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Keywords:
Interventional non-vascular, Interventional vascular, Liver, Percutaneous, Catheter arteriography, Ablation procedures, Chemoembolisation, Treatment effects, Cancer, Cirrhosis, Transplantation
Authors:
E. Villacastin Ruiz1, R. Pintado Garrido1, H. Calero1, A. Ginés Santiago1, M. Hernández1, F. X. Brunie1, M. Fajardo1, S. Plaza Loma2, I. Peñas Herrero1; 1Valladolid/ES, 2Valladolid, VA/ES
DOI:
10.1594/ecr2016/C-0159
Methods and materials
273 consecutive patients with 218 hepatocellular carcinoma nodules,
who underwent imaging (ultrasound (US),
multidetector computed tomography (MDCT) and magnetic resoance imaging (MRI)),
and subsequent transplantation,
were examined. Patients at risk of exceeding the Milan criteria either by the number or the size of HCC were treated by microwave ablation or chemoembolization.
We analyze the size of the nodules before treatment (according to the description of imaging techniques) and after treatment (according to the morphological study of the explanted liver) and compared their growth with those nodules that were untreated.
Microwave Ablation Technique
Percutaneous microwave ablation is usually performed with the patient under conscious sedation and local anesthesia.
With either MDCT or US guidance,
the tumor is localized and the optimal approach is determined.
A thin (14 gauge) microwave antenna is then placed directly into the tumor.
When the antenna is attached to the microwave generator with a coaxial cable,
an electromagnetic microwave is emitted from the exposed,
noninsulated portion of the antenna.
Each generator is capable of producing 60W.
Intratumoral temperatures can be measured with a separately placed thermocouple.
We used the microwave ablation generator manufactured by Tyco HealthCare Group.
(Figures 1,
2)
Chemoembolization Technique
A selective catheterization of hepatic artery is performed and a chemotherapeutic agent (50 mg doxorubicin) dissolved (1: 1) is injected into a carrier medium (Lipiodol).
(Figure 3)
When the selective catheterization of the feeding arteries of the HCC is possible,
microspheres are used (DC Beads Precision V,
Terumo).
This type of microspheres concentrates the chemotherapeutic agent (doxorubicin 150mg) and releases it in a controlled manner for a week.
This known as "Chemoembolization With Drug-Eluting Beads" (DEB-TACE).
This strategy has the advantage of increasing the local concentration of the drug and releases it steadily decreasing liver toxicity and systemic side effects.
(Figure 4)
Statical Analyses
The statistical analysis was performed using SPSS for Windows®,
version 15.0.
A value of p<0.05 was taken to indicate statistical significance.
In bivariate analysis,
depending on the application conditions (parametric or non-parametric),
the Chi-square test with the Fisher exact test,
or likelihood function,
are used to study the association between qualitative variables and to study differences between quantantive variables in two groups,
Student's T test or the Mann-Whitney U test and when there are more than two groups,
ANOVA or the Kruskal-Wallis H test.