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HepatoCATT Study Group for the Multidisciplinary Management of HCC. Interventional oncology treatments for unresectable early stage HCC in patients with a high risk for intraprocedural bleeding: Is a single-step combined therapy safe and feasible?

Authors :
Iezzi, R
Pompili, M
Posa, A
Carchesio, F
Siciliano, M
Annicchiarico, Be
Agnes, S
Giuliante, F
Garcovich, M
Cerrito, L
Ponziani, Fr
Basso, M
Cassano, A
Rapaccini, Gl
De Gaetano, Anna Maria
Gasbarrini, A
Manfredi, R
Iezzi R (ORCID:0000-0002-2791-481X)
Pompili M (ORCID:0000-0001-6699-7980)
Siciliano M
Agnes S (ORCID:0000-0002-3341-4221)
Giuliante F (ORCID:0000-0001-9517-8220)
Garcovich M (ORCID:0000-0001-8967-6688)
Cerrito L
Ponziani FR (ORCID:0000-0002-5924-6238)
Basso M
Cassano A (ORCID:0000-0002-3311-7163)
De Gaetano AM (ORCID:0000-0002-7493-9462)
Gasbarrini A (ORCID:0000-0002-7278-4823)
Manfredi R (ORCID:0000-0002-4972-9500)
Iezzi, R
Pompili, M
Posa, A
Carchesio, F
Siciliano, M
Annicchiarico, Be
Agnes, S
Giuliante, F
Garcovich, M
Cerrito, L
Ponziani, Fr
Basso, M
Cassano, A
Rapaccini, Gl
De Gaetano, Anna Maria
Gasbarrini, A
Manfredi, R
Iezzi R (ORCID:0000-0002-2791-481X)
Pompili M (ORCID:0000-0001-6699-7980)
Siciliano M
Agnes S (ORCID:0000-0002-3341-4221)
Giuliante F (ORCID:0000-0001-9517-8220)
Garcovich M (ORCID:0000-0001-8967-6688)
Cerrito L
Ponziani FR (ORCID:0000-0002-5924-6238)
Basso M
Cassano A (ORCID:0000-0002-3311-7163)
De Gaetano AM (ORCID:0000-0002-7493-9462)
Gasbarrini A (ORCID:0000-0002-7278-4823)
Manfredi R (ORCID:0000-0002-4972-9500)
Publication Year :
2019

Abstract

PURPOSE: This study was designed to assess the feasibility and safety of a single-step combined therapy using radiofrequency ablation and transarterial chemoembolization (RFA + TACE) in patients with hepatocellular carcinoma (HCC) and uncontrolled coagulopathy. The study also aimed to compare the effectiveness of this approach with TACE alone, performed in a control group. MATERIAL AND METHODS: One hundred and forty-three consecutive cirrhotic patients having a single HCC < 8 cm were enrolled in this observational prospective single-center study from January 2010 to June 2017 and were divided, according to coagulation tests, into three groups (A: low risk; B: intermediate risk and C: high risk of bleeding). The feasibility and safety of a single-step combined treatment (RFA followed by TACE) were evaluated in terms of technical success rate, periprocedural complications, and laboratory values variations. Tumor response obtained at 1-month CT follow-up for group C was compared with that of control group, composed by 16 matched patients with severe coagulopathy and single HCC < 8 cm, who underwent only TACE in a previous period, performed by the same operator. RESULTS: Technical success was achieved in all patients, without any major complications. Minor complications rate was significantly higher in group C after RFA; however, the patients were successfully treated with subsequent TACE therapy, without any differences between pre- and post-procedural laboratory values. One-month complete response rates were similar in all the three groups; however, the response rates of group C were significantly higher as compared to that of the control TACE Group (p < .001). CONCLUSION: The single-step RFA plus TACE therapy allows expansion of the indication for percutaneous thermal ablation, allowing to also include cases previously contraindicated due to the procedural high-risk of complications associated with bleeding, thus improving short-term patient outcome.

Details

Database :
OAIster
Notes :
English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1196083114
Document Type :
Electronic Resource