Abstract

Objective

To evaluate the feasibility and safety of using cone-beam CT (CBCT) to measure changes in parenchymal blood volume (PBV) of patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to guide microwave ablation (MWA) for residual tumors.

Methods

A retrospective study was performed on 42 patients with HCC who completed TACE and received CBCT-guided perfusion imaging. The residual active lesions after TACE were supplemented with MWA to complete the treatment process according to the residual PBV. The outcomes were analyzed, including PBV changes, interventional-related complications, local tumor progression (LTP) and overall survival (OS).

Results

Technical success was achieved in all lesions. Correlation analysis revealed that greater volume of residual PBV after MWA is negatively correlated with LTP. (p = .000); and the decrease of PBV was positively correlated with LTP (p = .000). All adverse events and complications were CTCAE Grade 1/2. After combination treatment, the 1-, 3-, and 5-year LTP-free survival were 97.6%, 69.0% and 15.1%, respectively, with a median LTP of 49.0 months (95% CI:43.129,54.871). Multivariate Cox regression revealed that the residual PBV > 13 ml/1000 was an independent factor predicting a shorter OS and LTP (Both p< .05). For LTP, multivariate Cox regression showed that a tumor in a single lesion were independently predicted to have a longer LTP in patients with HCC (p = .033).

Conclusion

CBCT is feasible and safe to use to measure changes in the PBV before and after TACE treatment, while it can also guide MWA for the treatment of residual tumors in one session

中文翻译：

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根据锥束CT肝脏灌注结果，在TACE后及时采取补救措施

摘要

客观的

评估使用锥形束CT（CBCT）测量经导管动脉化疗栓塞（TACE）后肝细胞癌（HCC）患者实质血容量（PBV）的变化并指导微波消融（MWA）的残留量的可行性和安全性肿瘤。

方法

对完成TACE并接受CBCT引导的灌注成像的42例HCC患者进行了回顾性研究。在TACE后残留的活动性病变中，根据残留的PBV补充MWA以完成治疗过程。分析了结局，包括PBV变化，介入相关并发症，局部肿瘤进展（LTP）和总生存期（OS）。

结果

在所有病变中均取得了技术成功。相关分析显示，MWA后更大的残留PBV量与LTP负相关。（p  = .000）；PBV的下降与LTP呈正相关（p  = .000）。所有不良事件和并发症均为CTCAE 1/2级。联合治疗后，无LTP的1年，3年和5年生存率分别为97.6％，69.0％和15.1％，中位LTP为49.0个月（95％CI：43.129,54.871）。多元Cox回归显示，残余PBV> 13 ml / 1000是预测较短的OS和LTP的独立因素（均为p <.05）。对于LTP，多因素Cox回归显示，独立预测单个病变中的肿瘤在HCC患者中具有更长的LTP（p  = .033）。

结论

CBCT在TACE治疗之前和之后用于测量PBV的变化是可行且安全的，同时它还可以指导MWA在一个疗程中治疗残留肿瘤