Hepatic Arterial Chemoembolization Research Articles

Prognosis for intrahepatic cholangiocarcinoma patients treated with postoperative adjuvant transcatheter hepatic artery chemoembolization

Objective: We used meta-analysis to evaluate the efficacy of transcatheter hepatic arterial chemoembolization (TACE) for the treatment of intrahepatic cholangiocarcinoma (ICC). Methods: We performed the meta-analysis using the R 3.12 software and the quality evaluation of data using the Newcastle-Ottawa Scale. The main outcomes were recorded as 1-year overall survival (OS), 3-year OS, 5-year OS, and hazard ratio (HR) of TACE treatment or non-TACE treatment. The heterogeneity test was performed using the Q-test based on chi-square and I2 statistics. Egger's test was used to test the publication bias. The odds ratio or HR and 95% confidence interval (CI) were used to represent the effect index. Results: Nine controlled clinical trials involving 1724 participants were included in this study; patients came mainly from China, Italy, South Korea, and Germany. In the OS meta-analysis, the 1-year and 3-year OS showed significant heterogeneity, but not the 5-year OS. TACE increased the 1-year OS (odds ratio = 2.66, 95% CI: 1.10-6.46) of the patients with ICC, but the 3- and 5-year OS rates were not significantly increased. The results had no publication bias, but the stability was weak. The HR had significant heterogeneity (I2 = 0%, P= 0.54). TACE significantly decreased the HR of ICC patients (HR = 0.59, 95% CI: 0.48-0.73). The results had no publication bias, and the stability was good. Conclusions: Treatment with TACE is effective for patients with ICC. Regular updating and further research and analysis still need to be carried out.

The role of a multidisciplinary approach in the treatment of hepatocellular carcinoma

Aim. Evaluation of treatment options and efficacy in patients with hepatocellular carcinoma based on data from the FSBI Rostov Cancer Research Institute using a multidisciplinary approach to the problem.
 Materials and methods. 124 cases of hepatocellular carcinoma were analyzed. In 79.8% of patients (average age of 61.4 years) the disease was diagnosed at advanced stages (IIIIV). Antibodies to viral hepatitis B were detected in 18 (14.5%) patients, and antibodies to viral hepatitis C in 35 (28.2%) patients. Liver cirrhosis occurred in 38 (30.6%) cases, and ChildPugh class A in 20 (16.1%) cases. In the FSBI RCRI, a multidisciplinary approach has been introduced into clinical practice; decision on treatment tactics is made with a close cooperation of several specialists. The use of special treatment methods was available in 67 (54%) patients. 32 patients with Barcelona Clinic Liver Cancer (BCLC) stage A (early) or stage B (intermediate), had surgical treatment or hepatic arterial chemoembolization (HACE) with lipiodol or microspheres using various cytostatics (18 and 14 patients, respectively). 35 patients with advanced stage C were given a systemic therapy with various cytostatics (gemcitabine, oxaliplatin, doxorubicin) or targeted therapy with sorafenib. The treatment efficacy was assessed according to mRECIST.
 Results. The best median overall survival (OS) up to 21 months was in the group of patients (n=18) who underwent volume resection surgery. In this group, sorafenib was prescribed to 2 patients after surgery. When performing HACE, the median OS was 14.2 months. In 6 patients, HACE was performed 2 or more times. Among the 14 patients who had HACE, sorafenib was prescribed in 8 cases, and the median OS in this group was 16.3 months. 20 patients were given targeted therapy with sorafenib. Following 3 months of taking the drug, 16 patients achieved stabilization of the disease according to the mRECIST, in 1 patient a partial response, in 3 patients disease progression. Median OS was 9.1 months; progression-free survival among patients treated with sorafenib was 5.4 months.
 Conclusions. The use of a multidisciplinary approach in clinical practice makes it possible to choose the optimal treatment option for hepatocellular carcinoma and contributes to the improvement in OS. The combination of local treatment methods (surgical treatment, HACE) with effective drug therapy is the most optimal approach to treating patients with advanced stages of hepatocellular carcinoma.

The blooming intersection of transcatheter hepatic artery chemoembolization and nanomedicine

Transcatheter hepatic artery chemoembolization (TACE) is a universal treatment for patients with hepatocellular carcinoma (HCC) that inhibits tumor growth by cutting off the blood supply and provides chemotherapeutics locally to the tumor. The strategy of combining TACE formulation with image-guided ablation holds tremendous potential, but patient tolerance and undesired toxicity/immunosuppression remains a challenge. The application of nanotechnology in TACE opens new doors for the treatment of HCC. Strikingly, nanomaterials or nano-drugs dispersed in the TACE formulation can effectively improve the delivery efficiency of drugs by achieving both controlled and continuous release. In addition, the utilization of multifunctional nanoparticles can provide guidance and monitoring for various advanced imaging methods for TACE treatment, and can realize the combination therapy of thermal ablation, microwave ablation, in situ radiotherapy, and other therapies, greatly expanding the therapeutic strategies available for HCC treatment. Here, the current exploration of nanotechnology in TACE of HCC is briefly summarized and the challenges of TACE with nanoformulations for clinical translation are comprehensively discussed.

Role of Dynamic Subtraction MRI in Assessment of Reactivity of Hepatic Focal Lesions post Trance arterial chemoembolization

Abstract The aim of this work was to assess HCC cases after trans-arterial chemoembolization by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specifity in detecting residual tumor and assess the need for further treatment. Patients and methods: This was a retrospective comparative study will be conducted on 35 patients hepatocellular carcinoma (HCC); to assess HCC cases after trans-arterial chemoembolization (TACE) by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specificity in detecting residual tumor and assess the need for further treatment. We found that; the mean age of all patients was (62.31 ± 7.14) years. Regarding gender of the patients, the majority (88.6%) of patients were males; while only (11.4%) were females. Regarding residence, the majority (77.1%) of patients live in rural areas, while only (22.9%) live in urban areas. Comparative study between D-MRI and DS-MRI assessments revealed; highly significant increase in disease detection rate, sensitivity, and NPV in favor of DS-MRI in HCC patients; with highly significant difference (p < 0.01 respectively). Comparative study between D-MRI and DS-MRI assessments revealed; non-significant difference in specificity and PPV in HCC patients; with non-significant difference (p > 0.05). We found a moderate agreement between D-MRI and DS-MRI assessments of reactivity among HCC patients (kappa =0.44). Conclusion: Dynamic MRI is valuable in detecting recurrent lesions however, this value is augmented by the addition of subtraction technique especially in lesions having high signal before administration of contrast medium. So we recommend adding the subtraction technique in the protocol of MRI in the follow up after transarterial chemoembolization as it increases the diagnostic confidence. This may help to facilitate the appropriate clinical management of patients including the need for re-treatment sessions.

Application of nursing management under the guidance of Omaha system in patients with primary liver cancer

Objective To explore the effect of nursing management under the guidance of Omaha system in patients with primary hepatocellular carcinoma (HCC). Methods A total of 214 HCC patients admitted to Xianning Central Hospital from May 2013 to May 2018 were selected as study subjects.1 case was lost in the middle of the test, 2 cases were transferred to another hospital, 1 case was withdrawn without authorization, 4 cases were lost in the later period, and 206 cases finally met the standard.A total of 206 HCC patients who planned to undergo hepatic arterial interventional chemoembolization (TACE) were randomly divided into control group and observation group, each with 103 patients.The control group was given routine care, and the observation group was given nursing management under the guidance of the Omaha system.Changes in quality of life at admission and 3 months after discharge were compared. Results After discharge, the self-management behaviors of the observation group included diet management, daily life management, medication management and disease detection management scores, which were significantly higher than those of the control group on admission and after discharge, with statistically significant differences(P<0.05). After discharge, the 17 items of Hamilton Depression Scale(HAMD-17) score and Hamilton Anxiety Scale(HAMA) score in the two groups were significantly decreased, and the Social Support Rating Scale(SSQ) score and Numeric Rating Scale(NRS) score were significantly improved, and the changes in observation group were significantly greater than those in control group, and the differences were statistically significant(P<0.05). At 3 months after discharge, the scores of four items of physical function, psychological function, social function and material life status of Generic Quality of Life Inventory(GQOLI-7) in the two groups were significantly increased(P<0.05), and the increases in observation group were significantly higher than those in control group, and the differences were statistically significant(P<0.05). Conclusions The application of nursing management under the guidance of Omaha system to HCC patients undergoing TACE treatment can promote the development of good self-management behaviors, correct their negative emotions, improve their level of social support, alleviate their pain, and improve their quality of life. Key words: Primary hepatocellular carcinoma; Omaha system; Nursing management

Chemotherapy for breast cancer progresses to liver metastases after surgery and systemic treatment.

BackgroundThis study aims to evaluate the effectiveness of hepatic arterial infusion chemotherapy/portal vein infusion chemotherapy (HAIC/PVIC), transcatheter hepatic arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE) for unresectable breast cancer liver metastases (UBCLM).MethodsThe present study included 57 patients. These patients were randomly divided into three groups (n=19, each): HAIC/PVIC group, TACE group and TAE group. Patients in the HAIC/PVIC group were treated with the same systemic chemotherapy regimen previously received by infusion through an intra-arterial and portal vein catheter. Patients in the TACE group received cyclophosphamide, epirubicin and 5-fluorouracil, and embolization. Patients in the TAE group were only treated with embolization.ResultsThe median number of treatments was 6 (range, 3–13) in the HAIC/PVIC group, 5 (range, 4–9) in the TACE group, and 6 (range, 4–8) in the TAE group. The 1-, 2- and 3-year survival rates for these groups were 18/19 (94.7%), 14/19 (73.7%) and 11/19 (57.9%), 14/19 (73.7%), 9/19 (47.4%) and 8/19 (42.1%), and 8/19 (42.1%), 4/19 (21.1%) and 0/19 (0%), respectively. The median overall survival from the original breast cancer diagnosis was 88 (range, 11–133), 75 (range, 9–115), and 49 (range, 10–64) months in the HAIC/PVIC, TACE and TAE groups, respectively. Grade I–II and grade III–IV bone marrow suppression was observed in 12/19 (63.2%) and 3/19 (15.8%) patients in the HAIC/PVIC group, respectively, in 17/19 (89.5%) and 5/19 (26.3%) patients in the TACE group, respectively, and in 0/19 (0%) and 0/19 (0%) patients in the TAE group, respectively.ConclusionsHAIC/PVIC with the same regional chemotherapy regimen of the original systemic treatment is feasible, and can benefit patients with UBCLM, who have progressed on prior systemic therapies.

Clinical characteristics and prognostic factors of primary hepatic neuroendocrine tumor: a study of 21 patients

Objective To analyze the clinical characteristics, diagnosis, treatment and prognostic factors of primary hepatic neuroendocrine tumor (PHNET). Methods To analyze the clinical data of 21 patients with PHNET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2019. There were 11 males and 10 females, with ages which ranged from 36 to 75 years. Log-rank test was used for single-factor analysis of the relationship between clinical and pathological indicators and prognosis. Cox proportional risk model was used for multi-factor analysis. Results Among the 21 PHNET patients, 10 presented with central and upper abdominal pain, 3 abdominal pain accompanied by nausea and vomiting, 5 abdominal distension, and 3 were asymptomatic. Carbohydrate antigen (CA) 19-9 was elevated in 6 patients and CA125 in 7 patients. Abdominal enhanced CT showed solid liver space occupying lesions. Four patients had solitary and 17 had multiple lesions. The mean diameter was 58 mm. Fourteen patients had lymph node metastasis. Five patients underwent radical hepatectomy, 2 transcatheter hepatic arterial chemoembolization + chemotherapy, 12 chemotherapy, and 2 supportive treatment. Factors which were associated with prognosis of PHNET patients were surgery, tumor grading, cytokeratin positivity and lymph node metastasis. Multivariate Cox regression analysis showed that inoperability (HR=8.99, 95%CI: 1.13-71.80) was an independent risk factor of prognosis of PHNET patients. The prognosis in patients who underwent surgical resection was better. Conclusion Patients with PHNET had no specific clinical manifestations. Surgical resection gave the best results in treatment. As surgical resection affected prognosis, it should be carried out if technically feasible. Key words: Diagnosis; Primary liver neuroendocrine tumor; Clinical characteristics; Influencing factor

Safety and Short-term Efficacy of Licartin Combined with Conventional Transcatheter Hepatic Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma

To evaluate the safety and short-term efficacy of Licartin combined with conventional transcatheterheaptic arterial chemoembolization for patients with unresectable hepatocellular carcinoma, 13 patients with unresectable primary liver cancer treated with Licartin combined with conventional transcatheter arterial chemoembolization at the First Affiliated Hospital from January 2012 to December 2014, were retrospectively analyzed. Licartin was infused via hepatic artery at a dose of 27.75 MBq/kg prior to conventional transcatheter arterial chemoembolization (pirarubicin 20 mg and iodized oil), supplemented with poly vinyl alcohol particles. Here, the iodized oil is used as an embolic agent and carrier of anticancer drugs. After entering into the small arteries and peritumoral sinusoid of hepatocellular carcinoma through a catheter, the iodized oil gets retained there to block the terminal blood flow. According to mRECIST evaluation criteria, the remission and control rates after 1, 3, 6, and 9 mo were 69.3 and 100; 69.3 and 84.6; 61.5 and 76.9 and 60 % and 80 %, respectively. The survival rate was 100 % after 6 mo. The 1 y and 2 y survival rates estimated with Life Tables were 68 and 45 %, respectively. Liver and kidney function showed no significant difference pre- and posttreatment. No serious infections, jaundice, gastrointestinal bleeding or bone marrow suppression occurred. Licartin combined with conventional transcatheter arterial chemoembolization showed short-term efficacy and minimal side-effects in patients afflicted with unresectable primary liver cancer. Long-term follow-up involving large cohorts is needed to determine the long-term efficacy of the intervention.

Efficacy and survival analysis of TACE combined with radiofrequency ablation in the treatment of liver metastasis from colorectal cancer

Objective To observe the clinical efficacy and safety of transhepatic arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in the treatment of colorectal cancer with liver metastasis. Methods The data of 92 patients with colorectal cancer with liver metastasis admitted to Nanyang First People′s Hospital of Henan Province from January 2014 to January 2016 were retrospectively analyzed. A total of 46 patients treated with TACE were selected as the TACE group, and another 46 patients treated with TACE and RFA were selected as the combined group. The clinical efficacies of the two groups were compared, and the changes of Karnofsky functional status (KPS) scores before and after treatment in the two groups were analyzed. The incidences of complications in the two groups were calculated. Patients in the two groups were followed up, and the progress-free survival (PFS) and overall survival (OS) were calculated. Results The disease control rate of the combined group was 82.61% (38/46), and that of the TACE group was 63.04% (29/46). The disease control rate of the combined group was higher than that of the TACE group (χ2=4.449, P=0.035). Before treatment, the KPS scores of the combined group and the TACE group were 71.84±4.37, 72.22±4.26, with no statistically significant difference (t=0.423, P=0.673). After treatment, the KPS scores of the two groups were higher than those before treatment, and the KPS score of the combined group was higher than that of the TACE group (79.81±6.15 vs. 75.86±6.02; t=3.108, P=0.003). The incidence of complications was 54.35% (25/46) in the combined group and 41.30% (19/46) in the TACE group. The difference between the two groups was not statistically significant (χ2=1.568, P=0.210). The median PFS and OS in the TACE group were 12.6 and 20.7 months, and those in the combined group were 18.9 and 28.2 months. The PFS and OS of the combined group were longer than those of the TACE group (χ2=72.025, P<0.001; χ2=26.580, P<0.001). Conclusion TACE combined with RFA is effective in the treatment of liver metastasis of colorectal cancer, which can effectively improve the KPS score of patients, prolong the PFS and OS, and do not increase the risk of complications. Key words: Colorectal neoplasms; Neoplasm metastasis; Hepatic arterial chemoembolization; Radiofrequency ablation; Survival analysis

Effect of palonosetron and dexamethasone administration on the prevention of gastrointestinal symptoms in hepatic arterial chemoembolization with epirubicin.

There are several studies on premedication to prevent postembolization syndromes which occurs after transcatheter arterial chemoembolization (TACE), but the medication to be used is still not established. This study aimed to examine the effect of palonosetron and dexamethasone on the prevention of gastrointestinal symptoms induced by TACE. Patients with hepatocellular carcinoma who were treated with TACE with epirubicin were retrospectively evaluated. The complete response rate of antiemetic drugs and incidence and severity of gastrointestinal symptoms were compared between the antiemetic group (AE group), which includes 51 patients prophylactically administered with palonosetron 0.75 mg and dexamethasone 9.9 mg intravenously before TACE on day 1 and dexamethasone 6.6 mg intravenously on days 2 and 3, and control group with 101 patients without antiemetic premedication. Complete response rate in the entire evaluation period was significantly higher in the AE group compared with that in the control group. In the acute phase, the incidence and severity of nausea, vomiting, and anorexia significantly decreased in the AE group, but only anorexia improved in the delay phase. Additionally, postembolization syndromes, such as abdominal pain and fever, were significantly attenuated in the AE group; however, constipation worsened in this group. Premedication of palonosetron and dexamethasone significantly prevents the incidence and reduces the severity of gastrointestinal symptoms especially in the acute phase. Further studies will be needed to determine the most recommended 5-HT3 antagonist or dosage of dexamethasone in establishing the optimal antiemetic regimen.

