白芨在经肝动脉化疗栓塞术治疗大鼠肝细胞癌实验中的应用

目的评价白芨在经肝动脉化疗栓塞术(transarterialchemoembolization,TACE)治疗ACI大鼠肝细胞癌实验中的应用价值。方法在30只ACI大鼠肝包膜下植入MorrisHepatom3924A肝癌瘤块(2mm3),移植术后13d进行MR检查,测量肿瘤体积(V1),第14天时,经大鼠胃十二指肠动脉逆行插管至肝动脉,采取以下治疗方案A组01mg丝裂霉素+01ml碘油+10mg白芨(10只);B组01mg丝裂霉素+01ml碘油+10mg白芨+肝动脉结扎(10只);C组01mg丝裂霉素+01ml碘油(对照组,10只)。13d后再次进行MR检查以测量肿瘤体积(V2),比较肝肿瘤体积生长率(V2/V1)。结果介入治疗后与治疗前肿瘤体积之比(V2/V1)分别为A组628,B组153,C组914。与对照组C相比,采取A、B组的治疗方案均能抑制肝肿瘤的生长(P<005和P<001),A组与B组之间的肿瘤生长率差异亦有统计学意义(P<001)。结论白芨作为肝动脉栓塞剂,结合局部化疗术和肝动脉结扎术能明显抑制大鼠肝细胞癌的生长。     

化疗药在动脉化疗栓塞治疗大鼠肝癌实验中的价值

目的评价经肝动脉化疗栓塞术（transarterial chemoembolization,TACE）治疗大鼠移植性肝癌中化疗药物的抑瘤及肝损害作用。材料与方法复制大鼠移植性肝癌模型,经肝动脉插管采取以下介入治疗方案：A组（小剂量TACE,n=10）：经肝动脉灌注丝裂霉素（MMC）50μg＋超液态碘油（UFLP）50μl＋明胶海绵粉（GF）25μg;B组（常规剂量TACE,n=10）经肝动脉灌注5-Fu5mg＋MMC50μg＋UFLP50μl＋GF25μg;C组（对照组,n=10）经肝动脉灌注生理盐水0．3ml。介入术前及术后12d,分别行MRI检查测量肿瘤体积V1及V2,并计算、比较V2／V1,取术后肿瘤及瘤周肝组织行病理学检查,并行肝功能检查。结果存活27只大鼠,V2／V1比较结果：C组高于A、B组,且均有显著性差异（P〈0．05）,而A、B两组无显著性差异（P〉0．05）;三组间肿瘤坏死程度分别为58．25％、55．60％、26．67％,C组低于A、B组,均存在显著性差异（P〈0．05）,而A、B两组无显著性差异（P〉0．05）;三组间瘤周肝组织改变分别为肝细胞胞浆疏松化、气球样变、无变性坏死;肝功能比较结果：A组谷丙转氨酶（ALT）、谷草转氨酶（AST）水平高于C组（P〈0．05）,而B组又高于A组（P〈0．05）,A、C组间总胆红素（TBIL）与白蛋白（ALB）水平无显著性差异（P〉0．05）,但前者低于B组（P〈0．05）后者高于B组（P〈0．05）。结论一定剂量化疗药的TACE可有效治疗大鼠移植性肝肿瘤,增加化疗药剂量并不能增加这种作用,相反能明显加重对肝组织的损害及对肝功能的影响作用。     

原发性肝癌的复合性栓塞治疗

目的：通过对原发性肝癌（PHC）三种介入治疗方法的疗效比较，评估其应用价值。材料和方法：根据不同的治疗方法，分为3组。A组：30例，为单纯动脉内抗癌药灌注（TAI）；B组：15例，为单纯用碘化油动脉栓塞（TA）；C组：45例，碘化油与抗癌药再加明胶海绵复合性动脉栓塞（TACE）。对三组的肿瘤直径缩小率、甲胎蛋白的变化、累计生存率及生存期进行观察对比。结果：TACE组甲胎蛋白降至正常者高于TAI或TAE组（p＜0．01）。TACE组肿瘤缩小率高于TAI或TAE组（p＜0．01）。TACE组累计生存率显著高于TAI或TAE组（p＜0．01）。TACE组平均生存期也高于TAI或TAE组（p＜0．05）。结论：含抗癌药碘油加明胶海绵复合性栓塞治疗原发性肝癌是目前一种比较好的方法。     

