Effects of hepatic artery embolization with Lipiodol and gelatin sponge particles on normal swine liver

The incidence and predictors of post transarterial chemoembolization variceal bleeding in hepatocellular carcinoma patients

BACKGROUND & AIMS

Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) patients. Variceal bleeding is a life-threatening complication and may alter the initial treatment plan. This study was aimed to elucidate the risk factors for variceal bleeding in HCC patients receiving TACE treatment.

METHODS

From 2005 to 2016, a total of 1233 treatment-naive HCC patients receiving first time TACE treatment in Chang Gung Memorial Hospital, Linkou medical center were recruited. Pre-TACE status including baseline characteristics, prior history of ascites, and parameters for liver function evaluation were analyzed. All the variables were compared between patients with and without variceal bleeding.

RESULTS

Among the 1233 patients, the median age was 63.7 (range 25.8-91.5) years old, and 73.5% were male. Variceal bleeding events were documented in 19 patients (1.5%) within 3 months post TACE treatment. Patients with younger age, cirrhosis, pre-treatment ascites and advanced fibrosis status (higher MELD score, CTP score, ALBI grade, FIB-4 and APRI score) were more likely to encounter post-treatment variceal bleeding. Multivariate Cox regression analysis revealed existence of ascites (adjusted HR: 4.859 (1.947-12.124), p = 0.001), and higher FIB-4 score (adjusted HR: 4.481 (1.796-11.179), p = 0.001) were the independent predictive factors for variceal bleeding. Patients with post-TACE variceal bleeding are more likely to encounter tumor progression (42.1% vs. 20.3%, p = 0.039) and mortality owing to GI bleeding (15.8% vs. 3%, p = 0.032).

CONCLUSION

The incidence of post-TACE variceal bleeding was 1.5%. Patients with post-TACE variceal bleeding have poorer TACE treatment response. The pre-treatment ascites and FIB-4 score are the independent predictors for post-TACE variceal bleeding.

Change in portal vein hemodynamics after chemoembolization for hepatocellular carcinoma: evaluation through multilevel dynamic multidetector computed tomography during arterial portography

OBJECTIVE

This study aimed to clarify the effect of embolization with lipiodol on portal vein hemodynamics.

METHODS

Time-density curves of the main portal vein on multilevel dynamic multidetector computed tomography during arterial portography were used to analyze peak computed tomography value (PV), time to PV (TPV), arrival time of contrast medium at the main portal vein (ATMPV), slope [(PV - 150) / (TPV - ATMPV)], and slope ratio (slope after embolization / slope before embolization).

RESULTS

In 20 patients with hepatoma, ATMPV and TPV were significantly prolonged and the time-density curve slope was significantly less after embolization. The difference in TPV increased (P = 0.02) and the slope ratio decreased with increasing embolized volume rate (P < 0.001). Strong correlation (R = -0.86) was found between the slope ratio and the embolized volume rate.

CONCLUSIONS

Time-density curves revealed significant portal vein flow delay after embolization; the degree of which was correlated with the extent of the embolized volume.

Comparison of blood dynamics of anticancer drugs (cisplatin, mitomycin C, epirubicin) in treatment groups of hepatic arterial infusion, hepatic arterial infusion with lipiodol and transcatheter arterial chemoembolization with lipiodol plus gelatin sponge particles in a swine model

AIM

  To compare the blood dynamics of anticancer drugs (cisplatin, mitomycin, epirubicin) and the negative effect on normal liver tissue among the following procedures: hepatic arterial infusion (HAI), HAI with lipiodol (Lp-HAI) and transcatheter arterial chemoembolization (TACE) with Lp plus particles (Lp-TACE).

METHODS

  Nine swine were divided into three groups: (i) HAI group animals were infused with 5 mg/mL cisplatin, 1 mg/mL mitomycin and 4 mg/mL epirubicin in 0.1 mL/kg contrast medium; (ii) Lp-HAI group animals, with the same doses in 0.1 mL emulsified fluid (0.05 mL/kg, Lp); and (iii) Lp-TACE group animals, with the same doses in 0.1 mL emulsified fluid plus gelatin sponge particles. Outflow ratio (area under plasma concentration curve [AUC(0-60) ] / total infused dose of anticancer drug) and necrosis volume ratio (necrosis volume / total slice volume × 100) were explored.

