Arterial hepatic embolization of unresectable hepatocellular carcinoma using a cyanoacrylate/lipiodol mixture

Purpose: A survival analysis in 16 patients with unresectable hepatocellular carcinoma (HCC) undergoing transcatheter arterial embolization (TAE) using a combination of lipiodol and N-butyl-2-cyanoacrylate (5 : 1) was performed in a retrospective study. Methods: A combination of lipiodol and N-butyl-2-cyanoacrylate (5 : 1) was used for TAE. All patients had disease compatible with Okuda stages I and II. Results: Twenty-four embolizations were done; five patients had more than one embolization. Median alpha-fetoprotein levels declined from 116 to 48.6 ng/ml. A median of 0.3 ml cyanoacrylate was administered per patient. Median survival was 8.5 months (range 2–49 months). After a median follow-up of 4 years, 12 patients have died (75%). Okuda stage I and II patients had a median survival time of 34.4 and 5.5 months respectively. Few side effects (19%) were seen. Conclusion: We conclude that the TAE procedure used [lipiodol and N-butyl-2-cyanoacrylate (5 : 1)] is safe and produced only few side effects, thus constituting a valuable therapeutic option for patients with Okuda stage I andII HCC.     

Arterial Embolization of Unresectable Hepatocellular Carcinoma with Use of Microspheres, Lipiodol, and Cyanoacrylate

We performed a retrospective analysis of 46 patients with histologically confirmed hepatocellular carcinoma (HCC) who were treated with transarterial embolization (TAE) of the hepatic arteries. To induce permanent embolization, microspheres (Embosphere; 100 to 700) and a mixture of ethiodized oil (Lipiodol Ultrafluide) with cyanoacrylate (Glubran) was injected. A total of 106 TAE procedures were performed. Cumulative survival rates were calculated. No patient died during embolization or within the first 24 hours. Severe procedure-related complications were observed in 2 patients. At the time of analysis, 38 of 46 patients were alive. The 180-, 360-, 520-, and 700-day cumulative survival rates for the total study population were 80.6%, 70.7%, 70.7%, and 47.1%, respectively, with a median survival of 666 days. TAE with the use of microspheres and Lipiodol and cyanoacrylate for unresectable HCC is a feasible treatment modality. Bland embolization with the use of microspheres can be used in patients for whom chemoembolization is not desired.     

肾段及亚段疾病血管栓塞术的临床应用

目的：探讨经肾动脉手管超选择至肾段及肾亚段对肾肿瘤及肾动静脉畸形进行栓塞治疗的临床应用价值。方法：4例肾肿瘤患，经导管超选择至肾段及肾亚段，行化疗栓塞术。8例肾动静脉畸形均经DSA证实，经导管超选择性插管至肾段及肾亚段行栓塞治疗。栓塞材料为弹簧图、无水酒精、PVA或IBCA。结果：4例肾肿瘤患节段性栓塞均获得成功，治疗后肿瘤缩小，碘油沉积良好，CT复查肿瘤平均6个月无复发，相邻的肾段无梗死征象。8例肾动静脉畸形患超选择性栓塞均获得成功。1例术后6个月血尿复发，再次栓塞后血尿症状消失，其余未见复发。结论：肾段及肾亚段栓塞是治疗无手术适应证的肾脏肿瘤及肾动静脉畸形的有效方法，互能够最大限度的保护正常肾脏，并发症少。     

Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma

PURPOSE: To determine the survival of patients with hepatocellular carcinoma (HCC) treated with a standardized method of transcatheter arterial embolization (TAE) with small embolic particles intended to impart terminal vessel blockade, and to evaluate prognostic factors that impact overall survival. MATERIALS AND METHODS: A total of 322 patients with HCC who underwent 766 embolizations from January 1997 to December 2004 were retrospectively reviewed. Selective embolization of vessels feeding individual tumors was performed with small (50 microm) polyvinyl alcohol or spherical embolic particles (40-120 microm) intended to cause terminal vessel blockade. Repeat embolization was performed in cases of evidence of persistent viable tumor or development of new lesions. Patient, tumor, and treatment characteristics were prospectively recorded and tested for prognostic significance by univariate and multivariate analysis. RESULTS: The median survival time was 21 months, with 1-, 2-, and 3-year overall survival rates of 66%, 46%, and 33%, respectively. In patients without extrahepatic disease or portal vein involvement by tumor, the overall 1-, 2-, and 3-year survival rates increased to 84%, 66%, and 51%, respectively. Okuda stage, extrahepatic disease, diffuse disease (> or =5 tumors), and tumor size were independent predictors of survival on multivariate analysis. There were 90 complications (11.9%) in 75 patients, including eight deaths (2.5%), within 30 days of embolization. CONCLUSIONS: Hepatic arterial embolization with small particles to cause terminal vessel blockade is an effective treatment method for patients with unresectable HCC. These data support our hypothesis that particles alone may be the critical component of catheter-directed embolotherapy.     

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.     

Effective segmental chemoembolization of advanced hepatocellular carcinoma with tumor thrombus in the portal vein

Purpose: Evaluate therapeutic results of transcatheter segmental hepatic artery chemo-oily-embolization (segmental TAE) against advanced hepatocellular carcinomas (HCC) accompanied by portal tumor thrombus (PTT). Methods: Segmental TAE was performed in nine patients with hepatic cirrhosis and advanced HCCs accompanied by PTT. Four subsegmental portal branches were obstructed by PTT in three patients, and two were obstructed in the remaining six patients. TAE was performed into the targeted segmental hepatic artery followed by embolization with gelatin sponge particles. Results: In one patient undergoing subsequent resection, a marked anticancer effect on the PTT was demonstrated histologically. In the eight other patients who did not undergo subsequent resection, the cumulative survival rates were 67% at 6 months, 44% at 1 year, and 22% at 2 years. No serious complications were noted. Conclusions: This therapeutic approach is thought to be a useful treatment for HCC with PTT, because it reinforces anticancer effects and can be performed more safely than conventional transcatheter arterial embolization.     

动脉介入栓塞治疗肝癌破裂出血

目的分析原发性肝癌自发性破裂出血经动脉介入栓塞(TAE或TACE)治疗的效果。方法回顾性分析安徽省立医院2008年8月-2011年11月的11例采用急症介入栓塞治疗的原发性肝癌破裂出血患者的临床资料。结果 11例患者均得以成功止血,术后30 d生存10例(90.9%),术后3个月生存6例(54.5%),术后1年生存3例(27.2%)。结论 TAE(TACE)是治疗肝癌破裂出血的有效方法,不仅能达到立即止血,提高患者生存率的目的 ,还能为后续进一步治疗创造条件。     

不能切除的肝癌动脉内治疗：方法选择和疗效分析

随访了２１３例不能切除的原发性肝癌动脉内治疗的病例。采用以下三种方式：（１）化疗药物灌注（ＨＡＩ组）；（２）碘油抗癌药乳剂栓塞（Ｌｐ－ＴＡＥ组）；（３）碘油乳剂加明胶海绵栓塞（Ｌｐ－ＴＡＥ＋ＧＳ组）。Ｌｐ－ＴＡＥ＋ＧＳ组、Ｌｐ－ＴＡＥ组和ＨＡＩ组，各组１年生存率分别为４２．４％、２７．５％和６．４％（Ｐ＝０．００４７），合并门静脉瘤栓的病例其半年、１年生存率分别为６８．９％和１８．０％。     

Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials

PURPOSE: To review the available evidence of chemoembolization for unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Computerized bibliographic searches with MEDLINE and CANCERLIT databases from 1980 through 2000 were supplemented with manual searches, with the keywords "hepatocellular carcinoma," "liver cell carcinoma," "randomized controlled trial [RCT]," and "chemoembolization." Studies were included if patients with unresectable HCC were enrolled and if they were RCTs in which chemoembolization was compared with nonactive treatment (five RCTs) or if different transarterial modalities of therapy (13 RCTs) were compared. Data were extracted from each RCT according to the intention-to-treat method. Five of the RCTs with a nonactive treatment arm were combined by using the random-effects model, whereas all 18 RCTs were pooled from meta-regression analysis. RESULTS: Chemoembolization significantly reduced the overall 2-year mortality rate (odds ratio, 0.54; 95% CI: 0.33, 0.89; P =.015) compared with nonactive treatment. Analysis of comparative RCTs helped to predict that overall mortality was significantly lower in patients treated with transarterial embolization (TAE) than in those treated with transarterial chemotherapy (odds ratio, 0.72; 95% CI: 0.53, 0.98; P =.039) and that there is no evidence that transarterial chemoembolization is more effective than TAE (odds ratio, 1.007; 95% CI: 0.79, 1.27; P =.95), which suggests that the addition of an anticancer drug did not improve the therapeutic benefit. CONCLUSION: In patients with unresectable HCC, chemoembolization significantly improved the overall 2-year survival compared with nonactive treatment, but the magnitude of the benefit is relatively small.     

肝癌TAE疗效与碘油乙醇乳剂用量的相关性研究

目的　探讨肝癌经皮肝动脉栓塞术 (TAE)的疗效与碘油乙醇乳剂用量的相关性 ,进一步提高TAE在肝癌治疗中的疗效。材料与方法　 3 5例肝癌患者 ,分成两组。第一组 17例 ,按肿瘤直径与碘油乙醇乳剂剂量等比例行TAE治疗 ;第二组 18例 ,按碘油乙醇乳剂最大剂量法进行治疗 ,并进行对比分析。结果　第一组和第二组 1、2年生存率分别为 5 8.82 %、2 3 .5 3 %和 77.78%、44.44% (P <0 .0 5 )。结论　对于适合TAE的肝癌患者 ,肝癌TAE疗效与碘油乙醇乳剂用量成明显正相关。     

The use of transarterial chemoembolization in the treatment of unresectable hepatocellular carcinoma: a response to the Cochrane Collaboration review of 2011

This commentary is written in response to a recent Cochrane Collaboration review published in March 2011 (1). The authors of this commentary would like to express their concerns over the conclusions of the Cochrane review, which state, "There is no firm evidence to support or refute transarterial chemoembolization (TACE) or transarterial embolization (TAE) for patients with unresectable hepatocellular carcinoma (HCC)."     

Transarterial Embolization With Cyanoacrylate for Severe Arterioportal Shunt Complicated by Hepatocellular Carcinoma

Purpose

To evaluate the efficacy and safety of cyanoacrylate glue embolization in the treatment of severe arterioportal shunt (APS) presenting with hepatofugal portal venous flow in hepatocellular carcinoma (HCC) patients.

Materials and Methods

Between July 2000 and January 2010, 27 HCC patients with severe APS presenting with hepatofugal portal venous flow underwent transarterial angiography and treatment. Among them, four patients were excluded from the study. Twelve patients underwent transarterial chemoperfusion and embolization of APS with cyanoacrylate glue between January 2006 and January 2010 (Emb group), and the other 11 patients undergoing only transarterial chemoperfusion without embolization of APS between July 2000 and December 2005 served as a control group (non-Emb group). The change of APS, survival rates, and procedure related complications were analyzed.

Results

In the Emb group, APS was improved in all of the 12 patients after initial glue embolization; long-term APS improvement with hepatopetal portal flow was achieved in 80 % (8 of 10) patients who underwent follow-up angiography. Survival rates in the Emb group were 67 % at 6 months, 33 % at 1 year, and 8 % at 2 years, whereas those in the non-Emb group were 0 % at 6 months (P < 0.05). Median survival time in the Emb group was 275 days, which was longer than that of 107 days in the non-Emb group (P = 0.001). There were no major complications in both groups.

Conclusion

The preliminary experience suggests that glue embolization may be an effective and safe therapy in the management of severe APS accompanied by HCC and also improve patient survival.     