血管生成抑制剂烟曲霉素衍生物在介入治疗肝细胞癌实验中的应用

目的研究经肝动脉化疗栓塞术结合肝动脉灌注血管生成抑制剂合成的烟曲霉素衍生物（TNP-470）治疗ACI大鼠肝细胞癌的疗效。方法在20只雄性ACI大鼠肝包膜下移植Morris Hepatoma3924A肝癌小瘤块（2mm^3），移植术后第13天时进行MR检查，测量肿瘤体积V1，第14天时，在荷瘤大鼠经胃十二指肠动脉逆行插管至肝动脉而采取以下介入治疗方案：治疗组：碘化油（0．1ml）＋丝裂霉素（0．1mg）＋TNP-470（5．0mg）（10只）；对照组：碘化油（0．1ml）＋丝裂霉素（0．1mg）（10只）。治疗后再次进行MR检查测量肿瘤体积V2，比较肝肿瘤体积变化（V2／V1）。结果治疗组和对照组大鼠经介入治疗前后的肝肿瘤平均体积分别为0．04cm^3和0．15cm^3以及0．04cm^3和0．34cm^3。治疗组和对照组肿瘤体积平均增长倍数（V2／V1）分别为4．11和9．14。与对照组相比，治疗组能明显抑制肝肿瘤体积的增长（P〈0．01）。结论在ACI大鼠肝细胞癌模型，采用肝动脉化疗栓塞术结合肝动脉灌注血管生成抑制剂TNP-470的治疗方法可明显抑制肝肿瘤体积的生长。     

Early Stage Hepatocellular Carcinomas Not Feasible for Ultrasound-Guided Radiofrequency Ablation: Comparison of Transarterial Chemoembolization Alone and Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation

Purpose

To report the results of combined therapy with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early stage hepatocellular carcinoma (HCC) considered infeasible for ultrasound (US)-guided RFA in comparison with those of TACE monotherapy.

Methods

From January 2007 through December 2010, 91 patients with early or very early stage HCC infeasible for US-guided RFA received either TACE alone (TACE group; n = 54) or TACE immediately followed by RFA (TACE–RFA group; n = 37) as a first-line treatment. 1-month tumor response, time to progression (TTP), and overall survival (OS) rates were calculated. Univariate and multivariate analyses were performed to identify prognostic factors.

Results

TACE–RFA group showed a better 1-month tumor response than TACE group (P < .001). The mean TTP was 29.7 ± 3.4 months (95 % confidence intervals [CIs] 23.0–36.5) in TACE group and 34.9 ± 2.8 months (95 % CIs 29.4–40.4) in TACE–RFA group. TACE–RFA group had a significantly longer TTP (P = .014). Cumulative 1-, 2-, and 3-year OS rates in the TACE and TACE–RFA groups were 91, 79, and 71 % and 100, 97, and 93 %, respectively (P = .008). Initial treatment of TACE was found to be the only significant risk factor for tumor progression and OS in multivariate analysis.

Conclusion

TACE–RFA combination therapy appears superior to TACE monotherapy in terms of 1-month tumor response, TTP, and OS when performed for early stage HCC infeasible for US-guided RFA.

