Intra-arterial Chemoembolization Research Articles

Gustative Roussy Immune Score is a Predictor for Major Pathological Response in Rectal Cancer: A Result from the Preoperative Intraarterial Chemoembolization Combined with Radiotherapy (PCAR) Study

Despite the emergence of various treatment strategies for rectal cancer based on neoadjuvant chemoradiotherapy, there is currently a lack of reliable biomarkers to determine which patients will respond well to neoadjuvant chemoradiotherapy. Through collecting hematological and biochemical parameters data of patients prior to receiving neoadjuvant chemoradiotherapy, we evaluated the predictive value of systemic inflammatory indices for pathological response and prognosis in rectal cancer patients. We found that baseline GRIm-Score was an independent predictor for MPR in rectal cancer patients. However, no association was observed between several commonly systemic inflammation indices and long-term outcome.

X-ray vascular technologies. analysis of errors in the diagnostic and treatment algorithm of patients with mediastinum tumors

This article considers the unsolved problem of diagnostic and therapeutic approach to patients with mediastinal tumors. The aim of the study was to increase the efficacy of treatment of patients with mediastinal epithelial tumors by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors over a long period of time to devitalize tumor tissue and reduce overall chemotherapy toxicity. Object of study. Epithelial tumors of the thymus gland. Research methods: Clinical, laboratory, morphological, instrumental, statistical. Laboratory tests will include general clinical blood tests, biochemical parameters (ALT, AST, bilirubin, alkaline phosphatase, gamma-glutamine transpeptidase, lactate dehydrogenase, albumin), biochemical markers of thymus tumor (AFP, HGT), acetyl. General blood test (hemoglobin, erythrocytes, leukocytes, platelets). Instrumental methods of examination will include CT (computed tomography) with intravenous contrast, MRI (magnetic resonance imaging). Conclusions can be drawn from the literature. It can be stated that there is no single point of view on the diagnosis and choice of treatment tactics for patients with epithelial tumors of the thymus. Histological heterogeneity of tumors of this anatomical region with the similarity of clinical manifestations and radiological symptoms requires the development of algorithms for their differential diagnosis and optimization of treatment. In addition, over the last decade in Ukraine there has been a significant increase in the number of mediastinal tumors, especially thymus. Given mainly the young age of patients with this disease and the high degree of aggressiveness of the disease, the problem is transformed at the social level. It is also necessary to reconsider the traditional approach to the treatment of this pathology, the first link of which is considered to be surgery.

Non-surgical treatment of hilar cholangiocarcinoma.

Cancer of the biliary confluence also known as hilar cholangiocarcinoma (HC) or Klatskin tumor, is a rare type of neoplastic disease constituting approximately 40%-60% of intrahepatic malignancies, and 2% of all cancers. The prognosis is extremely poor and the majority of Klatskin tumors are deemed unresectable upon diagnosis. Most patients with unresectable bile duct cancer die within the first year after diagnosis, due to hepatic failure, and/or infectious complications secondary to biliary obstruction. Curative treatments include surgical resection and liver transplantation in highly selected patients. Nevertheless, very few patients are eligible for surgery or transplant at the time of diagnosis. For patients with unresectable HC, radiotherapy, chemotherapy, photodynamic therapy, and liver-directed minimally invasive procedures such as percutaneous image-guided ablation and intra-arterial chemoembolization are recommended treatment options. This review focuses on currently available treatment options for unresectable HC and discusses future perspectives that could optimize outcomes.

