Clinical usefulness of the triaxial system in super-selective transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

Background Transcatheter arterial chemoembolization (TACE) has been widely performed for inoperable hepatocellular carcinoma (HCC). Super-selective TACE is preferable to non-selective therapy and it is important to advance the catheter tip as close to the tumor as possible in the feeding artery. A new microcatheter with a 1.9-Fr non-tapered tip has recently become available and this new microcatheter can be inserted into a 2.7-Fr. microcatheter. It is called the triple co-axial (triaxial) system. Purpose To evaluate the clinical usefulness of super-selective TACE for HCC using the triaxial system. Material and Methods We evaluated 63 HCCs that underwent super-selective TACE. Requirements for inclusion in this study were: (a) HCCs 3 cm or less in diameter; (b) TACE performed by a single operator; and (c) no additional treatment in the absence of local progression. All patients were followed for more than 1 year after TACE. The median follow-up period for surviving patients was 20 months (range, 17–31 months). The conventional system was used in 35 HCCs (control group), and the triaxial system was used in 28 (triaxial group). We reviewed angiographies at TACE and follow-up CT, and then evaluated local tumor status in the two groups. Results Local tumor control rates at 3, 6, and 18 months were 64%, 36%, and 29%, respectively, in the triaxial group, and 40%, 14%, and 8.6%, respectively, in the control group ( P = 0.0086). There were no major complications in either group. Conclusion The triaxial system appears to be useful for super-selective TACE and may contribute to achieving higher local control rates for HCC.