.5-5 cm) and with circumferential peripheral lipiodol uptake (safety margin) of at least 0.5 cm (0.5-1.3cm). Conclusions: TACE and BO-RFA, plus TACE in a singlestep approach seems to be a safe and effective combined therapy for treating advanced, unresectable HCC lesions, allowing a high rate of complete local response to be achieved in large lesions also. Springer-Verlag Italia, 2013 Hepatocellular carcinoma nationallicence Radiofrequency ablation nationallicence Chemoembolization nationallicence Combined therapy nationallicence Treatment algorithm nationallicence Epatocarcinoma nationallicence Termoablazione a radiofrequenza nationallicence Chemioembolizzazione nationallicence Terapia combinata nationallicence Algoritmo di trattamento nationallicence Iezzi R. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Cesario V. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Siciliani L. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Campanale M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut De Gaetano A. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Siciliano M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Agnes S. General Surgery and Transplantation Unit, Department of Surgery, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Giuliante F. Hepatobiliary Surgery Unit, "A. Gemelli” Hospital, Catholic University, L.go A Gemelli 8, 00168, Rome, Italy aut Grieco A. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Pompili M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Rapaccini G. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Gasbarrini A. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut Bonomo L. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut La radiologia medica Springer Milan 118/4(2013-06-01), 555-569 0033-8362 118:4<555 2013 118 11547 https://doi.org/10.1007/s11547-012-0914-7 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11547-012-0914-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Iezzi R. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Cesario V. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Siciliani L. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Campanale M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- De Gaetano A. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Siciliano M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Agnes S. General Surgery and Transplantation Unit, Department of Surgery, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Giuliante F. Hepatobiliary Surgery Unit, "A. Gemelli” Hospital, Catholic University, L.go A Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Grieco A. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Pompili M. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Rapaccini G. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Gasbarrini A. Department of Internal Medicine, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 700 1- Bonomo L. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy aut NATIONALLICENCE 773 0- La radiologia medica Springer Milan 118/4(2013-06-01), 555-569 0033-8362 118:4<555 2013 118 11547 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer