Hepatic Chemoembolization Research Articles

Computational assessment of occupational exposure during hepatic chemoembolization

One of the treatment alternatives for hepatocellular carcinoma (HCC) is transarterial chemoembolization (TACE). During this procedure, occupationally exposed individuals (OEIs) remain in the room and, therefore, are exposed to radiation. The objective of this work was to evaluate the equivalent and effective doses that OEIs received from TACE procedure of HCC. The evaluation was carried out by means of conversion coefficients for equivalent (CC[HT]) and effective (CC[E]) doses. The study was conducted based on computer simulation, using the Monte Carlo N-Particle code, version 6.2. An interventional radiology (IR) room was built containing 3 male virtual phantoms (MASH3) to represent the main physician, the assistant, and the patient. The scenarios varied according to the posteroanterior (PA), cranial, 12º (CRA12), caudal, 12º (CAU12) and right anterior oblique, 26° (RAO26) projections and different tube voltage values (70 and 80 kV) with the field size fixed at 35×35 cm2. Furthermore, personal protective equipment (PPE) and collective protective equipment (CPE) were incorporated into the scenarios to evaluate the dose reduction on the OIEs. It was observed that the highest dose values received by the OEIs were for the RAO26 projection when an 80 kV tube voltage was applied. The CC[E] values were reduced by up to 95%, while the CC[HT] values saw a reduction of up to 99% with the use of PPEs, for the main physician. Considering the scenario without the use of PPEs, the absolute effective dose received by the main physician was 266.71 μSv and by the assistant 30.29 μSv. When all PPEs and CPEs were used, the effective doses for these professionals were reduced to 24.12 μSv (main physician) and 1.16 μSv (assistant). The significant dose reduction achieved with protective equipment underscores the critical importance of consistently using these devices.

Occupational radiation exposure in anesthesia for hepatic chemoembolization: a prospective study

Introduction: Anesthetists play an important role during interventional radiology procedures. Like the main operator, anesthetists may also be subject to significant radiation levels in the fluoroscopy suite. Due to its complexity, hepatic chemoembolization procedures demand high fluoroscopic times and digital subtraction angiography images, exposing patients and medical staff to high radiation doses.
 Objetive: To assess and quantify the radiation to which one anesthetist was exposed over the course of seven consecutive hepatic chemoembolization procedures, and compare it to the exposure received by the main operator.
 Methods: Medical staff dosimetry was evaluated during seven consecutive hepatic chemoembolization procedures conducted in a private hospital in Recife (Brazil), using thermoluminiscent dosimeters placed in regions of the head and torso.
 Results: For the seven procedures evaluated in this study, the anesthetist received, on average, absorbed doses to the glabella, left eyebrow, right eyebrow and effective dose of 142.4 ± 72 µSv, 117.3 ± 66 µSv, 137.8 ± 71 µSv and 12.4 ± 8.4 µSv, respectively. 
 Conclusions: In some cases, ocular dose and effective dose received by the anesthetist may be 4 and 4.7 times greater, respectively, when compared to the main operator. According to the results of this study, the current occupational annual dose limit to the lens of the eye of 20 mSv can be exceeded with only two hepatic chemoembolization procedures per week if adequate radiation protection conditions are not guaranteed.

Incidence and predictors of abdominal pain after transarterial chemoembolization of hepatocellular carcinoma: a single-center retrospective study

