TACE was performed by experienced interventional radiologists with over 10-year experience (K.J. and C.Y.). The modified Seldinger method was adopted to puncture the femoral artery and insert a 5 F catheter sheath in patients under local anesthesia. The 4 F RH catheter was used for selective catheterization into the celiac trunk artery and superior mesenteric artery for angiography to verify the anatomical structure of the variant hepatic artery. Computed tomography during hepatic angiography and arterial portography was performed to evaluate the locations, sizes, numbers and patency of tumors supplying arteries and portal veins. Then, the microcatheter was superselective intubated into the third or fourth hepatic artery branch supplying blood to the target tumor. The infusion of iodized oil (2–20 ml) and adriamycin (10–60 mg) was injected, followed by embolization with gel foam particles (150–350 μm or 350–560 μm). The endpoint of embolization was that the tumor intravascular blood flow was significantly reduced compared with the initial blood flow, and the contrast medium was not emptied in 3–5 cardiac cycles. The doses of the chemotherapeutic drugs and embolization materials were decided according to the tumor burden, tumor characteristics and hepatic functional reserve [20 (link)]. None of the patients in this study underwent drug-eluting beads-TACE (DEB-TACE).
Adverse events (AEs) were evaluated in accordance with the National Cancer Institute Common termination criteria for adverse events version 5.0, and the AEs were divided into five levels according to the severity. Grade 1: asymptomatic or mild, only clinical or diagnostic findings, without treatment; Grade 2: requires minor, local or noninvasive treatment; Grade 3: serious or medically significant but not immediately life-threatening, resulting in hospitalization or prolonged hospitalization; Grade 4: life-threatening; emergency treatment is required; Grade 5: AE related death.
CT or MRI examination was performed at 6–8 weeks after TACE. For patients with residual activity of tumor or new lesions, ‘on-demand’ TACE was performed according to the tumor response and hepatic functional reserve. The modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria [21 ] were used to evaluate the tumor response. CR and partial response (PR) were considered as the presence of radiological responses, whereas stable disease (SD) and progressive disease (PD) were considered as the absence of radiological response. The time of all-cause death or last follow-up of the patients was recorded by reviewing the medical records or telephone follow-up. The date of last follow-up in this study was 30 November 2020.
Adverse events (AEs) were evaluated in accordance with the National Cancer Institute Common termination criteria for adverse events version 5.0, and the AEs were divided into five levels according to the severity. Grade 1: asymptomatic or mild, only clinical or diagnostic findings, without treatment; Grade 2: requires minor, local or noninvasive treatment; Grade 3: serious or medically significant but not immediately life-threatening, resulting in hospitalization or prolonged hospitalization; Grade 4: life-threatening; emergency treatment is required; Grade 5: AE related death.
CT or MRI examination was performed at 6–8 weeks after TACE. For patients with residual activity of tumor or new lesions, ‘on-demand’ TACE was performed according to the tumor response and hepatic functional reserve. The modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria [21 ] were used to evaluate the tumor response. CR and partial response (PR) were considered as the presence of radiological responses, whereas stable disease (SD) and progressive disease (PD) were considered as the absence of radiological response. The time of all-cause death or last follow-up of the patients was recorded by reviewing the medical records or telephone follow-up. The date of last follow-up in this study was 30 November 2020.
