Journal of Liver

Watershed hepatocellular carcinoma - utility of cone beam CT for transcatheter therapy

CO-ORGANIZED EVENT: 5^th World Congress on Hepatitis & Liver Diseases & 2^nd International Conference on Pancreatic Cancer & Liver Diseases

August 10-12, 2017 London, UK

Sam McCabe

New York Medical College, USA

Posters & Accepted Abstracts: J Liver

Abstract:

Statement of the Problem: Transcatheter arterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) has shown survival benefit and is widely utilized. To achieve a complete response (CR), the entire target tumor volume must be chemoembolized. Watershed HCCs, those bridging two or more Couinaud liver segments, commonly receive arterial supply from more than one segmental hepatic artery regardless of tumor size. Consequently, watershed HCCs have lower CR rates and higher rates of local tumor progression after TACE. These suboptimal results are at least partially attributable to incomplete treatment, i.e. not embolizing one or more tumor-feeding arterial branches during TACE. Intraprocedural C-arm cone beam CT (CBCT) is widely utilized during various interventional procedures including TACE and has a role complimentary to digital subtraction angiography (DSA). In the setting of watershed HCC, CBCT is particularly useful for tumor targeting (i.e., mapping of arterial supply to the tumor) and treatment monitoring (i.e., assessing the extent of tumor coverage after embolic delivery). Methodology & Theoretical Orientation: Using a case-based approach, we will discuss the utility and various roles of CBCT in transarterial liver directed therapies. CBCT protocol and utilization will be covered. Findings: CBCT facilitates tumor arterial supply mapping, may detect tumor-supplying arterial branches not apparent by DSA alone, and provides additional information in the characterization of �??pseudolesions�?�, i.e., questionable HCCs. CBCT also allows assessment of tumor coverage after embolization, improving operator confidence that a complete treatment was provided or raising operator suspicion for additional tumor feeding arteries. Conclusion & Significance: CBCT plays a central role in modern transarterial liver therapy, particularly in the treatment of complex tumors such as watershed HCCs. Understanding the specific strengths and added value of CBCT allows effective use of this technology.