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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3915_Библиотеки_им_академика_М_И_Перельмана
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f g h
Fig. 16.7 A 79-year-old patient with hepatitis C virus-
related hepatic cirrhosis, recent asthenia, weight loss
(8kg), and pancytopenia. Previous asportation of Kaposi
sarcoma of the right foot and squamous cell carcinoma of
the left eye treated with mitomycin. Baseline CT exami-
nation showing a 45 millimeter partly exophytic lesion in
the liver segment VIII, with wash-in in the arterial (a)
phase and washout in the delayed (b) phase, respectively,
suggestive for HCC (as conrmed by the subsequent liver
biopsy). Selective catheterization and angiography of
right hepatic artery originating from the superior mesen-
teric artery conrmed the HCC nodule (c). Superselective
catheterization of the feeding artery was performed (d).
Under US guidance, radiofrequency ablation is performed
with a 3-cm exposed tip electrode after local anesthesia
and during conscious sedation of the patient (e).
Arteriography performed from the microcatheter in the
feeding vessel shows hyperaemia in the target lesion (f).
Superselective chemoembolization with drug-eluting
beads (ranging from 100 to 300 micron) preloaded with
50mg of doxorubicin is performed until complete dose
was administered with complete devascularization of the
HCC lesion (g). One-month post-procedural CT examina-
tion showing complete response to treatment of the target
lesion, with complete absence of viable tissue in the arte-
rial phase (h)
P. Lucatelli et al.
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Fig. 16.8 A 62-year-old male with alcoholic cirrhosis
(Child-Pugh A) with a 7-cm inltrative tumor invading the
right portal vein consistent with hepatocellular carcinoma
(biopsy proven). The patient was given sorafenib but pro-
gressed on follow-up MRI with alpha-fetoprotein (AFP)
levels of 299,535ng/mL (a). The patient was switched to
durvalumab and tremelimumab (Himalaya Trial) with a
dramatic response at 3 months on follow-up MRI (b).
Response still improved and was durable at 20months
from starting the dual checkpoint inhibition (c). The
patient eventually progressed with the development of a
tumor nodule in segment IVB and in the right liver (d).
The patient was brought to the angiosuite. Celiac trunk
angiography shows “tumor blush” of the two nodules (e,
top). Superselective conventional TACE (c-TACE) was
performed in the tumor feeding vessels of these nodules
(e, bottom). Unenhanced CT performed immediately after
c-TACE demonstrates a good uptake of the Lipiodol-
based emulsion by the tumors (e). Follow-up CT per-
formed at 7 months from c-TACE (35 months from
durvalumab and tremelimumab administration) shows a
complete response (f). This case highlights the potential
of combinatorial strategies for liver cancer particularly
hepatocellular carcinoma. Courtesy: Gastrointestinal
oncology unit at Institut Gustave Roussy
16 Miscellaneous
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d e f
Fig. 16.9 A 61-year-old male with NASH cirrhosis with
a 4-cm well-dened and typical HCC (arterial phase
CE-MRI (a), delayed phase CE-MRI (b)) in segment VI
conrmed at angiography DSA (c) and dual-phase cone-
beam CT (d) acquired during balloon-occluded TACE
procedure. After microballoon ination, a signicative
drop of the arterial pressure measured at the tip of the
microcatheter was obtained (49 mmHg vs 109 mmHg)
and chemoembolization was performed with epirubicin
and microspheres (LifePearl, Terumo 100 and 200
micron), with optimal opacication of the tumor (e).
CE-MRI showed a sustained complete response 3years
after the treatment (f)
P. Lucatelli et al.
t.me/medicina_free
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