Analysis of hepatocellular carcinoma fed by internal thoracic artery

Purpose: The purpose of this study was to elucidate the clinical features of hepatocellular carcinoma (HCC) fed by the internal thoracic artery (ITA). Methods: In seven patients HCC fed by the ITA was confirmed by digital subtraction angiography. The number of previous transcatheter arterial embolization (TAE), the period from the first TAE to TAE of the ITA, tumor location, tumor size, and occlusion of the hepatic artery (HA) and other collateral vessels were explored in each case. Results: The HCCs were located in S4 of the liver (n = 5) and in S8 (n = 1) and were fed by the right ITA and one nodule in S2-3 was fed by the left ITA. Tumor size was 3-10 cm. The number of previous TAE of the HA ranged from 2 to 12. The period from the first TAE to TAE of the ITA was 3-53 months. Angiography of these patients showed occlusion of the HA in six cases, and of the extrahepatic collaterals including the inferior phrenic artery (IPA) in five cases, intercostal artery (ICA) in one case, and epicholedocal artery (EPA) in one case. Conclusion: The ITA often supplies HCC located in the anterior superior region of the liver under the diaphragm; there can be long-term survival with repeated TAE and occlusion of HA.     

Transcatheter arterial embolization for spontaneous rupture of hepatocellular carcinoma

Transcatheter arterial embolization (TAE) was performed in 20 patients with ruptured hepatocellular carcinoma (HCC). Bleeding was improved in all patients, but only four survived for over three months. Rerupture occurred in seven patients (35%) and the prognosis was extremely poor. TAE should be considered the treatment of choice for ruptured HCC; however, long-term survival was limited to those patients without portal extension of HCC. The severity of rupture also influenced the prognosis.     

肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓疗效分析

目的：探讨肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓的疗效。方法：癌栓组为无手术指征的原发性肝癌合并门静脉癌栓患者50例，对照组为原发性肝癌42例，两组患者均行肝动脉化疗栓塞术（TACE）治疗，观察两组患者的疗效、生存率和并发症。结果：对照组和癌栓组近期总有效率分别为50．0％（21／42）和42．0％（21／50），组间比较无显著差异；癌栓组门静脉癌栓消失或缩小〉25％者为44％（22／50），两组治疗后肝癌二期手术切除率分别为38．1％（16／42）和30％（15／50），无显著差异；对照组0．5、1、2年生存率分别为71．4％（30／42）、47．6％（20／42）、31．0％（13／42），中位生存期为15．6个月；癌栓组分别为64．0％（32／50）、40．0%（20／50）、24．0％（12／50），中位生存期为14．2个月，组间差异不显著；两组患者术后并发症发生率无显著差异。结论：肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓具有较好疗效。     

肝血管瘤合并动静脉瘘的DSA表现及介入治疗

目的:回顾性分析肝海绵状血管瘤(CHL)合并动静脉瘘(AVF)的数字减影血管造影(DSA)的特征性表现并探讨合理的治疗方法。方法:分析合并AVF的26例CHL的完整DSA及经平阳霉素碘油乳剂肝动脉栓塞(PLE-TAE)治疗的资料。改进造影技术采集DSA图像,采取超选择插管行PLE-TAE后再用明胶海绵颗粒栓塞瘘口及少量无水酒精闭塞瘘口后再行PLE-TAE等处理方法。结果:CHL合并的AVF的DSA的特征性表现为瘘口较为局限,多位于瘤周近供血动脉处;以周围型动-门静脉瘘(APVF)为多见;分流量多较小;AVF供血动脉无浸润破坏现象。对瘘口采取适当的处理措施后,AVF中碘油沉积静脉数较TAE前DSA显著减少(P<0.01),邻近肝组织亦未见明显碘油异常沉积。结论:CHL中AVF有较高的发生率且有特征性DSA表现。通过适当处理可以显著减少或避免PLE异常沉积及其可能造成的肝脏和肺脏纤维化。     

肝癌合并门脉癌栓的化疗栓塞治疗

１２８例肝癌合并门脉癌栓病人经２次以上插管治疗，Ａ组肝动脉内灌注化疗药物，Ｂ组药物灌注加碘油栓塞，Ｃ组化疗加碘油及明胶海绵粒栓塞。三组１年生存率分别为２５．００％，２８．５２％，４１．７６％，平均生存７．２个月、８．４个月及１０．３个月。Ｃ组疗效最好，１例病人存活达７年，说明、门脉癌栓不应是肝动脉化疗栓塞的禁忌证，对没有严重肝硬化及肝功能损害的门脉癌栓病人均应进行化疗栓塞治疗。     

