1
|
Atay M, Ozdemir H. An Unusual Complication of Transarteriel Chemoembolization of Hepatocellular Carcinoma; Pseudoaneurysm: A Case Report. Curr Med Imaging 2022; 18:1244-1247. [PMID: 35339188 DOI: 10.2174/1573405618666220325101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is a globally recognised treatment method for hepatic tumors, especially unresectable hepatocellular carcinoma (HCC). Although the technique is relatively safe, it may cause serious complications such as liver abscess, liver failure, and non-target embolization. The case is here presented of a rare complication of TACE. CASE PRESENTATION A-55-year-old male patient was referred to the interventional radiology department for surgically unresectable HCC. CT scan showed a heterogeneously enhancing lesion with capsular enhancement consistent with HCC. On MRI examination, a central necrotic part was seen within the lesion and TACE was performed. At the end of the TACE, pseudoaneurysm of the hepatic artery was detected, which was successfully embolized with pushable microcoils. CONCLUSION To the best of our knowledge, very few cases of pseudoaneurysm of the hepatic artery have been described in the literature, and in those cases, the cause has been thought to be guidewire manipulation. In contrast, in the current case it was thought that it may due to central necrosis and central perfusion insufficiency of the lesion. Pseudoaneurysm is a treatable condition with coil embolization.
Collapse
Affiliation(s)
- Musa Atay
- Department of Radiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin Ozdemir
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul- Turkey
| |
Collapse
|
2
|
Overview of spontaneous intraabdominal tumor hemorrhage: etiologies, imaging findings, and management. Abdom Radiol (NY) 2021; 46:427-440. [PMID: 32691111 DOI: 10.1007/s00261-020-02663-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Hemorrhage is a potential complication of benign and malignant tumors and tumor-like conditions in the abdomen. Patients often have non-specific presentations, although they may present critically ill and hemodynamically unstable. Imaging plays an important role not only in the diagnosis of hemorrhage but also in the detection and characterization of an underlying mass. Ultrasound, computed tomography, and magnetic resonance imaging are utilized in evaluating these patients, with each having particular strengths and limitations. Spontaneous tumor hemorrhage is most commonly seen in hepatic and renal lesions, although it can arise from nearly every abdominal organ. In this article, we will review principles of tumor hemorrhage, illustrate common and uncommon imaging features, and highlight different options for management.
Collapse
|
3
|
Embolization with microspheres alone for hepatocellular carcinoma with portal vein tumor: analysis of outcome and liver function at disease progression. HPB (Oxford) 2020; 22:588-594. [PMID: 31474455 DOI: 10.1016/j.hpb.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/08/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND This retrospective study reviews long-term outcome of hepatic artery embolization (HAE) using microspheres alone in patients presenting with Hepatocellular Carcinoma (HCC) and portal vein tumor (PVT). METHODS From 2005 to 2015, 43 patients with HCC and PVT underwent HAE. Response to treatment, time-to-progression (TTP), local-tumor-progression (LTP), distant-hepatic-progression (DHP), PVT-progression (PVTP), and/or the development of extra-hepatic progression (EHP) were assessed on pre-HAE CT/MRI scans, within 4 weeks post-HAE and at quarterly intervals thereafter, along with liver function (Child-Pugh score, CP). RESULTS Forty (40/43) patients progressed during a median follow-up of 10 months with a median TTP of 2.9 months. Eleven of the 40 patients (27.5%) developed EHP, with only 2 patients (5%) demonstrating solely LTP. Six patients (15%) developed PVTP only. At progression, 27 patients (27/40, 77%) maintained their initial CP status, including all 5 CP-B patients. Median survival was 12.5 (95% CI 8-23) months for the entire group; 17.3 (95% CI 10-33) months for the patients with segmental/lobar PVT, compared with 8.4 (95% CI 6-13) months for the patients with main PVT (p = 0.02). CONCLUSION HAE can be used to treat patients with HCC and PVT with median survival of approximately a year and preserved liver function.
Collapse
|
4
|
Predicting Survival Using Pretreatment CT for Patients With Hepatocellular Carcinoma Treated With Transarterial Chemoembolization: Comparison of Models Using Radiomics. AJR Am J Roentgenol 2018; 211:1026-1034. [PMID: 30240304 DOI: 10.2214/ajr.18.19507] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the use of radiomics features as prognostic biomarkers for predicting the survival of patients treated with transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS We retrospectively analyzed 88 patients with HCC treated with TACE. High-dimensional quantitative feature analysis was applied to extract 116 radiomics features of pretreatment CT. A radiomics score model was constructed from these features with the use of least absolute shrinkage and selection operator Cox regression. A clinical score model was constructed from clinical variables with the use of multivariate Cox regression. A combined score model was constructed using the radiomics and clinical models. We compared the three models (the radiomics score, clinical score, and combined score models) for predicting overall survival, using Kaplan-Meier analysis and the log-rank test. RESULTS The following radiomics features were selected for the radiomics score model: histogram-based features (median, kurtosis, and energy), shape-based features (spherical disproportion and surface-to-volume ratio), gray-level co-occurrence matrix (GLCM)-based features (energy, informational measure of correlation, maximum probability, contrast, and sum average), and intensity size zone matrix-based features (size zone variability). For the clinical score model, the Child-Pugh score, α-fetoprotein level, and HCC size were included. The combined score model included five radiomics features (surface area-to-volume ratio, kurtosis, median, gray-level co-occurrence matrix contrast, and size zone variability) and three clinical factors (Child-Pugh score, α-fetoprotein level, and HCC size). The combined model was a better predictor of survival (hazard ratio, 19.88; p < 0.0001) than the clinical score model or the radiomics score model. CONCLUSION A radiomics approach combined with conventional clinical variables could be effective in predicting the survival of patients with HCC treated with TACE.
Collapse
|
5
|
Gaba RC, Lokken RP, Hickey RM, Lipnik AJ, Lewandowski RJ, Salem R, Brown DB, Walker TG, Silberzweig JE, Baerlocher MO, Echenique AM, Midia M, Mitchell JW, Padia SA, Ganguli S, Ward TJ, Weinstein JL, Nikolic B, Dariushnia SR. Quality Improvement Guidelines for Transarterial Chemoembolization and Embolization of Hepatic Malignancy. J Vasc Interv Radiol 2017; 28:1210-1223.e3. [PMID: 28669744 DOI: 10.1016/j.jvir.2017.04.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/29/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612.
