Hepatic vascular side effects of styrene maleic acid neocarzinostatin in the treatment of hepatocellular carcinoma |
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Authors: | Kenji Ikeda Satoshi Saitoh Masahiro Kobayashi Yoshiyuki Suzuki Fumitaka Suzuki Akihito Tsubota Yasuji Arase Kazuaki Chayama Naoya Murashima Hiromitsu Kumada |
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Institution: | (1) Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-0001, Japan, JP;(2) Okinaka Memorial Institute for Medical Research, Tokyo, Japan, JP |
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Abstract: | Styrene-maleic acid neocarzinostatin (SMANCS) sometimes causes hepatic vascular side effects, including arterial stricture,
obstruction, and arterio-portal shunt. A total of 128 intra-arterial SMANCS injection treatments, performed for 89 patients
with hepatocellular carcinoma, were analyzed to determine the relationship between angiographic findings and subsequent hepatic
vascular injuries. After SMANCS therapy, hepatic arterial stricture or obstruction occurred in 5 patients (5/128; 3.9%), arterio-portal
shunting in 12 (12/128; 9.4%), liver shrinkage in 4 (4/128; 3.1%), and cholangitis or biloma in 2 (2/128; 1.6%). Among 23
patients whose plain abdominal X-ray films just after SMANCS injection showed Lipiodol retention in the hepatic artery, 5
patients developed arterial obstruction, 10 developed arterio-portal shunt, and 2, cholangitis or biloma. Among 26 patients
with Lipiodol retention in the portal vein, 4 developed hepatic lobe atrophy with aggravation of liver function. Among 3 patients
with Lipiodol retention in both the hepatic artery and the portal vein, 1 developed arterio-portal shunt. In 76 treatments
without excessive Lipiodol retention, only 1 of the patients developed arterio-portal shunt. Excessive retention of Lipiodol
in hepatic vascular beds just after SMANCS therapy was significantly associated with future vascular side effects (22/52 vs
1/76; P < 0.0001). Lipiodol retention in arteries just after SMANCS injection was closely associated with subsequent arterial obstruction
or arterio-portal shunt, and Lipiodol retention in the portal vein was related to subsequent hepatic lobe atrophy.
Received: April 28, 1999 / Accepted: November 26, 1999 |
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Keywords: | : hepatocellular carcinoma styrene maleic acid neocarzinostatin side effect hepatic artery obstruction arterio-portal shunt hepatic atrophy |
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