RESULTS

  Outflow ratios (AUC(0-60) /mg) of cisplatin, mitomycin and epirubicin, and the necrosis volume ratio (%) of the livers, were 2.30, 6.91, 0.97 and 0, respectively, in the HAI group; 1.71, 5.43, 0.79 and 1.37, respectively, in the Lp-HAI group; and 1.23, 3.37, 0.47 and 20.88, respectively, in the Lp-TACE group. The significantly lowest outflow ratio for each anticancer drug (P = 0.05/3) and the significantly highest necrosis volume ratio (P = 0.05/3) were found in Lp-TACE, followed by Lp-HAI and HAI.

CONCLUSION

  Although the necrosis volume ratio of the liver was tolerable, Lp-TACE caused the greatest delay in outflow ratio for each cancer drug and the greatest negative effect to liver in a swine model.

Evaluation of the role of cisplatin-conjugated-soluble gelatin sponge: feasibility study in a swine model

PURPOSE

To evaluate the safety and the delivery function of cisplatin-conjugated-soluble gelatin sponge in a swine model.

METHODS

Fifteen healthy young swine were assigned into three groups: transarterial cisplatin infusion group, transarterial chemoembolization (TACE) with cisplatin-conjugated 120-min soluble gelatin sponge (TACE-120) group, and TACE with cisplatin-conjugated 360-min soluble gelatin sponge (TACE-360) group. A total volume of 0.8 mL/kg cisplatin in each group and 8 mg/kg soluble gelatin sponge in TACE-120 and TACE-360 groups were injected from the left hepatic artery in small increments for 10 min. Common hepatic angiography and whole-blood sampling via the left hepatic vein were conducted to explore recanalization immediately after the procedure and again at 10, 30, 60, 90, 120, 180, 240, 300, 360, and 420 min later. The area under the plasma concentration curve (AUC) of non-protein-bound platinum was compared among the three groups. Each liver was removed and cut into 10-cm-thick sections for calculating liver-damaged volume ratio.

RESULTS

Sequential angiography depicted gradual recanalization of the occluded hepatic artery and total recanalization at 120 and 360 min after embolization in the TACE-120 and TACE-360 groups, respectively. Of the three groups, AUC(0-30), AUC(30-120), and AUC(120-420) were significantly highest in the transarterial cisplatin infusion group (p < 0.001), the TACE-120 group (p < 0.001), and the TACE-360 group (p < 0.001), respectively. The liver-damaged volume ratio in the TACE-360 group was small (8.20 %) but significantly higher than that in the TACE-120 group (2.67%, p = 0.014).

CONCLUSION

Cisplatin-conjugated soluble gelatin sponge functions as a cisplatin carrier and is associated with tolerable liver damage.

Ablative zone size created by radiofrequency ablation with and without chemoembolization in small hepatocellular carcinomas

PURPOSE

We retrospectively evaluated whether combined use of chemoembolization expands ablative zone sizes created by radiofrequency (RF) ablation in patients with small hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS

Fifty-seven patients treated with single RF ablation for solitary HCC measuring ≤2 cm were assessed. RF ablation alone was done in nine patients and in 48 patients following chemoembolization, with an interval of 0 days in 6, 1-14 days in 27, 15-28 days in 6, and ≥4 weeks in 9. Ablative zone sizes, disappearance of tumor enhancement, and creation of sufficient ablative margins (>5 mm) were evaluated on contrast-enhanced computed tomography (CT) images.

RESULTS

Both mean long-axis (4.2-4.7 vs. 3.6 ± 0.4 cm, p < 0.04) and short-axis (3.3-3.8 vs. 2.3 ± 0.5 cm, p < 0.03) diameters were expanded significantly when RF ablation was done until 4 weeks after chemoembolization than with RF ablation alone. Tumor enhancement disappeared in all patients. Frequency of achieving sufficient ablative margins was significantly higher when RF ablation was done until 4 weeks after chemoembolization than with RF ablation alone (74.0-83.3 vs. 22.2 %, p < 0.05).

