<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04420026</url>
  </required_header>
  <id_info>
    <org_study_id>APHP190581</org_study_id>
    <secondary_id>2019-A02524-53</secondary_id>
    <nct_id>NCT04420026</nct_id>
  </id_info>
  <brief_title>Study of Automatic Image Fusion of a CT Volume With Ultrasound During Percutaneous Ablation Treatment of Hepatic Tumors</brief_title>
  <acronym>IAT</acronym>
  <official_title>Study of the Contribution of Automatic Image Fusion of a Cone-beam CT Volume With Ultrasound During Percutaneous Ablation Treatment of Hepatic Tumors</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Assistance Publique - Hôpitaux de Paris</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>General Electric</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
  </sponsors>
  <source>Assistance Publique - Hôpitaux de Paris</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The automatic fusion of the ultrasound with a cone-beam CT volume will guide the positioning&#xD;
      of the electrodes, despite the visibility of the tumor in ultrasound, in patients treated&#xD;
      with irreversible electroporation in the interventional radiology room at Avicenna Hospital&#xD;
      for hepatocellular carcinoma (HCC). The objective is to evaluate the primary success rate of&#xD;
      the automatic cone-beam CT fusion procedure and ultrasound, regardless of the tumor's&#xD;
      visibility status in ultrasound.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Percutaneous removal of hepatic tumours allows curative treatment using a range of techniques&#xD;
      such as radiofrequency ablation, microwave, cryoablation or, more recently, irreversible&#xD;
      electroporation. These treatments require the introduction of one or more electrodes into or&#xD;
      around the areas to be treated. This insertion phase requires that the practitioner has a&#xD;
      means of continuously visualizing the area to be treated and the position of the electrodes.&#xD;
&#xD;
      The reference modality for the treatment of hepatic tumours by ablation is ultrasound. The&#xD;
      scanner is the conventional alternative recommended in case of invisibility of the target in&#xD;
      ultrasound.&#xD;
&#xD;
      When the target is not clearly visible in ultrasound, advanced multimodal image fusion&#xD;
      applications can allow the practitioner to overcome this difficulty. This fusion is made&#xD;
      possible by tracking the movement of the ultrasound probe in relation to the patient using an&#xD;
      electromagnetic navigation system, and by alignment between the ultrasound system and the&#xD;
      fused volume.&#xD;
&#xD;
      This alignment can be done manually or automatically using a specific marker placed on the&#xD;
      patient's skin, called an &quot;Active Tracker&quot;.&#xD;
&#xD;
      The &quot;INTERACT Active Tracker&quot; functionality will also simplify the registration process by&#xD;
      providing automatic pre-registration.&#xD;
&#xD;
      The purpose of this study is to prospectively evaluate the primary success of patients&#xD;
      treated at Avicenna Hospital for HCC by irreversible electroporation using this fusion&#xD;
      technique. The hypothesis of the study is that this image fusion makes it possible to improve&#xD;
      the location of the lesions to be treated and to allow treatment by percutaneous ablation of&#xD;
      lesions that are not very visible under ultrasound alone.&#xD;
&#xD;
      This study will also assess the time and accuracy savings when an automatic fusion solution&#xD;
      between ultrasound and cone-beam (CB) CT is used, compared to manual alignment.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">July 6, 2020</start_date>
  <completion_date type="Actual">July 29, 2022</completion_date>
  <primary_completion_date type="Actual">July 29, 2022</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <primary_purpose>Diagnostic</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Evaluation of the primary success rate of percutaneous ablation treatment with IRE of hepatic tumors, as a function of the ultrasound visibility of the tumor, when using automatic CT cone-beam fusion and ultrasound</measure>
    <time_frame>At 1 month on post-operative imaging</time_frame>
    <description>Primary success is assessed on the control MRI or CT performed one month after the first IRE (Irreversible Electroporation) ablation procedure targeting a given tumor. It is defined by the absence of visible recurrence at 1 month on post-operative imaging. In the case of a partial response, a % of active tumor will be evaluated.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Evaluate the time savings when using &quot;INTERACT Active Tracker&quot; allowing automatic alignment of the CBCT volume with ultrasound</measure>
    <time_frame>The day of the operation</time_frame>
    <description>The ultrasound visibility of the tumor is evaluated by an ordered discrete variable defined as follows:&#xD;
0: Not identifiable with or without merging&#xD;
identifiable with the help of fusion, tumor boundaries are poorly defined&#xD;
