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Background We performed a meta-analysis and trial sequential analysis (TSA) to compare the therapeutic efficacy and adverse events (AEs) of balloon-occluded transarterial chemoembolization (B-TACE) with conventional transarterial chemoembolization (cTACE) in treating early-to-intermediate-stage hepatocellular carcinoma (HCC). Methods We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases for studies comparing B-TACE and cTACE in the treatment of HCC. The outcomes included the complete response (CR) rate, objective response rate (ORR), lipiodol consumption, and adverse events (AEs). Depending on the heterogeneity assessment, either a fixed-effects or random-effects model was utilized, followed by a meta-analysis using Review Manager 5.3. Additionally, a TSA was conducted to assess the adequacy of the sample size. Results Five studies including a total of 1166 patients were analyzed. This meta-analysis revealed that compared with cTACE, B-TACE significantly improved the CR rate (risk ratio [RR] = 1.21, 95% confidence interval [CI] 1.04–1.42, p  = 0.02) and the ORR (RR = 1.23, 95% CI 1.09–1.38, p  = 0.0006). These findings were validated using TSA, which did not require a larger information size. The TSA results indicated that B-TACE consumed more lipiodol than cTACE, potentially leading to more satisfactory embolization efficacy. In terms of AEs, only post-embolization syndrome was found to occur more frequently in patients treated with B-TACE than in those treated with cTACE (RR = 1.30, 95% CI 1.01–1.68, p  = 0.04). However, the TSA suggested that additional cases are necessary to confirm this difference. Conclusions B-TACE consumed more lipiodol and demonstrated superior effects on the CR rate and ORR compared to cTACE in the treatment of HCC. Importantly, this improvement in efficacy did not correspond to a significant increase in AEs. Based on these findings, it is recommended that well-designed, large-scale randomized controlled trials be conducted to further validate and expand upon these results. Trial registration This study was registered in the international prospective register of systematic reviews PROSPERO (registration No: CRD42023489055).

BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.MethodsWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T− (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.ResultsWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T−. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T−.ConclusionsTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.

ObjectiveThis trial compared the efficacy and safety of transarterial chemoembolisation (TACE) plus sorafenib with TACE alone using a newly established TACE-specific endpoint and pre-treatment of sorafenib before initial TACE.DesignPatients with unresectable hepatocellular carcinoma (HCC) were randomised to TACE plus sorafenib (n=80) or TACE alone (n=76). Patients in the combination group received sorafenib 400 mg once daily for 2–3 weeks before TACE, followed by 800 mg once daily during on-demand conventional TACE sessions until time to untreatable (unTACEable) progression (TTUP), defined as untreatable tumour progression, transient deterioration to Child-Pugh C or appearance of vascular invasion/extrahepatic spread. Co-primary endpoints were progression-free survival (PFS), which is not a conventional one but defined as TTUP, or time to any cause of death plus overall survival (OS). Multiplicity was adjusted by gatekeeping hierarchical testing.ResultsMedian PFS was significantly longer in the TACE plus sorafenib than in the TACE alone group (25.2 vs 13.5 months; p=0.006). OS was not analysed because only 73.6% of OS events were reached. Median TTUP (26.7 vs 20.6 months; p=0.02) was also significantly longer in the TACE plus sorafenib group. OS at 1 year and 2 years in TACE plus sorafenib group and TACE alone group were 96.2% and 82.7% and 77.2% and 64.6%, respectively. There were no unexpected toxicities.ConclusionTACE plus sorafenib significantly improved PFS over TACE alone in patients with unresectable HCC. Adverse events were consistent with those of previous TACE combination trials.Trial registration number NCT01217034.

Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) “selectively targetable” and “accessible to supraselective catheterization.” The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5–2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the “drop test.” Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care.

There is considerable potential for integrating transarterial chemoembolization (TACE), programmed death-(ligand)1 (PD-[L]1) inhibitors, and molecular targeted treatments (MTT) in hepatocellular carcinoma (HCC). It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations. In this nationwide, retrospective, cohort study, 826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT (combination group, n = 376) or TACE monotherapy (monotherapy group, n = 450) were included from January 2018 to May 2021. The primary endpoint was progression-free survival (PFS) according to modified RECIST. The secondary outcomes included overall survival (OS), objective response rate (ORR), and safety. We performed propensity score matching approaches to reduce bias between two groups. After matching, 228 pairs were included with a predominantly advanced disease population. Median PFS in combination group was 9.5 months (95% confidence interval [CI], 8.4–11.0) versus 8.0 months (95% CI, 6.6–9.5) (adjusted hazard ratio [HR], 0.70, P  = 0.002). OS and ORR were also significantly higher in combination group (median OS, 19.2 [16.1–27.3] vs. 15.7 months [13.0–20.2]; adjusted HR, 0.63, P  = 0.001; ORR, 60.1% vs. 32.0%; P  < 0.001). Grade 3/4 adverse events were observed at a rate of 15.8% and 7.5% in combination and monotherapy groups, respectively. Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS, OS, and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice, with an acceptable safety profile.

