Chemoembolization and radioembolization

Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.     

Meta-Analysis: Therapeutic Effect of Transcatheter Arterial Chemoembolization Combined With Compound Kushen Injection in Hepatocellular Carcinoma

Compound Kushen Injection (CKI) is Sophora Flavescens and Heterosmilacis Japonicae extract. Meta-analysis confirmed that CKI plus transcatheter arterial chemoembolization (TACE) is more superior to TACE alone for unresectable hepatocellular carcinoma (UHCC) patients.     

加味小柴胡汤对肝癌患者栓塞化疗后脂质过氧化反应的影响

[目的]探讨原发性肝癌患者介入栓塞化疗(TACE)导致肝损害等不良反应的过氧化损伤机制,观察加味小柴胡汤的抗氧化作用.[方法]将56例肝癌患者随机分2组(TACE后均行水化治疗),各28例.对照组口服肌苷、肝泰乐、胃复安、维生素B6等;观察组给予加味小柴胡汤.观测TACE前、后2、7、14、21、28 d肝功能及过氧化指标的动态变化.[结果]TACE后2 d肝功能异常加重,过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性、谷胱甘肽(GSH)水平明显降低,丙二醛(MDA)水平增加,以对照组变化显著.观察组肝功能及氧化指标恢复较快,均优于对照组(P＜0.01).[结论]肝癌TACE引起的不良反应及肝损害,与化疗药诱致的脂质过氧化反应有关.加味小柴胡汤有明显的抗氧化作用.     

碘[131I]美妥昔单抗注射液与肝动脉化疗栓塞术治疗原发性肝癌的对比研究

目的 对比分析碘[131I]美妥昔单抗注射液与肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌(primary liver cancer,PLC)的临床疗效.方法 根据治疗方法的不同将PLC患者分为TACE组(n=31)和碘[131I]美妥昔单抗组(n=32).TACE组行TACE治疗,碘[131I]美妥昔单抗组经肝动脉途径灌注碘[131I]美妥昔单抗注射液,治疗3个月后对两组甲胎蛋白(AFP)转阴率、肿瘤缩小率及生存期进行比较,并观察不良反应发生情况,随访至2015年8月.结果 治疗3个月后,碘[131I]美妥昔单抗组AFP转阴率及肿瘤缩小率略高于TACE组,但差异无统计学意义(P＞0.05);治疗期间两组均无明显不良反应;截止到随访结束,TACE组生存率为19.4％(6/31),碘[131I]美妥昔单抗组为43.8％ (14/32),碘[131I]美妥昔单抗组生存率高于TACE组,且差异有统计学意义(P＜0.05).结论 对于PLC的治疗,碘[131I]美妥昔单抗注射液在提高AFP转阴率、肿瘤缩小率及生存率方面优于TACE.     

青蒿琥酯聚乳酸微球栓塞治疗兔VX2移植性肝癌的研究

目的 研究青蒿琥酯聚乳酸微球栓塞治疗兔VX2移植性肝癌的疗效。方法 将VX2瘤粒直接种植于新西兰大白兔左肝内2周,CT证实已成功接种VX2的荷瘤兔随机分为4组,每组10只,经股动脉微导管超选择性肝动脉插管分别给予不同处理：青蒿琥酯聚乳酸微球(ART-PLA-MS)组,注入ART-PLA-MS 76.0 mg·kg^-1;青蒿琥酯(artesunate,ART)溶液组,注入ART溶液23.4 mg·kg^-1;空白微球组,注入空白聚乳酸微球52.6 mg·kg^-1;空白对照组,注入2 mL复方泛影葡胺溶液。每天观察动物生长情况,术后2周处死动物,测量肿瘤体积、坏死区面积,计算肿瘤生长率、坏死率;实验兔于治疗前及治疗后第1,3,7天经耳缘静脉采血,检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)及肌酐(Cr)值,评价肝肾功能情况。结果 术前1 d 4组动物肿瘤体积差异无统计学意义。治疗后2周,与其他3组比较,ART-PLA-MS组肿瘤体积、肿瘤生长率和肿瘤坏死率差异均具有统计学意义(P<0.01);与空白对照组比较,空白微球组肿瘤体积和坏死率差异有显著统计学意义(P<0.01),肿瘤生长率有统计学意义(P<0.05);与ALT溶液组比较,空白微球组肿瘤坏死率差异有显著统计学意义(P<0.01),肿瘤体积和生长率有统计学意义(P<0.05);与空白对照组比较,ALT溶液组差异无统计学意义。治疗前,4组ALT、AST、BUN及Cr值值无统计学差异;治疗后1,3 d,ART-PLA-MS组、ALT溶液组和空白微球组ALT、AST、BUN及Cr值均显著升高(P<0.05);治疗后7 d,各组肝肾功能均恢复至治疗前水平。结论 ART-PLA-MS经肝动脉栓塞对兔VX2肝癌具有一定的治疗作用。     

Risk factors of infection after transarterial chemoembolization for hepatocellular carcinoma: A protocol for systematic review and meta-analysis

Background:Transarterial chemoembolization (TACE) has the characteristics of minimally invasive, strong repeatability, and good curative effect, so it is commonly used in the nonoperative treatment of hepatocellular carcinoma (HCC). However, infection will occur after TACE, which not only increases the hospitalization time and medical expenses, but also affects the efficacy of TACE treatment. At present, there is a lack of analysis of the risk factors of infection after TACE of patients with HCC. In this study, meta-analysis was used to further explore the risk factors of postoperative infection in patients with HCC after TACE, and to provide strategies for infection prevention and intervention.Methods:To search the literatures about the influencing factors of post-TACE infection in patients with HCC published from the establishment of PubMed, Embase, The Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WANFANG to April 2021. Screening was carried out according to inclusion criteria and exclusion criteria. A meta-analysis was performed using RevMan 5.3 software.Results:We disseminated the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusion:This study systematically reviewed the existing evidence and determined the incidence and predictors of infection after TACE of patients with HCC.Ethics and dissemination:The private information from individuals will not be published. This systematic review also should not damage participants’ rights. Approval from an ethics committee is not required for this study. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/26P5X     

Computed tomography perfusion in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma

AIM： To prospectively assess the changes in parameters of computed tomography （CT） perfusion pre- and post-transarterial chemoembolization （TACE） of hepatocellular carcinoma （HCC） in different treatment response groups, and to correlate the changes with various responses of HCC to TACE. METHODS： Thirty-nine HCC patients underwent CT perfusion examinations pre-（1 d before TACE） and post-treatment （4 wk after TACE）. The response evaluation criteria for solid tumors （RECIST） were referred to when treatment responses were distributed. Wilcoxon-signed ranks test was used to compare the differences in CT perfusion parameters pre- and post- TACE for different response groups.
RESULTS： Only one case had treatment response to CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signals. In the PR treatment response group, hepatic artery perfusion （HAP）, hepatic arterial fracture （HAF） and hepatic blood volume （HBV） of viable tumors post-TACE were reduced compared with pre-TACE （P = 0.001, 0.030 and 0.001, respectively）. In the SD group, all CT perfusion parameters were not significantly different pre- and post-TACE. In the PD group, HAP, HAl=, portal vein perfusion （PVP） and hepatic blood flow （HBF） of viable tumors post-TACE were significantly increased compared with pre-TACE （P = 0.005, 0.012, 0.035 and 0.005, respectively）.
CONCLUSION： Changes in CT perfusion parameters of viable tumors are correlated with different responses of HCC to TACE. Therefore, CT perfusion imaging is a feasible technique for monitoring response of HCC to TACE.