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A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 26420

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Prof. Dr. Boris Guiu

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Guest Editor

Department of Medical Imaging and Interventional Radiology, St-Eloi University Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
Interests: interventional radiology; liver; HCC; metastases; radiofrequency ablation; microwave ablation; irreversible electroporation; chemoembolization; radioembolization; portal vein embolization

Dr. Etienne Garin

E-Mail Website
Guest Editor

Rennes Cancer Center, Rennes, France
Interests: radioembolization; nuclear medicine

Special Issue Information

Dear Colleagues,

Interventional oncology (IO) plays a major role in the field of cancer treatment. The liver is certainly the organ in which IO is the most frequently applied, with so many different techniques available from liver biopsy to chemoembolization, percutaneous ablation, radioembolization, and hepatic arterial infusion of chemotherapy, to name but a few.

This Special Issue will review and discuss some of the most recent innovations, as well as the consensus regarding liver IO.

Prof. Dr. Boris Guiu
Dr. Etienne Garin
Guest Editors

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Published Papers (6 papers)

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Research

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17 pages, 1837 KiB

Open AccessArticle

Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group

by Sanne Nieuwenhuizen, Robbert S. Puijk, Bente van den Bemd, Luca Aldrighetti, Mark Arntz, Peter B. van den Boezem, Anna M. E. Bruynzeel, Mark C. Burgmans, Francesco de Cobelli, Marielle M. E. Coolsen, Cornelis H. C. Dejong, Sarah Derks, Arjen Diederik, Peter van Duijvendijk, Hasan H. Eker, Anton F. Engelsman, Joris I. Erdmann, Jurgen J. Fütterer, Bart Geboers, Gerie Groot, Cornelis J. A. Haasbeek, Jan-Jaap Janssen, Koert P. de Jong, G. Matthijs Kater, Geert Kazemier, Johan W. H. Kruimer, Wouter K. G. Leclercq, Christiaan van der Leij, Eric R. Manusama, Mark A. J. Meier, Bram B. van der Meijs, Marleen C. A. M. Melenhorst, Karin Nielsen, Maarten W. Nijkamp, Fons H. Potters, Warner Prevoo, Floris J. Rietema, Alette H. Ruarus, Simeon J. S. Ruiter, Evelien A. C. Schouten, Gian Piero Serafino, Colin Sietses, Rutger-Jan Swijnenburg, Florentine E. F. Timmer, Kathelijn S. Versteeg, Ted Vink, Jan J. J. de Vries, Johannes H. W. de Wilt, Barbara M. Zonderhuis, Hester J. Scheffer, Petrousjka M. P. van den Tol and Martijn R. Meijerink Show full author list Hide full author list

Cancers 2020, 12(7), 1779; https://doi.org/10.3390/cancers12071779 - 3 Jul 2020

Cited by 48 | Viewed by 6531

Abstract

The guidelines for metastatic colorectal cancer crudely state that the best local treatment should be selected from a ‘toolbox’ of techniques according to patient- and treatment-related factors. We created an interdisciplinary, consensus-based algorithm with specific resectability and ablatability criteria for the treatment of colorectal liver metastases (CRLM). To pursue consensus, members of the multidisciplinary COLLISION and COLDFIRE trial expert panel employed the RAND appropriateness method (RAM). Statements regarding patient, disease, tumor and treatment characteristics were categorized as appropriate, equipoise or inappropriate. Patients with ECOG≤2, ASA≤3 and Charlson comorbidity index ≤8 should be considered fit for curative-intent local therapy. When easily resectable and/or ablatable (stage IVa), (neo)adjuvant systemic therapy is not indicated. When requiring major hepatectomy (stage IVb), neo-adjuvant systemic therapy is appropriate for early metachronous disease and to reduce procedural risk. To downstage patients (stage IVc), downsizing induction systemic therapy and/or future remnant augmentation is advised. Disease can only be deemed permanently unsuitable for local therapy if downstaging failed (stage IVd). Liver resection remains the gold standard. Thermal ablation is reserved for unresectable CRLM, deep-seated resectable CRLM and can be considered when patients are in poor health. Irreversible electroporation and stereotactic body radiotherapy can be considered for unresectable perihilar and perivascular CRLM 0-5cm. This consensus document provides per-patient and per-tumor resectability and ablatability criteria for the treatment of CRLM. These criteria are intended to aid tumor board discussions, improve consistency when designing prospective trials and advance intersociety communications. Areas where consensus is lacking warrant future comparative studies. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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20 pages, 2132 KiB