     

Transarterial Chemoembolization Using Gelatin Sponges or Microspheres Plus Lipiodol-Doxorubicin versus Doxorubicin-Loaded Beads for the Treatment of Hepatocellular Carcinoma

ObjectiveTo retrospectively compare treatment of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) using gelatin sponges or microspheres plus lipiodol-doxorubicin vs. doxorubicin-loaded drug-eluting beads (DEB).ResultsNo significant difference was found at baseline among the three groups. The doxorubicin dosage in group C was significantly (p < 0.001) higher compared to the dose used in groups A or B (median, 50 mg vs. 31 mg or 25 mg). Significantly (p < 0.001) more patients in group C achieved complete response compared to those in groups A or B (32.1% vs. 6.3% or 2.4%). Significantly (p < 0.001) less patients in group C had progressive disease compared to those in groups A or B (34.0% vs. 57.8% or 68.3%). Minor AEs were more common in groups A and B compared to group C, with rates of 54.7%, 34.1%, and 5.7%, respectively.ConclusionIn patients with HCC, TACE with DEB offers better safety and efficacy profiles compared to either TACE with gelatin sponges or TACE with microspheres.     

经肝动脉化疗栓塞术联合激光热疗治疗大鼠肝转移癌

目的:评价经肝动脉化疗栓塞术(TACE)联合激光热疗(LITT)治疗大鼠肝转移癌的疗效.方法:30只雄性WAG大鼠肝包膜下注入CC531结直肠癌肝转移癌细胞混悬液,种植术后13天行MRI检查,测量肿瘤体积V1,然后采取介入治疗措施:①第14天时采取单纯TACE治疗(丝裂霉素(碘油(降解淀粉);②第14天时采取单纯LITT治疗(Nd:YAG激光);③联合TACE(第14 天时)和LITT治疗(第21 天时).第28天时再次行MRI检查以确定肿瘤体积V2变化,比较肝肿瘤体积生长率V2/V1.结果:介入治疗后肿瘤体积与治疗前肿瘤体积之比分别为A组5.42、B组6.14、C组3.15.与对照组A组和B组相比,采取C组即TACE联合LITT的治疗方案明显抑制肝肿瘤的生长(Bonferroui检验,P＜0.01).结论:联合TACE和LITT的综合介入治疗方法与单纯TACE以及LITT相比,能明显抑制大鼠肝转移癌的生长.     

Use of 120 Kilovolt Tube Potential for Digital Subtraction Angiography and Fluoroscopy in an Image-Intensifier Angiographic System: Decrease of Skin Dose in Transarterial Chemoembolization Therapy for Hepatocellular Carcinoma

In an image-intensifier angiographic system, the tube potential is commonly regulated in ranges from 75 to 90 kV for digital subtraction angiography (DSA) and fluoroscopy in transarterial chemoembolization therapy (TACE) for hepatocellular carcinoma. The purpose of this study was to investigate whether or not a 120-kV tube potential could be used for DSA and fluoroscopy in TACE to decrease the skin dose. Forty-three patients administered TACE were randomly allocated into two groups: TACE was performed using standard-kilovoltage (75- to 90-kV) DSA and fluoroscopy modes (group A; n = 20) or using high-kilovoltage (120-kV) modes (group B; n = 23). The peak skin dose was compared between the groups. One case in group A was excluded from the study because the HCC nodule was not depicted on DSA. The peak skin dose (mGy) for group A was 383.6 ± 176.5 and that for group B was 265.1 ± 145.1. The peak skin dose was decreased by 31% in the 120-kV mode, a statistically significant difference (t-test, p = 0.022). We conclude that the use of 120 kV tube potential for DSA and fluoroscopy may be one option for performing TACE while decreasing the skin dose.     

