Transhepatic Arterial Embolization Research Articles

1014TiP Efficacy and safety of recombinant human adenovirus type 5 injection combined with transhepatic arterial embolization sequential thermal ablation for medium-and high-risk recurrent liver cancer: a prospective, open-label, randomized controlled study

1014TiP Efficacy and safety of recombinant human adenovirus type 5 injection combined with transhepatic arterial embolization sequential thermal ablation for medium-and high-risk recurrent liver cancer: a prospective, open-label, randomized controlled study

Construction of an anoikis‒related prognostic signature to predict immunotherapeutic response and prognosis in hepatocellular carcinoma.

Anoikis resistance is an important inducer of tumor metastasis. The role of anoikis-related genes (ARGs) in hepatocellular carcinoma (HCC) remains unclear. A list of ARGs was obtained and regression analysis was employed to assemble an anoikis-related prognostic signature and risk score formula from mRNA data and clinical prognostic data downloaded from The Cancer Genome Atlas database. Quantitative real-time PCR (qRT-PCR) was performed on clinical samples to validate the selected ARGs expressions. Kaplan‒Meier curves, ROC curves, and Cox regression analyses were used to demonstrated the prognostic value of this signature. Biological functional enrichment analysis and immune infiltration analysis were utilized to analyze the differences in potential biological functions, immune cell infiltration, immune functions, and immunotherapeutic responses. A prognostic signature based on 6 ARGs and corresponding prognostic nomogram were established. Our qRT-PCR results showed a higher expression of 6 ARGs in HCC tissues (p value < 0.05). Kaplan‒Meier curves, ROC curves, and Cox regression analyses demonstrated good prognostic value of the signature in HCC (p value < 0.05). Significant differences between the enriched biological functions and immune landscapes of patients in different risk groups were discovered (p value < 0.05). In addition, patients with higher risk scores possibly had poor therapeutic response to transhepatic arterial chemotherapy and embolization or sorafenib, but their responses to immunotherapy might be more effective. A successful anoikis-related prognostic signature and corresponding clinical nomogram were established, which might facilitate better predictions of prognosis and therapeutic responses for HCC patients.

Hepatic Arterial Infusion Chemotherapy Plus Lenvatinib and Tislelizumab with or Without Transhepatic Arterial Embolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and High Tumor Burden: A Multicenter Retrospective Study.

The current therapeutic strategies for high-risk, unresectable hepatocellular carcinoma (HCC) patients demonstrate suboptimal outcomes. This study aimed to assess the clinical efficacy of the combined approach of hepatic arterial infusion chemotherapy (HAIC), lenvatinib, and tislelizumab, either with or without transhepatic arterial embolization (TAE), in managing HCC patients with portal vein tumor thrombus (PVTT) and significant tumor load. In this multicenter retrospective study, we analyzed patients diagnosed with primary, unresectable HCC presenting with PVTT and substantial tumor load who had undergone treatment with HAIC, lenvatinib, and tislelizumab, with or without TAE (referred to as the THLP or HLP group), between January 2019 and February 2022 across four medical centers in China. The outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS). The study cohort comprised 100 patients, 50 each in the THLP and HLP groups. The THLP group demonstrated a significantly superior ORR (72% vs 52%, P=0.039). However, both groups exhibited comparable DCR (88% vs 76%, P=0.118), as assessed by the modified response evaluation criteria in solid tumors. The median OS and PFS for the entire cohort were 12.5 months (95% CI, 10.9-14.8) and 5.0 months (95% CI, 4.2-5.4), respectively. The THLP group exhibited a significantly extended OS (median, 14.1 vs 11.3 months, P=0.041) and PFS (median, 5.6 vs 4.4 months, P=0.037) in comparison to the HLP group. The most frequently reported treatment-related adverse events included abdominal pain and nausea, both reported by 59% of patients. The combination of HAIC, lenvatinib, tislelizumab, and TAE was feasible in HCC patients with PVTT and high tumor burden, with tolerable safety.

Experimental study of the effects of absorbable gelatin sponge and non‑absorbable polyvinyl alcohol particle material used in transcatheter arterial embolization on liver tissues.

Hepatic trauma is a leading cause of death in major abdominal trauma, and transcatheter arterial embolization has been widely used to treat it. However, there is limited research on whether absorbable gelatin sponge (AGS) and non-absorbable polyvinyl alcohol particles (PVA) have different effects on liver tissue, making it an important area of exploration. The present study investigated this issue using animal experiments by performing transhepatic arterial embolization with AGS and PVA. The effects on normal liver tissue in rabbits were examined by detecting liver function and inflammatory indexes, conducting histopathological examination, and using western blotting to detect apoptotic proteins. There were significant differences between the AGS and PVA groups after embolization. The AGS group exhibited a trend of improvement at ~1 week after embolization, and all indicators were statistically different until day 21 compared with the PVA group. The AGS group exhibited improved repair of hepatocytes and the biliary system based on H&E staining, while the PVA group exhibited more severe necrosis of the hepatocytes and biliary system around the embolization site. The western blotting results indicated that the Bcl-2/Bax ratio decreased on day 1 and day 3, and then rebounded in the AGS group on days 7 and 21, demonstrating gradual repair of hepatocytes compared with the PVA group.

