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

Figure 1 Contrast enhanced computed tomography in patient with multinodular hepatocellular carcinoma before the degradable starch microspheres transcatheter arterial chemoembolization not in agreement with new-Milan-criteria. The enhanced computed tomography images show 5 hypervascular lesions, in the patients with a score of 8 using the new-Milan-criteria. A: Hepatocellular carcinoma (HCC) on VII segment with maximum diameter of 14 mm¹; B: HCC on VIII segment with maximum diameter of 10 mm¹; C: HCC on VII segment with maximum diameter of 12 mm¹; D: HCC on VIII segment with maximum diameter of 31 mm¹; E: HCC on IV-II segment with maximum diameter of 14 mm.

Figure 2 Hepatic intraprocedural angiograms show staining of multiple tumors, which are diagnosed as hepatocellular carcinoma. A and B: Early arterial digital subtraction angiography (DSA) phase; C: Late parenchymal DSA phase.

Figure 3 Enhanced computed tomography control after degradable starch microspheres transcatheter arterial chemoembolization shows a complete response of 4/5 lesions in well downstaged patient. After degradable starch microspheres transcatheter arterial chemoembolization patients had a new-Milan-criteria score of 4. A: Complete response of hepatocellular carcinoma (HCC) nodule on VIII segment; B: On VII segment (white arrows); C and D: Partial response of HCC nodules (red and white arrows).