The TACE’s role in the management of primary liver cancer

Objective: Identify the most effective and safe method of transcatheter hepatic artery chemoembolization (TACE) in patients with primary liver cancer. Methods: Overall, 139 patients, who underwent 558 TACE procedures were included in the study. Gender in the group of patients was distributed approximately equally and amounted to 72 men (52%) and 67 women (48%), the average age was 57.8 (9.9) years (range from 23 to 92 years). In most patients, the underlying disease for the development of hepatocellular carcinoma was cirrhosis of the liver in the outcome of hepatitis C or B. Characteristics of liver tumors were examined by magnetic resonance imaging or computed tomography and ultrasound. For verification of the diagnosis, a percutaneous liver biopsy was performed under ultrasound guidance, and the level of alpha-fetoprotein was also determined. All patients were considered unresectable due to cirrhosis and / or local spread of the tumor. Chemoembolization was performed by following scheme: one procedure in 2 months, not less than 3 procedures. Doxorubicin was used for chemotherapy. As a carrier of chemotherapy, Lipiodol (Guerbet, France) or saturable Hepaspheres (Merit Medical, USA) were used. Each patient received from 3 to 13 procedures. Results: Postembolization syndrome occurred in all cases, but was effectively treated. One patient died due to acute liver failure with the borderline stage of the disease according to the BCLC classification (EASL 2012) and the multinodular form of HCC. There were no serious complications in the treatment process. In two patients in the area of the puncture of the femoral artery, pseudoaneurysm was formed, which was eliminated by compression under ultrasound guidance. About 10% of patients developed subacute cholecystitis in the postoperative period and were associated with non-targeted chemoembolization in the cystic artery. In all patients, the symptoms of cholecystitis at the time of discharge were relieved conservatively. Survival median – 19 months. Dynamics of tumors was assessed by RECIST criteria. In the group of patients with hepatocellular carcinoma after first 3 TAСEs partial response and stabilization were observed in 83%, progression in 17%. In 18 cases (13%), histologically proved tumor necrosis after TAСE was achieved, without progression during follow-up. Three patients after reducing of tumor size was resected, 32 patients continue treatment. Conclusion: Transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma shows high efficacy, low mortality and the development of postoperative complications in patients with concomitant liver cirrhosis and locally advanced tumor lesion.

Non-Pharmacological Therapeutic Options for Liver Metastases in Advanced Neuroendocrine Tumors.

The incidence of liver metastasis in digestive neuroendocrine tumors is high. Their presence appears as an important prognostic factor in terms of quality of life and survival. These tumors may be symptomatic because of the tumor burden itself and/or the hormonal hyper-secretion induced by the tumor. Surgery is the treatment of choice for resectable tumors and metastasis. Nevertheless, surgery is only possible in a small number of cases. The management of non-resectable liver metastasis is a challenge. The literature is rich but consists predominantly in small retrospective series with a low level of proof. Thus, the choice of one technique over another could be difficult. Local ablative techniques (radiofrequency) or trans-catheter intra-arterial liver-directed treatments (hepatic artery embolization, chemo-embolization, and radio-embolization) are frequently considered for liver metastasis. In the present review, we focus on these different therapeutic approaches in advanced neuroendocrine tumors, results (clinical and radiological), and overall efficacy, and summarize recommendations to help physicians in their clinical practice.

Clinical application value of prognosis of nutrition index and apparent diffusion coefficient in patient with hepatocellular carcinoma underwent transarterial chemoembolization