| | - R Peter Lokken
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Ryan M Hickey
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Andrew J Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Robert J Lewandowski
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Riad Salem
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ana Maria Echenique
- Department of Interventional Radiology, University of Miami School of Medicine, Coral Gables, Florida
| | - Mehran Midia
- Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Mitchell
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas J Ward
- Vascular and Interventional Radiology, Florida Hospital, Orlando, Florida
| | - Jeffrey L Weinstein
- Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Sean R Dariushnia
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
6
|
Gaba RC, Lewandowski RJ, Hickey R, Baerlocher MO, Cohen EI, Dariushnia SR, Janne d'Othée B, Padia SA, Salem R, Wang DS, Nikolic B, Brown DB. Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria. J Vasc Interv Radiol 2016; 27:457-73. [PMID: 26851158 DOI: 10.1016/j.jvir.2015.12.752] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Emil I Cohen
- Department of Radiology, Medstar Washington Hospital Center, Washington, DC
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bertrand Janne d'Othée
- Department of Diagnostic Radiology and Nuclear Medicine, Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Siddharth A Padia
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - David S Wang
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, California
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Daniel B Brown
- Department of Radiology, Division of Interventional Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
7
|
Zhang Y, Fan W, Wang Y, Lu L, Fu S, Yang J, Huang Y, Yao W, Li J. Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis. Oncologist 2015; 20:1417-24. [PMID: 26446238 DOI: 10.1634/theoncologist.2015-0196] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/21/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The survival benefit of combining sorafenib and transarterial chemoembolization (TACE) therapy compared with sorafenib monotherapy for patients with advanced hepatocellular carcinoma (HCC) and main portal vein tumor thrombosis (MPVTT) is unclear. METHODS Between January 2009 and June 2013, 183 consecutive patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) and MPVTT were retrospectively reviewed. Of these, 89 patients with advanced HCC and MPVTT were enrolled in this study: 45 were treated with combination therapy (sorafenib-TACE group), and the other 44 treated with sorafenib monotherapy (sorafenib group). RESULTS The mean number of TACE sessions per patient was 2.6 (range: 1-5). The median duration of sorafenib in the sorafenib-TACE group and sorafenib group was 5.6 months and 5.4 months, respectively. The disease control rate was similar between the two groups. Median time to progression was 3.0 months (95% confidence interval [CI]: 2.2, 3.7) in the sorafenib-TACE group, and 3.0 months (95% CI: 2.1, 3.8) in the sorafenib group (p = .924). Median overall survival was 7.0 months (95% CI: 6.1, 7.8) and 6.0 months (95% CI: 4.7, 7.3) in the sorafenib-TACE group and the sorafenib group, respectively (p = .544). The adverse events related to sorafenib were comparable between the two groups. Twenty-one adverse events of grade 3-4 related to TACE occurred in 12 patients (26.7%), and 2 of them died (4.4%). CONCLUSION This study demonstrated no advantage of combination therapy over sorafenib monotherapy. Considering the patients' morbidity after TACE, sorafenib monotherapy is appropriate for managing patients with advanced HCC and MPVTT.
Collapse
Affiliation(s)
- Yingqiang Zhang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ligong Lu
- Department of Interventional Oncology, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Sirui Fu
- Department of Interventional Oncology, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Jianyong Yang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yonghui Huang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| |
Collapse
|
8
|
Kohla MAS, Abu Zeid MI, Al-Warraky M, Taha H, Gish RG. Predictors of hepatic decompensation after TACE for hepatocellular carcinoma. BMJ Open Gastroenterol 2015; 2:e000032. [PMID: 26462282 PMCID: PMC4599160 DOI: 10.1136/bmjgast-2015-000032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/14/2015] [Indexed: 12/21/2022] Open
Abstract
Aim To study predictive factors for hepatic decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). Methods Between November 2009 and August 2010, of 254 patients with HCC who presented to our multidisciplinary HCC clinic for evaluation, 102 (40%) were amenable for TACE. In this prospective study, there were 102 patients with compensated cirrhosis with HCC and Child-Pugh Class A cirrhosis who underwent TACE at the National Liver Institute, Menoufiya University, Egypt. We excluded all patients with prior locoregional therapy, systemic therapy and/or surgical intervention. At baseline and at 1 month postprocedure, laboratory criteria, tumour criteria (size, number) and Child-Pugh score were recorded. Patients were classified into group 1 (no Child-Pugh point increase after TACE) and group 2 (one or more added Child-Pugh points after TACE, defining hepatic decompensation). Univariate and multivariate analyses were performed to identify factors predictive of hepatic decompensation. Results Patients were mostly males (82.4%) of mean age 58.4±8.1 years. The only significant changes in laboratory findings at 1 month after TACE were increased international normalised ratio, serum total bilirubin, alanine transaminase and aspartate transaminase and decreased serum albumin and α-fetoprotein (AFP). The statistically significant predictive factors for hepatic decompensation using univariate analysis were found to be baseline lower serum albumin, higher serum α-fetoprotein, more advanced Barcelona Clinic Liver Cancer (BCLC) stage, larger tumour size and a greater number of tumour nodules; with logistic regression, multivariate analysis found that at baseline larger tumour size (p=0.004 at 95% CI), higher serum AFP (p=0.046 at 95% CI) and lower serum albumin (p=0.033 at 95% CI) predicted decompensation; BCLC stage, number of tumour nodules and pre-TACE bilirubin did not predict changes in liver function. Conclusions Lower serum albumin and increased tumour burden (larger tumour size/more nodules and higher α-fetoprotein) at baseline may help predict post-TACE decompensation.
Collapse
Affiliation(s)
- Mohamed A S Kohla
- Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt
| | - Mai I Abu Zeid
- Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt
| | - Mohamed Al-Warraky
- Department of Radiology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt
| | - Hossam Taha
- Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt
| | - Robert G Gish
- Department of Medicine, Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA
| |
Collapse
|
9
|
Keane FK, Tanguturi SK, Zhu AX, Dawson LA, Hong TS. Radiotherapy for liver tumors. Hepat Oncol 2015; 2:133-146. [PMID: 30190993 PMCID: PMC6095425 DOI: 10.2217/hep.15.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Many patients with primary hepatic malignancies present with advanced disease that is not suitable for surgical resection, orthotopic liver transplantation, or radiofrequency ablation. Outcomes are particularly dismal in patients with large, unresectable tumors and/or tumor venous thrombosis. Liver-directed radiotherapy, including stereotactic body radiotherapy (SBRT), is able to treat a variety of tumor sizes and tumors with venous involvement and has demonstrated excellent safety and control outcomes. SBRT should be considered a standard option in patients with early-stage hepatocellular carcinoma who are not candidates for surgical resection, orthotopic liver transplantation or radiofrequency ablation. SBRT should be strongly considered in patients with larger tumors and/or tumors with tumor venous thrombosis who have adequate liver function. Radiotherapy should remain a focus of hepatocellular carcinoma research.
