Abstract
Purpose
To report the 1-month tumor response and safety of selective transarterial chemoembolization (TACE) via the intercostal artery (ICA) for the treatment of hepatocellular carcinoma (HCC) in comparison with those of non-selective TACE.
Methods
This retrospective study included 79 HCC patients who underwent TACE via the ICA selectively (selective TACE group; n = 26) or non-selectively (non-selective TACE group; n = 53) between January 2001 and December 2016. Selective TACE was defined when TACE was performed with selective catheterization of the tumor feeding branch of the ICA. TACE performed without selective catheterization of the tumor feeding branch was defined as non-selective TACE. One-month target and overall tumor responses and complications of the two groups were compared. Univariate and multivariate analyses were performed to identify prognostic factors.
Results
Selective TACE group showed better 1-month target and overall tumor responses and lower frequency of complications than non-selective TACE group (P = .007, P = .018, and P < .001, respectively). Performing selective TACE was the only significant favorable factor for better target and overall tumor responses (P = .001 and P = .028, respectively). In univariate analysis for complications, serum α-fetoprotein > 200 ng/mL and non-selective TACE were statistically significant. However, multivariate analysis showed that performing non-selective TACE was the only significant risk factor (odds ratio 13.56; 95% confidence interval 3.51–52.5; P < .001).
Conclusion
Compared to non-selective TACE via the ICA, selective TACE via the ICA for the treatment of HCC can achieve better tumor response and safety.
Similar content being viewed by others
References
Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11(4):317–70.
Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics. 2005;25(Suppl 1):S25–39.
Miyayama S, Matsui O, Taki K, Minami T, Ryu Y, Ito C, et al. Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Interv Radiol. 2006;29(1):39–48.
Kim MU, Kim HC, Chung JW, An S, Seong NJ, Jae HJ, et al. Hepatocellular carcinoma: prediction of blood supply from an intercostal artery with multidetector row computed tomography. J Vasc Interv Radiol. 2011;22(10):1403–8.
Park SI, Lee DY, Won JY, Lee JT. Extrahepatic collateral supply of hepatocellular carcinoma by the intercostal arteries. J Vasc Interv Radiol. 2003;14(4):461–8.
Hur S, Kim HC, Chung JW, Kim MU, Kim JD, Kim GM, et al. Hepatocellular carcinomas smaller than 4 cm supplied by the intercostal artery: can we predict which intercostal artery supplies the tumor? Korean J Radiol. 2011;12(6):693–9.
Kim HC, Chung JW, Lee IJ, An S, Seong NJ, Son KR, et al. Intercostal artery supplying hepatocellular carcinoma: demonstration of a tumor feeder by C-arm CT and multidetector row CT. Cardiovasc Interv Radiol. 2011;34(1):87–91.
Wang DS, Louie JD, Kothary N, Shah RP, Sze DY. Prophylactic topically applied ice to prevent cutaneous complications of nontarget chemoembolization and radioembolization. J Vasc Interv Radiol. 2013;24(4):596–600.
Li Z, Cai Z, Dai S, Deng H, Li Z, Ji F. Cutaneous necrosis associated with transcatheter arterial chemoembolization of the intercostal artery. J Vasc Interv Radiol. 2014;25(7):1141–8.
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.
Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6.
Kim HC, Chung JW, Kim WH, An S, Seong NJ, Jae HJ, et al. Chemoembolization of the left inferior phrenic artery in patients with hepatocellular carcinoma: 9-year single-center experience. AJR Am J Roentgenol. 2010;194(4):1124–30.
Kim SH, Kim HC, Hur S, Lee M, Jung HS, Jae HJ, et al. Chemoembolization via the left internal mammary artery supplying hepatocellular carcinoma. J Vasc Interv Radiol. 2014;25(9):1389–97.
Ueno K, Miyazono N, Inoue H, Miyake S, Nishida H, Nakajo M. Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol. 1995;18(3):183–5.
Kim JH, Yeon JE, Jong YK, Seo WK, Cha IH, Seo TS, et al. Spinal cord injury subsequent to transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Dig Liver Dis. 2010;42(1):67–70.
Park SJ, Kim CH, Kim JD, Um SH, Yim SY, Seo MH, et al. Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma. Clin Mol Hepatol. 2012;18(3):316–20.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical Approval
This study has obtained IRB approval from Samsung Medical Center and the need for informed consent was waived.
Informed Consent
For this type of study formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hyun, D., Cho, S.K., Shin, S.W. et al. Selective Versus Non-selective Transarterial Chemoembolization via the Intercostal Artery for the Treatment of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 43, 587–596 (2020). https://doi.org/10.1007/s00270-019-02405-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-019-02405-4