Objective: To explore clinical application value of prognostic nutrition index(PNI) and apparent diffusion coefficient(ADC) in treating hepatic arterial chemoembolization (TACE) of patients with hepatic cell carcinoma (HCC). Methods: A total of 77 patients with HHC of BCLC B were retrospectively analyzed in Dalian Medical University Affiliated Second Hospital who were diagnosed for the first time and received TACE treatment from October 2017 to December 2018, of whom 64 Males, 13 females, mean age was 54±13 years.At 1 month after surgery, TACE efficacy was evaluated according to revised solid tumor evaluation criteria (mRECIST), the enrolled patients were divided into TACE effective group (41 cases, 53.2%) and TACE ineffective group (36 cases, 46.8%) to compare ability of PNI and ability of ADC alone or in combination in evaluating efficacy of TACE and the relationship between these two groups. Results: Overall postoperative PNI of enrolled patients was decreased compared with preoperative PNI, 47.7±6.6 vs 48.3±5.9 (P<0.05), preoperative and postoperative PNI of TACE effective group were all higher than that of TACE ineffective group (49.9±6.0 vs 46.6±5.3, 50.6±5.4 vs 44.4±5.1,all P<0.05), there was no significant difference in PNI between the treatment groups (P>0.05). The value of ADC in postoperative tumor region increased compared with that in preoperative tumor region ((1.43±0.15) ×10(-3) vs (1.28±0.08) ×10(-3) mm(2)/s, P<0.05), the difference between postoperative tumor region ADC value and postoperative normal liver parenchyma had no statistical significance(P>0.05). Overall postoperative PNI and tumor region ADC value of enrolled patients had linear correlation (P<0.05).Threshold value of PNI and ADC value in preoperative prediction were 51.05 and 1.32×10(-3) mm(2)/s; postoperative evaluation threshold value were 50.11 and 1.41×10(-3) mm(2)/s.Postoperative combination of PNI and ADC had the highest value in evaluating TACE efficacy. Conclusions: TACE postoperative PNI and tumor region ADC are related. PNI and tumor region ADC could be used in predicting and evaluating TACE efficacy in HCC patients, combination of these two could further increase the efficiency.

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer

Objective To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization(SPVCE) in the treatment of primary liver cancer. Methods A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study, and randomly divided into two groups according to the digital table, namely TACE(hepatic carcinoma arterial perfusion chemoembolization)+ SPVCE group and TACE group, with 59 cases in each group.In the TACE+ SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug-borne embolic agent, superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed, regional embolization was performed for liver cancer, and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared. Results The short-term objective(CR+ PR) efficiency of the TACE+ SPVCE group was 74.57%(44/59), which was significantly higher than that of the TACE group [54.23% (32/59)], the difference was statistically significant(χ2=5.323, P=0.021). The differences were statistically significant in the main indicators, such as the decrease of tumor lesion volume, the increase of liver volume without cancer, and the decrease of FAP(all P<0.05). The long-term objective efficiency of the TACE+ SPVCE group was 45.76%(27/59), which was also significantly higher than that of the TACE group[32.2%(19/59)], but the difference was no statistically significant(χ2=2.280, P=0.131). The TACE+ SPVCE group extended the median survival time by 3.5 months compared to the TACE group, there was statistically significant difference in median survival between the two groups(t=3.211, P=0.000). Major adverse reactions were compared between the two groups, the patients with decreased albumin in the TACE + SPVCE group was less than the TACE group, but there was no statistically significant difference(χ2=1.156, P=0.282), the patients with bone marrow inhibition in the TACE + SPVCE group decreased significantly compared with the TACE group, the difference was statistically significant(χ2=4.882, P=0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group, but there was no statistically significant difference(χ2=1.035, P=0.308). Conclusion Injection for drug carrier with lobaplatin with gelatin sponge embolism agent, percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization, is safe and effective, and can improve the curative effect of conventional TACE, and prolong survival, has important clinical value for advanced liver cancer patients that cannot be surgically removed. Key words: Liver neoplasms; Percutaneous catheter selective portal vein embolism; Hyperselective hepatic artery chemoembolization; Los platinum; Medicated embolism; Regional embolization of liver cancer; Clinical efficacy; Security

Clinical efficacy of hepatic arterial chemoembolization before percutaneous microwave ablation on liver cancer in elderly patients