BackgroundCorneal neovascularisation (NV) is a challenging condition that can often be refractory to standard treatments, leading to lipid deposition, causing opacification, scarring, irregular astigmatism and decreased visual acuity. The aetiology of corneal vascularisation includes: 1) Infection; fungal, bacterial, viral (HSV, VZV), acanthamoeba; 2) Chemical injury with stem cell failure; 3) Corneal graft rejection; 4) Inflammatory; PUK, atopy, SJS, MMP; 5) Trauma. The efficacy of intravascular chemoembolisation with mitomycin C is well documented, particularly in hepatocellular carcinoma. This led to the hypothesis that a similar technique could be applied to corneal NV. It was first described in 2021 by Oauna et al, who reported on three patients with successful outcomes and Riaz et al in 2024 describing a fourth case with successful treatment prior to penetrating keratoplasty. Using their methodology with some modifications we started in March 2023 and in the preliminary results are the summary of the first 13 cases.ResultsMoorfields (13 cases).Regression(partial and full not distinguished). 77% (10 cases) at 1-3 months, 1 no regression (5 months), 1 lost to FU, 85% (1 further case had regressed by 3-6 months).ConclusionMitomycin intravascular chemoembolisation (MICE) is the most effective treatment to date for established corneal vessels demonstrating sustained regression and improvement in BCVA over time. MICE is generally well-tolerated, with no cases of infection and a very low incidence of significant adverse events. MICE is an exciting new technique that opens up the possibility of treating cases that are currently untreatable.

Objective: To compare radiation doses associated with transradial access (TRA) and transfemoral access (TFA) in transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) procedures for hepatic cancers. Methods: This retrospective, single-center study analyzed 119 patients who underwent TACE or TARE between October 2016 and October 2024. Radiation dose parameters were compared between TRA and TFA groups, including fluoroscopy time, fluoroscopy and fluoroscopy-digital radiography combined dose-area product (DAP), and total air kerma (AK). Statistical analyses were performed using the Mann-Whitney U test and Chi-squared test. Results: TRA was associated with significantly higher radiation exposure compared to TFA, including increased fluoroscopy time (median: 15.2 vs. 8.9 minutes, P<0.001), fluoroscopy DAP (median: 84.4 vs. 45.2 Gy∙cm², P<0.001), fluoroscopy-digital radiography combined DAP (median: 246 vs. 156.5 Gy∙cm², P=0.003), and AK (median: 959 vs. 612.9 mGy, P=0.001). No significant differences were observed in patient demographics, tumor localization, or treatment approach between the groups. Conclusions: TRA is associated with higher radiation exposure compared to TFA in TACE and TARE procedures. While TRA offers procedural benefits, further research is needed to optimize techniques and reduce radiation risks, particularly in interventional radiology.

Objectives This study aimed to assess the effectiveness and safety of conventional transarterial chemoembolization (c-TACE) followed by irreversible electroporation (IRE) for the treatment of hepatocellular carcinoma (HCC). Methods From January 2019 to September 2019, 12 patients with HCC who received c-TACE followed by IRE comprised the study group. The control group comprised 15 patients who received c-TACE followed by radiofrequency ablation (RFA). The 1-month, 3-month, 6-month, and 12-month local control rates and median progression-free survival (PFS) were compared between the two groups. Additionally, postoperative complications were assessed. Results The study group comprised 12 patients (median age: 57.5 years; range: 46–68 years), while the control group consisted of 15 patients (median age: 56 years; range: 31–69 years). Local control rates at 1, 3, 6, and 12 months were 91.7%, 91.7%, 83.3%, and 33.3%, respectively, for the study group, and 73.3%, 66.7%, 66.7%, and 20.0% for the control group. Statistical analysis revealed no significant differences between the two groups. In terms of survival, 9 patients (75%) in the study group and 11 patients (73.3%) in the control group were still alive at the last follow-up. The median PFS was 8 months in the study group and 7 months in the control group, with no significant difference between the two groups ( p  = 0.96). Notably, no severe surgery-related side effects were observed in either group, and also no significant differences were found in postoperative complications between the two groups ( p  = 0.64). Conclusions The long-term therapeutic outcomes of c-TACE followed by IRE were found to be similar to those of c-TACE followed by RFA in the study. The research suggests that c-TACE followed by IRE offered an effective and safe treatment option for HCC.

