SIR 2024
Interventional Oncology
Rachel Todd, BA (she/her/hers)
Medical Student
Icahn School of Medicine At Mount Sinai
Financial relationships: Full list of relationships is listed on the CME information page.
Alex Sher, MD
Interventional Radiology Resident
Icahn School of Medicine at Mount Sinai
Financial relationships: Full list of relationships is listed on the CME information page.
Kartik M. Menon, BA (he/him/his)
Medical Student
Icahn School of Medicine at Mount Sinai
Financial relationships: Full list of relationships is listed on the CME information page.
Dan Shilo, MD
Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Hospital
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Kirema Garcia-Reyes, MD
Assistant Professor
Mount Sinai
Financial relationships: Full list of relationships is listed on the CME information page.
Vivian Bishay, MD
IR
Mount Sinai Hospital System
Financial relationships: Full list of relationships is listed on the CME information page.
Rajesh I. Patel, MD
Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Hospital
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Rahul S. Patel, MD
Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Medical Center\n
Financial relationships: Full list of relationships is listed on the CME information page.
Aaron M. Fischman, MD, FSIR, FCIRSE, FSVM
Professor, Diagnostic, Molecular and Interventional Radiology
Icahn School of Medicine at Mount Sinai
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F Scott Nowakowski, MD
Professor of Radiology and Surgery
Mount Sinai Medical System
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Robert A. Lookstein, MD
Executive Vice Chair; Diagnostic, Molecular, and Interventional Radiology
Mount Sinai Hospital
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Parissa Tabrizian, MD
Associate Professor of Surgery
Recanati/Miller Transplant Institute
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Edward Kim, MD (he/him/his)
Professor of Radiology
Mount Sinai Health System
Financial relationships: Full list of relationships is listed on the CME information page.
In many centers, transarterial chemotherapy (TACE) is the favored locoregional therapy (LRT) for treating unresectable HCC. However, trends within the United Network for Organ Sharing (UNOS) have demonstrated rising usage of other LRTs such as transarterial radioembolization (TARE). Achieving complete pathologic response after transplant has been correlated with lower recurrence rates and longer overall survival {1}. Our goal was to compare the histopathologic outcomes of different LRTs.
Materials and Methods:
Lesions treated with locoregional therapies and transplanted between 2014 and 2022 were retrospectively reviewed. Transarterial therapies before 2014 were excluded due to the infrequent use of cone-beam computed tomography. Patients with more than four lesions treated were also excluded. Pre-procedural data and procedural details including demographic information, etiology of disease, Child-Pugh (CP), BCLC score, and lesion and treatment characteristics were recorded. Lesions were stratified by last treatment modality. Histopathologic evaluation of the explanted liver and post transplant outcomes such as recurrence and mortality were assessed within two years. Propensity scoring was conducted with a 1-to-1 nearest neighbor algorithm to account for differences in age, gender, liver disease etiology, CP score, BCLC stage, lesion size, AFP, and injection location.
Results:
339 lesions in 215 patients were included. 142 (43.1%) lesions required more than one intervention with a mean reintervention rate for TACE of 1.84+/-0.99, TARE 1.28+/-0.60, TACE plus ablation 1.12+/-0.39, and ablation of 1.65+/-0.80. The last treatment for a given lesion was TACE for 97 lesions (28.6%), TARE for 157 lesions (46.3%), TACE plus ablation for 42 lesions (12.4%), and ablation for 43 lesions (12.6%). Propensity-matched analysis comparing TARE to TACE demonstrated statistically significant higher complete radiologic response rates (89.7% vs. 73.4%; p=0.0055), CPN (68.0% vs. 34.0%;p < 0.00001) and necrosis >90% (75.3% vs. 49.0%;p < 0.0001). Rates of CPN were similar between matched TARE and ablation groups. Overall survival and recurrence rates after two years were not significantly different between groups.
Conclusion:
The propensity-matched analysis demonstrated significantly higher rates of CPN and complete radiologic response in lesions treated with TARE compared to TACE.