Objective To investigate the clinical efficacy and safety of transcatheter arterial chemoembolization(TACE)before percutaneous microwave ablation(MWA)on liver cancer in elderly patients. Methods Eighty elderly patients with primary liver cancer admitted into our hospital from January 2015 to December 2017 were randomly divided into the MWA group(n=32)and the MWA combined with TACE group(n=48). The MWA group received percutaneous microwave ablation, and the MWA combined with TACE group were treated with transcatheter arterial chemoembolization before percutaneous microwave ablation.The therapeutic effects were compared between groups. Results The total effective rate was increased in the MWA combined with TACE group vs.MWA group(79.2% vs.56.3%, χ2=7.064, P=0.008). The proportion of patients who presented with serum AFP level >200 mg/L had no significant difference between the combination group and the MWA group(68.8% vs.70.8%, χ2=0.040, P=0.842). While, after treatment, the proportion of patients who presented with serum AFP level decreased by >50% was higher in the combination group than in the MWA group(79.2% vs.56.3%, χ2=7.064, P=0.008). There was no significant difference in the incidences of adverse reactions between the two groups(P>0.05). Conclusions Compared with percutaneous microwave ablation, transcatheter arterial chemoembolization combined with percutaneous microwave ablation has a better efficacy and higher safety. Key words: Liver neoplasms; Radiology, interventional; Ablation techniques

Survival analysis and clinical characteristics of forty-eight patients with alpha-fetoprotein-positive gastric cancer treated by integrated Chinese and western medicine.

e15550 Background: Alpha-fetoprotein-producing gastric carcinoma (AFPGC) is a special type of gastric cancer, which has characteristics of strong invasiveness, prone to liver and lymphnode metastasis, easy misdiagnosis and worse prognosis. According to the literature, the survival of AFPGC was 4-14 months (m). There is no report about integrated Chinese and Western Medicine on the AFPGC patients. This study is to explore the effect of integrated Chinese and Western Medicine on the survival and clinical characteristics of patients with AFPGC. Methods: 398 consecutive patients with gastric cancer admitted to Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from Jan 2012 to Jun 2018 were retrospectively collected. All patients were diagnosed by pathology. And on the basis treatment of conventional Western Medicine combined with Chinese Medicine for more than 3 m. Follow-up up to Dec 31th 2018. The median follow-up time was 11.1 m. According to the results of serum alpha-fetoprotein chemiluminescence assay, AFPGC was found in 48 out of 398 patients. The median overall survival (mOS) and clinical characteristics of AFPGC patients were analyzed. Results: Among 48 patients with AFPGC, 1 case (2.1%) in stage Ⅰ, 1 case (2.1%) in stage Ⅱ, 8 cases (16.7%) in stage Ⅲ, 36 cases (75.0%) in stage Ⅳ, and 2 cases with unknown stages; 35 cases (72.9%) received chemotherapy, 22 cases (45.8%) received local treatment, including palliative radiotherapy and hepatic artery chemoembolization, and 4 cases (8.3%) received targeted therapy. At the end of follow-up, 40 patients died, with the mOS of 16 m, 27.5 m in stage Ⅰ-Ⅲ and 14 m in stage Ⅳ, which was significantly longer than reported in the literature. Compared with non-AFPGC patients, tumor metastasis and serosal invasion of higher incidence ( 75.0% vs 38.9, x2= 22.3, p &lt; 0.0001; 75.0% vs 38.9%, x2= 17.5, p = 0.0015 ). The incidence of liver and/or lymph node metastasis is higher (52.1% vs 17.4%, x2= 25.1, p &lt; 0.0001; 33.3% vs 15.7%, x2= 7.7, p = 0.0054 ). The incidence of pleuroperitoneal and omental metastasis is higher (33.3% vs 11.7%, x2= 13.0, p = 0.0003 ). Conclusions: Integrated Chinese and Western Medicine can significantly prolong the survival of patients with AFPGC. AFPGC seem to be more prone to tumour metastasis, serosal invasion, liver metastasis, lymph node metastasis, pleuroperitoneal and omental metastasis. However, limited by the sample size, whether the above factors are independent prognostic factors for AFPGC is still not conclusive.

Effects of psychological flexibility intervention on symptoms and self-management efficacy of patients after hepatic arterial infusion chemoembolization