Collapse
Affiliation(s)
- Florence K Keane
- Harvard Radiation Oncology Program, Harvard Medical School, 75 Francis Street, Brigham & Women's Hospital, ASB1 L2, Boston, MA 02215, USA
| | - Shyam K Tanguturi
- Harvard Radiation Oncology Program, Harvard Medical School, 75 Francis Street, Brigham & Women's Hospital, ASB1 L2, Boston, MA 02215, USA
| | - Andrew X Zhu
- Massachusetts General Hospital, Division of Hematology-Oncology, Department of Medicine; 32 Fruit St, Yawkey 7, Boston, MA 02114, USA
| | - Laura A Dawson
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, USA
| | - Theodore S Hong
- Massachusetts General Hospital, Department of Radiation Oncology, 32 Fruit St, Yawkey 7, Boston, MA 02114, USA
| |
Collapse
|
10
|
Shin JU, Kim KM, Shin SW, Min SY, Park SU, Sinn DH, Gwak GY, Choi MS, Lee JH, Paik SW, Yoo BC, Koh KC. A prediction model for liver abscess developing after transarterial chemoembolization in patients with hepatocellular carcinoma. Dig Liver Dis 2014; 46:813-7. [PMID: 24881853 DOI: 10.1016/j.dld.2014.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/25/2014] [Accepted: 05/01/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Liver abscess is a rare but potentially fatal complication of transarterial chemoembolization. Other than for biliary abnormalities, risk factors for liver abscess formation after transarterial chemoembolization have rarely been discussed. AIMS To identify other risk factors of liver abscess after transarterial chemoembolization in patients with hepatocellular carcinoma. METHODS Data for 5299 patients with hepatocellular carcinoma who underwent transarterial chemoembolization from July 1999 to December 2009 were retrospectively reviewed. 72 patients who experienced liver abscess after transarterial chemoembolization were enrolled as a case group, which was compared with a randomly selected control group (n=1009) of patients who did not develop liver abscess after transarterial chemoembolization. RESULTS Pneumobilia, type 2 biliary abnormality, type 1 biliary abnormality, diabetes mellitus, tumour number (≥3), tumour size (≥3cm), and tumour necrosis on the pre-transarterial chemoembolization computed tomography, and gelfoam embolization and vessel injury during transarterial chemoembolization were all significant predisposing factors for liver abscess after transarterial chemoembolization. A prediction model for postembolization liver abscess was developed from these risk factors. CONCLUSION The group of patients with risk scores greater than 71 showed a significantly increased risk of liver abscess after transarterial chemoembolization. These high-risk patients should be monitored carefully after transarterial chemoembolization.
Collapse
Affiliation(s)
- Jae Uk Shin
- Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea
| | - Kwang Min Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shin Young Min
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Un Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Geum Youn Gwak
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moon Seok Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Hyoek Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woon Paik
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Chul Yoo
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Cheol Koh
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Terzi E, Piscaglia F, Forlani L, Mosconi C, Renzulli M, Bolondi L, Golfieri R. TACE performed in patients with a single nodule of hepatocellular carcinoma. BMC Cancer 2014; 14:601. [PMID: 25139639 PMCID: PMC4155116 DOI: 10.1186/1471-2407-14-601] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 08/06/2014] [Indexed: 02/07/2023] Open
Abstract
Background Patients with single hepatocellular carcinoma (HCC) usually undergo transarterial chemoembolization (TACE) if they are not candidates for curative surgical or ablative therapy. The primary aim of the study was to assess the overall survival and clinical determinants of survival in patients with single HCC who underwent TACE. The secondary aims were tumor response, local and distant recurrence rates, time to recurrence and the impact of TACE on liver function. Methods The outcomes of 148 consecutive patients with single HCC who underwent TACE from January 2004 to December 2009 were retrospectively analyzed. Results Complete response (CR) was observed in 95/148 (64%) patients and a partial response (PR) in 39 (26%) patients. The recurrence rate was 27%, 42% and 65% at 6, 12 and 24 months, respectively. The day after TACE, 56 (38%) patients had a Child-Pugh increase ≥1 and 93 (63%) had a MELD increase ≥1. Median survival was 36.0 months with 1-, 3- and 5-year survival rates of 85%, 50% and 26%, respectively. Bland portal thrombosis was not seen to have any impact at univariate survival analysis; however, a slight impairment of PS (PS-1) in small tumors had some, although minor, impact on prognosis. Factors associated with shorter survival at multivariate analysis were tumor >5 cm, absence of CR, ascites, alpha-fetoprotein (AFP) ≥14.5 ng/mL and a MELD increase ≥1. Conclusions Transarterial chemoembolization is a valid treatment option in patients with single HCC not suitable for curative treatment. Bland PVT has no major impact on survival and a slight impairment of PS attributable to cirrhosis in patients within the Milan criteria should not preclude the use of TACE.
Collapse
Affiliation(s)
| | - Fabio Piscaglia
- Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
12
|
Tanguturi SK, Wo JY, Zhu AX, Dawson LA, Hong TS. Radiation therapy for liver tumors: ready for inclusion in guidelines? Oncologist 2014; 19:868-79. [PMID: 25001265 DOI: 10.1634/theoncologist.2014-0097] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatment modality. Surgical resection and/or liver transplantation are traditionally regarded as the most effective forms of therapy, although the majority of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma present with locally advanced or unresectable disease on the basis of local vascular invasion or inadequate baseline hepatobiliary function. In this context, many efforts have focused on nonoperative treatment approaches including novel systemic therapies, transarterial chemoembolization, ethanol ablation, radiofrequency ablation, and stereotactic body radiation therapy (SBRT). This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies.
Collapse
Affiliation(s)
- Shyam K Tanguturi
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Y Wo
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew X Zhu
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Theodore S Hong
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Hui TC, Pua U. Arterial Portography during Transarterial Chemoembolization: Still a Necessity in the Age of Contrast-enhanced Cross-sectional Imaging? J Vasc Interv Radiol 2014; 25:41-6. [DOI: 10.1016/j.jvir.2013.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 01/28/2023] Open
|
14
|
Chern MC, Chuang VP, Liang CT, Lin ZH, Kuo TM. Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein invasion: safety, efficacy, and prognostic factors. J Vasc Interv Radiol 2013; 25:32-40. [PMID: 24290099 DOI: 10.1016/j.jvir.2013.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 10/10/2013] [Accepted: 10/10/2013] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of transarterial chemoembolization and to identify the prognostic factors associated with survival in patients with hepatocellular carcinoma (HCC) and portal vein (PV) invasion. MATERIALS AND METHODS From January 2006 to March 2012, 50 patients with HCC invading into the PV (Barcelona Clinic Liver Cancer stage C) were treated with transarterial chemoembolization. The parenchymal tumor and PV tumor were confirmed by multidetector computed tomography (CT) and angiography. There were 14 patients with right PV tumor, 12 patients with left PV tumor, and 24 patients with main PV tumor. The response was evaluated by multidetector CT using Response Evaluation Criteria in Solid Tumors. Patients with residual tumors received repeated transarterial chemoembolization every 6-8 weeks unless the patients achieved complete remission or developed contraindications. RESULTS The median survival period of the entire group was 6.2 months (range, 1.7-50.9 mo), and the overall response rate was 42% (21 of 50 patients). The 6-month, 12-month, 24-month, and 36-month survival rates were 54%, 22%, 10%, and 8%. There were no instances of 30-day mortality or acute liver failure related to transarterial chemoembolization. The median survival of the 21 responders was 10.5 months, and the median survival of the 29 nonresponders was 5.5 months (P < .001). In both univariate and multivariate analyses, only the response to transarterial chemoembolization (hazard ratio = 0.25, P < .001) and the absence of ascites (hazard ratio = 0.24, P = .01) were significant prognostic factors. CONCLUSIONS Transarterial chemoembolization is a safe and effective treatment for HCC with major PV invasion. The response to transarterial chemoembolization and the ascites status were the most significant predictive factors for prolonged survival.