CONCLUSION

Ablative zones created by RF ablation with chemoembolization become larger than RF ablation alone, leading to secure ablative margins.

Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma

PURPOSE

To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group.

RESULTS

No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p = 0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p = 0.019).

CONCLUSION

TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.

Effect of interval between transcatheter hepatic arterial embolization and radiofrequency ablation on ablated lesion size in a swine model

PURPOSE

The aim of the study was to clarify the effect of the interval between transcatheter hepatic arterial embolization (TAE) with Lipiodol plus gelatin sponge particles and radiofrequency (RF) ablation on the extent of ablation.

MATERIALS AND METHODS

Eight healthy swine were divided into four groups: RF ablation (ablation only), RF ablation immediately after TAE (immediate ablation), RF ablation 3 days after TAE (3-day ablation), and RF ablation 6 days after TAE (6-day ablation). Five ablated lesions were created in each swine (10 per group). A 2-cm expandable LeVeen needle electrode was used for RF ablation. Ablated lesions are composed of an outer reddish zone and an inner whitish zone.

RESULTS

The average longest length of the major, intermediate, and minor axes and the volume in the immediate ablation, 3-day ablation, and 6-day ablation groups were significant longer and greater (1.52 and 1.52, 1.46 and 1.50, and 1.37 and 1.35 times greater in the red zone and the whitish area, respectively) than those in the ablation-only group (P < 0.05/3). Accumulation of Lipiodol was still noted in the hepatic sinusoids in the 3-day and 6-day ablation groups.

CONCLUSION

RF ablation delayed to 6 days following TAE produced larger ablation volumes than did RF ablation alone.

Complications of hepatic chemoembolization

Transarterial hepatic chemoembolization continues to evolve as an integral therapy for unresectable primary and secondary liver tumors. Despite relatively low morbidity, major complications may be seen. This article provides an overview of the spectrum of vascular and nonvascular complications related to this therapy.

Water-soluble polyvinyl alcohol microspheres for temporary embolization: development and in vivo characteristics in a pig kidney model

PURPOSE

To preliminarily examine whether solubility of water-soluble polyvinyl alcohol (PVA) microspheres in blood plasma changes in proportion to their degrees of saponification. The study also examined their feasibility as a temporary embolic agents in the pig renal artery.

MATERIALS AND METHODS

Three types of PVA microspheres with the degrees of saponification of 97 mol% (S97), 98 mol% (S98), and 99 mol% (S99) were prepared. Seven kidneys in seven miniature pigs were embolized and divided into three groups so there would be at least two kidneys for each type of PVA. One animal in each group was euthanized immediately after angiography at 3 hours after embolization and the other one at 7 days after. In addition, one animal embolized with S99 microspheres was euthanized at 21 days after embolization.

RESULTS

With S97 microspheres, the vascular network had recovered to the preembolic state by 3 hours after embolization. With S98 microspheres, blood flow in the third-order branch had been restored in the same period. With S99 microspheres, the second- and lower order branches remained occluded until 21 days. Histopathologic specimens harvested at 3 hours revealed only a trace of PVA for S97 microspheres. With S98 microspheres, the vascular lumen was still found to be filled with PVA gel. With S99 microspheres, swollen microspheres densely filled the vascular lumen even on day 21.

CONCLUSIONS

Dissolution process in vitro and the duration of arterial occlusion in vivo were possibly related to the degree of saponification of PVA. This result may support feasibility of PVA microspheres as a temporary embolic agent.

Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism

OBJECTIVE

To provide an overview of recent studies on transarterial chemoembolization-related hepatic and biliary damage (TRHBD) in patients with malignant hepatic tumors (MHT) and to explore the reasons for TRHBD.

METHODS

Literature on the treatments for MHT by TACE was sought in PubMed and the related information was summarized.