PurposeTo assess the incidence and predictive factors of abdominal pain following transarterial hepatic chemoembolization (TACE) in patients with hepatocellular carcinoma. MethodsIn this single-center retrospective cohort study, abdominal pain was defined as a score of 4 or more within 72 h after TACE and requiring additional drug intervention. Patient, tumor characteristics, and technical factors associated with severe pain were identified using the decision tree and binary logistic regression model. ResultsOf 220 patients who were included in the study, 126 (57.3%) had abdominal pain after 206 of 420 TACE procedures (49.0%). A predictive model built based on the logistic regression identified the drug-eluting bead TACE (DEB-TACE) (odds ratio [OR] = 3.340; 95% confidence interval [CI] 2.169–5.141), the number of tumors (OR = 2.235; 95% CI 1.060–4.713), embolization of both hepatic lobes (OR = 2.310; 95% CI 1.109–4.813), and concomitant extrahepatic artery embolism (OR = 2.654; 95% CI 1.227–5.739) as the independent predictors of severe abdominal pain. Similarly, the decision tree confirmed the DEB-TACE as the strongest predictor of subsequent performance, followed by the history of hepatectomy and the embolization in the right or both lobes. The area under the receiver operating characteristic curve (AUC) of the classification prediction effect of the two models was 0.706 for the logistic regression and 0.676 for the decision tree. Internal validation results show that the accuracy of logistic regression model prediction was 71.4%. ConclusionThe model suggests that DEB-TACE and multiple treatment sites are predictors of abdominal pain after TACE in patients with hepatocellular carcinoma. It may help improve nursing management practices.

Chemoembolization with Degradable Starch Microspheres (DSM-TACE): expanding indications in HCC multidisciplinary tumor board

The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has changed over the last twenty years. There has been a trend towards an overall decline in TACE procedures, but with a more aggressive approach, repeating multiple TACE sessions in case of tumor response. The survival of treated patients was prolonged because of better patient selection and advancements in TACE techniques aimed at preserving liver function. At present, TACE is approved by the International Guidelines also outside of the BCLC intermediate stage after evaluation of a multidisciplinary tumor board (MDTB), permitting a customized treatment for every patient. An alternative therapeutic strategy is represented by hepatic chemoembolization with Degradable Starch Microspheres (DSM-TACE), which is based on the chemotherapeutic effect rather than on the ischemic damage to the liver tumor, requiring multiple cycles of treatment. The higher safety profile of DSM-TACE has broadened the indications to patients waiting for liver transplantation (with bridging or downstaging intention), at high risk of liver failure and ineligible for systemic therapies. This review summarises the scientific publications supporting the use of DSM-TACE and illustrates its indications depending on the disease stage from the Interventional Radiologist’s perspective.

DIAGNOSTIC REFERENCE LEVELS AND COMPLEXITY INDICES IN INTERVENTIONAL RADIOLOGY.

The establishment of typical diagnostic reference levels (DRLs) values according to the complexity indices (CIs) for hepatic chemoembolisation (HC), iliac stent placement (ISP) and femoropopliteal revascularisation (FR) is reported in this study. To estimate patients' stochastic effects, effective dose was calculated through dose area product (DAP) values of this study and E/DAP conversion factors derived from the literature. Data for DAP, Reference Air Kerma (Ka,r) and fluoroscopy time (FT) were collected for 218 patients and CIs were assigned to each procedure to extract DRLs. To estimate effective dose, conversion factors and DAP values were used for seven IR procedures. DRL values for DAP were 141, 130 and 28Gy*cm2 for HC, ISP, and FR, respectively. The corresponding DRL values for Ka,r were 634.6, 300.1 and 112.0mGy, and for FT were 15.3, 12.4 and 17.9min, respectively. CIs in interventional radiology are a useful tool for the optimisation of DRLs since they contribute to patient's doses.

Assessment of the incidence of accessory hepatic arteries: a literature review

Modern medicine is developing towards application of endovascular techniques such as trans-arterial hepatic chemoembolisation. They displace classic open procedures. However, their correct planning and performance depend on the knowledge pre-operative detection of hepatic arterial anatomical variations. The main abnormality that may generate complications during radiological and surgical procedures is occurrence of an accessory hepatic artery. In the present study we propose our own classification of the variability observed in the vessels based on cases reported in the literature. It analyses more types of variations as compared to previous trials. A great advantage of this study is also a description of different pathological and frequently life-threatening conditions associated with hepatic arteries. This study is of value to medical practitioners, e.g. surgeons.

