Radioembolization-Induced Chronic Hepatotoxicity: A Single-Center Cohort Analysis

PurposeTo identify and characterize the delayed effects of transarterial radioembolization (TARE) on the liver.Materials and MethodsA single-institution retrospective analysis was undertaken of all patients who received TARE between 2005 and 2014 and survived at least 1 year from the initial TARE (n = 106). Patients were evaluated for the presence or absence of radioembolization-induced chronic hepatotoxicity (RECHT) occurring at least 6 months after TARE. The mean age of patients was 63 years of age, and the malignancy most commonly treated was neuroendocrine tumor (54%). Adjudication of hepatic decompensation to RECHT versus alternative causes was performed by a multidisciplinary panel of specialists from hepatology, radiation oncology, and interventional radiology.ResultsEight patients were excluded from analysis because of liver transplantation (2) or incomplete data (6). RECHT occurred in 13 of 98 patients (13%), and 5 deaths (5%) occurred from hepatic decompensation. There were a total of 69 toxicity events in patients developing RECHT. The most common events were elevation of alkaline phosphatase (10), decrease in serum albumin (10), and development of ascites (9). RECHT patients had a higher intrahepatic tumor volume (P = .021) and a higher number of hepatic comorbidities leading to cirrhosis (P = .015).ConclusionsDelayed radiation-induced hepatic toxicity occurred in 13% of patients following radioembolization, with 5 fatalities adjudicated to be a result of the treatment. Tumor involvement of greater than 50% of the liver and cirrhosis were predisposing factors for RECHT.     

彩色多普勒超声检测肝动脉栓塞后原发性肝癌血流阻力

本文采用超声多普勒技术记录肝癌动脉血流速度，以动脉系统血流动力学的气室模型及其等效电路为基础，并对血流速度曲线作Ｂ样条函数模似，从而计算出肝癌动脉的阻力，为肝动脉栓塞术后肝癌动脉的栓塞程度提供了较为理想的评价手段。本文同时还比较多巴酚丁胺使用前后肝癌动脉血流的变化，从而提高了肝癌动脉血流评价的灵敏度。     

肝癌化疗栓塞后联合经皮无水酒精注射术（附32例报告）

目的评价肝癌动脉化疗栓塞(TAE)后联合经皮无水酒精注射术(PEI)的效果。方法32例肝癌患TAE1月后又经PEI2-12次。依据病灶中碘化油充盈状况，将全部病人分为A、B两组，并观察了TAE PEI对患生存率与肿块大小的影响。结果CT示整个病灶或其边缘被碘化油充盈归类于A组(13例)而病灶边缘与中心区均有碘化油充盈缺损归类于B组(19例)。TAE后1、2、3年时生存率A组为100％、84％、61％，B组为90％、63％、44％。A组全部病人的肿块缩小，边缘清晰，而B组有11例的肿块缩小，3例未变，5例增大。结论TAE PEI对肝癌有明显疗效。     

射频消融联合动脉栓塞治疗肝脏巨大血管瘤的疗效分析（英文）

目的：对射频消融（RFA）联合动脉栓塞（TAE）治疗巨大肝血管瘤的疗效进行回顾性分析。方法：对2004年至2008年应用RFA联合TAE模式治疗的27例巨大肝血管瘤患者进行回顾性分析,共纳入31个瘤体,直径6cm-18.5cm。所有患者首先给予TAE治疗（一次或多次）,在包块明显缩小后,进而给予RFA治疗。随访时间为12-64月（最后一次RFA治疗后,中位时间38个月）。所有患者均根据增强CT结果评价疗效。结果：本组患者无严重并发症以及死亡发生。RFA治疗3个月后,21例患者的症状减轻或消失（77.8%）。并且第一次增强CT示瘤体明显缩小,其中完全坏死率为71.0%（22/31）。对于9个提示血流存在的病灶,再次行RFA治疗。至随访结束,10/31（32.3%）已回缩瘤体显示增强信号,其中5个瘤体直径增大。结论：TAE＋RFA是治疗巨大肝血管瘤的一种安全有效的模式。     

