Cycles Of Transcatheter Arterial Chemoembolization Research Articles

Role of preoperative x-ray endovascular interventions for improvement of resectability of colorectal liver metastases

The objective was of the study to evaluate the role of preoperative x-ray endovascular interventions – transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) – for improvement of resectability of colorectal liver metastases.Material and methods. Between 1997 and 2017, we treated 11 patients who simultaneously had large-volume (60–70 %) of right liver lobe colorectal metastases and small future remnant liver. The treatment was started from 1–4 cycles of TACE to reduce or stabilize the rapid growth of the tumor. In case of good effect, we performed PVE and then we performed liver resection.Results. There were no major complications of TACE or PVE. After 1–4 cycles of TACE, the volume of metastases showed partial decrease or stabilization. The following PVE allowed to increase the future remnant volume of the left liver lobe up to a safe 40–45 %. Right – sided hemihepatectomy was performed in 6 patients and extended right-sided hemihepatectomy in 5 patients. There were no postoperative mortality or severe complications. At present, 4 patients are alive without recurrence during 1.5–8 years, and 4 other patients received endovascular treatment for local recurrence are alive during 1.5–5 years. The 3 patients died from tumor progression during 13–30 months. CONCLUSION. In patients with simultaneously extensive for resection volume of right liver lobe metastases and small left liver lobe, the primary treatment with TACE is reasonable. Only after the documentation of tumor decrease or stabilization, it is necessary to determine the timing of PVE and following major liver resection. This order of treatment procedures allows to improve resectability in cases with extensive, large-volume, rapidly grown malignant liver lesions.

A retrospective study on patients with BCLC intermediate stage HCC treated with TACE and hepatic resection

Objective To study the treatment outcomes using transcatheter arterial chemoembolization (TACE) followed by hepatic resection (HR) in patients with BCLC stage B hepatocellular carcinoma (HCC). Methods The clinical data of 46 patients with intermediate stage HCC in the Third Affiliated Hospital of Sun Yat-sen University from Jan. 2004 to Jul. 2013 were analyzed retrospectively. The baseline characteristics of these 46 patients were recorded. The levels of serum aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), and albumin (Alb), and the prothrombin time (PT) at 1 week and 1 month after HR were compared with those at the baseline. The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan-Meier method. The effect on PFS by the changes in the alpha-fetal protein level and the modified Response Evaluation Criteria In Solid Tumors (mRECIST) after TACE were analyzed using the log-rank test. Results The number of cycles of TACE given before HR was 1.7±1.1. The mean time interval between TACE and HR was 3.0±3.2 months. The levels of serum AST, ALT, TBil, Alb and PT at 1 week after HR were significantly different from the baseline levels (P 0.05). The mean OS was 72.1±6.0 (95% CI 60.36~83.86) months. The median PFS was 46.0 (95% CI: 42.60~49.40) months. Using the log-rank test, the decrease in AFP (P<0.001) and the improvement in mRECIST (CR+ PR) (P<0.001) after TACE were significantly associated with better PFS. Conclusions HR after TACE was safe for patients with BCLC stage B HCC and might prolong the PFS and OS. Decreases in AFP level and improvement in mRECIST (CR+ PR) after TACE were factors they could be used to predict the survival outcomes of HR. Key words: Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Hepatectomy; Progression-Free survival; Overall survival

The efficacy and risk of prophylactic entecavir for hepatitis B virus-related hepatocellular carcinonma receiving transcatheter arterial chemoembolization.

388 Background: Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE. Methods: A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints. Results: Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation. Conclusions: Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.

Value of hepatic diffusion-weighted magnetic resonance imaging in evaluating liver fibrosis following transarterial chemoembolization with low doses of chemotherapy.

The aim of the present study was to investigate the value of apparent diffusion coefficients (ADCs) measured with magnetic resonance (MR) diffusion-weighted imaging (DWI) in evaluating liver fibrosis and curative effects on hepatocellular carcinoma (HCC) following transcatheter arterial chemoembolization (TACE) with low doses of chemotherapy. In total, 84 patients with HCC not recommended for surgical resection underwent TACE. The patients were divided into small dose (n=46) and conventional dose (n=38) chemotherapy groups, and underwent MR-DWI prior to and following TACE. Examination of the four liver fibrosis indexes, hyaluronate, laminin, human procollagen type-III and collagen type-IV, as well as ADC values (b=600 sec/mm2), was conducted in the two groups. With small dose chemotherapy, the ADC values were not significantly different preoperatively and postoperatively (P>0.05). By contrast, with a conventional dose, statistically significant differences were observed between the preoperative and postoperative ADC values (P<0.01). ADC values in the small and conventional dose chemotherapy groups prior to the first cycle of TACE were 1.613±0.133×10−3 and 1.488±0.248×10−3 mm2/sec, respectively, while following four cycles of TACE, the ADC values were 1.598±0.147×10−3 and 1.206±0.222×10−3 mm2/sec, respectively. With regard to chemotherapy, the ADC values before and after TACE were significantly different (P<0.05). A significant negative correlation was observed between the ADC values and the fibrosis stage (P<0.05). Therefore, hepatic MR-DWI plays a key role in evaluating liver fibrosis following TACE with low doses of chemotherapy, resulting in improved curative effects of TACE.