IMPROVING THE SELECTIVE TREATMENT OF THYMUS TUMORS USING INTRA-ARTERIAL CHEMOEMBOLIZATION

Epithelial tumors of the thymus occur in the thymus and include thymomas and carcinomas of the thymus. Thymomas are the most common primary tumor in the anterior mediastinum, but are generally rare (1.5 cases / 1,000,000). Although thymomas can spread locally, they are much less invasive than thymic carcinomas. Patients with thymic carcinomas often have metastases. The 5-year survival of patients with thymoma reaches 90%. At the same time, the 5-year survival rate for thymic carcinoma is approximately 55% (NCCN Guidelines. Version 1.2020).Surgical treatment as an independent method can be used only when there are thymus tumors in encapsulated and minimally invasive tumors in the first degree, rarely in the second degree. In all other cases, patients are subject to combined, complex or conservative treatment. In combined and complex treatment, preference should be given to neoadjuvant methods, which allows to achieve regression of the tumor, reduces its volume, limits the invasion of surrounding tissues, as well as to transform the inoperable process into operability.Endovascular technologies, namely regional chemotherapy, in the preoperative period, as a preparatory stage, will increase the level of ablastics and antiblastics in surgical treatment of thymus and reduce the percentage of cytostatics on the whole body, as in intravenous administration. At patients with a paraneoplastic syndrome it is necessary to increase term of regression of displays of these syndromes.Intra-arterial administration of chemotherapeutics has certain advantages:• cytostatics in the arteries that supply blood to the tumor are injected directly into the affected area, which allows you to significantly increase the concentration of the drug in the tumor itself;• reduces the toxic effects of chemotherapy on the whole body;• longer action of drugs allows long-term contact of the cytostatic with tumor cells at all stages of the cell cycle.Another main detail of treatment is that after the introduction of the cytostatic, it is necessary to introduce special emboli (microspheres) to block the removal of the chemotherapeutic agent.The analysis of treatment is taking into account the stage, anamnestic data, the development of clinical manifestations, the results of laboratory and instrumental methods of examination.According to our evidence, taking into account clinical and anamnestic (complaints), laboratory, instrumental (CT OGK with IV contrast), certain conclusions were made in the treatment of thymic tumors.According to our observations, a method of complex treatment of thymic tumors was developed. In this technique, we used regional chemotherapy (namely intra-arterial administration of chemotherapy-cytostatics) as the main method.Object of study. Epithelial tumors of the thymus gland. Subject of study. Indicators of survival and quality of life of patients with malignant thymoma without surgical treatment. The results of radical surgical treatment after regional chemotherapy. Indicators of ablastic and antiblastic. Indicators of results of patients with paraneoplastic syndrome.The aim of the study. Increase the effectiveness of treatment of patients with epithelial tumors of the thymus by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors for a long period of time to achieve devitalization of tumor tissue and reduce overall toxicity of chemotherapy.Objectives of the study.1. To determine the causes of unsatisfactory results of treatment of patients with epithelial tumors of the thymus using standard methods2. Improve the technique of intra-arterial chemoembolization in epithelial tumors of the thymus gland (technology, choice of cytostatics)3. To study the dynamics of biochemical markers (AFP, HGT) and antibodies to acetylcholine in paraneoplastic syndrome using intra-arterial chemoembolization4. To study pathomorphological changes in tumor tissue using intra-arterial chemoembolization5. To compare the clinical efficacy (increased tumor operability) of intra-arterial chemoembolization in the complex therapy of patients with epithelial tumors of the thymus gland.

The Place of X-ray Endovascular Catheter Technologies Taking into Account Errors in the Diagnostic and Treatment Algorithm of Patients with Mediastinal Tumors

The purpose of the study. Increase the effectiveness of treatment of patients with epithelial tumors of the mediastinum by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors for a long period of time to achieve devitalization of tumor tissue and reduce overall toxicity of chemotherapy. Object of study. Epithelial tumors of the thymus gland. Research methods: Clinical, laboratory, morphological, instrumental, statistical. Laboratory tests will include general clinical blood tests, biochemical parameters (ALT, AST, bilirubin, alkaline phosphatase, gammaglutamine transpeptidase, lactate dehydrogenase, albumin), biochemical markers of thymus tumor (AFP, HGT), acetylcholine. General blood test (hemoglobin, erythrocytes, leukocytes, platelets). Instrumental methods of examination will include CT (computed tomography) with intravenous contrast, MRI (magnetic resonance imaging). The conclusions can be made from the literature review. It can be stated that there is no common view on the diagnosis and choice of treatment tactics for patients with epithelial tumors of the thymus. Histological heterogeneity of tumors of this anatomical region with the similarity of clinical manifestations and radiological symptoms requires the development of algorithms for their differential diagnosis and optimization of treatment. In addition, over the last decade in Ukraine there has been a significant increase in the number of mediastinal tumors, especially the thymus gland. Given mainly the young age of patients with this disease and the high degree of aggressiveness of the disease, the problem is transformed to the social level. It is also necessary to review the traditional approach to the treatment of this pathology, the first link of which is considered to be surgery.