identifiable with the help of fusion, the limits of the tumour are clearly visible&#xD;
identifiable without fusion, tumor boundaries are poorly defined&#xD;
identifiable without fusion, the limits of the tumour are clearly visible</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the time saved by using &quot;INTERACT Active Tracker&quot; allowing automatic alignment of the CBCT volume with ultrasound compared to the manual alignment procedure performed on a series of patients treated when the new function was not available.</measure>
    <time_frame>The day of the operation</time_frame>
    <description>Time is measured from the moment the entire volume is loaded onto the ultrasound scanner. The stopwatch is stopped when the operator declares himself satisfied with the adjustment</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the confidence gain associated with the use of ultrasound fusion.</measure>
    <time_frame>The day of the operation</time_frame>
    <description>The confidence gain associated with the use of ultrasound fusion is assessed by noting the number of non-visible or non-localizable tumors in ultrasound alone that can be identified through fusion.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the accuracy of the automatic alignment judged on the ultrasound measurement of the distance from the center of the target seen in ultrasound to that segmented on the pre-therapeutic pour Cone Beam Computed Tomography (CBCT).</measure>
    <time_frame>The day of the operation</time_frame>
    <description>The accuracy of the automatic alignment judged on the ultrasound measurement of the distance from the center of the target seen in ultrasound to that segmented on the pre-therapeutic CBCT is evaluated by comparison with the accuracy of the manual alignment recorded on a series of patients treated when the new function was not available</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the percentage of procedures for which similarity points must be added due to an initial delay in automatic merging that the operator considers too long.</measure>
    <time_frame>The day of the operation</time_frame>
    <description>The percentage of procedures for which similarity points must be added due to an initial delay of the automatic merge considered too long by the operator is evaluated in comparison with the historical series (manual alignment, when the new function was not available).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the failure rate of the Interact Active Tracker automatic alignment.</measure>
    <time_frame>The day of the operation</time_frame>
    <description>If the operator is not satisfied with the automatic registration between the CBCT and ultrasound, the number of similarity point(s) to be placed and the time required to make this adjustment will be recorded</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the secondary and third-party therapeutic effectiveness rate of the procedures.</measure>
    <time_frame>The day of the operation</time_frame>
    <description>The failure rate of the Interact Active Tracker automatic alignment is evaluated by the number of procedures where this function is not functional for any reason. Throughout the procedure, the number of times the operator will have to correct the alignment with new anatomical landmarks will be counted. Any failure of the automatic merge will be recorded.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>For incomplete responses, estimate the percentage of active tumour (enhanced by contrast material).</measure>
    <time_frame>One month after the ablation</time_frame>
    <description>The secondary and third-party therapeutic effectiveness rate of the procedures is defined by the number of cases in which two or three ablation procedures will be required to achieve a complete MRI response within one month of the last ablation session. For each tumour, the number of ablation procedures required to achieve a complete MRI response within one month of the last ablation session will be recorded. For patients requiring more than one treatment, only treatments performed over the duration of the study should be included.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Assess the complication rate.</measure>
    <time_frame>The day of the ablation</time_frame>
    <description>The complication rate is evaluated by the Dindo-Clavian classification so complication will be recorded and classified</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluate the global survival at 12 months</measure>
    <time_frame>12 months after the ablation</time_frame>
    <description>Overall survival at 12 months. It will be collected by consulting medical records based on the recorded dates of the last visits, images...</description>
  </secondary_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Actual">44</enrollment>
  <condition>Hepatocellular Carcinoma</condition>
  <arm_group>
    <arm_group_label>Experimental Arm</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Hepatocellular tumours</description>
  </arm_group>
  <intervention>
    <intervention_type>Radiation</intervention_type>