Objective This retrospective study aimed to evaluate the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with hepatic arterial infusion chemotherapy (HAIC) and donafenib in the treatment of unresectable hepatocellular carcinoma (uHCC). Materials and methods This dual-center retrospective study collected and analyzed clinical data from 87 patients with unresectable hepatocellular carcinoma (uHCC) who received either DEB-TACE combined with HAIC and donafenib or DEB-TACE combined with donafenib between November 2022 and December 2023 at two hospitals in China. Patients were stratified into two groups based on whether HAIC was administered: the DEB-TACE + H + D group and the DEB-TACE + D group. Treatment efficacy was evaluated using objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Prognostic factors for PFS and OS were assessed using Cox proportional hazards regression models. Treatment safety was evaluated by the incidence and severity of adverse events (AEs). Results In terms of treatment efficacy, the DEB-TACE + H + D group showed significantly higher objective response rate (ORR; 69.0% vs. 44.4%, P  = 0.021) compared with the DEB-TACE + D group. Moreover, the disease control rate (DCR) in the DEB-TACE + H + D group was higher than that in the DEB-TACE + D group (90.5% vs. 73.3%, P  = 0.039).The median progression-free survival (PFS) was significantly longer in the DEB-TACE + H + D group than in the DEB-TACE + D group (9.00 months vs. 7.00 months, P  = 0.0078), as was the median overall survival (OS) (19.00 months vs. 13.00 months, P  = 0.0031).Cox regression analysis identified treatment method as the only independent prognostic factors for PFS, while tumor diameter, BCLC staging, and treatment method were independent predictors of OS. Regarding safety, there were no significant differences between the two groups in the incidence or severity of adverse events (AEs) ( P  > 0.05), and most AEs were mild to moderate in intensity. Conclusion Compared with DEB-TACE combined with donafenib, the combination of DEB-TACE, HAIC, and donafenib demonstrated superior tumor control and survival benefit in patients with uHCC, with an acceptable safety profile. Further prospective randomized controlled trials are warranted to validate the long-term efficacy and safety of this combination strategy.

Purpose Bile duct injury is a serious complication after transcatheter arterial chemoembolization (TACE). If it is not detected early and treated actively, it will not only affect the subsequent tumor-related treatment of hepatocellular carcinoma (HCC) patients, but also may lead to serious consequences such as infection, liver failure and even death. To analyze the risk factors of bile duct injury after TACE in patients with HCC and explore the predictive indicators of bile duct injury after TACE, which is helpful for doctors to detect and intervene early and avoid the occurrence of serious complications. Method We retrospectively analyzed the clinical data of 847 patients with primary hepatocellular carcinoma who underwent TACE for the first time in our interventional department. Patients were divided into two groups according to whether bile duct injury occurred after TACE: (1) bile duct injury group, N  = 55; (2) no bile duct injury group, N  = 792. The basic data, intraoperative conditions and the outcome of bile duct injury were analyzed. The chi-square test was used for comparison of enumeration data. The Mann-Whitney U test was used for comparison of measurement data. Risk factor analysis was performed using binary logistic regression analysis. Results Basic data and intraoperative conditions were compared between the bile duct injury group and the group without bile duct injury: preoperative alkaline phosphatase (ALP) (103.24 ± 32.77U/L vs. 89.17 ± 37.35U/L, P  = 0.003); history of hepatobiliary surgery (36.4% vs. 20.8%, P  = 0.011); intraoperative lipiodol volume ( P  = 0.007); combined use of gelatin sponge particles (65.5% vs. 35.0%, P  < 0.001); hypovascularity (58.2% vs. 24.5%, P  < 0.001); and embolization site ( P  < 0.001). Comparison of postoperative liver function between bile duct injury group and non-bile duct injury group: postoperative total bilirubin (43.34 ± 25.18umol/L vs. 21.94 ± 9.82umol/L, P  < 0.001); postoperative γ-glutamyltransferase(GGT) (188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L, P  < 0.001); postoperative ALP(251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L, P  < 0.001). Conclusion The dosage of lipiodol in TACE, supplementation of gelatin sponge particles, embolization site, and hypovascularity of the tumor are risk factors for biliary duct injury after TACE. After TACE, GGT and ALP increased ≥ 2 times compared with preoperative indicators as predictors of bile duct injury. Bile duct injury occurring after TACE can achieve good outcomes with aggressive management.