肝癌伴下腔静脉癌栓行TACE联合下腔静脉放射性支架或裸支架治疗的对照研究

目的 探讨TACE联合下腔静脉放射性支架植入治疗肝细胞肝癌伴下腔静脉癌栓的安全性及有效性.方法 对61例肝细胞肝癌伴下腔静脉癌栓患者的资料行回顾性分析,放射性支架采用125I粒子条捆载裸支架的方法,共对33例患者采用此方法(A组),28例患者植入裸支架(B组).采用倾向性评分匹配(propensity score matching)对原数据进行后随机化分析以减少选择性偏倚,对两组患者的生存期,症状缓解率及不良反应进行对照分析.结果 两组患者术后不良反应发生率相仿,均采用内科对症处理.A组患者较B组显示更长的生存期优势,A组中位生存时间(203.0±28.1)d,B组(93.0±24.3)d(P=0.006),倾向性评分匹配后(24对)A组(200±31)d,B组(66.0±23) d(P=0.019),A组水肿缓解率97.0％,B组为96.4％,多因素分析显示放射性支架植入与肿瘤客观有效率为患者预后好的独立性影响因素.结论 TACE联合放射性支架植入对治疗肝细胞肝癌伴下腔静脉癌栓安全有效,可能延长患者生存时间.     

Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma with Intra-atrial Tumor Extension: Imaging Response and Oncologic Outcomes

To evaluate outcomes in patients with right atrial (RA) hepatocellular carcinoma extension treated with transarterial chemoembolization. Eight patients were retrospectively reviewed. Follow-up visits occurred at 4–6 weeks; transarterial chemoembolization was repeated if residual tumor persisted. After transarterial chemoembolization, RA tumor volume reduction was 86% ± 19; α-fetoprotein level showed a reduction of 95%. From RA tumor diagnosis, 3-, 6-, and 12-month overall survival was 100% ± 0, 100% ± 0, and 67% ± 29, respectively. In patients with hepatocellular carcinoma invading the right atrium, transarterial chemoembolization alone or in combination with systemic therapy yields an improved imaging response and may be associated with improved survival.     

经动脉内灌注利多卡因-碘油乳剂在恶性肿瘤栓塞化疗术中止痛疗效的评价

目的　评价经动脉内给予利多卡因 碘油乳剂行栓塞化疗术中控制疼痛和预防动脉痉挛的可行性和有效性 ,并探讨其最佳用量。方法　 1 2 0例恶性肿瘤患者均行栓塞化疗术 (TACE) ,随机分成3组 :行利多卡因 碘油乳剂栓塞者为A组 (n =4 0 ) ;TACE术前行利多卡因团注者为B组 (n =4 0 ) ,单纯TACE为C组者 (无利多卡因组 ,n =4 0 )。术后疼痛程度用一主观指标评价 (即视觉模拟等级 VAS 0 - 1 0)和一客观指标评价 (术后肌注镇痛剂的使用数量 ) ,术中动脉痉挛发生率通过DSA来评价。结果　 3组间疼痛发生率的差异有显著性 (P <0 .0 5 ) ,A ,B ,C组平均积分分别为 2 .78,3.87和 4 .4 6。术后疼痛积分提示A组较B组和C组显著降低 (P <0 .0 5 ) ,但B组和C组间差异无显著性 (P >0 .0 5 )。肌注镇痛剂控制难以忍受疼痛的药量上A组和B组患者均较C组有显著减少 (P <0 .0 5 ) ,A组和B组患者动脉痉挛发生率差异无显著性 ,但两者均较C组低 ,恶性肿瘤内碘油沉积在A组患者中最致密 ,尤其是在肝脏转移性肿瘤中碘油沉积更好。结论　经动脉灌注利多卡因 碘油乳剂行栓塞化疗术不但能减轻疼痛发生率 ,而且能阻止动脉痉挛的发生。它较术前给予哌替啶等强效镇痛剂和术中动脉灌注利多卡因更有效     

Transarterial chemoembolization alone and in combination with other therapies: a comparative study in an animal HCC model