P-228 Phase II multicentric randomized controlled trial to compare first-line treatment with FOLFOX6m + mAB alone or in combination with liver chemoembolization (Lifepearls-Irinotecan) in poor prognosis colorectal cancer with liver-limited disease

Around 40% of patients with colorectal cancer (CRC) are diagnosed with exclusive liver metastases, and in most cases, they present poor prognostic factors that contradict surgery. Intraarterial hepatic chemoembolization (TACE) with irinotecan-loaded drug-eluting beads (DEBIRI) has shown to be feasible for liver-limited disease (LLD) with acceptable toxicity. Several guidelines already include TACE as a therapeutic option for CRC with LLD although they strongly recommend further evaluation in randomized clinical trials as intensification therapy (ESMO guidelines 2016). This is a prospective, open, randomized, multicentric, phase II clinical trial for colorectal cancer patients with bad prognosis liver metastases (defined as > 3 lesions or > 5 cm) to evaluate first-line chemotherapy with FOLFOX6m + monoclonal antibody (Bevacizumab or anti-EGFR) associated or not to intraarterial hepatic chemoembolization with irinotecan-loaded drug-eluting beads (IRINOPEARL). The primary endpoint is to evaluate the Objective Response Rate at 6 months, according RECIST v.1.1. Secondary endpoints include Overall Survival (OS), Progression-Free Survival (PFS), Hepatic PFS, Safety, and R0 resection rate. The study will include 126 patients, 62 for each arm. Patients in the experimental arm will receive standard chemotherapy (FOLFOX + mAb) associated to TACE with LIFEPEARLS-IRINOTECAN at C2 and C4 (catheterization and infusion of 100 +/- 50 microspheres eluded with 100mg of irinotecan for each hepatic lobe or same-lobe in case of unilobar disease). GEMCAD 1802 ClinicalTrials.gov Identifier: NCT04595266 EudraCT Number: 2020-003795-40. GEMCAD (Grupo Español Multidisciplinario del Cancer Digestivo).

Clinical characteristics and surgical treatments of primary hepatic angiosarcoma

PurposePrimary hepatic angiosarcoma is a very rare and highly malignant tumor with poor prognosis. It is difficult to diagnose because of the lack of typical clinical features, and the treatment protocols for PHA are also not clear. Therefore, this study wants to find out the clinical characteristics and surgical treatments of primary hepatic angiosarcoma.MethodsAmong 8990 patients diagnosed with primary malignant tumor of the liver from January 2000 to December 2019 in our hospital, only four patients were diagnosed with primary hepatic angiosarcoma. The demographics, clinical manifestation, past history, serology test results, MRI features, pathology, treatment modality and prognosis of four patients were collected and analyzed.ResultsThree of four patients had no clinical symptoms, while one patient's symptom was abdominal pain. The levels of tumor markers of all four patients were within the normal reference range and serological tests were negative for hepatitis B and C virus. The MRI imaging findings of all four patients were mixed mass with highly disordered vascular characteristics. All four patients were misdiagnosed preoperatively. One patient who underwent hepatic lobectomy was still alive for about 18 months after surgery. One patient who underwent hepatic lobectomy has survived for only 6 months due to severe pneumonia. The other two patients who received transarterial chemoembolization survived 16 months and 11 months respectively.ConclusionThe clinical symptoms of primary hepatic angiosarcoma are not typical, and primary hepatic angiosarcoma is easily misdiagnosed. The typical imaging manifestations are structural disorder and heterogeneous tumor. Hepatic lobectomy and transarterial chemoembolization may be important surgical treatments to improve the prognosis of patients.

Treatment of Hepatocellular Carcinomas by Hepatic Transarterial Chemoembolization, Case Presentation and Review of the Literature

Abstract Hepatocellular carcinoma is one of the most common liver tumours. At the time of diagnosis, only 20% of patients are suitable for liver resection for curative purposes. In patients who are not suitable for surgical resection, chemoembolization of the hepatic artery is a viable therapeutic option. We present the case of a 60-year-old male patient being admitted with a diagnosis of liver tumour in the right liver lobe. Abdominal angio-CT examination revealed the existence of a tumour formation of 9x10 cm in the liver segments IV, VIII. Given the large size of the tumour, as well as the patient’s comorbidities, it was decided to practice hepatic chemoembolization with Irinotecan. The clinical evolution was favourable, the patient being discharged 48 hours after the intervention. Hepatic transarterial chemoembolization is a viable alternative in the treatment of patients with unresectable hepatocellular carcinomas, which may improve the prognosis of these patients.