不同栓塞剂、不同栓塞水平经导管子宫动脉栓塞术后对血清性激素的影响

目的:探讨不同栓塞剂、不同栓塞水平在经导管子宫动脉栓塞术后对女性卵巢功能的影响。方法:对21例行子宫动脉栓塞术患者测定术前及术后3个月的血清雌激素(E2)、促卵泡成熟素(FSH)、黄体生成素(LH)水平。其中行子宫动脉栓塞术(UAE)18例,髂内动脉栓塞术(IIAE)3例;栓塞剂采用明胶海绵颗粒(GF)14例,PVA颗粒4例,超液态碘化油(lipodol)3例。结果:不同栓塞水平之间术后3个月血清三种性激素无明显差别,同一种栓塞水平于手术前后三种性激素无明显差别;不同栓塞剂之间术后3个月血清三种性激素无明显差别,同一种栓塞剂手术前后三种性激素无明显差别。结论:栓塞部位在高位的髂内动脉或是低位的子宫动脉,选用颗粒较粗的GF颗粒还是更加细小的PVA颗粒,对卵巢分泌功能影响小,不会对血清性激素产生不良影响。     

Massive Hemorrhage from Internal Carotid Artery Pseudoaneurysm Successfully Treated by Transcatheter Arterial Embolization with Assessment of Regional Cerebral Oxygenation

A 54-year-old male presented with intermittent massive hemorrhage from recurrent oropharyngeal cancer. The angiogram showed the encasements at the main trunk of the left internal carotid artery (ICA) and external carotid artery (ECA). Transcatheter arterial embolization (TAE) of the ECA with gelatin sponge particles and microcoils was performed. However, hemorrhage recurred several hours after the initial TAE. The second angiogram showed a large pseudoaneurysm of the ICA developing at the encasement on the initial angiogram. As a simple neurologic test, regional cerebral oxygenation (rSO₂) was assessed with and without manual compression of the common carotid artery (CCA). With compression of the left CCA, the rSO₂ did not change. We therefore performed isolation of the pseudoaneurysm. We embolized proximally and distally to the ICA pseudoaneurysm with microcoils and the pseudoaneurysm disappeared. No major complications occurred and no massive hemorrhage recurred until death from the cancer. TAE was an effective treatment for massive hemorrhage caused by tumor invasion to ICA. Assessment of rSO₂ was a simple and useful neurologic test predicting the cerebral blood flow to prevent complications of TAE.     

Relationship between efficencies of segmental hepatic artery chemoembolization and PCNA labeling index in HCC

Hepatocellular carcinoma (HCC) is one of the most common cancers in China as well as Southeast Asia and Africa. Many findings suggest that chronic hepatitis and hepatic cirrhosis seem to play an important role in the pathogenesis of HCC[1]. Proliferating cell nuclear antigen (PCNA) is a 36 kilodalton, nonhistone protein known as cyclin[2], or auxiliary protein for DNA polymerase-d[3]. PCNA is essential for cellular DNA synthesis, and is closely linked to the cell cycle. Transcatheter…     

Mechanism of action of non-cisplatin type DNA-targeted platinum anticancer agents: DNA interactions of novel acridinylthioureas and their platinum conjugates

The DNA binding of two novel acridinylthioureas, ACR-NH-(CH(2))(2)-C(S)-NHCH(3) (1) and ACR-N(CH(3))-C(S)-NHCH(3) (3), and their platinum conjugates 4 and 5-derived from [PtCl(2)(en)]-was studied in cell-free model systems using various physico-chemical and biophysical methods. These included: spectrophotometric drug-DNA titrations, ethidium-DNA fluorescence quenching, competitive drug displacement, high-resolution NMR spectroscopy, and unwinding of plasmid DNA monitored by agarose gel electrophoresis. The acridinium cation of 1 showed strong binding to native DNA with K(i)=1.5 x 10(6)M(-1) and an excluded site size (n) of 2bp (McGhee-von Hippel fits of absorbance data). Compound 3 showed no measurable association with DNA. Binding of 1 was an order of magnitude stronger than that of simple 9-methylaminoacridine (2). In alternating copolymers, 1 exhibited slight AT preference. In poly(dA-dT)(2), enhanced association was accompanied by an increased binding site (approximately 3bp), while parameters in poly(dG-dC)(2) were consistent with classical intercalation. Displacement of 1 by distamycin from calf thymus DNA was suggestive of non-intercalating thiourea in 1 being located in the minor groove of the duplex. 1H NMR data of d(GGAGCTCC)(2) modified with 1 indicated intercalative binding of planar acridine, based on upfield shifts of aromatic proton signals relative to those in unbound 1 (Deltadelta approximately equal to -0.5 to -1ppm). Finally, 4 and 5 were found to unwind negatively supercoiled pUC19 plasmid by 21 degrees and 7 degrees per adduct, respectively (electrophoretic gel mobility assays). The difference in DNA binding modes of 4 and 5 is discussed as the ultimate source of the distinctly different biological activities of the conjugates.