Collapse
Affiliation(s)
- Ming-Chih Chern
- Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan.
| | - Vincent P Chuang
- Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan
| | - Chung-Ting Liang
- Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan
| | - Z H Lin
- Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan
| | - Tse-Ming Kuo
- Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan
| |
Collapse
|
15
|
Radioembolization and chemoembolization for unresectable neuroendocrine liver metastases - a systematic review. Surg Oncol 2012; 21:299-308. [PMID: 22846894 DOI: 10.1016/j.suronc.2012.07.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/28/2012] [Accepted: 07/14/2012] [Indexed: 01/15/2023]
Abstract
This review examines the clinical efficacy and safety of the use of hepatic arterial chemoembolization, bland embolization and radioembolization in the treatment of unresectable neuroendocrine tumor liver metastases (NETLM). Response to treatment, survival outcome and toxicity were examined in this review of 37 studies comprising 1575 patients. These therapies are safe and effective in the treatment of NETLM. Prospective clinical trials to compare the relative efficacy and toxicity are warranted.
Collapse
|
16
|
Brown DB, Nikolic B, Covey AM, Nutting CW, Saad WEA, Salem R, Sofocleous CT, Sze DY. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 2012; 23:287-94. [PMID: 22284821 DOI: 10.1016/j.jvir.2011.11.029] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 12/17/2022] Open
|
17
|
Zangos S, Ulrich F, Eichler K, Vogl TJ. Hepatozelluläres Karzinom: Bridging-Verfahren vor der Lebertransplantation. VISZERALMEDIZIN 2012. [DOI: 10.1159/000343673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
18
|
Abstract
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.
Collapse
Affiliation(s)
- Timothy W I Clark
- Section of Vascular and Interventional Radiology, New York University Medical Center, New York, New York
| |
Collapse
|
19
|
Chung GE, Lee JH, Kim HY, Hwang SY, Kim JS, Chung JW, Yoon JH, Lee HS, Kim YJ. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011; 258:627-34. [PMID: 21273524 DOI: 10.1148/radiol.10101058] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the efficacy and safety of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and main portal vein (MPV) invasion. MATERIALS AND METHODS This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The authors retrospectively assessed the electronic medical records of patients in whom HCC with MPV invasion was newly diagnosed from January 2004 to December 2007 at a single tertiary medical center. Patients with decompensated hepatic function were excluded. Outcomes of patients treated with TACE were compared with those of patients given supportive care according to Child-Pugh class. RESULTS One hundred twenty-five patients (104 men and 21 women; mean age, 55.7 years; age range, 33.4-83.0 years) were included. The median overall survival was 3.7 months (range, 0.2-33.3 months). Eighty-three of the 125 patients (66.4%) were treated with TACE and 42 (33.6%) received supportive care. Repeated TACE showed significant survival benefits compared with supportive care in patients with Child-Pugh class A (median survival, 7.4 months vs 2.6 months, respectively; P < .001) and class B (median survival, 2.8 months vs 1.9 months, respectively; P = .002) disease. Results of multivariate analysis showed that treatment with TACE (hazard ratio, 0.263; 95% confidence interval [CI]: 0.164, 0.424; P < .001) and Child-Pugh class A status (hazard ratio, 0.550; 95% CI: 0.368, 0.822; P = .004) were independent predictive factors of a favorable outcome. There were no procedure-related deaths within 4 weeks after TACE, and patient morbidity was 28.9% (24 of 83 patients). CONCLUSION TACE can be performed safely and may improve the overall survival of patients with HCC and MPV invasion.
Collapse
Affiliation(s)
- Goh Eun Chung
- Department of Internal Medicine, Gangnam Healthcare Center, Seoul National University Hospital, 28 Yungun-dong, Chongno-gu, Seoul 110-744, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Tsai AL, Burke CT, Kennedy AS, Moore DT, Mauro MA, Dixon RD, Stavas JM, Bernard SA, Khandani AH, O'Neil BH. Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 2010; 21:1377-84. [PMID: 20691606 DOI: 10.1016/j.jvir.2010.04.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 03/01/2010] [Accepted: 04/16/2010] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 ((90)Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of (90)Y microspheres in HCC with major PVT. MATERIALS AND METHODS A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with (90)Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 8-12 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method. RESULTS A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04). CONCLUSIONS Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
Collapse
Affiliation(s)
- Andrea Lan Tsai
- Department of Hematology/Oncology, University of North Carolina School of Medicine, 3009 Old Clinic Building, CB 7305, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Brown DB, Cardella JF, Sacks D, Goldberg SN, Gervais DA, Rajan DK, Vedantham S, Miller DL, Brountzos EN, Grassi CJ, Towbin RB, Angle JF, Balter S, Clark TWI, Cole PE, Drescher P, Freeman NJ, Georgia JD, Haskal Z, Hovsepian DM, Kilnani NM, Kundu S, Malloy PC, Martin LG, McGraw JK, Meranze SG, Meyers PM, Millward SF, Murphy K, Neithamer CD, Omary RA, Patel NH, Roberts AC, Schwartzberg MS, Siskin GP, Smouse HR, Swan TL, Thorpe PE, Vesely TM, Wagner LK, Wiechmann BN, Bakal CW, Lewis CA, Nemcek AA, Rholl KS. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 2009; 20:S219-S226, S226.e1-10. [PMID: 19560002 DOI: 10.1016/j.jvir.2009.04.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 10/29/2005] [Indexed: 01/01/2023] Open
Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St. Louis, MO 63110, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Brown DB, Gould JE, Gervais DA, Goldberg SN, Murthy R, Millward SF, Rilling WS, Geschwind JFS, Salem R, Vedantham S, Cardella JF, Soulen MC. Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009; 20:S425-34. [PMID: 19560030 DOI: 10.1016/j.jvir.2009.04.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The field of interventional oncology includes tumor ablation as well as the use of transcatheter therapies such as embolization, chemoembolization, and radioembolization. Terminology and reporting standards for tumor ablation have been developed. The development of standardization of terminology and reporting criteria for transcatheter therapies should provide a similar framework to facilitate the clearest communication among investigators and provide the greatest flexibility in comparing established and emerging technologies. An appropriate vehicle for reporting the various aspects of catheter directed therapy is outlined, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings. Methods for standardizing the reporting of outcomes toxicities, complications, and other important aspects that require attention when reporting clinical results are addressed. It is the intention of the group that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication for reporting the various aspects of transcatheter management of hepatic malignancy that will translate to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.