Objective To explore the effects of psychological flexibility intervention on the symptoms and self-management efficacy of patients after hepatic arterial infusion chemoembolization. Methods By convenient sampling, a total of 90 patients with hepatocellular carcinoma who had undergone hepatic arterial transcatheter chemoembolization in the First Affiliated Hospital of Zhengzhou University from January to February 2018 were selected. By random number table method, they were divided into the observation group and the control group, with 45 participants in each group. The control group received routine nursing intervention, and the observation group received psychological flexibility intervention, both for 2 weeks. Before and after the intervention, the Memorial Symptom Assessment Scale (MSAS) and the Chinese version of the Strategies Used People to Promote Health (SUPPH) were used to assess the symptomatic distress and self-management efficacy of the two groups in order to evaluate the effects of the intervention. Results There were no significant statistical differences in the average scores of physical symptoms, psychological symptoms, distressed index, and main clauses of MSAS before intervention between the two groups (P>0.05) . After intervention, the physical symptoms of the patients in both groups had no statistical difference compared with those pre-intervention (P>0.05) , while the average scores of psychological symptoms, distress index, main clauses of MSAS were all lower than those pre-intervention with statistical significance (P 0.05) . After intervention, the total score of SUPPH and the scores from each dimension increased with statistical significance (P 0.05) . The total score of SUPPH and the scores from each dimension were all higher than the control group with statistical significance (P<0.01) . Conclusions The psychological flexibility intervention can effectively reduce the patients' psychological distress after chemoembolization, and promote their self-management efficiency, therefore is worth promoting in the clinical practice. Key words: Liver neoplasms; Psychological flexibility; Hepatic arterial infusion chemoembolization; Symptomatic distress; Self-management efficacy

Liver Transplantation After Downstagings of Ruptured Advanced Hepatocellular Carcinoma in Cirrhotic Liver: Is It Advisable? A Case Report

Spontaneous rupture of hepatocellular carcinoma (HCC), defined as T4 in TNM stage by the American Joint Committee on Cancer (eighth edition), is a serious life-threatening complication. Effective treatment remains challenging because of a high 1-month mortality, a short median survival, and the potential of peritoneal metastasis. We reported on a case that received a living related donor liver transplantation (LDLT) after successful consecutive downstaging therapies. A 63-year-old man with alcohol-related liver cirrhosis and multiple HCC developed spontaneous rupture and hemoperitoneum. He received 3 sessions of transcatheter hepatic arterial chemoembolization and target therapy with sorafenib. Computed tomography scans and magnetic resonance imaging after 11 months of treatment showed that the patient's HCCs fulfilled the Milan criteria and the University of California San Francisco criteria prior to LDLT. The perioperative course was rather smooth. After discharge, interval follow-up computed tomography studies of chest and liver and a whole-body bone scan showed no tumor recurrence or metastasis up to 20 months post-operation. Successful downstaging therapies of ruptured HCC to fulfill Milan criteria to receive liver transplantation is advisable in highly selected patients.

Interventional Oncology in Immuno-Oncology Part 2: Transcatheter Therapies

AbstractThe use of transcatheter embolization in its various forms in interventional oncology has altered the treatment paradigms for multiple types of cancer. Though direct investigation of the immunologic effects of transcatheter treatments has been limited, research on radiation therapy can be extrapolated to better understand the potential effects of radioembolization and studies on the immune response to chemotherapy can potentially explain the immune response to hepatic artery infusion and chemoembolization. Utilization of newer systemic immunotherapies in combination with various transcatheter therapies also presents the potential for improving outcomes for multiple malignancies. This review will discuss the role of transcatheter therapies in stimulating an immune response as well as the potential these techniques have to enhance the effects of systemic immunotherapy.

Clinical observation of Bazhen decoction Huaji pill combined with chemoembolization in the treatment of primary liver cancer

Objective To observe the clinical effect of Bazhen decoction Huaji pill combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary liver cancer. Methods From December 2016 to October 2017, 76 patients with primary liver cancer admitted to the People's Hospital of Haiyang were selected.According to the different clinical treatment methods, the patients were divided into two groups, with 38 cases in each group.The control group received hepatic arterial chemoembolization, and the observation group received Bazhen decoction Huaji pill combined with TACE. Results The total remission rate of the patients in the observation group was 63.16% (24/38), which was significantly higher than 23.68%(9/38) in the control group (χ2=12.050, P<0.05). The improvement rate and stability rate of KPS score in the observation group were 47.37%(18/38), 36.84%(14/38), respectively, which were higher than those in the control group [26.32%(10/38), 31.58%(12/38), χ2=6.397, P<0.05]. The incidence rate of adverse reactions in the observation group was 21.05%, which was lower than 44.74% in the control group, the difference was significant(χ2=4.828, P<0.05). Conclusion Bazhen decoction Huaji pill combined with TACE in the treatment of patients with primary liver cancer can effectively alleviate the patients' condition, improve the quality of life of patients, and has high safety.It is worthy of popularization and application. Key words: Liver neoplasms; Chemoembolization, therapeutic; Quality of life; Clinical effect; Bazhen Tanghe; Huaji pill; Combined modality therapy; Contrastive study