Open AccessArticle

Multimodal Percutaneous Thermal Ablation of Small Hepatocellular Carcinoma: Predictive Factors of Recurrence and Survival in Western Patients

by Margaux Hermida, Christophe Cassinotto, Lauranne Piron, Serge Aho-Glélé, Chloé Guillot, Valentina Schembri, Carole Allimant, Samir Jaber, Georges-Philippe Pageaux, Eric Assenat and Boris Guiu

Cancers 2020, 12(2), 313; https://doi.org/10.3390/cancers12020313 - 29 Jan 2020

Cited by 30 | Viewed by 2731

Abstract

Background: To identify the predictive factors of recurrence and survival in an unselected population of Western patients who underwent multimodal percutaneous thermal ablation (PTA) for small Hepatocellular Carcinomas (HCCs). Methods: January 2015–June 2019: data on multimodal PTA for <3 cm HCC were extracted from a prospective database. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), time-to-LTP, time-to-IDR, recurrence-free (RFS) and overall (OS) survival were evaluated. Results: 238 patients underwent 317 PTA sessions to treat 412 HCCs. During follow-up (median: 27.1 months), 47.1% patients had IDR and 18.5% died. LTP occurred after 13.3% of PTA. Tumor size (OR = 1.108, p < 0.001; hazard ratio (HR) = 1.075, p = 0.002) and ultrasound guidance (OR = 0.294, p = 0.017; HR = 0.429, p = 0.009) independently predicted LTP and time-to-LTP, respectively. Alpha fetoprotein (AFP) > 100 ng/mL (OR = 3.027, p = 0.037) and tumor size (OR = 1.06, p = 0.001) independently predicted IDR. Multinodular HCC (HR = 2.67, p < 0.001), treatment-naïve patient (HR = 0.507, p = 0.002) and AFP > 100 ng/mL (HR = 2.767, p = 0.014) independently predicted time-to-IDR. RFS was independently predicted by multinodular HCC (HR = 2.144, p = 0.001), treatment naivety (HR = 0.546, p = 0.004) and AFP > 100 ng/mL (HR = 2.437, p = 0.013). The American Society of Anesthesiologists (ASA) score > 2 (HR = 4.273, p = 0.011), AFP (HR = 1.002, p < 0.001), multinodular HCC (HR = 3.939, p = 0.003) and steatotic HCC (HR = 1.81 × 10^-16, p < 0.001) independently predicted OS. Conclusions: IDR was associated with tumor aggressiveness, suggesting a metastatic mechanism. Besides AFP association with LTP, IDR, RFS and OS, treatment-naïve patients had longer RFS, and multi-nodularity was associated with shorter RFS and OS. Steatotic HCC, identified on pre-treatment MRI, independently predicted longer OS, and needs to be further explored. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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Review

