Does Establishing a Safety Margin Reduce Local Recurrence in Subsegmental Transarterial Chemoembolization for Small Nodular Hepatocellular Carcinomas?.
10.3348/kjr.2015.16.5.1068
- Author:
Hyo Jin KANG
1
;
Young Il KIM
;
Hyo Cheol KIM
;
Hwan Jun JAE
;
Saebeom HUR
;
Jin Wook CHUNG
Author Information
1. Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. chungjw@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Safety margin;
Local tumor recurrence;
Subsegmental transarterial chemoembolization;
Hepatocellular carcinoma;
Cone-beam CT
- MeSH:
Adult;
Aged;
Carcinoma, Hepatocellular/radiography/*therapy;
Chemoembolization, Therapeutic;
Cone-Beam Computed Tomography;
Ethiodized Oil/*administration & dosage;
Female;
Follow-Up Studies;
Humans;
Liver Neoplasms/radiography/*therapy;
Male;
Middle Aged;
Multivariate Analysis;
Neoplasm Recurrence, Local/radiography
- From:Korean Journal of Radiology
2015;16(5):1068-1078
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To test the hypothesis that a safety margin may affect local tumor recurrence (LTR) in subsegmental chemoembolization. MATERIALS AND METHODS: In 101 patients with 128 hepatocellular carcinoma (HCC) nodules (1-3 cm in size and < or = 3 in number), cone-beam CT-assisted subsegmental lipiodol chemoembolization was performed. Immediately thereafter, a non-contrast thin-section CT image was obtained to evaluate the presence or absence of intra-tumoral lipiodol uptake defect and safety margin. The effect of lipiodol uptake defect and safety margin on LTR was evaluated. Univariate and multivariate analyses were performed to indentify determinant factors of LTR. RESULTS: Of the 128 HCC nodules in 101 patients, 49 (38.3%) nodules in 40 patients showed LTR during follow-up period (median, 34.1 months). Cumulative 1- and 2-year LTR rates of nodules with lipiodol uptake defect (n = 27) and those without defect (n = 101) were 58.1% vs. 10.1% and 72.1% vs. 19.5%, respectively (p < 0.001). Among the 101 nodules without a defect, the 1- and 2-year cumulative LTR rates for nodules with complete safety margin (n = 52) and those with incomplete safety margin (n = 49) were 9.8% vs. 12.8% and 18.9% vs. 19.0% (p = 0.912). In multivariate analyses, ascites (p = 0.035), indistinct tumor margin on cone-beam CT (p = 0.039), heterogeneous lipiodol uptake (p = 0.023), and intra-tumoral lipiodol uptake defect (p < 0.001) were determinant factors of higher LTR. CONCLUSION: In lipiodol chemoembolization, the safety margin in completely lipiodolized nodule without defect will not affect LTR in small nodular HCCs.
