Lipiodol-Based Balloon-Occluded Transcatheter Arterial Chemoembolization Can Be a Curative Treatment Option for
Dong Il Gwon1, Jin Hyoung Kim1, Hee Ho Chu1
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Purpose:
To investigate whether ethiodized oil-based balloon-occluded transcatheter arterial chemoembolization (B-TACE) could be a curative treatment option for hepatocellular carcinoma (HCC) on the basis of pathological evaluation and clinical follow-up results.
Materials And Methods:
Eighty-two patients who presented with treatment-naive HCC between September 2018 and January 2024 were included in this single-center retrospective study. Radiological evaluations of oily subsegmentectomy, defined as necrotic area that includes the entire ethiodized oil-laden HCC and peritumoral liver parenchyma with absent perfusion on arterial and portal venous image, were performed.
Results:
Subsegmental B-TACE was technically successful in all 82 patients with a single HCC (mean diameter, 36 mm; range, 18-65 mm). A complete response (CR) and oily subsegmentectomy on first follow-up computed tomography (CT) were observed in 81 (98.8%) and 33 (40.2%) patients, respectively. Curative response, including pathological complete necrosis (36 of 39) and CR without local recurrence (LR) (28 of 43), was achieved during follow-up in 64 (78%) of 82 patients. During the median follow-up of 39.1 months, 14 HCCs (32.6%) demonstrated LR. All 33 patients with oily subsegmentectomy showed pathological complete necrosis (n = 19), and none demonstrated any LR (n = 14). Univariate log-rank analysis showed that the oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (P = .013).
Conclusions:
Ethiodized oil-based subsegmental B-TACE is an effective method with a high initial CR rate in patients with a single HCC. Oily subsegmentectomy on first follow-up CT is a good predictor of complete necrosis of HCC. Therefore, ethiodized oil-based B-TACE can be considered a curative treatment option in selected patients showing oily subsegmentectomy.