Safety and Tolerability of Topotecan-Eluting Radiopaque Microspheres for Hepatic Chemoembolization in a Rabbit Preclinical Model.

Topotecan is a camptothecin analogue with potential advantages over irinotecan for transarterial chemoembolization (TACE) of hepatic colorectal metastases including greater anti-neoplastic activity without enzymatic activation. The purpose of this study was to assess safety and tolerability of topotecan-loaded radiopaque microspheres (ROMTOP) administered by TACE in a rabbit model and to compare the in vitro elution of topotecan from microspheres to irinotecan. Topotecan was loaded into radiopaque microspheres (70-150µm, DC Bead LUMI™, Biocompatibles UK Ltd-Boston Scientific Corporation) to the maximum capacity of 80mg/mL of microspheres. Six healthy New Zealand White rabbits underwent hepatic TACE with ROMTOP under fluoroscopic guidance until angiographic stasis. Assessment of toxicities included regular liver function tests and complete blood counts until euthanasia 28days post-TACE. In vitro topotecan elution from the microspheres was assessed using an open-loop flow-through system and compared to irinotecan. The mean bead volume and topotecan dose delivered were 0.086mL (0.076-0.105mL) and 1.99mg/kg (1.51-2.55mg/kg), respectively. Aspartate aminotransferase and alanine aminotransferase were elevated post-embolization but resolved within 2 weeks. One rabbit died two days after TACE with pyloric duodenal perforation observed at necropsy, potentially due to non-target embolization. In vitro elution of topotecan from ROMTOP was complete in 10h compared to 3h for irinotecan-loaded microspheres. Selective embolization with ROMTOP was tolerated at a dose of 2mg/kg (24mg/m2) in rabbits. In vitro topotecan elution from microspheres was more prolonged compared to irinotecan.

The Role of Diffusion Weighted MRI in The Assessment of Post Ablation HCC Viability

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Local ablative therapies include chemical (ethanol, acetic acid) or thermal ablation [radiofrequency ablation (RFA), microwave, laser, cryoablation] are curative treatment options that treat HCC. The apparent diffusion coefficient (ADC) calculated in diffusion-weighted MRI has become a favorable biomarker of tumor. The ADC is a measure of the mobility of water in tissues Methods: 30 cases of patients having HCC to radiology department of Damietta Cancer Center who underwent locoregional therapies (radio frequency ablation, microwave ablation percutaneous ethanol injection and trans-arterial hepatic chemoembolization) over a period of 18 months (APR.2017–OCT.2018). Patient are scheduled for dynamic contrast enhanced (DCE) MRI and diffusion weighted images (DWI) either in the routine follow up or after inconclusive triphasic CT study to assess tumor response to treatment and detect residual or recurrent lesions. Results: The ADC variable was found to be a fair indicator to differentiate marginal recurrence of HCC from benign or pseudo- lesions the sensitivity of DWI was 80%, its Specificity was 76.7%, positive predictive value was 53.3% and negative predictive value was 92%. Conclusion: we concluded that DWI together with conventional imaging is a promising tool in the evaluation of HCC post ablation. DWI can provide information about molecular tissue characteristics; it can help to distinguish between viable and necrotic tumor areas thus facilitating the diagnosis of residual or recurrent tumor. We could recommend a cut -off value 1.024 x 10-3mm2/sec, with t values below this level, express viability of the malignancy.

DSM-TACE of HCC: Evaluation of Tumor Response in Patients Ineligible for Other Systemic or Loco-Regional Therapies.