    <intervention_name>Interact Active Tracker</intervention_name>
    <description>Interact Active Tracker, allowing the automation of the fusion between a CBCT and ultrasound imaging</description>
    <arm_group_label>Experimental Arm</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Age &gt;18 years&#xD;
&#xD;
          -  Patient treated at Avicenna Hospital for HCC by irreversible electroporation (IRE)&#xD;
&#xD;
          -  Patient whose tumor treatment requires the use of fusion tools with CBCT imaging at&#xD;
             the beginning of the procedure&#xD;
&#xD;
          -  Patients with a scheduled follow-up examination 1 month after the ablation procedure&#xD;
             by irreversible electroporation (IRE)&#xD;
&#xD;
          -  Patient who has understood the information and agreed to participate in this research&#xD;
             by signing the consent form&#xD;
&#xD;
          -  Patient affiliated to a social security system or entitled person&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patients with a history of allergy to iodinated contrast material&#xD;
&#xD;
          -  Patients with MRI contraindications&#xD;
&#xD;
          -  Patients with a history of allergy to contrast material containing gadolinium&#xD;
&#xD;
          -  Pregnant or breastfeeding women&#xD;
&#xD;
          -  Patients under the protection of justice&#xD;
&#xD;
          -  Patients unable to understand research information in an informed manner&#xD;
&#xD;
          -  Participation in another interventional therapeutic trial&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Olivier Mr SEROR, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Assistance Publique - Hôpitaux Paris</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>SERROR</name>
      <address>
        <city>Bobigny</city>
        <zip>93000</zip>
        <country>France</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>France</country>
  </location_countries>
  <link>
    <url>https://www.intechopen.com/books/updates-in-liver-cancer/minimally-invasive-treatments-for-liver-cancer</url>
    <description>Minimally Invasive Treatments for Liver Cancer, Updates in Liver Cancer. Nicolas Cardenas, Rahul Sheth and Joshua Kuban.</description>
  </link>
  <reference>
    <citation>Nault JC, Sutter O, Nahon P, Ganne-Carrie N, Seror O. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol. 2018 Apr;68(4):783-797. doi: 10.1016/j.jhep.2017.10.004. Epub 2017 Oct 13.</citation>
    <PMID>29031662</PMID>
  </reference>
  <reference>
    <citation>Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol. 2014 Jun;31(2):129-37. doi: 10.1055/s-0034-1373788.</citation>
    <PMID>25071303</PMID>
  </reference>
  <reference>
    <citation>Monfardini L, Orsi F, Caserta R, Sallemi C, Della Vigna P, Bonomo G, Varano G, Solbiati L, Mauri G. Ultrasound and cone beam CT fusion for liver ablation: technical note. Int J Hyperthermia. 2018;35(1):500-504. doi: 10.1080/02656736.2018.1509237. Epub 2018 Sep 11.</citation>
    <PMID>30204007</PMID>
  </reference>
  <reference>
    <citation>Lee LH, Hwang JI, Cheng YC, Wu CY, Lee SW, Yang SS, Yeh HZ, Chang CS, Lee TY. Comparable Outcomes of Ultrasound versus Computed Tomography in the Guidance of Radiofrequency Ablation for Hepatocellular Carcinoma. PLoS One. 2017 Jan 9;12(1):e0169655. doi: 10.1371/journal.pone.0169655. eCollection 2017.</citation>
    <PMID>28068369</PMID>
  </reference>
  <reference>
    <citation>Cornelis FH, Korenbaum C, Ben Ammar M, Tavolaro S, Nouri-Neuville M, Lotz JP. Multimodal image-guided electrochemotherapy of unresectable liver metastasis from renal cell cancer. Diagn Interv Imaging. 2019 May;100(5):309-311. doi: 10.1016/j.diii.2019.01.001. Epub 2019 Jan 26. No abstract available.</citation>
    <PMID>30691970</PMID>
  </reference>
  <verification_date>September 2022</verification_date>
  <study_first_submitted>May 4, 2020</study_first_submitted>
  <study_first_submitted_qc>June 3, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">June 9, 2020</study_first_posted>
  <last_update_submitted>October 3, 2022</last_update_submitted>
  <last_update_submitted_qc>October 3, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">October 4, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>ablation</keyword>
  <keyword>cone-beam CT volume</keyword>
  <keyword>ultrasonography</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Carcinoma, Hepatocellular</mesh_term>
    <mesh_term>Liver Neoplasms</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04420026
org study id: APHP190581
secondary id: 2019-A02524-53
nct id: NCT04420026
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The automatic fusion of the ultrasound with a cone-beam CT volume will guide the positioning
      of the electrodes, despite the visibility of the tumor in ultrasound, in patients treated
      with irreversible electroporation in the interventional radiology room at Avicenna Hospital
      for hepatocellular carcinoma (HCC). The objective is to evaluate the primary success rate of
      the automatic cone-beam CT fusion procedure and ultrasound, regardless of the tumor's
      visibility status in ultrasound.
