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The Impact of the use of C-Arm Cone-Beam CT during Chemoembolization for Hepatocellular Carcinoma

Author(s):

Mohamed E. Abdelsalam*, Tomas M. Appleton Figueira, Joe Ensor, Alda L. Tam, Rony Avritscher, Ahmed Kaseb and Sanjay Gupta  

Abstract:


Objective: The objective of the study was to investigate the consequences of using C-arm cone-beam computed tomography (CBCT) on super-selective catheterization of hepatic artery (HA) branches during chemoembolization of hepatocellular carcinoma.

Methods: Two groups of patients were created according to the dates of their treatment sessions. Group A and Group B included patients who had their treatment sessions in 2004 - 2005 and 2008 - 2010, respectively. The sessions performed in 2006 and 2007 were excluded to allow for the adoption and incorporation of CBCT imaging into clinical practice. All chemoembolized HA branches were categorized according to selection order (0-1, 2, or ≥3). Other procedure variables were documented.

Results: A total of 58 and 183 sessions were included in Groups A and B, respectively, for 144 patients. C-arm CBCT was used in 2 (3%) sessions and 142 (78%) sessions in groups A and B, respectively. The average number of vessels treated was significantly higher in group B (1.8) compared to group A (1.3) (P < .0001). A shift to an increased selection order in group B (0-1, 44 [24%]; 2, 85 [46%]; ≥3, 54 [30%]) was more significant (P = .0004) than that in group A (0-1, 32 [55%]; 2, 18 [31%]; ≥3, 8 [14%]). The average duration of the procedure was significantly longer in group B (P = .0002).

Conclusions: Using C-arm CBCT during chemoembolization has a positive impact on increasing the number and order of HA selected and chemoembolized. This comes at the expense of an increase in the duration of the procedure.

Keywords:

CBCT, HCC, Chemoembolization, TACE, Subselective catheterization

Affiliation:

Departments of Interventional Radiology (M.E.A., A.T., R.A., S.G.), and Gastrointestinal Medical Oncology (A.K.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston Texas 77030-4009, Departments of Radiology (T.M.AF.), Upstate University Hospital, 750 East Adams Street Syracuse, NY 13210, Departments of Biostatistics (J.E.), Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030, Departments of Interventional Radiology (M.E.A., A.T., R.A., S.G.), and Gastrointestinal Medical Oncology (A.K.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston Texas 77030-4009, Departments of Interventional Radiology (M.E.A., A.T., R.A., S.G.), and Gastrointestinal Medical Oncology (A.K.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston Texas 77030-4009, Departments of Interventional Radiology (M.E.A., A.T., R.A., S.G.), and Gastrointestinal Medical Oncology (A.K.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston Texas 77030-4009, Departments of Interventional Radiology (M.E.A., A.T., R.A., S.G.), and Gastrointestinal Medical Oncology (A.K.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston Texas 77030-4009



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