Safety assessment of preoperative oil chemoembolization with nanoparticle albumin-bound paclitaxel in patients with pancreatic head adenocarcinoma

Results of combined treatment of 36 patients suffering from pancreatic head ductal adenocarcinoma are evaluated, including preoperative chemotherapy using nanodispersed albumin-stabilized paclitaxel (nab-paclitaxel) in intraarterial oil chemoembolization or intravenous administration and radical surgical treatment. Intraarterial oily chemoembolization of the pancreatic head consisted of the introduction of 17 patients (main group) into the gastroduodenal artery of an emulsion of super-liquid lipiodol (Lipiodol Ultra Fluid) in an aqueous solution of nab-pacliaxel 50 mg/m2 and gemcitabine 400 mg/m2. 19 patients (control group) were administered nab-paclitaxel 100 mg/m2 and gemcitabine 1000 mg/m2 intravenously according to standard guidelines. Safety and tolerability assessment of combined treatment with preoperative application of nab-paclitaxel was carried out in advance. Pil-preserving pancreatoduodenal resection is considered safe on day 710, after completion of preoperative chemotherapy with nab-paclitaxel. The use of nab-paclitaxel in preoperative intraarterial oily chemoembolization of the pancreatic head requires extension of the pancreatic crossing boundary to body level. Postoperative lethality and 4th degree complications according to the Clavien-Dindo classification were not observed. In the main group, grade 3a complication was observed in 2 (12%) patients and was represented by bleeding from acute gastric erosions resolved endoscopically. In the control group, complications of degree 3 were also noted in 2 (11%) patients and were represented by: one bleeding from acute stomach erosions that required endoscopic hemostasis and an intraabdominal abscess allowed by percutaneous drainage. In the main group, complications of the 2nd degree were recorded in 8 (47%) patients: in 3 (17%) patients the formation of pancreatic fistula was noted, in 4 (23%) postoperative pancreatitis was detected, and in 1 (6%) gastrostasis phenomena that required conservative therapy. In the control group, complications of the 2nd degree were observed in 11 (58%) patients and were presented: pancreatic fistulae in 2 (10%) patients, postoperative pancreatitis in 6 (31%) and gastrostasis in 3 (16%) patients. The most common complication observed in both groups was the suppression of a postoperative wound, corresponding to the 1st degree of severity: in the main group in 5 (29%) patients, in the control group in 7 (37%) patients. Thus, the use of intraarterial oil chemoembolization with nab-paclitaxel as a preoperative antitumor treatment can be considered safe.

Comparative evaluation of treatment methods of neoadjuvant intra-arterial chemotherapy and chemoembolization by drug-saturated embospheres in II–IVa stages cervical cancer

