Transcatheter Hepatic Chemoembolization Research Articles

Accuracy of software-assisted detection of tumour feeders in transcatheter hepatic chemoembolization using three target definition protocols

To compare the accuracy of computer software analysis using three different target-definition protocols to detect tumour feeder vessels for transarterial chemoembolization of hepatocellular carcinoma. C-arm computed tomography (CT) data were analysed for 81 tumours from 57 patients who had undergone chemoembolization using software-assisted detection of tumour feeders. Small, medium, and large-sized targets were manually defined for each tumour. The tumour feeder was verified when the target tumour was enhanced on selective C-arm CT of the investigated vessel during chemoembolization. The sensitivity, specificity, and accuracy of the three protocols were evaluated and compared. One hundred and eight feeder vessels supplying 81 lesions were detected. The sensitivity of the small, medium, and large target protocols was 79.8%, 91.7%, and 96.3%, respectively; specificity was 95%, 88%, and 50%, respectively; and accuracy was 87.5%, 89.9%, and 74%, respectively. The sensitivity was significantly higher for the medium (p = 0.003) and large (p < 0.001) target protocols than for the small target protocol. The specificity and accuracy were higher for the small (p < 0.001 and p < 0.001, respectively) and medium (p < 0.001 and p < 0.001, respectively) target protocols than for the large target protocol. The overall accuracy of software-assisted automated feeder analysis in transarterial chemoembolization for hepatocellular carcinoma is affected by the target definition size. A large target definition increases sensitivity and decreases specificity in detecting tumour feeders. A target size equivalent to the tumour size most accurately predicts tumour feeders.

Foresightedness research of three dimensional conformal radiotherapy and complex therapy for primary hepatic cancer

Objective To compare the therapeutic effects of transcatheter hepatic chemoembolization (TACE) alone、 three dimensional conformal radiotherapy (3 DCRT) alone,and TACE + 3 DCRT.Methods 67 patients with primary hepatic cacer were randomized divided into three groups:A-25patients were treated with 1-5 times of TACE alone;B-20 patients,radiotherapy with 3DCRT 45-60 Gy average 50 Gy;Group c-22 patients,TACE plus radiotherapy,at the first time were received 1-4 times of TACE by radiotherapy,then with 3DCRT after a rest of 4-8 week.for TACE,1000-1250 mg 5-fluorouracil and 20-30 mg hydroxyeamptothecine were perfused into the hepatic arteries,then 60-80 mg cisplatin and 14-20 mg mitomycin(or 50-60 mg epirubicin)and iodized oil 10-30 ml were given to embolized the hepatic arteries which was then followed by 1-2 mm gelform spieces.For 3DCRT,radiation was given by 6MV X-ray.Results The overall survivals at 1-,2-and 3-years were 61.3% ,34.0% and 19.0%for A-group TACE alone,53.1% ,31.3% and 18.8% for B-group 3DCRT;74.8%,57.0% and 40.4% for C-group TACE + 3DCRT.The differences in the survivals are statistically significant(P ＜0.05).the main complication was fever.Conclusion Treatment result of TACE + 3DCRT is better than TACE alone or3DCRTalone. Key words: Liver neoplansms/therapy; Liver neoplasms/radiotherapy; Embolization; Therapeutic

Acute Thrombocytopenia: An Unusual Complication Occurring After Drug-Eluting Microspheres Transcatheter Hepatic Chemoembolization

Image-guided transcatheter hepatic chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma and liver metastases from neuroendocrine tumors, colorectal carcinomas, and uveal melanomas. Although the technique is relatively safe, it has been associated with several complications. We report the cases of two patients with colorectal liver metastases who developed acute thrombocytopenia a few hours after TACE. To our knowledge, acute thrombocytopenia occurring after TACE with drug-eluting microspheres has not yet been reported. Here we discuss the hypothetical etiopathogenetic mechanisms.

Pulmonary Complications after Hepatic Artery Chemoembolization or Infusion via the Inferior Phrenic Artery for Primary Liver Cancer

The purpose of this study was to determine the frequency, patterns of disease, and risk factors for development of pulmonary complications after liver chemoembolization via the inferior phrenic artery (IPA). Forty-four selective transcatheter hepatic chemoembolization (THCE) procedures via the IPA were performed in patients with primary liver cancers with use of a mixture of anticancer agents and iodized oil (Lipiodol) with or without transcatheter arterial embolization. The grades of pulmonary complications were assessed on triphasic helical computed tomographic (CT) images after THCE and were correlated with angiographic findings of the IPA, infused dosages of Adriamycin and Lipiodol, and hepatic venous tumor thrombus on triphasic CT images before THCE. THCE via the IPA frequently resulted in lung CT changes: Lipiodol accumulation in the lung field (52%), consolidation (68%), and pleural effusion (41%). Among 44 patients, two (5%) developed respiratory symptoms. An excellent correlation was shown between Lipiodol accumulation and the presence of angiographic abnormalities of the IPA (P <.005). A significant correlation was also shown between the grades of pulmonary complications and the numbers of angiographic abnormalities (P <.01). The grades of pulmonary complications increased according to the infused dosage of Adriamycin and Lipiodol (P <.05). Angiographic abnormalities such as arteriovenous shunts, dilated anastomotic branches, and dense pleural staining are important risk factors for pulmonary complications of THCE via the IPA. Embolization for shunts may be required to prevent such complications, especially in cases with shunts to pulmonary vessels or hepatic veins.

Mr Imaging of the Liver before and after Transcatheter Hepatic Chemo-Embolization for Hepatocellular Carcinoma

Mr Imaging of the Liver before and after Transcatheter Hepatic Chemo-Embolization for Hepatocellular Carcinoma

MR Imaging of the Liver before and after Transcatheter Hepatic Chemo-Embolization for Hepatocellular Carcinoma

Transcatheter chemo-embolization (TCE) in hepatocellular carcinoma (HCC) was performed in 38 patients. The patients were examined by MR imaging before TCE as well as one week and 4 to 5 weeks after TCE. The tumor signal intensity in T2 weighted images increased in 13 cases and decreased in 19 cases after TCE. Increased intensity seemed to reflect intra-tumoral hemorrhage or liquefaction accompanying tumor necrosis. Decreased intensity seemed to reflect coagulation necrosis. In 9 of 18 cases followed over a 2-month period the signal intensity had decreased in both T1 and T2 weighted images. In these patients the tumor showed no recurrence at angiography and the decreased signal seemed to reflect the completion of coagulation necrosis. A hyper- and/or hypointense rim around the tumor appeared in 22 cases. These changes were thought to be perifocal edema or granulation tissue around the tumor. MR imaging was useful in evaluating the necrotic process of the tumor after TCE.

Mr Imaging of the Liver before and after Transcatheter Hepatic Chemo-Embolization for Hepatocellular Carcinoma

Mr Imaging of the Liver before and after Transcatheter Hepatic Chemo-Embolization for Hepatocellular Carcinoma