Collapse
Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Kim KM, Kim JH, Park IS, Ko GY, Yoon HK, Sung KB, Lim YS, Lee HC, Chung YH, Lee YS, Suh DJ. Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol 2009; 24:806-14. [PMID: 19207681 DOI: 10.1111/j.1440-1746.2008.05728.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM This study aimed to evaluate the therapeutic efficacy and safety of repeated transarterial chemoembolization (TACE) with additional radiation therapy (RT) in hepatocellular carcinoma (HCC) with portal vein (PV) invasion. METHODS We performed survival analysis of consecutive HCC patients with PV invasion according to the treatment modalities after stratification by the degree of PV invasion and liver function retrospectively. RESULTS During 2005, 281 patients were newly diagnosed to have HCC with PV invasion at our institution. Repeated TACE or transarterial chemoinfusion (TACI) was performed in 202 (71.9%) patients and additional RT was performed for PV invasion in 43 of them. A total of 281 patients had a median survival of 5.2 months and a 2-year survival rate (YSR) of 19.2%. Repeated TACE showed significant survival benefits compared with conservative management in patients with PV branch invasion; median survival and 2-YSR was 10.2 vs 2.3 months and 33.7% vs 0% in Child-Pugh A categorized patients and 5.5 vs 1.3 months and 10.3 vs 0% in Child-Pugh B categorized patients, respectively (P < 0.001). In patients with PV branch invasion, the survival rate was significantly longer with TACE/TACI plus RT than with TACE/TACI alone both in Child-Pugh A categorized patients (1-YSR: 63.6 vs 35.6%, P = 0.031) and Child-Pugh B categorized patients (1-YSR: 66.7 vs 7.7%, P = 0.007). Repeated TACE was well tolerated in our patients, with only one dying within one month after TACE. CONCLUSION Repeated TACE with additional RT can be performed safely and showed a significant survival benefit in HCC patients with PV branch invasion with conserved liver function.
Collapse
Affiliation(s)
- Kang Mo Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
[Transcatether chemoembolization in the treatment of hepatocellular carcinoma]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:139-42. [PMID: 20420010 DOI: 10.2298/aci0904139m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED The authors describe their own experience with chemoembolization as a palliation in the treatment of non resectable hepatocellular carcinoma. MATERIAL/METHODS During period of 64 months procedure was performed in 41 patients with non resectable hepatocellular carcinoma. The combination of Lipiodol and chemotherapeutic agents were applied in a. hepatica propria and its branches via transfemorally placed catheter. Stages of neoplasms were defined by Okuda method. RESULTS The majority of tumors (30) were classified as Grade I. Liver cirrhosis was present in 36 patients, and abnormal levels of alpha-fetoprotein were found in 68% of cases. Each of twenty nine patients had more than one chemoembolization therapy, therefore, a total of 85 treatments were carried out. CT scanning perfomed one month following the procedure revealed more than 75% of Lipiodol retention in 42% of cases, and over 90% of neoplasm necrosis was recorded in 90% of cases, while all treated patients manifested lower levels of alpha-fetoprotein. All patients survived during three and six months, respectively, while the survival rate was 68% after 18 months. No letal outcome was reported during procedure, and morbidity in relation to total number of interventions was 19%. CONCLUSION Achieved effects of this relatively safe procedure in our series do not differ significantly from those in the literature.
Collapse
|
26
|
Pleguezuelo M, Germani G, Marelli L, Xiruochakis E, Misseri M, Manousou P, Arvaniti V, Burroughs AK. Evidence-based diagnosis and locoregional therapy for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2008; 2:761-84. [PMID: 19090737 DOI: 10.1586/17474124.2.6.761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early identification of hepatocellular carcinoma (HCC) is crucial to improving the results of therapy and for patients to be eligible for liver transplantation. Recent advances in noninvasive imaging technology include various techniques of harmonic ultrasound, new ultrasound contrast agents, multislice helical computed tomography and rapid high-quality magnetic resonance. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. Since the use of better radiological techniques has improved the accuracy of noninvasive diagnosis, the role of liver biopsy in the diagnosis of HCC has declined. With recent advances in genomics and proteomics, a great number of potential markers have been identified and developed as new candidate markers for HCC. Locoregional therapies currently constitute the best options for early nonsurgical treatment of HCC. Percutaneous ethanol injection shows similar results to resection surgery for single tumors less than 3 cm in diameter. Radiofrequency ablation is superior to percutaneous ethanol injection in terms of local recurrence. Transarterial chemoembolization is currently the most common approach for the management of HCC without curative options since it improves patient survival, but the optimal embolizing agent, length of interval between sessions and whether the chemotherapeutic agent has any effect have not yet been determined. Combining transarterial chemoembolization with antiangiogenic agents, as well as with other techniques, such as radiofrequency ablation, may improve the results. Injection of radioisotopes such as yttrium-90, via the hepatic artery, may be particularly useful in patients with portal vein thrombosis. Comparisons with other transarterial techniques are needed.
Collapse
Affiliation(s)
- Maria Pleguezuelo
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Transarterial chemoembolization in patients not eligible for liver transplantation: single-center results. AJR Am J Roentgenol 2008; 190:1035-42. [PMID: 18356452 DOI: 10.2214/ajr.07.2755] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of transarterial chemoembolization in the care of patients not eligible for liver transplantation. CONCLUSIONS Prognosis depends on local response, Okuda score, alpha-fetoprotein level, and tumor size and is independent of the presence of portal venous thrombosis.
Collapse
|
28
|
Brown DB, Gould JE, Gervais DA, Goldberg SN, Murthy R, Millward SF, Rilling WS, Geschwind JFS, Salem R, Vedantham S, Cardella JF, Soulen MC. Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2008; 18:1469-78. [PMID: 18057279 DOI: 10.1016/j.jvir.2007.08.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The field of interventional oncology includes tumor ablation as well as the use of transcatheter therapies such as embolization, chemoembolization, and radioembolization. Terminology and reporting standards for tumor ablation have been developed. The development of standardization of terminology and reporting criteria for transcatheter therapies should provide a similar framework to facilitate the clearest communication among investigators and provide the greatest flexibility in comparing established and emerging technologies. An appropriate vehicle for reporting the various aspects of catheter directed therapy is outlined, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings. Methods for standardizing the reporting of outcomes toxicities, complications, and other important aspects that require attention when reporting clinical results are addressed. It is the intention of the group that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication for reporting the various aspects of transcatheter management of hepatic malignancy that will translate to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.