Objective: comparative evaluation of treatment methods for neoadjuvant intra-arterial chemotherapy and chemoembolization by drug-saturated microspheres followed by surgical treatment in II–IVa stages cervical cancer.Materials and methods. This study presents the results of complex treatment in 209 patients (average age – 40.57 ± 8 years) with II– IVa stages cervical cancer and 384 endovascular interventions as the first stage of complex treatment in the period from 2010 to 2016. The scheme neoadjuvant intra-arterial chemotherapy was carboplatin (AUC6 intra-arterial) + irinotecan (200 mg/m2 intravenously on day 1) every 21 days. Radical surgical treatment was performed basically after 2 cycles of chemotherapy. Patients who did not respond sufficiently to neoadjuvant intra-arterial chemotherapy underwent a radical course of chemoradiation therapy according to the standard scheme.Results. The overall response to neoadjuvant intra-arterial chemotherapy was 84.8 % and 79 % of patients in groups of chemoinfusion and trans-arterial chemoembolization, respectively (p >0.05). Operability was higher in group of chemoinfusion (69 % versus 46.4 %) (p <0.01), and fewer patients with metastases to regional lymph nodes were revealed in this group (30.2 % versus 42 %), p <0.05. Overall and survival rate is statistically significantly better in group of chemoinfusion – 63.9 % and 61 % versus 43 % and 42 %, respectively, p <0.05. At the same time, statistically significant differences between the groups were revealed only at stages III–IVа cervical cancer. Radically operated patients, as expected, had a better prognosis (p <0.001). The age of patients, tumor differentiation and therapeutic pathomorphosis did not affect the prognosis of life.Conclusions. Neoadjuvant intra-arterial chemoinfusion and chemoembolization using irinotecan + carboplatin scheme are relatively safe treatment methods with acceptable toxicity and have a high cytotoxic effect. Patients in chemoinfusion group have a better prognosis compared with patients in chemoembolization group. Selective chemoembolization with subsequent surgical treatment or radiation therapy may be the treatment of choice for stage II cervical cancer complicated by bleeding.

Stage 4\u2009s neuroblastoma: features, management and outcome of 268 cases from the Italian Neuroblastoma Registry

BackgroundInfants diagnosed with stage 4 s neuroblastoma commonly experience spontaneous disease regression, with few succumbing without response to therapy. We analyzed a large cohort of such infants enrolled in the Italian Neuroblastoma Registry to detect changes over time in presenting features, treatment and outcome.MethodsOf 3355 subjects aged 0–18 years with previously untreated neuroblastoma diagnosed between 1979 and 2013, a total of 280 infants (8.3%) had stage 4 s characteristics, 268 of whom were eligible for analyses. Three treatment eras were identified on the basis of based diagnostic and chemotherapy adopted. Group 1 patients received upfront chemotherapy; Group 2 and 3 patients underwent observation in the absence of life-threatening symptoms (LTS), except for Group 3 patients with amplified MYCN gene, who received more aggressive therapy.ResultsThe three groups were comparable, with few exceptions. Ten-year overall survival significantly increased from 76.9 to 89.7% and was worse for male gender, age 0–29 days and presence of selected LTS on diagnosis, elevated LDH, and abnormal biologic features. Infants who underwent primary resection ± chemotherapy did significantly better. On multivariate analysis, treatment eras and the association of hepatomegaly to dyspnea were independently associated with worse outcome.ConclusionsOur data confirm that stage 4 s neuroblastoma is curable in nearly 90% of cases. Hepatomegaly associated to dyspnea was the most important independent risk factor. The cure rate could be further increased through timely identification of patients at risk who might benefit from surgical techniques, such as intra-arterial chemoembolization and/or liver transplantation, which must be carried out in institutions with specific expertise.

Interdisciplinary Approach in Treatment of Primary Unresectable Liver Metastases of Colorectal Cancer: 8.5 Years Follow-up

Background: The aim of the study was to explore the effectiveness of the interdisciplinary approach in the treatment of primary unresectable liver metastasis of colorectal cancer (mCRC). Methods: Treatment results of 192 patients with mCRC were included in the retrospective analysis. Strategy of treatment were developed due to the interdisciplinary approach of oncosurgery, medical oncologist and intervention radiologist. Patients characteristics: mean age 55.9 ± 12.2 years, primary tumors - colon/rectum 149/43, number of metastases 5.1 ± 2.8. All patients underwent neoadjuvant chemotherapy (FOLFOX, FOLFIRI) 3-9 course (an average 4 courses), 11 patients additionally intra-arterial chemoembolization (an average 2 courses), 97 (50.5 %) patients liver resection combined with RFA, 11 (5.7 %) patients - two-stage hepatectomy. Results: Tumor response after a first-line chemotherapy gave possibility to perform a resection in 154 (80.2 %) of patients, 38 (19.8 %) had held the second line chemotherapy, which was combined with embolization in 14 (7.3 %) patients. 3-, 5- and 8.5-year survival rates were 51%, 36.2 % and 26.3%, respectively. The median survival was 47 months. Median follow-up was 51.6 months (12-90). Conclusion: The interdisciplinary approach in treatment of primary unresectable hepatic colorectal cancer metastases increased the 8.5-year survival rate till 26.3%.

