SIR 2024
Interventional Oncology
Clark R. Restrepo, MD (he/him/his)
Resident Physician
Medstar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Julian Ricci, BS
Medical Student
Georgetown University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Gregorio Baek, BS
Medical student
Georgetown University School of Medicine
Disclosure information not submitted.
Nathan E. Frenk, MD
Assistant Professor
Medstar Georgetown University Hospital
Disclosure information not submitted.
Filip Banovac, MD
Chief of Interventional Oncology
MedStar Georgetown University Hospital
Disclosure information not submitted.
Saher Sabri, MD, FSIR
Chief of Interventional Radiology
MedStar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Emil I. Cohen, MD, FSIR
Associate Professor
Medstar Georgetown University Hospital
Disclosure information not submitted.
To retrospectively compare the complete pathologic response (CPR) rates in all patients with hepatocellular carcinoma (HCC) who underwent single treatment thermal ablation under conventional CT versus fluoroscopy and cone beam CT (CBCT) guidance, with or without transarterial embolization, prior to liver explantation.
Materials and methods:
From 2011 to 2022, sixty patients (61 ± 8.2 years, 47/60 male) with 85 HCC lesions underwent liver explantation (58 transplants, 2 hepatectomies) after being treated with microwave or radiofrequency ablation under conventional CT or fluoroscopy and CBCT guidance. Bland or chemoembolization was also performed within 1 month prior or at the same time of ablation at the discretion of the interventionalist. Pathologic response was determined at liver explant with CPR defined as no viable tumor present. Patients were excluded if they were re-treated prior to transplant or if pathology data was unavailable. Statistical analysis was performed using Fisher’s exact test for categorical variables and Student’s t-test for continuous variables.
Results:
Average baseline lesion size was not significantly different between CT and CBCT guidance (2.0 ± 0.64 vs 2.3 ± 0.87 cm, p=0.08). Overall CPR rate was not significantly different in lesions that underwent ablation using conventional CT compared to fluoroscopy with CBCT guidance (55.6%, 20/36 vs 62.5%, 20/32; p=0.63). CPR was not significantly different in lesions that underwent ablation alone with either guidance modality (CT: 37.5%, 3/8 vs CBCT: 62.5%, 10/16; p=0.39). Transarterial embolization was performed for 27/36 (75%) CT-guided ablations and 15/32 (46.9%) CBCT guided ablations. CPR was not significantly different in lesions that underwent transarterial embolization and ablation with either guidance modality (CT: 63.0%, 17/27 vs CBCT: 73.3%, 11/15; p=0.73). The mean interval from ablation to transplant was significantly longer for the CBCT guided lesions (8.9 ± 5.4 vs 5.1 ± 4.4 months, p=0.001). Of the 85 total lesions, 15 (7 CT and 8 CBCT guided) were excluded from the pathologic comparison because the patients underwent subsequent treatment prior to transplantation (6 TACE, 2 TARE, 6 repeat ablation, and 1 Cyberknife) and 2 were excluded due to missing pathologic data.
Conclusion:
Despite the differences in technique, CPR rates do not differ significantly in HCC lesions that undergo thermal ablation using conventional CT guidance compared to fluoroscopy and CBCT guidance. Additionally, concomitant transarterial embolization had no impact on CPR rates.