Collapse
Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kulik LM, Carr BI, Mulcahy MF, Lewandowski RJ, Atassi B, Ryu RK, Sato KT, Benson A, Nemcek AA, Gates VL, Abecassis M, Omary RA, Salem R. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 2008; 47:71-81. [PMID: 18027884 DOI: 10.1002/hep.21980] [Citation(s) in RCA: 435] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization with Yttrium ((90)Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2%. Using European Association for the Study of the Liver (EASL), the response rate was 70%. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis. CONCLUSION The use of minimally embolic (90)Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.
Collapse
Affiliation(s)
- Laura M Kulik
- Department of Hepatology, Northwestern University, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Abstract
The incidence of hepatocellular carcinoma (HCC) is predicted to continue to increase over the next 30 years. Surgical intervention, including resection and orthotopic liver transplantation (OLT) is offered to a limited number of patients. Novel approaches to the treatment of patients with HCC are needed. This article aims to review emerging approaches in the care of the HCC patient including systemic treatment, selection of appropriate candidates for OLT, improved imaging to follow treatment response, and management pre-OLT and post-OLT.
Collapse
Affiliation(s)
- Laura M Kulik
- Division of Hepatology, Departments of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | | | | |
Collapse
|
32
|
Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, Tibballs J, Meyer T, Patch DW, Burroughs AK. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007; 30:6-25. [PMID: 17103105 DOI: 10.1007/s00270-006-0062-3] [Citation(s) in RCA: 590] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chemoembolization (TACE) improves survival in cirrhotic patients with hepatocellular carcinoma (HCC). The optimal schedule, or whether embolization (TAE) alone gives the same survival advantage, is not known. PURPOSE To evaluate whether specific patient characteristics and/or radiological transarterial techniques result in better outcomes. METHOD A PubMed search was carried out for cohort and randomized trials (n = 175) testing transarterial therapies; meta-analysis was performed where appropriate. RESULTS Anticancer drugs were used as sole agent in 75% of cases (double 15% and triple 6%): doxorubicin (36%), cisplatin (31%), epirubicin (12%), mitoxantrone (8%), mitomycin (8%), and SMANCS (5%). Embolizing agents used were: gelatin sponge particles (71%), polyvinyl alcohol (PVA) particles (8%), degradable starch microspheres (DSM) (4%), and embospheres (4%). Sessions per patient were 2.5 +/- 1.5 (interval: 2 months). Objective response was 40 +/- 20%; survival rates at 1, 2, 3, and 5 years were: 62 +/- 20%, 42 +/- 17%, 30 +/- 15%, and 19 +/- 16%, respectively, and survival time was 18 +/- 9.5 months. The post-TACE complications were: acute liver failure, 7.5% (range 0-49%); acute renal failure, 1.8% (0-13%); encephalopathy, 1.8% (0-16%); ascites, 8.3% (0-52%); upper gastrointestinal bleeding; 3% (0-22%); and hepatic or splenic abscess, 1.3% (0-2.5%). Treatment-related mortality was 2.4% (0-9.5%), mainly due to acute liver failure. Our meta-analysis of nine randomized controlled trials (RCTs) confirmed that TACE improves survival; but a meta-analysis of TACE versus TAE alone (3 RCTs, 412 patients) demonstrated no survival difference. CONCLUSIONS No chemotherapeutic agent appears better than any other. There is no evidence for benefit with lipiodol. Gelatin sponge is the most used embolic agent, but PVA particles may be better. TAE appears as effective as TACE. New strategies to reduce the risk of post-TACE complications are required.
Collapse
Affiliation(s)
- Laura Marelli
- Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond Street, NW3 2QG, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Brown DB, Cardella JF, Sacks D, Goldberg SN, Gervais DA, Rajan D, Vedantham S, Miller DL, Brountzos EN, Grassi CJ, Towbin RB. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 2006; 17:225-32. [PMID: 16517768 DOI: 10.1097/01.rvi.0000195330.47954.48] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kiely JM, Rilling WS, Touzios JG, Hieb RA, Franco J, Saeian K, Quebbeman EJ, Pitt HA. Chemoembolization in Patients at High Risk: Results and Complications. J Vasc Interv Radiol 2006; 17:47-53. [PMID: 16415132 DOI: 10.1097/01.rvi.0000195074.43474.2f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Transarterial chemoembolization (TACE) has become a standard treatment option for unresectable hepatocellular carcinoma (HCC) and is often used to palliate hepatic metastases. Many patients who are candidates for TACE present with poor hepatic reserve, advanced tumor stage with major portal vein (PV) invasion or thrombosis, and/or biliary dilation. These factors have been associated with a poor prognosis and increased complications after chemoembolization. Accordingly, these patients are classified as being at high risk and may not be considered for therapy. The aim of this study is to evaluate the results of TACE in these patients. MATERIALS AND METHODS Over a period of 5 years, 141 patients underwent 355 TACE procedures. Thirty-six patients (26%) were in the high-risk group as a result of major PV thrombosis, increased serum bilirubin level (>2 mg/dL), and/or intrahepatic biliary dilation. HCC was the underlying tumor in 60% of patients. Thirty-seven percent of patients had Child-Pugh class B/C disease. Patients in the high-risk group received more selective embolization with fewer particles and fewer procedures (2.0 vs 2.7; P < .04). RESULTS Patients in the high-risk group were more likely to have HCC (83% vs 51%; P < .01) and were also more likely to have advanced disease according to Child-Pugh classification versus patients in the low-risk group (49% vs 20%; P < .01). The overall complication rate was 4.3%, with no significant difference in complication rate between groups (3.2% vs 8.2%; P = .12). The overall 30-day mortality rate was 2.3%, and no significant difference in 30-day mortality rate was observed between the high- and low-risk groups (5.5% vs 1.4%; P = .11). A trend toward increased survival in the low-risk group did not reach statistical significance. CONCLUSIONS These data suggest that patients with advanced disease and decreased hepatic reserve who are treated with TACE exhibit no significant increase in morbidity or mortality and no significant decrease in survival. With variations in technique, TACE can be performed safely in patients with the relative risk factors that may classify them in high-risk groups.