Combined minimally invasive treatment of liver and bile ducts malignancies

Aim. To analyze radiofrequency ablation per se and in combination with other X-ray surgical procedures in patients with liver and bile ducts malignancies. Material and methods. Radiofrequency ablation was used in three groups: percutaneous intervention or in combination with liver resection – group 1 (n = 111); ablation combined with intra-arterial chemoembolization (n = 3) – group 2; RFA followed by right portal vein embolization (RALPPES) in order to induce liver hypertrophy to enable liver resection – group 3 (n = 20). Results. There were no recurrences after radiofrequency ablation. Two-year survival was 55% in patients with hepatocellular carcinoma and liver cirrhosis.Colorectal cancer metastases were followed by 4-year survival near 55%. RFA combined with intra-arterial chemoembolization were associated with complete tumor destruction in patients with hepatocellular carcinoma over 4–5 cm and stabilization in patients with progressive intrahepatic cholangiocarcinoma. Liver hypertrophy was over 50% in two weeks after RALPPES that enables liver resection in 95% of patients. Symptoms of liver failure after hemihepatectomy were not observed in any patients. Conclusion. Combination of interventional methods is able to improve outcomes in patients with liver and bile ducts malignancies.

NEW POSSIBILITIES OF COMPLEX TREATMENT FOR METASTATIC AND LOCALLY ADVANCED NEUROENDOCRINE TUMORS OF THE PANCREAS

During the period 2006 to 2017 years 86 patients with neuroendocrine pancreatic tumors were observed and treated. 25 (29,1%) patients underwent only chemotherapy due to generalized tumor process or severe concomitant somatic status. 61 (70,9%) patients with neuroendocrine pancreatic tumors underwent surgical treatment. In 34 patients tumors were localized in the body and tail, in 27 - in the head of the pancreas. Women predominated among patients (n = 41), the average age of the patients was 51 ± 3.1 years. Synchronous metastatic liver metastases were detected in 33 (54,1%) of 61 patients, with the size of the primary tumor from 10 to 73 mm. In 47 (77%) neuroendocrine pancreatic tumors were regarded as non-functioning. Radical surgery was performed in 24 patients of 61 (39,3%) with tumor sizes from 11 to 128 mm (average 56 ± 21 mm), cytoreductive surgery was performed in 37 (60.7%) patients. Patients with locally advanced neuroendocrine pancreatic tumors (n = 13) and neuroendocrine pancreatic tumors with synchronous liver metastases (n = 33) undergone combined treatment (n = 46). Combined treatment was performed by means of intra-arterial selective oil chemoembolization and chemoinfusion, supplemented with one or several local methods effects: cytoreductive surgery and radiofrequency ablation (n = 8). 6 (12.2%) of patients with high, moderately and low-grade tumors died after the operation in period from 7 to 63 months from progression of disease. 43 (87.8%) patients survived in period from 4 to 112 months, 32 patients still alive without signs of disease progression. Because of recurrence in five patients (11.9%) repeated operations were performed. One patient (2.4%) underwent conformal radiation therapy. Life expectancy after surgery in patients with low-grade neuroendocrine cancer of the pancreas ranged from 3 to 16 months, and the median survival was 8.3 ± 1.2 months.