RESULTS

TRHBD is found to occur in the hepatic parenchymal cells, biliary tree and blood-vascular system. The damage is mainly due to ischemia resulting from embolic materials such as gelatin sponge and lipiodol. In addition, clinicians' skill levels in non-superselective catheterization, the health condition of the patients, and the chemical agents used may also be related to the damage. Most of the deterioration can be reversed if the patients are diagnosed and treated properly and promptly.

CONCLUSIONS

Understanding the mechanisms of TRHBD more comprehensively is helpful in developing effective methods for prevention and treatment.

Effects of hepatic artery chemoembolization using cisplatin-lipiodol suspension with gelatin sponge particles on swine liver

PURPOSE

To define the effects of hepatic artery chemoembolization with cisplatin-lipiodol suspension and gelatin sponge particles on swine liver tissue and estimate the concentration of cisplatin that would have a minimal negative effect on normal liver parenchyma.

MATERIALS AND METHODS

Twelve pigs were divided into four groups: group A was the control group in which hepatic arteries were embolized with lipiodol and gelatin sponge particle (n = 3); group B animals were embolized with 10 mg/mL cisplatin-lipiodol suspension plus gelatin sponge particle (n = 3), group C with 20 mg/mL cisplatin-lipiodol suspension plus gelatin sponge particle (n = 3), and group D with 30 mg/mL cisplatin-lipiodol suspension plus gelatin sponge particle (n = 3). Pigs were euthanized 1 week after embolization, and the resected livers were cut into 10-mm-thick sections. The livers and necrotic foci were contoured in each section, and the necrosis volume ratio was calculated.

RESULTS

The necrosis volume ratios of the livers in groups A, B, C, and D were 0.832% +/- 0.334, 2.324% +/- 1.126, 8.056% +/- 3.276, and 11.82% +/- 4.921, respectively. Significant differences (P < .05) in necrosis volume ratio were found between groups A and C, groups A and D, groups B and C, and groups B and D; no significant difference was found between groups A and B.

CONCLUSIONS

Hepatic artery chemoembolization with higher doses of cisplatin causes greater damage to liver tissue; 10 mg/mL cisplatin-lipiodol suspension causes minimal damage, similar to that without cisplatin, and is related to minimal negative changes in a swine model.

Effectiveness of hepatic arterial embolization on radiofrequency ablation volume in a swine model: relationship to portal venous flow and liver parenchymal pressure

PURPOSE

To evaluate the effectiveness of transcatheter arterial embolization (TAE) on radiofrequency (RF) ablation volume and compare portal vein (PV) flow and liver parenchymal pressure before and after treatment.

MATERIALS AND METHODS

Eight healthy female swine were divided into four groups to be treated with RF ablation alone (RF-only group), RF ablation after TAE with gelatin sponge particles (GSPs; RF/TAE group), RF ablation after TAE with Lipiodol plus GSPs (RF/TAE/Lipiodol group), and PV embolization (PVE) with GSPs after TAE with Lipiodol plus GSPs (RF/TAE/Lipiodol/PVE group). Five ablations were created in each swine, with 10 ablations per group. A 2-cm expandable LeVeen needle electrode was used for RF ablation.

RESULTS

The greatest ablation volume (18,410.1 mm(3) +/- 3,986.4) was observed in the RF/TAE/Lipiodol/PVE group. Of the RF-only, RF/TAE, and RF/TAE/Lipiodol groups, the RF/TAE/Lipiodol group (14,835.5 mm(3) +/- 2,743.2) had a significantly larger ablation volume than the RF-only (8,002.6 mm(3) +/- 2,788.3) and RF/TAE groups (10,398.5 mm(3) +/- 2965.8; P < .05/3). PV pressures increased significantly after TAE (P < .01) compared with the pressure before TAE in the RF/TAE/Lipiodol and RF/TAE/Lipiodol/PVE groups, but not in the RF/TAE group. A marked increase in liver parenchymal pressure was seen during RF ablation; however, there were no significant differences among groups. Accumulation of Lipiodol was noted in the sinusoids in the RF/TAE/Lipiodol and RF/TAE/Lipiodol/PVE groups.

CONCLUSIONS

TAE with blockade of PV flow before RF ablation was associated with greater ablation volumes. Liver parenchymal pressure showed no correlation with increased ablation volume.