Percutaneous removal of hepatic tumours allows curative treatment using a range of techniques
      such as radiofrequency ablation, microwave, cryoablation or, more recently, irreversible
      electroporation. These treatments require the introduction of one or more electrodes into or
      around the areas to be treated. This insertion phase requires that the practitioner has a
      means of continuously visualizing the area to be treated and the position of the electrodes.

      The reference modality for the treatment of hepatic tumours by ablation is ultrasound. The
      scanner is the conventional alternative recommended in case of invisibility of the target in
      ultrasound.

      When the target is not clearly visible in ultrasound, advanced multimodal image fusion
      applications can allow the practitioner to overcome this difficulty. This fusion is made
      possible by tracking the movement of the ultrasound probe in relation to the patient using an
      electromagnetic navigation system, and by alignment between the ultrasound system and the
      fused volume.

      This alignment can be done manually or automatically using a specific marker placed on the
      patient's skin, called an "Active Tracker".

      The "INTERACT Active Tracker" functionality will also simplify the registration process by
      providing automatic pre-registration.

      The purpose of this study is to prospectively evaluate the primary success of patients
      treated at Avicenna Hospital for HCC by irreversible electroporation using this fusion
      technique. The hypothesis of the study is that this image fusion makes it possible to improve
      the location of the lesions to be treated and to allow treatment by percutaneous ablation of
      lesions that are not very visible under ultrasound alone.

      This study will also assess the time and accuracy savings when an automatic fusion solution
      between ultrasound and cone-beam (CB) CT is used, compared to manual alignment.
allocation: N/A
intervention model: Single Group Assignment
primary purpose: Diagnostic
masking: None (Open Label)
measure: Evaluation of the primary success rate of percutaneous ablation treatment with IRE of hepatic tumors, as a function of the ultrasound visibility of the tumor, when using automatic CT cone-beam fusion and ultrasound
time frame: At 1 month on post-operative imaging
description: Primary success is assessed on the control MRI or CT performed one month after the first IRE (Irreversible Electroporation) ablation procedure targeting a given tumor. It is defined by the absence of visible recurrence at 1 month on post-operative imaging. In the case of a partial response, a % of active tumor will be evaluated.
measure: Evaluate the time savings when using "INTERACT Active Tracker" allowing automatic alignment of the CBCT volume with ultrasound
time frame: The day of the operation
description: The ultrasound visibility of the tumor is evaluated by an ordered discrete variable defined as follows:
0: Not identifiable with or without merging
identifiable with the help of fusion, tumor boundaries are poorly defined
identifiable with the help of fusion, the limits of the tumour are clearly visible
identifiable without fusion, tumor boundaries are poorly defined
identifiable without fusion, the limits of the tumour are clearly visible
measure: Evaluate the time saved by using "INTERACT Active Tracker" allowing automatic alignment of the CBCT volume with ultrasound compared to the manual alignment procedure performed on a series of patients treated when the new function was not available.
time frame: The day of the operation
description: Time is measured from the moment the entire volume is loaded onto the ultrasound scanner. The stopwatch is stopped when the operator declares himself satisfied with the adjustment
measure: Evaluate the confidence gain associated with the use of ultrasound fusion.
time frame: The day of the operation
description: The confidence gain associated with the use of ultrasound fusion is assessed by noting the number of non-visible or non-localizable tumors in ultrasound alone that can be identified through fusion.
measure: Evaluate the accuracy of the automatic alignment judged on the ultrasound measurement of the distance from the center of the target seen in ultrasound to that segmented on the pre-therapeutic pour Cone Beam Computed Tomography (CBCT).
time frame: The day of the operation
description: The accuracy of the automatic alignment judged on the ultrasound measurement of the distance from the center of the target seen in ultrasound to that segmented on the pre-therapeutic CBCT is evaluated by comparison with the accuracy of the manual alignment recorded on a series of patients treated when the new function was not available
measure: Evaluate the percentage of procedures for which similarity points must be added due to an initial delay in automatic merging that the operator considers too long.
