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[Volumetric and morphological CT parameters for assessing prognosis and treatment control in hepatocellular carcinoma
1Strahlenklinik und Poliklinik, Virchow-Klinikum, Humboldt-Universität zu Berlin.
Insights
Volumetric CT data guides transarterial chemo-embolisation (TAE) for hepatocellular carcinoma (HCC). Optimal outcomes for HCC patients involve repeated TAE with tumor volumes under 50 ml and high lipiodol retention.
Area of Science:
- Hepatobiliary Oncology
- Interventional Radiology
- Medical Imaging
Background:
- Hepatocellular carcinoma (HCC) is a primary liver malignancy.
- Transarterial chemo-embolisation (TAE) is a standard treatment for unresectable HCC.
- Accurate assessment of tumor burden and treatment response is crucial for optimizing TAE outcomes.
Purpose of the Study:
- To assess the utility of volumetric computed tomography (CT) data in guiding the indication for TAE in HCC.
- To determine the prognostic value of volumetric CT parameters for patients undergoing TAE for HCC.
- To correlate imaging findings with patient survival after TAE treatment.
Main Methods:
- Seventy-four patients with HCC underwent repeated TAE procedures.
- Treatment involved Adriblastin, cisplatin, lipiodol, and Spherex, administered selectively or superselectively.
- Volumetric CT scans were used to evaluate tumor characteristics and lipiodol retention post-procedure.
Main Results:
- Survival time demonstrated a statistically significant correlation with tumor volume, tumor-to-liver volume ratio, intratumoral lipiodol retention, tumor growth pattern, and number of liver segments involved (p < 0.0001).
- Patients with >75% lipiodol retention exhibited a mean survival of 819 days, compared to 382 days for those with <75% retention.
- Solitary HCC lesions with tumor volumes <50 ml and >75% lipiodol retention were associated with improved survival.
Conclusions:
- Volumetric CT assessment is valuable for guiding TAE indications in HCC.
- Tumor volume and intratumoral lipiodol retention are significant prognostic factors after TAE for HCC.
- Repeated TAE with specific parameters (solitary lesion <50 ml, >75% lipiodol retention) yields the best survival rates.
Purpose:
To evaluate volumetric CT data as a guide for indication and assessment of prognosis for transarterial chemo-embolisation (TAE) of hepatocellular carcinomas (HCC).
Material And Method:
74 patients with HCC were treated with repeated TAE. 50 mg Adriblastin/m2 body surface, 50 mg cisplatin/m2 body surface and 10 ml lipiodol were combined with 2-10 ml Spherex and injected selectively (25 cases) or superselectively (49 cases); in 28 patients a single injection and in 46 patients multiple injections were used.
Results:
CT findings before and after the procedure showed a solitary lesion in 17 patients, two lesions in 18 patients and in 39 patients there were three or more lesions. Mean expectation of life was 523 days (median = 372 days; 57% of one year survival probability). In 29 patients with > 75% lipiodol retention, mean survival was 819 days; in 17 patients with < 75% lipiodol retention it was 382 days; lower lipiodol retention of < 50% it was 231 days (< 25% 192 and < 10% 152 days). A statistically significant relationship (p < 0.0001) could be established between survival time and tumour volume, relationship of tumour to liver volume, intratumoral lipiodol retention, the type of tumour growth and the number of liver segments involved.
Conclusion:
TAE provides best survival rates after repeated injections of solitary HCC with tumour volumes < 50 ml and > 75% intra-tumoral lipiodol retention.