A New Porcine Sponge Material for Temporary Embolization: An Experimental Short-Term Pilot Study in Swine

PURPOSE

To evaluate the safety and efficacy of a porcine-derived gelfoam, Curaspon, for the temporary occlusion of the visceral arteries.

METHODS

Curaspon was used for the selective embolization of segmentary hepatic, unilateral polar renal, and single lumbar arteries of 10 pigs under general anesthesia. Sequential angiographic checks were carried out and the pigs killed between 3 days and 2 weeks later. Macroscopic and microscopic studies using standard techniques were used to evaluate the immediate efficacy of embolization, duration of and completeness of recanalization on angiography, macroscopic appearance of target-organ ischemia, and microscopic analysis of inflammatory reaction.

RESULTS

Immediate arterial occlusion was obtained in all cases. Renal arteries showed a total recanalization in 63% of cases on day 7 and 100% on day 14. Total hepatic recanalization was obtained in 100% of animals on day 7. All lumbar arteries were recanalized on day 14. Microscopic analysis in the kidney revealed a mild inflammatory reaction and a progressive lysis of the Curaspon (87% of samples at day 3 showed a persistence of Curaspon and 5% at day 14). In some cases, localized and partial destruction of the arterial wall was visualized. In the liver the same patterns were observed but resolved more completely and more rapidly.

CONCLUSIONS

Curaspon is an efficient material for the temporary occlusion of visceral and parietal arteries in pigs. However, arterial aneurysms were observed and a relationship of these with the material cannot be excluded.

Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients

BACKGROUND & AIMS

To elucidate the survival of the patients with unresectable hepatocellular carcinoma (HCC) who underwent transcatheter arterial lipiodol chemoembolization (TACE) and to analyze the factors affecting the survivals.

METHODS

During the last 8 years, a nationwide prospective cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment. Exclusion criteria were extrahepatic metastases and/or any previous treatment prior to the present TACE. The primary end point was survival. The survival rates were calculated by the Kaplan-Meier method. The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model. The mean follow-up period was 1.77 years.

RESULTS

For overall survival rates by TACE, median and 1-, 3-, 5-, and 7-year survivals were 34 months, 82%, 47%, 26%, and 16%, respectively. Both the degree of liver damage and the tumor-node-metastasis (TNM) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals (P = .0001). The multivariate analyses showed significant difference in degree of liver damage (P = .0001), alpha-fetoprotein value (P = .0001), maximum tumor size (P = .0001), number of lesions (P = .0001), and portal vein invasion (P = .0001). The last 3 factors could be replaced by TNM stage. The TACE-related mortality rate after the initial therapy was .5%.

CONCLUSIONS

TACE showed safe therapeutic modality with a 5-year survival of 26% for unresectable HCC patients. The degrees of liver damage, TNM stage, and alpha-fetoprotein values were independent risk factors for patient survival.

Liver microcirculation after hepatic artery embolization with degradable starch microspheres in vivo

AIM: To observe the dynamic changes of liver microcirculation in vivo after arterial embolization with degradable starch microspheres (DSM).

METHODS: DSM were injected into the proper hepatic artery through a silastic tube inserted retrogradely in gastroduodenal artery (GDA) of SD rats. Fluorescent microscopy was used to evaluate the dynamic changes of blood flow through the terminal portal venules (TPVs), sinusoids and terminal hepatic venules (THVs). The movements of DSM debris were also recorded. Six hours after injection of DSM, percentages of THVs with completely stagnant blood flow were recorded.

RESULTS: Two phases of blood flow change were recorded. In phase one: after intra-arterial injection of DSM, slow or stagnant blood flow was immediately recorded in TPVs, sinusoids and THVs. This change was reversible, and blood flow resumed completely. In phase two: after phase one, blood flow in TPVs changed again and three patterns of blood flow were recorded. Six hours after DSM injection, 36.9% ± 9.2% of THVs were found with completely stagnant blood flow.