time frame: The day of the operation
description: The percentage of procedures for which similarity points must be added due to an initial delay of the automatic merge considered too long by the operator is evaluated in comparison with the historical series (manual alignment, when the new function was not available).
measure: Evaluate the failure rate of the Interact Active Tracker automatic alignment.
time frame: The day of the operation
description: If the operator is not satisfied with the automatic registration between the CBCT and ultrasound, the number of similarity point(s) to be placed and the time required to make this adjustment will be recorded
measure: Evaluate the secondary and third-party therapeutic effectiveness rate of the procedures.
time frame: The day of the operation
description: The failure rate of the Interact Active Tracker automatic alignment is evaluated by the number of procedures where this function is not functional for any reason. Throughout the procedure, the number of times the operator will have to correct the alignment with new anatomical landmarks will be counted. Any failure of the automatic merge will be recorded.
measure: For incomplete responses, estimate the percentage of active tumour (enhanced by contrast material).
time frame: One month after the ablation
description: The secondary and third-party therapeutic effectiveness rate of the procedures is defined by the number of cases in which two or three ablation procedures will be required to achieve a complete MRI response within one month of the last ablation session. For each tumour, the number of ablation procedures required to achieve a complete MRI response within one month of the last ablation session will be recorded. For patients requiring more than one treatment, only treatments performed over the duration of the study should be included.
measure: Assess the complication rate.
time frame: The day of the ablation
description: The complication rate is evaluated by the Dindo-Clavian classification so complication will be recorded and classified
measure: Evaluate the global survival at 12 months
time frame: 12 months after the ablation
description: Overall survival at 12 months. It will be collected by consulting medical records based on the recorded dates of the last visits, images...
arm group label: Experimental Arm
arm group type: Experimental
description: Hepatocellular tumours
intervention type: Radiation
intervention name: Interact Active Tracker
description: Interact Active Tracker, allowing the automation of the fusion between a CBCT and ultrasound imaging
arm group label: Experimental Arm
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Olivier Mr SEROR, PhD
role: Principal Investigator
affiliation: Assistance Publique - Hôpitaux Paris
facility: 
country: France
url: https://www.intechopen.com/books/updates-in-liver-cancer/minimally-invasive-treatments-for-liver-cancer
description: Minimally Invasive Treatments for Liver Cancer, Updates in Liver Cancer. Nicolas Cardenas, Rahul Sheth and Joshua Kuban.
citation: Nault JC, Sutter O, Nahon P, Ganne-Carrie N, Seror O. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol. 2018 Apr;68(4):783-797. doi: 10.1016/j.jhep.2017.10.004. Epub 2017 Oct 13.
PMID: 29031662
citation: Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol. 2014 Jun;31(2):129-37. doi: 10.1055/s-0034-1373788.
PMID: 25071303
citation: Monfardini L, Orsi F, Caserta R, Sallemi C, Della Vigna P, Bonomo G, Varano G, Solbiati L, Mauri G. Ultrasound and cone beam CT fusion for liver ablation: technical note. Int J Hyperthermia. 2018;35(1):500-504. doi: 10.1080/02656736.2018.1509237. Epub 2018 Sep 11.
PMID: 30204007
citation: Lee LH, Hwang JI, Cheng YC, Wu CY, Lee SW, Yang SS, Yeh HZ, Chang CS, Lee TY. Comparable Outcomes of Ultrasound versus Computed Tomography in the Guidance of Radiofrequency Ablation for Hepatocellular Carcinoma. PLoS One. 2017 Jan 9;12(1):e0169655. doi: 10.1371/journal.pone.0169655. eCollection 2017.
PMID: 28068369
citation: Cornelis FH, Korenbaum C, Ben Ammar M, Tavolaro S, Nouri-Neuville M, Lotz JP. Multimodal image-guided electrochemotherapy of unresectable liver metastasis from renal cell cancer. Diagn Interv Imaging. 2019 May;100(5):309-311. doi: 10.1016/j.diii.2019.01.001. Epub 2019 Jan 26. No abstract available.
PMID: 30691970
responsible party type: Sponsor
mesh term: Carcinoma, Hepatocellular
mesh term: Liver Neoplasms