Initiative on Superselective Conventional Transarterial Chemoembolization Results (INSPIRE) View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-08-17

AUTHORS

Thierry de Baere, Maxime Ronot, Jin Wook Chung, Rita Golfieri, Roman Kloeckner, Joong-Won Park, Bernhard Gebauer, Nabil Kibriya, Ganapathy Ananthakrishnan, Shiro Miyayama

ABSTRACT

Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) “selectively targetable” and “accessible to supraselective catheterization.” The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5–2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the “drop test.” Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care. More... »

PAGES

1430-1440

References to SciGraph publications

  • 2012-02-23. Prospective Evaluation of Transcatheter Arterial Chemoembolization (TACE) with Multiple Anti-Cancer Drugs (Epirubicin, Cisplatin, Mitomycin C, 5-Fluorouracil) Compared with TACE with Epirubicin for Treatment of Hepatocellular Carcinoma in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2006-09-11. The Size of Gelatin Sponge Particles: Differences with Preparation Method in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
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  • 2011-04-12. Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival in EUROPEAN RADIOLOGY
  • 2019-05-13. Current Trends in the Treatment of Hepatocellular Carcinoma with Transarterial Embolization: Variability in Technical Aspects in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2014-08-19. TACE performed in patients with a single nodule of Hepatocellular Carcinoma in BMC CANCER
  • 2015-09-21. Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2006-10-01. A New Porcine Sponge Material for Temporary Embolization: An Experimental Short-Term Pilot Study in Swine in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2017-08-02. Parameters for Stable Water-in-Oil Lipiodol Emulsion for Liver Trans-Arterial Chemo-Eembolization in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2017-12-15. Development of pumping emulsification device with glass membrane to form ideal lipiodol emulsion in transarterial chemoembolization in EUROPEAN RADIOLOGY
  • 2012-05-30. Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis? in JAPANESE JOURNAL OF RADIOLOGY
  • 2009-10-22. MDCT Versus MRI Assessment of Tumor Response After Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2014-06-17. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma in BRITISH JOURNAL OF CANCER
  • 2017-08-01. Transarterial chemoembolization with miriplatin vs. epirubicin for unresectable hepatocellular carcinoma: a phase III randomized trial in JOURNAL OF GASTROENTEROLOGY
  • 2013-06-19. Comparison of Local Control in Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma ≤6 cm With or Without Intraprocedural Monitoring of the Embolized Area Using Cone-Beam Computed Tomography in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00270-022-03233-9

    DOI

    http://dx.doi.org/10.1007/s00270-022-03233-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1150300199

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35978174


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