Amrit Koirala_SFON_2019_HCC in Nepal.pptx

hi

1. Role of Therapeutic Interventional Radiology in HCC : Scenario in Nepal Amrit Koirala , MD Interventional Radiologist Nepal Cancer Hospital and Research Center

2. BCLC staging and treatment strategy Forner , A. et al. ( 2014) Treatment of intermediate-stage hepatocellular carcinoma Nat. Rev. Clin . Oncol . doi:10.1038/nrclinonc.2014.122

3. Background A variety of image-guided interventions now play a vital role in the management of HCC. A multidisciplinary approach including medical/radiation oncologists, diagnostic/interventional radiologists, pathologists, gastroenterologists/ hepatologists , hepatobiliary surgeons now play a vital role in successful management for patients with HCC . In clinical practice patients often present with large/ multinodular HCCs and are often inoperable at the time of diagnosis.

4. Therapeutic Procedures Percutneous Thermal/Alcohol ablation (RFA/MWA) Transarterial Chemoembolization ( cTACE ) Emergency embolization for Ruptured HCC Drug- elutting beads TACE (DEB-TACE) Radioembolization (Y90 therapy)

5. Adjunctive Procedures Hepatic Venous Pressure Gradient Measurement Portal Vein Embolization

6. ABLATIVE THERAPIES Ablation involves the direct application of chemicals or thermal energy to the tumor to achieve necrosis.

7. ETHANOL INJECTION Necrosis rate of 90-100% of HCC <2 cm Reduced to 70% in tumors between 2-3 cm and to 50% in HCC between 3-5 cm. Child–Pugh A : patients with successful tumor necrosis : 50% survival at 5 years.

8. THERMAL ABLATION MICROWAVE ABLATION

9. Microwave ablation Mechanism Electromagnetic microwaves heat matter by agitating water molecules in the surrounding tissue Producing friction heat Coagulation necrosis H 2 O H 2 O

10. Microwave ablation Advantage of microwave Higher intratumoral temperatures Larger tumor ablation volumes Faster ablation times Not require grounding pads

11. Post ablation

12. BCLC staging and treatment strategy Forner , A. et al. ( 2014) Treatment of intermediate-stage hepatocellular carcinoma Nat. Rev. Clin . Oncol . doi:10.1038/nrclinonc.2014.122

13. Spontaneous Rupture of HCC

14. Our Experience Started with 5 cases for TACE in 2015 In 2019 we performed 18 cases of TACE for various stage HCCs Total of 16 cases of MWA till date ( 10 HCCs) Longest survival on TACE alone is 4yrs (ongoing)

15. Summary IR plays an important role in managing HCCs in Nepalese context by offering therapeutic options in forms of ablation and transarterial therapies. Multidisciplinary approach and institutional collaboration are the keys to success for managing HCCs in our context.

16. Summary