Hepatitis B virus reactivation in hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization therapy

The effect of transcatheter arterial chemoembolization (TACE) therapy on hepatitis B virus (HBV) reactivation in hepatocellular carcinoma (HCC) patients with prior resolved hepatitis B is not fully understood. From January 2006 to December 2010, 43 hepatitis B surface antigen (HBsAg)-negative/anti-hepatitis B core antigen (HBc) positive patients with newly diagnosed unresectable HCC were enrolled in the study. All underwent TACE therapy. Four patients (9.3%) developed HBV reactivation with mild/moderate hepatitis. The median number of TACE cycles received was 3.5 (range 3-4 cycles). The median time interval between the occurrence of HBV reactivation and the completion of TACE therapy was 3 months (range 1-5 months) and their median HBV DNA level was 1.58 × 10(4) IU/mL (range, 1.65 × 10(3) -6.42 × 10(4) IU/mL). After the introduction of lamivudine at the occurrence of HBV reactivation, all had resolution of hepatitis. An exploratory analysis indicated that significant predictors of HBV reactivation included increased serum total bilirubin coexisting with cirrhosis and the total number of cycles of TACE received. The administration of TACE therapy may increase the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients diagnosed with unresectable HCC. Further studies are warranted to explore the optimal management of HBV reactivation in patients with prior resolved hepatitis B.

Role of Chemoembolization as a Rescue Treatment for Recurrence of Resected Hepatoblastoma in Adult Patients

Hepatoblastoma is the most common malignant liver tumor in children, but it is extremely rare in adults. A 33-year-old man was admitted with nausea, vomiting, weight loss, and right upper quadrant pain. A preoperative magnetic resonance imaging showed a nodular hepatic lesion infiltrating the lesser curvature of the stomach. A left hepatectomy and a subtotal gastrectomy were performed. The histological diagnosis was hepatoblastoma. A recurrence in the right lobe was seen. Three cycles of transcatheter arterial chemoembolization (TACE) were performed 40, 70, and 130 days after surgery. No sign of recurrence was present at the time of the second chemoembolization. The TACE was well tolerated by the patient and controlled the recurrence. The patient survived 11 months after recurrence of disease and died 1 year after the liver resection. The use of TACE to treat the hepatic recurrence was never described.

Early Three-Dimensional Conformal Radiotherapy for Patients With Unresectable Hepatocellular Carcinoma After Incomplete Transcatheter Arterial Chemoembolization

We prospectively evaluated the efficacy and toxicity of early 3-dimensional conformal radiotherapy (3D-CRT) for patients with unresectable hepatocellular carcinoma (HCC) after incomplete transcatheter arterial chemoembolization (TACE). Patients with unresectable HCC who failed 1 or 2 courses of TACE were eligible for this study. Three dimensional-CRT was added for HCC with incomplete uptake of iodized oil. Between January 2006 and February 2007, 40 patients (43 lesions) were enrolled. TACE was performed by using Lipiodol and adriamycin, followed by Gelfoam embolization. Two cycles of TACE were performed in 24 patients (60%), whereas 16 patients (40%) underwent one cycle. The median dose of 54 Gy (3 Gy daily) was delivered with 3D-CRT. Tumor response was evaluated by changes in tumor size on serial computed tomography scans and toxicity was evaluated by the Common Terminology Criteria for Adverse Events v3.0. An objective response was achieved in 27 of 43 lesions (62.8%), with a complete response in 9 lesions (20.9%) and partial response in 18 lesions (41.9%). The overall survival rate was 72.0% at 1 year and 45.6% at 2 years. There was no grade 3 or greater acute toxicity. Nine patients (22.5%) showed progression of the disease within the irradiated field during the follow-up and intrahepatic metastases developed in 16 patients (40.0%). Early 3D-CRT for HCC unresponsive to 1 or 2 cycles of TACE resulted in a 62.8% tumor response rate and relatively high complete response rates (20.9%) with acceptable toxicity. This study shows that the application of 3D-CRT could be considered for patients with incomplete TACE.

Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation

ObjectiveTo evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).Materials and MethodsTwenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.ResultsAfter TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.ConclusionTACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Transcatheter Arterial Chemoembolization in Unresectable Cholangiocarcinoma: Initial Experience in a Single Institution

Unresectable cholangiocarcinoma carries a dismal prognosis, with median survival times ranging from 6 to 12 months from the time of diagnosis. Palliative therapies have been disappointing and have not been shown to significantly prolong survival. Conversely, transcatheter arterial chemoembolization (TACE) has been effective in prolonging the lives of patients with hepatocellular carcinoma but has not been used against cholangiocarcinoma. Therefore, the purpose of the present study was to assess the safety and efficacy (ie, survival) of TACE in patients with unresectable intrahepatic cholangiocarcinoma. Seventeen patients with unresectable cholangiocarcinoma were treated with one or more cycles of TACE between 1995 and 2004 at our institution. Follow-up imaging was performed on all patients 4-6 weeks after each TACE procedure to determine tumor response and need for further treatment. Survival was calculated with use of the Kaplan-Meier survival curve. The median survival for 17 patients treated with TACE was 23 months. Two patients with previously unresectable disease underwent successful resection after TACE. The procedure was well tolerated by 82% of the patients, who experienced no side effects or mild side effects that quickly resolved with conservative therapy alone. Two patients had minor complications (12%), which were managed successfully, and one had a major complication that resulted in a fatal outcome. This patient had a rapidly declining course from the time of diagnosis and died shortly after TACE. The results suggest that TACE was effective at prolonging survival of patients with unresectable cholangiocarcinoma. Therefore, for these patients, TACE may be an appropriate palliative therapy.

Study Of Local Three-Dimensional Conformal Radiotherapy Combined With Transcatheter Arterial Chemoembolization for Patients With Stage III Hepatocellular Carcinoma

The purpose of this study was to evaluate treatment-related toxicity, outcome, patterns of failure, and prognostic factors for patients with stage III unresectable hepatocellular carcinoma (HCC) treated with a combination of local 3-dimensional conformal radiotherapy (3D-CRT) and transcatheter arterial chemoembolization (TACE) under the support of G-CSF. From October 1997 to August 2001, 45 patients with stage III unresectable hepatocellular carcinoma underwent transcatheter arterial chemoembolization with local 3D-CRT. Twenty-seven patients were classified as having stage IIIA disease according to the American Joint Committee on Cancer (AJCC) staging system and 18 were classified as stage IIIB. The mean diameter of the treated hepatic tumor was 8.5 cm. Before 3D-CRT, 2 cycles of transcatheter arterial chemoembolization were prescribed. Forty-eight hours later, the G-CSF was prescribed for 5 days after the completion of every TACE. With the interval of 10 to 14 days after the second cycle of TACE, 3D-CRT was prescribed to all patients with a total dose of 50.4 Gy at 1.8 Gy per fraction 5 days per week. After the completion of 3D-CRT, the additional 2 cycles of TACE were given. All patients were monitored for treatment-related toxicity, outcome, patterns of failure, causes of death, and prognostic factors. Forty-two of 45 patients were treated smoothly with the primary schedule. In a median follow-up period of 27 months, 22 patients were alive and 23 were dead. Progressive disease occurred in 28 patients, including local recurrence alone (4 patients), distant metastases with local recurrence (8 patients), and distant metastases alone (16 patients). Nine patients developed radiation-induced liver disease (RILD). Three patients had treatment-related gastrointestinal bleeding. There were 2 treatment-related deaths, including 1 from RILD and 1 from gastrointestinal bleeding. Complete regression (CR) was observed in 6 patients, partial regression (PR) in 35 patients, and stable disease (SD) in 4 patients. The median overall survival duration from treatment was 23.5 months with a 1-year overall survival rate of 68.5%, a 2-year survival rate of 48.3%, and a 3-year survival rate of 22.6%. The median freedom from progressive disease survival duration from treatment was 25 months with 1-year, 2-year, and 3-year progression-free survival rates of 76.2%, 56.8%, and 42.4%, respectively. The stage of HCC, regional lymph node status, portal vein thrombosis, pretreatment alpha-fetoprotein level (AFP), and tumor size affected the treatment outcomes significantly. Therefore, for patients with stage III unresectable hepatocellular carcinoma, combined local 3D conformal radiotherapy with transcatheter arterial chemoembolization under the support of G-CSF is an effective treatment protocol. Further research is required to decrease distant metastases and to determine the safe irradiation dose-volume.