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.
Unresectable hepatocellular carcinoma (HCC) is treated using locoregional therapies (LRT) including transarterial chemoembolization (TACE), radioembolization (TARE), and ablation. These therapies are often evaluated based on radiologic response due to limited pathologic outcomes data. Importantly, achieving complete pathologic necrosis improves post-transplant oncologic outcomes {1}. Thus, determining predictors of complete pathologic necrosis including LRT modality is of the utmost importance in improving oncologic outcomes.
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. 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 modality and lesions that underwent combination therapy were excluded. Bivariate analysis and multivariable logistic regression were performed.
Results:
Overall, 282 out of 339 lesions were treated with a single modality with CPN observed in 179 lesions (63.5%). Breakdown of LRT used was 85 (30.1%) TACE, 19 (6.7%) ablation, 34 (12.1%) TACE plus ablation, and 144 (51.1%) TARE. Lesions that achieved CPN were more likely to be CPA (64.6% vs. 46.1%), ECOG0 (83.8% vs. 72.8%), BCLCA (88.8% vs. 76.7%), undergo selective injection (90.5% vs. 73.7%), have pre-transplant imaging complete response (97.7% vs. 64.8%), have longer time from treatment to transplant (407.8 vs. 294.9 days) and less likely to have more than one treatment (28.0% vs. 37.8%). Treatments more likely to achieve CPN were TARE (81.8% p< 0.0001), TACE plus ablation (77.1% p=ns), ablation (68.5% p=ns) compared to TACE (43.3%). Lesions that achieved CPN were less likely to have a recurrence within two years of transplant (4.5% vs. 14.6%; p=0.003). TARE was an indepedent predictor of CPN (OR 6.318 2.988-13.356; p < 0.0001).
Conclusion:
TARE was an independent predictor of CPN. Achieving CPN was associated with significantly lower recurrence rates at two years post-transplant.