CONCLUSION: DSM can stop the microcirculatory blood flow in some areas of liver parenchyma. Liver parenchyma supplied by arteries with larger A-P shunt is considered at a higher risk of total microcirculatory blood stagnation after injection of DSM through hepatic artery.

Hepatic microcirculatory changes induced by hepatic artery embolization in rats: original investigation

RATIONALE AND OBJECTIVES

To evaluate the effects of hepatic artery embolization (HAE), hepatic microcirculatory changes induced by HAE were assessed quantitatively in rats.

METHODS

Using in vivo microscopy, the blood-flow velocity (BFV) through terminal portal venules (TPVs) and terminal hepatic venules (THVs) was measured during HAE with gelatin sponge powder (GSP), iodized oil (Lipiodol, 0.1, 0.2, and 0.4 mL/kg), or 0.1 mL/kg Lipiodol followed by GSP.

RESULTS

After HAE with GSP, BFV through TPVs decreased significantly, but BFV through THVs did not decrease. After HAE with Lipiodol (0.2 and 0.4 mL/kg), BFV through TPVs decreased significantly, but BFV through THVs did not. After HAE with Lipiodol followed by GSP, BFV through both TPVs and THVs decreased significantly.

CONCLUSIONS

Neither GSP nor Lipiodol adversely affects hepatic microcirculation when administered alone; however, HAE with a combination of Lipiodol and GSP does adversely affect hepatic microcirculation.

Modification of arterial and portal hemodynamics after injection of iodized oils and different emulsions of iodized oils in the hepatic artery: an experimental study

PURPOSE

A strong embolic effect of iodized oil/drug mixtures injected in the hepatic artery appeared to be an efficient way of prolonging the contact time between drugs and tumor tissue. Therefore, the authors evaluated arterial and portal embolic effects after hepatic intra-arterial injection of iodized oils and various emulsions of iodized oil.

MATERIALS AND METHODS

Twenty-five pigs were monitored for the Doppler resistance index (DRI) in the hepatic artery and wedge hepatic vein pressure (WHVP) during 1 hour after injection of pure iodized oil, ultra-fluid or fluid, and four different emulsions of iodized oil ultra-fluid, into the hepatic artery.

RESULTS

Mean area under the curve (AUC) values of DRI increases varied from 20.3 to 24.2 after injection of pure iodized oils or water-in-oil emulsions, and were 13.2 for large-droplet oil-in-water emulsion and 8.2 for small-droplet oil-in-water emulsion. Mean AUC values of WHVP increases varied from 151.6 to 195.6 after injection of pure iodized oils or water-in-oil emulsions, and were 105.5 for large-droplet oil-in-water emulsion and 8.5 for small-droplet oil-in-water emulsion. There was a significant difference in DRI and WHVP modifications between small-droplet oil-in-water emulsions and all other products (P = .001), between the two oil-in-water emulsions and the two water-in-oil emulsions (P = .004), and between the two oil-in-water emulsions and pure iodized oils (P = .002).

CONCLUSION

After hepatic intra-arterial injection, water-in-oil emulsions and pure iodized oils provided a stronger embolic effect than oil-in-water emulsion, both in the hepatic artery and in the portal vein.

Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma

PURPOSE

The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of sequential transarterial chemoembolization (TACE) for patients with unresectable advanced hepatocellular carcinoma (HCC).

METHODS

Twenty-one consecutive patients with unresectable T3 and T4 HCC were treated by sequential TACE (median time interval between treatments 7 weeks) up to six times with an emulsion of lipiodol, epirubicin, and cisplatin. All TACE procedures were performed as unilobar or whole-liver chemoembolization.

RESULTS

An average of 3.9 TACE procedures were performed per patient. One primary and two secondary technical failures occurred. No procedural death was observed. After exclusion of the patient with the primary technical failure and 3 patients with extrahepatic disease, the survival rates for the remaining 17 patients at 6, 12, 18, and 24 months were 70.6%, 52.9%, 44.1%, and 33.1%, respectively.

CONCLUSION

Sequential TACE is a safe procedure in patients with unresectable advanced HCC and feasible in most cases. It seems to prolong the survival time compared with historical series of untreated patients.