Collapse
Affiliation(s)
- James M Kiely
- Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Lau WY, Yu SCH, Lai ECH, Leung TWT. Transarterial chemoembolization for hepatocellular carcinoma. J Am Coll Surg 2005; 202:155-68. [PMID: 16377509 DOI: 10.1016/j.jamcollsurg.2005.06.263] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 06/20/2005] [Indexed: 12/30/2022]
Affiliation(s)
- W Y Lau
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, HKSAR, China
| | | | | | | |
Collapse
|
36
|
Salem R, Lewandowski R, Roberts C, Goin J, Thurston K, Abouljoud M, Courtney A. Use of Yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable hepatocellular carcinoma in patients with portal vein thrombosis. J Vasc Interv Radiol 2004; 15:335-45. [PMID: 15064336 DOI: 10.1097/01.rvi.0000123319.20705.92] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Intra-arterial injection of Yttrium-90 glass microspheres ((90)Y- microS; TheraSphere, MDS Nordion, Ottawa, Canada) is indicated for treatment of unresectable hepatocellular carcinoma (HCC) in the presence of acceptable liver function. This study presents hepatic toxicity results after unilobar and bilobar intra-arterial administration of (90)Y- microS in patients with unresectable HCC who had known portal vein thrombosis (PVT) without evidence of cavernous transformation. MATERIALS AND METHODS Fifteen patients with unresectable HCC and PVT of one or both first order and related segmental portal venous branches received a total of 29 infusions of (90)Y- microS for treatment of HCC. All patients had pretreatment evaluation including: computed tomography (CT) imaging, alpha-fetoprotein (AFP) levels, liver function tests, technetium-99m macroaggregated albumin ((99)Tc-MAA) scan for evaluation of lung and visceral shunting, and angiography with visualization into the portal venous phase. (90)Y- micro S dose was based on lobar hepatic volume with adjustment for lung shunt activity. Liver toxicity was assessed by serum total bilirubin graded for severity according to the NIH NCI Clinical Toxicity Criteria (CTC version 2.0). Other adverse events were reported according to the standards established by the Society of Interventional Radiology. RESULTS There were no procedural complications with delivery of (90)Y- microS, and treatment was well tolerated by all patients. Increased post-treatment bilirubin levels were observed across all treatments in five patients, four of whom had CT or AFP evidence of intrahepatic disease progression. After initial treatment, two patients developed bilirubin toxicity (grades 1 and 2); one patient demonstrated an increment in bilirubin toxicity grade (grade 1 to grade 3) and one patient had an improvement in grade after initial treatment. There were no new treatment-related toxicities in nine patients after a second treatment. CONCLUSIONS (90)Y- microS treatment was well tolerated and appears to be safe to use in patients with compromised portal venous flow in one or both first order and related segmental portal venous branches and no evidence of cavernous transformation. In patients who did not exhibit disease progression, there appeared to be no clinically significant change in bilirubin.
Collapse
Affiliation(s)
- Riad Salem
- Department of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Neeman Z, Libutti SK, Patti JW, Wood BJ. Percutaneous radiofrequency ablation of hepatocellular carcinoma in the presence of portal vein thrombosis. Clin Imaging 2004; 27:417-20. [PMID: 14585572 PMCID: PMC2374755 DOI: 10.1016/s0899-7071(03)00015-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Portal vein thrombosis (PVT) may not be an absolute contraindication for hepatic radiofrequency ablation (RFA). Although the data are sparse, PVT is commonly considered a contraindication to RFA. PVT has actually been described as a complication following RFA. RFA was used to treat a 3.9 x 2.9 cm primary hepatocellular carcinoma (HCC) in a patient with concomitant PVT without complication. RFA can be safely performed in this setting but further studies could clarify this issue.
Collapse
Affiliation(s)
- Ziv Neeman
- Imaging Sciences Program, Clinical Center, National Institutes of Health Building 10, Room 1C387, Bethesda, MD 20892, USA
| | - Steven K. Libutti
- Surgery Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 2B42, Bethesda, MD 20892, USA
| | - Jay W. Patti
- Imaging Sciences Program, Clinical Center, National Institutes of Health Building 10, Room 1C387, Bethesda, MD 20892, USA
- Georgetown University Medical Center, Washington, DC, USA
| | - Bradford J. Wood
- Imaging Sciences Program, Clinical Center, National Institutes of Health Building 10, Room 1C387, Bethesda, MD 20892, USA
- * Corresponding author. National Institutes of Health Clinical Center, Building 10, Room 1C660, Bethesda, MD 20892, USA. Tel.: +1-301-496-7700x226; fax: +1-301-496-9933. E-mail address: (B.J. Wood)
| |
Collapse
|
38
|
Ahrar K, Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am 2003; 12:105-26. [PMID: 12735133 DOI: 10.1016/s1055-3207(02)00089-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most patients with HCC do not qualify for surgical interventions. In carefully selected patients, TACE may improve survival, reduce the rate of tumor growth, and decrease the incidence of portal vein occlusion. Since the introduction of TACE in the 1980s, the technical aspects of the procedure have significantly improved. Sophisticated angiographic equipment and techniques have made superselective arterial catheterization possible for more focused drug delivery. The use of ethiodized oil allows for more effective targeting of HCC and provides dual embolization of the hepatic artery and the portal venules supplying the tumor. Many important technical questions about TACE remain unanswered at this time: there are no reliable, standardized patient selection criteria, ideal cytotoxic agents have not yet been identified, the optimal dose of ethiodized oil has not been confirmed, and the optimal frequency and timing of repeat treatment sessions remain unknown. One major limitation of TACE--the need for repeated treatments, which can result in deterioration of liver function--may be avoided by use of a combination of interventional therapies. The combination of limited TACE with PEI or RFA may lead to improved survival and decreased risk of liver failure. More recently, two excellent randomized clinical trials have demonstrated significant survival benefit for patients treated with TACE when compared with those treated symptomatically.
Collapse
Affiliation(s)
- Kamran Ahrar
- Section of Vascular and Interventional Radiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 325, Houston, TX 77030, USA.
| | | |
Collapse
|
39
|
Abstract
Liver metastases are one of the most difficult therapeutic challenges in modern oncologic practice. Few systemic therapies are effective for solid tumors in the liver. Resection is possible in a minority of patients and usually not curative. Image-guided therapies such as chemoembolization offer substantial intensification of treatment by combining tumor ischemia, increased drug concentrations, prolonged dwell time, and reduced systemic toxicity. Although not a curative therapy, durable responses are seen in most adenocarcinomas, which may contribute to prolongation and preservation of quality of life by delaying liver failure in patients with liver-dominant disease.
Collapse
Affiliation(s)
- Michael Gee
- Division of Interventional Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | |
Collapse
|
40
|
Ramsey DE, Kernagis LY, Soulen MC, Geschwind JFH. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2002; 13:S211-21. [PMID: 12354839 DOI: 10.1016/s1051-0443(07)61789-8] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for patients with unresectable hepatocellular carcinoma (HCC). Chemoembolization involves delivery of some type of chemotherapy combined with some type of arterial embolization to destroy tumor cells. Whereas diffuse tumors may require lobar embolization, smaller tumors may be treated selectively. The goal of TACE is to cause tumor necrosis and control tumor growth while preserving as much functional liver tissue as possible. The ultimate purpose, however, is to prolong life. Several different TACE protocols have been developed, with no consensus as to the most effective techniques. The effect of TACE on patient survival remains unclear. Several nonrandomized studies have demonstrated a beneficial effect of TACE on survival. This result has not been confirmed with randomized trials. It is clear, however, that TACE is a palliative procedure that has been unable to provide a cure for HCC. When combined with other procedures such as percutaneous ethanol injection, TACE has been more successful at achieving survival rates matching those obtained after surgical resection in similar patient populations. Finally, TACE may also be useful as a neoadjuvant therapy by improving the outcomes of potentially curative therapies and as a bridge to liver transplantation.
