Downstaging disease in patients with hepatocellular carcinoma outside up-to-seven criteria: Strategies using degradable starch microspheres transcatheter arterial chemo-embolization

AIM: To evaluate the downstaging rates in hepatitis C virus-patients with hepatocellular carcinoma(HCC), treated with degradable starch microspheres transcatheter arterial chemoembolization(DSM-TACE), to reach new-Milan-criteria(nM C) for transplantation. METHODS: This study was approved by the Ethics Committee of our institution. From September 2013 to March 2014 eight patients(5 men and 3 women) with liver cirrhosis and multinodular HCC, that did not meet n MC at baseline, were enrolled in this study. Patients who received any other type of treatment such as termal ablation or percutaneous ethanol injection were excluded. DSM-TACE was performed in all patients using Embo Cept? S and doxorubicin. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed measuring the longest enhancing axial dimension of each tumor according to the modified Response Evaluation Criteria In Solid Tumors measure-ments, and medical records were reviewed.RESULTS: DSM-TACE was successfully performed in all patients without major complication. We treated 35 lesions(mean 4.3 per patient). Six of eight patients(75%) had their HCC downstaged to meet nM C. Every patient whose disease was downstaged eventually underwent transplantation. The six patients who received transplant were still living at the time of this writing, without recurrence of HCC. Baseline age(P = 0.25), Model for End-stage Liver Disease score(P = 0. 77), and α-fetoprotein level(P = 1.00) were similar between patients with and without downstaged HCC. CONCLUSION: DSM-TACE represents a safely and effective treatment option with similar safety and efficacy of conventional chemoembolization and could be successfully performed also for downstaging disease in patients without n MC, allowing them to reach liver transplantation.

Relevant Factors and Optimization in the Management of a PET/CT Facility

Objectives: To analyze the whole PET/CT imaging protocol from patient’s registration to the end of the exam in order to optimize the use of such device. Methods: Data from June to July 2010 and from September to October 2010 were acquired, evaluating the time required by every step of the patient pathway. After the first data acquisition, we identified critical elements connected with the execution of the exams. Results: The results of the first data acquisition reported 12 daily performed exams. By reducing patient turnover time and consequently the device downtime, patient turnover time dropped from 6 min to only 3 min while device downtime dropped from 2 h and 30 min to 1 h and 20 min between the first and the second data collection. The number of daily performed exams increased from 12 to 14. Conclusions: The results show how the analysis of a complex study process such as PET/CT and a continuous activity control allow the identification of critical organizational and structural issues providing necessary information to the optimization in the use of devices with a clear value in public health, in large benefits for the patients and improved management results.