Transvaskul?re Ablation des hepatozellul?ren Karzinoms

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and represents the main cause of death among European patients with liver cirrhosis. Only 30-40% of patients diagnosed with HCC are candidates for curative treatment options (e.g. surgical resection, liver transplantation or ablation). The remaining majority of patients must undergo local regional and palliative therapies. Transvascular ablation of HCC takes advantage of the fact that the hypervascularized HCC receives most of its blood supply from the hepatic artery. In this context transvascular ablation describes different therapy regimens which can be assigned to four groups: cTACE (conventional transarterial chemoembolization), bland embolization (transarterial embolization TAE), DEB-TACE (TACE with drug-eluting beads, DEB) and SIRT (selective internal radiation therapy, radioembolization). Conventional TACE is the most common type of transvascular ablation and represents a combination of intra-arterial chemotherapy and embolization with occlusion of the arterial blood supply. However, there is no standardized regimen with respect to the chemotherapeutic drug, the embolic agent, the usage of lipiodol and the interval between the TACE procedures. Even the exact course of a cTACE procedure (order of chemotherapy or embolization) is not standardized. It remains unclear whether or not intra-arterial chemotherapy is definitely required as bland embolization using very small, tightly calibrated spherical particles (without intra-arterial administration of a chemotherapeutic drug) shows tumor necrosis comparable to cTACE. For DEB-TACE microparticles loaded with a chemotherapeutic drug combine the advantages of cTACE and bland embolization. Thereby, a continuing chemotherapeutic effect within the tumor might cause a further increase in intratumoral cytotoxicity and at the same time a decrease in systemic toxicity.     

Hepatocellular carcinoma: combined hepatic, arterial, and portal venous embolization

Transcatheter arterial embolization (TAE) is an effective means of treating primary hepatocellular carcinoma (HCC). However, in many cases of HCC the tumor recurs after treatment. In an attempt to obtain complete tumor necrosis, the authors studied the clinical and histologic effect of simultaneous embolization of both the hepatic artery and portal vein in ten patients with HCC. In those cases in which combined embolization caused infarction, tumor cells in the main tumor, tumor cells that had invaded the tumor capsule, and small intrahepatic metastases had become totally necrotic following treatment. No viable tumor cells were detected in four patients who subsequently underwent operations; nor were viable tumor cells present in one other patient who later died as a result of a perforated duodenal ulcer. Five patients who did not subsequently undergo operations were still free of the disease 2-17 months after combined arterial and portal embolization. The impact of combined embolization on liver function was nearly the same as that produced when TAE was performed alone. Combined embolization may be a viable alternative to hepatectomy for the treatment of HCC.     

TAE治疗原发肝细胞癌(对不同组织细胞学类型疗效的初步研究)

目的：通过对一组１５７例经组织细胞学检查证实的原发性肝细胞癌患者生存资料及影像学资料的分析，初步研究经导管动脉栓塞（ＴＡＥ）对不同组织细胞学类型肝细胞癌的治疗效果。材料与方法：８种不同组织细胞学类型的资料较完整的原发性肝细胞癌患者，共计１５７例，分别接受单纯ＴＡＥ、单纯手术或ＴＡＥ＋手术切除治疗。对上述病例分别按照不同组织细胞学类型及不同治疗方法进行生存资料和影像学资料分析。结果：本组原发性肝细胞癌的１年、２年、３年和５年的累计生存率分别为７４．５２％、４８．４０％、３２．４８％和１１．４６％。各组织细胞学类型中，纤维板层型与透明细胞型肝细胞癌的５年生存率分别为２５％和２９％，。三种治疗方法中，单纯ＴＡＥ组、单纯手术组与ＴＡＥ＋手术组的平均生存时间分别为２５．０６（标准误＝１．８７）、３０．３８（标准误＝２．０５）和７２．７２（标准误＝６．９０）个月。结论：ＴＡＥ对不同组织细胞学类型的原发性肝细胞癌在治疗效果上存在差异；本组中，以透明细胞型肝细胞癌对ＴＡＥ较为敏感，而以小细胞型和低（未）分化型肝细胞癌较不敏感。