Related Experiment Video
Updated: Jul 2, 2026
Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis
Published on: March 3, 2023
Radiation Segmentectomy versus Combined Chemoembolization plus Microwave Ablation: Histopathologic Tumor Necrosis in
Qian Yu1, Patrick Tran1, Tanner Storozuk2
1Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
Purpose:
To evaluate treatment effectiveness of radiation segmentectomy (RS) using yttrium-90 and combined transarterial chemoembolization (TACE) plus thermoablation (TACE-microwave ablation [MWA]) for treatment of hepatocellular carcinoma (HCC) by evaluating tumor necrosis (TN) on liver explant among patients bridged to transplant with HCC measuring up to 5 cm.
Materials And Methods:
A single-institution retrospective review was performed from October 2010 to February 2024 to include consecutive patients who underwent TACE-MWA or RS using glass microspheres for treatment-naive HCC measuring up to 5 cm and then liver transplant. All treatments and liver transplant were performed at the same institution. No crossover treatment was allowed. TACE and ablation were performed sequentially during the same admission. RS was defined as target dose greater than 200 Gy to up to 2 segments, performed in 2 outpatient settings for mapping and administration, respectively. Radiologic response (RR) was evaluated with contrast-enhanced computed tomography (CT) and/or magnetic resonance (MR) imaging prior to transplant. The percentage of TN was determined on liver explant. Complete pathologic necrosis (CPN) was defined as 100% TN.
Results:
A total of 25 and 28 patients underwent TACE-ablation and RS, respectively, with 40 tumors in each group. The mean segmental dose of the RS group was 284.5 Gy (SD ± 67.1). Tumor sizes were comparable between TACE-ablation and RS groups (mean, 2.1 cm [SD ± 0.9] vs 2.4 cm [SD ± 0.8]; P = .239). No significant difference was observed between 2 groups regarding percentage of TN on pathology (mean, 79.0% [SD ± 29.0] vs 83.6% [SD ± 29.6]; P = .484). The rate of CPN was also similar between 2 groups (mean, 45.0% vs 61.5%; P = .141) between tumors treated with TACE-ablation and RS, respectively. Tumor size of ≤3 cm was independently associated with CPN (odds ratio, 18.3; 95% CI, 2.14-156.48; P = .008) but not treatment modality. Tumors with complete RR demonstrated a higher degree of TN on liver explant than those did not (42.7% vs 26.6%, P = .0071).
Conclusions:
For tumor measuring up to 5 cm, TACE-ablation and RS were equivalent in achieving TN among patients bridged to transplant based on data from liver explant.