The purpose of this study is to compare transarterial chemoembolization (TACE) alone and in combination with other therapies in an animal model. Subcapsular implantation of a solid Morris hepatoma 3924A in the liver was carried out in 50 male ACI rats (day 0). Tumor volume (V1) was measured by MRI (day 13). After laparotomy and retrograde placement of a catheter into the gastroduodenal artery (day 14), the following protocols of the interventional procedure were applied: TACE (mitomycin C + lipiodol) + immunotherapy (group A: TNF + IL-2, group B: OK-432 + IL-2); TACE + antiangiogenesis therapy (group C: TNP-470, group D: endostatin); TACE alone in group E (control group). Tumor volume (V2) was assessed by MRI and the mean ratio of x (V2/V1) was calculated. Data were analyzed using Dunnetts t test (comparing therapeutic groups with the control group) and the Student-Newman-Keuls test (comparing significant therapeutic groups). Multivariate analysis showed a significant reduction in the tumor growth rate (P<0.05) in groups B (x=6.53) and C (x=4.01) compared to the mean ratio of the control group E (x=9.14). Significant results were observed in group C (P<0.05) in comparison with the other therapeutic groups. TACE combined with immunotherapy (OK-432) and antiangiogenesis therapy (TNP-470) retards tumor growth compared with TACE alone in an HCC animal model.The first two authors contributed equally to this publication.     

小剂量与常规剂量化疗药物经动脉化疗栓塞术治疗肝癌的对照研究

目的　探讨经动脉化疗栓塞术 (TACE)中化疗药物的用量对患者生存期与肝功能、术后副反应的影响。资料与方法　 341例肝癌患者 ,随机分为A、B两组 ,分别行TACE术。化疗药物 :A组小剂量组 (16 8例 ) ,丝裂霉素10mg与碘油乳化栓塞。B组常规剂量组 (173例 ) ,给予丝裂霉素 10mg ,5 氟尿嘧啶 10 0 0mg ,表阿霉素 4 0mg ,羟基喜树碱 4 0mg中的 3种联用后碘油与化疗药物乳化剂栓塞 ,随后用明胶海绵粒或聚乙烯醇 (PVA)微球栓塞。TACE术前、术后 3d、7d、2 8d分别行肝功能检查 ,比较丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)、总胆红素 (TBIL)、直接胆红素 (DBIL)、白蛋白 (ALB)、白蛋白 /球蛋白比值 (A/G比值 )以及患者术后腹痛、腹胀、恶心呕吐、发热、消化道出血等副反应的发生状况 ,并比较两组患者生存率有无显著差异。结果　两组 1年内平均生存率无明显差异。A、B两组术后 4周内肝功能ALT、AST和A/G比值均无显著性差异 (P >0 .0 5 ) ,术后第 4周 ,A、B两组间比较 ,B组TBIL和DBIL高于A组 ,ALB低于A组 (P <0 .0 5 )。术后腹痛、腹胀、恶心呕吐、发热、消化道出血等副反应的发生率B组明显高于A组 (P <0 .0 5 )。结论　小剂量TACE与常规剂量TACE组患者的生存率没有显著的差异。小剂量TACE对患者的肝功能损伤较     

Transarterial chemoembolization with miriplatin-lipiodol emulsion for neuroendocrine metastases of the liver

Miriplatin, a cisplatin derivative with a high affinity for iodized oil, is a novel chemotherapeutic agent designed for use in the transarterial treatment of hepatocellular carcinoma. This case report describes our experience with transarterial chemoembolization (TACE) using miriplatin in 2 patients with neuroendocrine liver metastases. A 38-year-old man with multiple neuroendocrine liver metastases was treated by whole liver chemoembolization, and a 35-year-old woman with a single hepatic lesion was treated by superselective chemoembolization. No serious adverse events were noted during the interventional procedures, or during the observation period of 3 mo in either patient. Sufficient iodized oil uptake was observed in the hypervascular lesions on the unenhanced computed tomography (CT) at 7 d after the procedure. Contrast-enhanced CT obtained at 3 mo after chemoembolization revealed that all hepatic lesions were substantially reduced in size irrespective of tumor vascularity or degree of cystic degeneration, although iodized oil accumulation was only marginal for lesions with cystic degeneration. Thus, TACE with miriplatin can be a safe and effective therapeutic option for the treatment of neuroendocrine metastases of the liver.     