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17 pages, 2732 KiB

Open AccessReview

Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design

by Etienne Garin, Xavier Palard and Yan Rolland

Cancers 2020, 12(6), 1557; https://doi.org/10.3390/cancers12061557 - 12 Jun 2020

Cited by 40 | Viewed by 3620

Abstract

Selective internal radiation therapy (SIRT) of hepatocellular carcinoma (HCC) has been used for many years, usually without any specific dosimetry endpoint. Despite good clinical results in early phase studies or in cohort studies, three randomized trials in locally advanced HCC available failed to demonstrate any improvement of overall overall survival (OS) in comparison with sorafenib. In recent years, many studies have evaluated the dosimetry of SIRT using either a simulation-based dosimetry (macroaggregated albumin (MAA)-based) or a post-therapy-based one (⁹⁰Y-based). The goal of this review is to present the dosimetry concept, tools available, its limitations, and main clinical results described for HCC patients treated with ⁹⁰Y-loaded resin or glass microspheres. With MAA-based dosimetry, the threshold tumor doses allowing for a response were between 100 and 210 Gy for resin microspheres and between 205 and 257 Gy for glass microspheres. The significant impact of the tumor dose on OS was reported with both devices. The correlation between ⁹⁰Y-based dosimetry and response was also reported. Regarding the safety, preliminary results are available for both products but with a larger range of normal liver doses values correlated with liver toxicities due to numerous confounding factors. Based on those results, international expert group recommendations for personalized dosimetry have been provided for both devices. The clinical impact of personalized dosimetry has been recently confirmed in a multicenter randomized study demonstrating a doubling of the response rate and an OS of 150% while using personalized dosimetry. Even if technical dosimetry improvements are still under investigation, the use of personalized dosimetry has to be generalized for both clinical practice and trial design. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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21 pages, 8713 KiB

Open AccessReview

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

by Sirish A. Kishore, Raazi Bajwa and David C. Madoff

Cancers 2020, 12(4), 791; https://doi.org/10.3390/cancers12040791 - 26 Mar 2020

Cited by 55 | Viewed by 6842

Abstract

Hepatocellular carcinoma (HCC) represents a significant contributor to cancer-related morbidity and mortality with increasing incidence in both developing and developed countries. Embolotherapy as a locoregional therapeutic strategy consists of trans-arterial or “bland” embolization (TAE), trans-arterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Trans-catheter arterial therapies can be applied along all stages of HCC, either as an alternative or neoadjuvant to surgical resection/transplantation in very early and early stage HCC or as a palliative option for local disease control in unresectable and advanced stage HCC. In advanced stage HCC, SIRT did not demonstrate superiority in comparison to systemic treatment options in several recent large prospective trials, though for carefully selected patients, may confer improved tolerability with similar disease control rates. The latest embolotherapeutic techniques and literature as they pertain to the management of HCC, as well as future directions, are reviewed in this article. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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14 pages, 370 KiB

Open AccessReview

Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with ⁹⁰Y-Microspheres: A Systematic Review

by Emrullah Birgin, Erik Rasbach, Steffen Seyfried, Nils Rathmann, Steffen J. Diehl, Stefan O. Schoenberg, Christoph Reissfelder and Nuh N. Rahbari

Cancers 2020, 12(2), 294; https://doi.org/10.3390/cancers12020294 - 27 Jan 2020

Cited by 22 | Viewed by 2673

Abstract

Radioembolization with ⁹⁰Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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13 pages, 918 KiB

Open AccessReview

Extracellular Vesicles, A Possible Theranostic Platform Strategy for Hepatocellular Carcinoma—An Overview

by Igea D’Agnano and Anna Concetta Berardi

Cancers 2020, 12(2), 261; https://doi.org/10.3390/cancers12020261 - 21 Jan 2020

Cited by 14 | Viewed by 3406

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third highest cause of mortality from cancer, largely because of delays in diagnosis. There is currently no effective therapy for advanced stage HCC, although sorafenib, the standard treatment for HCC, systemic therapy (including tyrosine kinase inhibitors and anti-angiogenesis agents), and more recently, immunotherapy, have demonstrated some survival benefit. The measurement and modification of extracellular vesicle (EVs) cargoes—composed of nucleic acids, including miRNAs, proteins, and lipids—holds great promise for future HCC diagnosis, prognosis, and treatment. This review will provide an overview of the most recent findings regarding EVs in HCC, and the possible future use of EVs as “liquid biopsy”-based biomarkers for early diagnosis and as a vehicle for targeted drug-delivery. Full article

(This article belongs to the Special Issue Liver Interventional Oncology)

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