COMBINED TREATMENT OF PATIENTS WITH PANCREATIC NEUROENDOCRINE CARCINOMAS

Aim. To analyze the results of treatment of patients with pancreatic malignant neuroendocrine tumors. Materials and Methods . Since 2005 to 2014 period 49 patients with malignant neuroendocrine tumors were examined and treated. 76.6% patients (n = 38) were treated within 2010–2014 years. In 59.2% of cases liver metastatic lesion occured. Comprehensive specific treatment with surgical resection of primary tumor site was used in 73.5% of cases (n = 36). Some patients received perioperative intraarterial chemoembolization and surgical tumor removal was supplemented by radiofrequency or microvave ablation of metastatic liver sites, anatomical liver resections. Results. Postoperative mortality was observed only after extended surgical resection (8.3%, (n = 3)). All patients with low differentiated tumors had histological signs of perineural invasion, abcence of therapeutical effect of specific treatment even after surgical resection of primary tumor site. In view of this long-term survival was low. At present time most of surgically treated patients (85.2%, (n = 32)) with low and moderately differentiated neuroendocrine tumors live without signs of progression. Follow-up varies within 5–119 months. Conclusion. Combined treatment including aggressive surgical approach and perioperative intraarterial chemoembolization is associated with good remote results in case of highly and moderately differentiated neuroendocrine tumors.

Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only.

The aim of the present study was to evaluate the efficacy and safety of a combination of intra-arterial and intravenous chemotherapy in the treatment of unresectable, advanced gastric cancer, and assess which patients are likely to benefit from combined treatment. The clinical data of 128 patients diagnosed with unresectable, advanced gastric cancer at The Fourth Hospital of Hebei Medical University (Shijiazhuang, China) from January 2009 to September 2012 were retrospectively analyzed. The patients were divided into two groups as follows: Those who received regional intra-arterial chemoembolization plus systemic chemotherapy (combined group; n=62) and those who received systemic chemotherapy only (venous group; n=66). The clinical response, overall survival (OS) and toxic effects in the two groups were compared. Univariate and multivariate analyses were performed to identify the primary factors affecting the survival time of patients in the combined group. The overall response rate was significantly increased (35.5%) in the combined group compared with the venous group (19.7%; P=0.045). The median OS was 14 months in the combined group and 13 months in the venous group, and the 1-year and 2-year survival rates in the two groups were 45.2 and 9.7%, and 40.9 and 6.1%, respectively. There were significant differences between the survival curves (P=0.044). The median time to progression in the combined group and the venous group was 10 months and 6 months, respectively, and the difference was statistically significant (P=0.003). Multivariate analysis revealed that tumor-node-metastasis (TNM)-stage and the degree of tumor staining were independent factors affecting OS. No differences in adverse reactions between the two groups were observed (P>0.05). The combination of intra-arterial and intravenous chemotherapy may effectively improve the rate of clinical response, prolong OS and time to symptomatic progression in patients with unresectable, advanced gastric cancer, in particular those with an earlier TNM stage and distinct tumor staining.

Sporadic desmoid tumors in the pediatric population: A single center experience and review of the literature

Background/PurposeWe present our long experience with desmoid tumors in children. MethodsData were retrospectively collected from 17 children/adolescents treated for sporadic desmoid tumors at a tertiary pediatric hospital in 1988–2016. There were 10 girls and 7 boys aged 1–17years. Tumor sites included head and neck, trunk, extremity, and groin. Eight patients underwent radical resection, with complete remission in 7 and local relapse in one which was treated with chemotherapy. Four patients underwent incomplete surgical resection, three with adjuvant chemotherapy. Five patients underwent biopsy only and chemotherapy. Two of the 9 chemotherapy-treated patients also had intraarterial chemoembolization. Chemotherapy usually consisted of vincristine and actinomycin-D with or without cyclophosphamide or low-dose vinblastine and methotrexate. Two patients also received tamoxifen. ResultsAfter a median follow-up of 3.3years, 10 patients were alive in complete remission, 5 had stable disease, and 2 had reduced tumor size. Five-year overall survival was 100%, and event-free survival, 87.5%. Ten were screened for CTNNB1 mutations. CTNNB1 gene sequencing yielded mutations in 5/10 samples tested: 3 T41A, 2 S45F. There was no association of CTNNB1 mutation with clinical outcome or prognosis. ConclusionPediatric desmoid tumors are rare, with variable biologic behavior and morbidity. Treatment requires a multidisciplinary approach. Level of evidenceLEVEL IV, treatment study.

Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis.

