Comparison of Local Control in Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma ≤6 Cm with or Without Intraprocedural Monitoring of the Embolized Area Using Cone-beam Computed Tomography

Purpose: This study was designed to compare technical success and local recurrence rates of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with/without monitoring of embolized areas using cone-beam computed tomography (CBCT).

Methods: A total of 207 HCCs ≤6 cm were treated with superselective TACE using digital subtraction angiography (DSA) alone (DSA group, 98 tumors of 70 patients) or plus CBCT monitoring (CBCT group, 109 tumors of 79 patients). Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5-mm wide for tumors <25 mm, and 10-mm wide for tumors 25≥ and ≤60 mm; grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Technical success and local recurrence rates in the DSA and CBCT groups were compared. Local recurrence rates of grade A and B tumors were also compared.

Results: The grade A/B/C tumors in the DSA and CBCT groups were 64 (65.3%)/25 (25.5%)/9 (9.2%) and 95 (87.2%)/11 (10.1%)/3 (2.8%), respectively. Local recurrence developed in 46/158 (29.1%) grade A tumors and 24/36 (66.7%) grade B. There were significant differences in technical success between the DSA and CBCT groups (p < 0.001) and local recurrence rates between grade A and B tumors (p < 0.001). The 1-, 2-, and 3-year local recurrence rates in the DSA and CBCT groups were 33.3 and 22.3%, 41.3 and 26.8%, and 48 and 30.6%, respectively (p = 0.0217).

Conclusion: Intraprocedural CBCT monitoring of embolized areas reduces the local tumor recurrence.