Collapse
Affiliation(s)
- Douglas E Ramsey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|
41
|
Lee KH, Sung KB, Lee DY, Park SJ, Kim KW, Yu JS. Transcatheter arterial chemoembolization for hepatocellular carcinoma: anatomic and hemodynamic considerations in the hepatic artery and portal vein. Radiographics 2002; 22:1077-91. [PMID: 12235337 DOI: 10.1148/radiographics.22.5.g02se191077] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Although several therapeutic options have been advocated, transcatheter arterial chemoembolization (TACE) in particular has been widely performed in the treatment of HCC. Still, hepatic arteriography and portography are mandatory for evaluation of (a) the resectability and multiplicity of HCCs and (b) the hemodynamic status of the portal vein. Thereafter, TACE can be considered as the initial therapeutic modality. The possibility of nontarget organ complications during TACE (eg, ischemic cholecystitis, splenic infarction, gastrointestinal mucosal lesions, pulmonary embolism and infarction, spinal cord injury, ischemic skin lesions) should be taken seriously. A thorough understanding of the anatomic variants and hemodynamic features of the hepatic artery and portal vein is the first step in performing effective and safe TACE for HCC.
Collapse
Affiliation(s)
- Kwang-Hun Lee
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
In conclusion, there are a variety of treatment approaches used by surgeons, interventional radiologists, and medical oncologists to treat metastatic cancer distributed throughout the liver. One conclusion is that the number of different techniques suggests that no single treatment has been uniformly successful to date. A second conclusion is that the number of techniques applied argues for the importance of this as a clinical problem in oncology today. The number of patients with metastatic disease to the liver and the potential for long-term survival if that disease can be controlled will lead to further combinations and refinements of these techniques in future clinical trials.
Collapse
Affiliation(s)
- Douglas L Fraker
- Department of Surgery, University of Pennsylvania Medical School, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
43
|
Soulen MC. Advances in Chemoembolization. J Vasc Interv Radiol 2002. [DOI: 10.1016/s1051-0443(02)70195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
44
|
Ciftci AO, Ekinci S, Balkanci F, Senocak ME, Büyükpamukçu N. Pseudocholangiocarcinoma sign associated with hepatoblastoma: a previously unreported entity in children. J Pediatr Gastroenterol Nutr 2001; 33:505-7. [PMID: 11698773 DOI: 10.1097/00005176-200110000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A O Ciftci
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
45
|
Soulen MC. Hepatic Chemoembolization and Chemoinfusion. J Vasc Interv Radiol 2001. [DOI: 10.1016/s1051-0443(01)70122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
46
|
Abstract
The battle against malignancies of the liver is far from over, although tremendous strides have been made in the past decade, such as improved diagnostic capabilities, safe surgical resection, availability of safe nonsurgical ablative modalities, multimodality therapy, and aggressive approach to recurrent disease. Even after the best attempts at curative treatment, recurrence of primary and secondary malignancies of the liver continues to be the cause of demise for more than 70% of treated patients. The battle continues in the laboratories, where investigations are focused on delineating the pathophysiology of cancer on the molecular and genetic levels and mapping the patterns of cancer emergence and spread. The new millennium holds promise for formulating therapies that may improve disease-free survival for patients with malignancies of the liver.
Collapse
Affiliation(s)
- J I Tsao
- Department of Surgery, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | | | | | | |
Collapse
|
47
|
Soulen MC. Regional Therapy of Hepatic Malignancies. J Vasc Interv Radiol 2000. [DOI: 10.1016/s1051-0443(00)70064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
48
|
Regional Therapy of Hepatic Malignancies. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 1999; 2:437-440. [PMID: 11097726 DOI: 10.1007/s11938-999-0045-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
49
|
Han YM, Park HH, Lee JM, Kim JC, Hwang PH, Lee DK, Kim CS, Choi KC. Effectiveness of preoperative transarterial chemoembolization in presumed inoperable hepatoblastoma. J Vasc Interv Radiol 1999; 10:1275-80. [PMID: 10527208 DOI: 10.1016/s1051-0443(99)70231-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and therapeutic role of preoperative transarterial chemoembolization (TACE) of hepatoblastoma. MATERIALS AND METHODS Four patients (one boy, three girls) with unresectable hepatoblastoma were treated twice with preoperative TACE in an effort to improve the surgical and clinical outcome. The patients ranged in age from 8 to 27 months (mean, 15 months). The first TACE was performed superselectively in tumor feeding arteries. The second TACE was performed 3 weeks later. Surgical hepatic resection was performed 1 month after the second TACE. Contrast-enhanced computed tomography (CT) was used to evaluate changes in size, volume, internal texture, and margin of the masses. The toxicity of the chemotherapeutic drugs was evaluated by blood chemistry analysis (AST/ALT, alpha-FP) performed before and after TACE, and after surgery. RESULTS TACE allowed subsequent surgical resection in all four patients, who remained disease free 16-52 months after operation. There were no major problems related to TACE. There was no chemotherapeutic agent toxicity from TACE. The average largest diameters and volumes of the tumors decreased by 31% (8.3 to 5.6 cm) and 69% (317 to 93 cm2), respectively. CONCLUSION TACE provided subsequent successful surgical resection and good long-term results in all four patients. The hepatoblastomas were initially considered inoperable because of extensive hepatic involvement and indistinct margins.
Collapse
Affiliation(s)
- Y M Han
- Department of Diagnostic Radiology, Chonbuk National University Medical School, Chonju City, Republic of Korea.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Gates J, Hartnell GG, Stuart KE, Clouse ME. Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 1999; 19:399-414. [PMID: 10194787 DOI: 10.1148/radiographics.19.2.g99mr08399] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chemoembolization of the liver for unresectable malignancy, although controversial, is being used with increasing frequency. Chemoembolization can be difficult, and there is great potential for causing complications. There are also findings after chemoembolization, particularly on computed tomographic scans, that may appear to indicate complications but are common and of no concern. Chemoembolization requires an understanding of the congenital and acquired variations of arterial anatomy that may be seen supplying the liver. Assessment of the patency of the portal vein is also required. An abnormal portal vein demands significant changes in technique to allow safe chemoembolization. Partial or complete occlusion of the portal vein is associated with significantly decreased survival but does not prevent a worthwhile response to chemoembolization and is not an absolute contraindication. The presence of chemoembolization material in the gallbladder is not uncommon; with the technique used by the authors, the chemoembolization material infrequently causes cholecystitis or gallbladder infarction. Extrahepatic chemoembolization material is commonly seen in other organs but usually does not cause problems, presumably because the dose deposited outside the liver is small compared with the dose delivered to the liver. Other complications include pseudocirrhosis, liver infarction and abscess formation, carcinoid crisis, hepatorenal syndrome, and liver rupture.
Collapse
Affiliation(s)
- J Gates
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass., USA
| | | | | | | |
Collapse
|