PurposeNumerous studies have tried to combine transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) with radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT.MethodsPubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR), overall survival (OS), and adverse events.ResultsEight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07–5.80; P<0.001) and OS (HR, 0.69; 95% CI, 0.57–0.83; P=0.001), but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67–2.79; P=0.390). The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478–13.56; P<0.001) and thrombocytopenia (OR, 3.77; 95% CI, 1.06–13.43; P=0.041) was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group.ConclusionCombination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could bring higher ORR of PVTT and better survival benefits. This combination therapy was also associated with a significantly increased risk of adverse events. However, they were mostly mild to moderate and successfully treated with conservative treatment.

Intra-arterial chemoembolization with hepasphere 50–100 μm for patients with unresectable hepatocellular carcinoma: Initial experience in Egyptian Liver Hospital

ObjectiveThis study examined the efficacy of transarterial chemoembolization of unresectable hepatocellular carcinoma using hepasphere 50–100μm. MethodsA total number of 52 patients with radiologically documented HCC [Child–Pugh score A and B; 32 and 20 respectively] were embolized with hepasphere 50–100μm. Forty-six patients were HCV positive and 6 patients were HBV positive. Local response of the tumor was evaluated radiologically after 1, 3, 6, 9months and one year. ResultsTACE with hepasphere 50–100μm was tolerated by all patients with no major complications. The total number of lesions in 52 patients was 67 lesions. Complete response was seen in 40 patients (76.9%), while residual lesions seen in 12 patients (23.1%). As regards complications, 48 patients (92.4%) developed post-embolization syndrome, 2 patients (3.8%) had isolated partial IVC thrombosis while 2 patients (3.8%) showed combined partial IVC thrombosis and partial thrombosis of posterior branch of right portal vein. ConclusionHepasphere 50–100μm is efficient for the treatment of hypervascular HCC. Further advances in drug-eluting beads including their size tailored to tumor anatomy may improve the results. Large series of patients, follow up for longer periods and comparison with conventional TACE and TACE with other DEB are needed.

Hepatic abscess: Diagnosis and management

Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity. Infection is usually bacterial, sometimes parasitic, or very rarely fungal. In the Western world, bacterial (pyogenic) HA is most prevalent; the mortality is high approaching 15%, due mostly to patient debilitation and persistence of the underlying cause. In South-East Asia and Africa, amebic infection is the most frequent cause. The etiologies of HA are multiple including lithiasic biliary disease (cholecystitis, cholangitis), intra-abdominal collections (appendicitis, sigmoid diverticulitis, Crohn's disease), and bile duct ischemia secondary to pancreatoduodenectomy, liver transplantation, interventional techniques (radio-frequency ablation, intra-arterial chemo-embolization), and/or liver trauma. More rarely, HA occurs in the wake of septicemia either on healthy or preexisting liver diseases (biliary cysts, hydatid cyst, cystic or necrotic metastases). The incidence of HA secondary to Klebsiella pneumoniae is increasing and can give rise to other distant septic metastases. The diagnosis of HA depends mainly on imaging (sonography and/or CT scan), with confirmation by needle aspiration for bacteriology studies. The therapeutic strategy consists of bactericidal antibiotics, adapted to the germs, sometimes in combination with percutaneous or surgical drainage, and control of the primary source. The presence of bile in the aspirate or drainage fluid attests to communication with the biliary tree and calls for biliary MRI looking for obstruction. When faced with HA, the attending physician should seek advice from a multi-specialty team including an interventional radiologist, a hepatobiliary surgeon and an infectious disease specialist. This should help to determine the origin and mechanisms responsible for the abscess, and to then propose the best appropriate treatment. The presence of chronic enteric biliary contamination (i.e., sphincterotomy, bilio-enterostomy) should be determined before performing radio-frequency ablation and/or chemo-embolization; substantial stenosis of the celiac trunk should be detected before performing pancreatoduodenectomy to help avoid iatrogenic HA.

Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies.

The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

Development of Intra-Arterial Chemoembolization for Various Types of Cancer in Humans

Development of Intra-Arterial Chemoembolization for Various Types of Cancer in Humans

Preoperative oral S-1 plus regional intra-arterial chemoembolization for patients with unresectable locally advanced gastric cancer

Preoperative oral S-1 plus regional intra-arterial chemoembolization for patients with unresectable locally advanced gastric cancer