Use of a Glass Membrane Pumping Emulsification Device Improves Systemic and Tumor Pharmacokinetics in Rabbit VX2 Liver Tumor in Transarterial Chemoembolization

PurposeTo evaluate the phamacokinetics of epirubicin in conventional transarterial chemoembolization using a developed pumping emulsification device with a microporous glass membrane in VX2 rabbits.Materials and MethodsEpirubicin solution (10 mg/mL) was mixed with ethiodized oil (1:2 ratio) using the device or 3-way stopcock. Forty-eight rabbits with VX2 liver tumor implanted 2 weeks prior to transarterial chemoembolization were divided into 2 groups: a device group (n = 24) and a 3-way-stopcock group (n = 24). Next, 0.5 mL of emulsion was injected into the hepatic artery, followed by embolization using 100–300-μm microspheres. The serum epirubicin concentrations (immediately after, 5 minutes after, and 10 minutes after) and the tumor epirubicin concentrations (20 minutes after and 48 hours after) were measured after transarterial chemoembolization. Histopathologic evaluation was performed with a fluorescence microscope.ResultsThe area under the curve and maximum concentrations of epirubicin in plasma were 0.45 ± 0.18 μg min/mL and 0.13 ± 0.06 μg/mL, respectively, in the device group and 0.71 ± 0.45 μg min/mL and 0.22 ± 0.17 μg/mL, respectively, in the 3-way-stopcock group (P = .013 and P = .021, respectively). The mean epirubicin concentrations in VX2 tumors at 48 hours in the device group and the 3-way-stopcock group were 13.7 ± 6.71 and 7.72 ± 3.26 μg/g tissue, respectively (P = .013). The tumor necrosis ratios at 48 hours were 62 ± 11% in the device group and 51 ± 13% in the 3-way-stopcock group (P = .039).ConclusionsConventional transarterial chemoembolization using the pumping emulsification device significantly improved the pharmacokinetics of epirubicin compared to the current standard technique using a 3-way stopcock.     

Necrosis and Apoptosis in Hepatocellular Carcinoma Following Low-Dose Versus High-Dose Preoperative Chemoembolization

Our purpose was to study necrosis and apoptosis of hepatocellular carcinoma (HCC) cells after preoperative transcatheter arterial chemoembolization (TACE) with use of low-dose and high-dose anticancer drugs in HCCs. Fifty-four patients with advanced but surgically resectable HCC were studied. Thirty-four patients who elected to undergo preoperative superselective TACE were randomized to low- and high-dose TACE. Patients in group A (n = 16) received low-dose anticancer drugs: 2 mg mitomycin C (MMC), 10 mg epirubicin (EPI), and 100 mg carboplatin (CBP). Patients in group B (n = 18) were given high doses of anticancer drugs (10 mg MMC, 40 mg EPI, and 300 mg CBP). Hepatic resection was subsequently performed. Group C comprised 20 patients who underwent resection without TACE. In all patients the necrosis rates and apoptosis index of tumor cells were evaluated by pathologic examinations and terminal deoxynucleotidyl transferase–mediated nick-end labeling assay. There was no significant difference between group A and group B in tumor response (p > 0.05) after TACE. Necrosis rates in groups A, B, and C were 88.4 ± 11.1%, 87.1 ± 12.5%, and 7.3 ± 3.5%, respectively. There was no significant difference between group A and group B (p > 0.05), while statistical difference was found between group A and group C (p < 0.001) and between group B and group C (p < 0.001). Apoptosis indexes in the three groups were 11.0 ± 4.0%, 10.7 ± 3.9%, and 5.6 ± 2.6%, respectively. Statistical difference exhibited between group A and group C (p < 0.001) and group B versus group C (p < 0.001). No significant difference was observed between group A and group B (p > 0.05). In conclusion, superselective TACE with low- and high-dose chemotherapeutic agents induced similar degrees of cellular apoptosis and necrosis.     