To analyze tumor response, survival and safety in patients with non-resectable hepatocellular carcinoma (HCC) treated with transarterial hepatic chemoembolization using degradable starch microspheres (DSM-TACE) combined with doxorubicin who had no local interventional or systemic therapy alternative according to an interdisciplinary conference. In this retrospective study, 28 patients (23male, 5 female, median age 67 years) with unresectable HCC, serum bilirubin levels < 3 mg/dl and contraindications to Sorafenib, RFA, SIRT or cTACE were included. DSM-TACE was performed using Embocept® S (15 ml) and doxorubicin (50 mg/25 ml) three times every 4-6 weeks. Patients were initially staged using the Barcelona Clinic Liver Cancer System (BCLC). Basic liver function was evaluated with the MELD-score. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). DSM-TACE could be technically successfully performed in all 28 patients. At control imaging after three treatments, the overall rates of complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were 14.3 %, 25 %, 39.3 % and 21.4 %, respectively, according to mRECIST. With regard to BCLC stages, the results were as follows (CR, PR, PD): BCLC A (n = 8): 7.1 %, 7.1 %, 10.7 %, 1.2 %; BCLC B (n = 12): 0 %, 10.7 %, 17.9 %, 14.3 %; BCLC C (n = 5): 0 %, 3.6 %, 10.7 %, 3.6 %; BCLC D (n = 3): 3.6 %, 3.6 %, 0 %, 3.6 %. According to this, DSM-TACE showed an overall good median survival of 682 days, although the patients' survival was strictly dependent on BCLC stage. DSM-TACE is a safe and promising treatment alternative for patients with unresectable HCC who are ineligible for other loco-regional therapies. · DSM-TACE is a safe treatment alternative for patients ineligible for other local or systemic treatments.. · DSM-TACE did not influence the MELD-score in our study population.. · Patients treated with DSM-TACE showed an overall good median survival of 682 days, strictly dependent on BCLC stage.. · Haubold J, Reinboldt MP, Wetter A et al. DSM-TACE of HCC: Evaluation of Tumor Response in Patients Ineligible for Other Systemic or Loco-Regional Therapies. Fortschr Röntgenstr 2020; 192: 862 - 869.

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

Does the Diffusion Weighted Images and Subtration MRI of Hepatocellular Carcinoma has a Role in Predicting Outcome of Transarterial Chemoembolization?

AbstractBackground: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Ablative therapies are promising treatment options for patients who are not eligible for surgery.Aim of Study: Is to evaluate the predictive values of diffusion-weighted imaging (DWI) and Subtration MRI in evaluating the efficacy of transcatheter arterial chemoembol-ization (TACE) in treatment of patients with hepatocellular carcinoma (HCC).Patients and Methods: This study included 30 patients with pathologically proven HCC (38 HCC lesions) who were referred to the Radiology Department of Ain Shams University Hospitals and National Liver Institute, Menofiya University for post therapeutic assessment after transarterial hepatic chemoembolization. The study was carried on over a period of 12 month (from August 2017 to August 2018). Patients' ages ranged from 59 to 73 with a mean of age 59.6 years. Of the 30 patients only 6 were females and 24 were males.Results: We found that dynamic study is the gold standard in detection of recurrent lesions. Well defined nodular en-hancement, thick irregular marginal enhancement or gross enlargement of the lesion with arterial phase enhancement and contrast wash out were considered positive for malignancy. Ill-defined persistent enhancement or well defined rim marginal enhancement were considered benign post ablation changes. We found that subtraction technique was essential in differ-entiation between the normal hyperintense T1 signal of the ablation zone and arterial enhancement of the lesion. The high signal intensity seen in T1 images post TACE was explained by haemorrhagic coagulative necrosis. Subtraction imaging is ideally suited for such a role where the unenhanced T1-weighted sequence is subtracted from the identical contrast enhanced sequence.Conclusion: We conclude that in evaluation of HCC after TACE, ADC calculated at DWI had weaker correlation to tumor necrosis degree than did findings with subtraction contrast-enhanced MRI. However, there was no difference between both methods in diagnosis of complete tumor necrosis.We suggest that whenever possible, gadolinium contrast enhancement and subtraction imaging be used for assessment of tumor necrosis after TACE.

Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program.

We aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success. We enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizations within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experience in TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patients were prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), and C (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and the other one using TFA in random order. All TFA procedures performed by the same operator in the same series of patients were considered as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve. Technical success was obtained in all patients, with a crossover rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD values were significantly higher only in group A (cases 1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and more limitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001). TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.

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

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

Diagnostic accuracy of intermediate b-value diffusion-weighted imaging for detection of residual hepatocellular carcinoma following transarterial chemoembolization with drug-eluting beads.

Purpose:To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual malignant tumor of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with drug-eluting beads (DEBs).Subjects and Methods:Pre-contrast T1, T2, dynamic contrast–enhanced, and respiratory-triggered DW-MRI (b factor 0, 400, and 800 s/mm2) were obtained in 60 patients with HCC who underwent tran-sarterial hepatic chemoembolization with DEBs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the DW imaging images. Apparent diffusion coefficients (ADCs) were calculated searching for the optimal cut-off value using the receiver operating characteristic (ROC) curve.Results:DW-MRI had a sensitivity of 77.1%, a specificity of 60.7%, a PPV of 71.05%, and a NPV of 68%. The difference between the malignant and benign groups’ ADC variables was statistically significant (P < 0.003). The ROC curve showed that the area under the curve is C = 0.718 with SE = 0.069 and 95% confidence interval from 0.548 to 0.852.Conclusion:In our study, we demonstrated that diffusion MRI has limited diagnostic value in the assessment of viable tumor tissue after TACE with DEBs in cases of HCC.

Pilot Study Comparing Systemic and Tissue Pharmacokinetics of Irinotecan and Metabolites after Hepatic Drug-Eluting Chemoembolization

Differences in drug metabolism associated with UGT1A1 polymorphism could result in individualized local response to hepatic chemoembolization with irinotecan-eluting beads (DEBIRI) or predictable toxicities. Five patients with inoperable hepatic metastases from colorectal or anal malignancies treated with DEBIRI were assessed for UGT1A1 mutations. No difference in area under the curve (AUC) for SN38 in normal liver and tumor tissue samples was noted with variant or wild-type UBT1A1 (P = .16 and P = .05, respectively). Plasma SN-38 AUC was significantly lower in wild-type compared to variant patients (P < .0001). UGT1A1 genotype may not be predictive of hematologic toxicity after DEBIRI.

A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma.

Purpose To develop and validate a predictive model for postembolization syndrome (PES) following transarterial hepatic chemoembolization (TACE) for hepatocellular carcinoma. Materials and Methods In this single-center, retrospective study, 370 patients underwent 513 TACE procedures between October 2014 and September 2016. Seventy percent of the patients were randomly assigned to a training data set and the remaining 30% were assigned to a testing data set. Variables included demographic, laboratory, clinical, and procedural details. PES was defined as pain and/or nausea beyond 6 hours after TACE that required intravenous medication for symptom control. The predictive model was developed by using conditional inference trees and Lasso regression. Results Demographics, laboratory data, performance, tumor characteristics, and procedural details were statistically similar for the training and testing data sets. Overall, 83 of 370 patients (22.4%) after 107 of 513 TACE procedures (20.8%) met the predefined criteria. Factors identified at univariable analysis included large tumor burden (P = .004), drug-eluting embolic TACE (P = .03), doxorubicin dose (P = .003), history of PES (P < .001) and chronic pain (P < .001), of which history of PES, tumor burden, and drug-eluting embolic TACE were identified as the strongest predictors by the multivariable analysis and were used to develop the predictive model. When applied to the testing data set, the model demonstrated an area under the curve of 0.62, sensitivity of 79% (22 of 28), specificity of 44.2% (53 of 120), and a negative predictive value of 90% (53 of 59). Conclusion The model identified history of postembolization syndrome, tumor burden, and drug-eluting embolic chemoembolization as predictors of protracted recovery because of postembolization syndrome. © RSNA, 2018.