Intraarterial Lidocaine Administration for Relief of Pain Resulting from Transarterial Chemoembolization of Hepatocellular Carcinoma: Its Effectiveness and Optimal Timing of Administration

PURPOSE: Patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) commonly have significant post-procedural abdominal pain necessitating narcotic administration. It is known that intraarterial administration of lidocaine is effective in controlling the pain during the procedure. However, optimum timing of the lidocaine administration is not precisely known. The purpose of this study was to assess the efficacy of intraarterial lidocaine administration for control of pain resulting from TACE and to evaluate the optimal timing of administration. METHODS: In a prospective trial, 113 consecutive patients with HCC who underwent TACE were classified into three groups: those who received a lidocaine bolus intraarterially immediately prior to TACE (group A, n = 30), those who received lidocaine immediately after TACE (group B, n = 46), and those who did not received lidocaine (group C, n = 37). Incidence and degree of post-procedural pain was assessed using a subjective method (visual analogue scales scored from 0 to 10) and an objective method (amount of post-procedural analgesics). RESULTS: The incidence of post-procedural pain in group A (16.7%) was significantly lower than that of group B (38.3%; p = 0.005). The mean pain score was 3.0 in group A and 4.8 and 3.1 in groups B and C, respectively. The mean dose of analgesic used after the procedure in group A (25.0 mg) was significantly lower than those in group B (52.9 mg) and group C (41.0 mg; p = 0.002). CONCLUSIONS: Pre-TACE intraarterial administration of lidocaine is much more effective than post-TACE administration in reducing the incidence and the severity of post-procedural pain. Furthermore, in order to reduce the incidence of post-procedural pain and dose of post-procedural analgesics, we recommend routine pre-TACE administration of lidocaine because post-procedural pain might developed even in patients who did not feel any pain during the TACE.     

Treatment of Hepatocellular Carcinoma with Tumor Thrombus with the Use of Iodine-125 Seed Strand Implantation and Transarterial Chemoembolization: A Propensity-Score Analysis

Purpose

To evaluate the safety and efficacy of iodine-125 (¹²⁵I) seed strand implantation in combination with transarterial chemoembolization for the treatment of hepatitis B–related unresectable hepatocellular carcinoma (HCC) with portal vein invasion.

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。     

A Motion Artifact Correction Algorithm for Cone-Beam CT in Patients with Hepatic Malignancies Treated with Transarterial Chemoembolization

PurposeTo evaluate the effect of a motion artifact correction algorithm (MACA) on cone-beam computed tomography (CT) during transarterial chemoembolization for hepatic malignancies.Materials and MethodsFrom June 2020 to March 2021, 42 patients with mild-to-severe motion artifacts detected using single cone-beam CT scans were evaluated retrospectively. The image quality of native and motion-corrected data was compared. The maximum intensity, sharpness, and full width at half maximum (FWHM) of 5 segmental hepatic arteries were quantitatively measured. The overall quality of maximum intensity projection (MIP) images, conspicuity of tumor-supplying arteries, and need for selective angiography to ascertain the vascular anatomy were qualitatively evaluated by multiple readers. Paired t and Wilcoxon signed rank tests were used to compare the parameters.ResultsThe mean maximum intensity and sharpness increased from 2,792.01 HU ± 451.36 to 3,148.40 HU ± 594.46 and from 0.31 ± 0.02/mm to 0.34 ± 0.02/mm, respectively, using the MACA (both P < .001). The MACA decreased the mean FWHM from 2.02 mm ± 0.27 to 1.78 mm ± 0.26 (P < .001). The overall quality of the MIP images and the conspicuity of the tumor-supplying artery were enhanced from 2.5 to 3.0 points and from 3.0 to 4.0 points, respectively (both P < .001). Selective angiography was expected to be omitted in 7 cases (16.7%, 7/42) after using the MACA.ConclusionsThe MACA significantly improved both quantitative and qualitative image quality of cone-beam CT in selected patients with motion artifacts during transarterial chemoembolization for hepatic malignancies.