A meta-analysis and trial sequential analysis of high intensity focused ultrasound ablation combined with transhepatic arterial chemotherapy and embolization for hepatoma

The efficacy of High Intensity Focused Ultrasound Ablation(HIFU) combined with Transhepatic Arterial Chemotherapy And Embolization(TACE) versus TACE alone in the treatment of hepatoma was evaluated by meta-analysis and trial sequential analyses(TSA). Pubmed, Cochrane, Embase, Web of Science, Scoups and CNKI, CQVIP, Wanfang Data(China National Knowledge Infrastructure) databases were searched from database construction to April 2022, and randomized controlled trials were included. Revman and Stata software were used for meta-analysis of tumor changes, survival rate, laboratory indicators and adverse reactions in the included studies, and TSA0.9 was used for sequential analysis. Grade Pro was also used to evaluate the included indicators. Twelve studies were included with a sample size of 1025 cases. Meta-analysis showed that the tumor response rate in the combined treatment group was 1.54 times higher than that in TACE alone (OR: 2.54; 95%CI:1.81-3.57) and the 6-month to 5-year survival rate was 1-4 times higher, with statistically significant differences (P<0.05). Subgroup analysis showed that country, pathological type and study type were the sources of heterogeneity. Egger results showed that there was no publication bias (95%CI: -1.333, 3.552; Ppublication=0.276), and the sensitivity analysis results were reliable. TSA results suggest that there may be false positive results, which need to be further confirmed by more studies. Grade evaluation results indicated that the quality of evidence for response rate and one-year survival was low. HIFU combined with TACE has better efficacy in the treatment of hepatoma, which is worthy of promotion. However, there may be false positive results in this study, which needs to be further verified by more extensive and more tests.

Hepatic epithelioid hemangioendothelioma: Clinical characteristics, diagnosis, treatment, and prognosis.

BACKGROUNDHepatic epithelioid hemangioendothelioma (HEHE) is a rare hepatic vascular tumor with unpredictable malignant potential. The etiology, characteristics, diagnosis, treatment, and prognosis of HEHE are not well-understood, and large-scale retrospective studies are required to understand better this disease.AIMTo determine the characteristics of HEHE and identify its optimal treatments and prognostic factors.METHODSThe clinical data of two patients diagnosed with HEHE at the Fourth Hospital of Hebei Medical University and 258 previously reported cases retrieved from the China National Knowledge Infrastructure and PubMed databases between 1996 and 2021 were combined and summarized. All cases were pathologically identified as HEHE. Information such as clinical features, laboratory examination findings, imaging findings, pathological characteristics, treatment, and survival periods was reviewed. Kaplan-Meir curves were used for survival analysis. Prognostic factors were identified by Cox regression analysis.RESULTSHEHE primarily affected middle-aged women. The typical manifestations included epigastric pain, hepatosplenomegaly, inappetence, distension, weight loss, and fatigue. Tumor markers were expressed normally. The incidence of extrahepatic metastasis was 34.5% at the time of diagnosis. The most common sites of extrahepatic involvement were the lungs (22.3%), lymph nodes (5.6%), peritoneum (3.6%), bones (6.6%), and spleen (5.1%). Furthermore, “capsular retraction”, “target sign”, and “lollipop sign” were the characteristic features of HEHE on imaging. The immunohistochemical profile for HEHE (expression of vascular markers, such as factor VIII-related antigen, CD31, and CD34; expression levels of D2-40) can facilitate and ensure an accurate diagnosis. The management options for patients with HEHE include liver resection (29.7%), liver transplantation (16.1%), palliative treatments (12.7%), transhepatic arterial chemotherapy and embolization (TACE, 10.2%), chemotherapy (11.0%), antiangiogenic therapy (15.3%), and other treatments (5.1%); the mean survival time was 158.6, 147.3, 4.2, 90.8, 71.4, 83.1, and 55.0 mo, respectively. The survival time of patients who underwent surgical treatment was longer than that of patients who did not. TACE and antiangiogenic therapy tended to prolong survival compared with other nonsurgical treatments. The 1-, 5-, and 10-year survival rates were 82%, 71%, and 64%, respectively. Multivariate analysis showed that liver function (P = 0.045), intrahepatic metastasis (P = 0.029), and treatment (P = 0.045) were independent prognostic factors. The presence of extrahepatic metastases was not an independent risk factor for poor prognosis (P = 0.558).CONCLUSIONThe clinical course of HEHE is rare and variable, and patients with intrahepatic metastases and liver dysfunction may have a poorer prognosis than those without. Surgical intervention, whether liver resection or transplantation, might be warranted regardless of extrahepatic metastasis. For patients without the option for surgery, clinicians should consider the use of TACE with antiangiogenic drugs in the treatment of HEHE.

A clinical trial of super-stable homogeneous lipiodol-nanoICG formulation-guided precise fluorescent laparoscopic hepatocellular carcinoma resection

BackgroundApplying traditional fluorescence navigation technologies in hepatocellular carcinoma is severely restricted by high false-positive rates, variable tumor differentiation, and unstable fluorescence performance.ResultsIn this study, a green, economical and safe nanomedicine formulation technology was developed to construct carrier-free indocyanine green nanoparticles (nanoICG) with a small uniform size and better fluorescent properties without any molecular structure changes compared to the ICG molecule. Subsequently, nanoICG dispersed into lipiodol via a super-stable homogeneous intermixed formulation technology (SHIFT&nanoICG) for transhepatic arterial embolization combined with fluorescent laparoscopic hepatectomy to eliminate the existing shortcomings. A 52-year-old liver cancer patient was recruited for the clinical trial of SHIFT&nanoICG. We demonstrate that SHIFT&nanoICG could accurately identify and mark the lesion with excellent stability, embolism, optical imaging performance, and higher tumor-to-normal tissue ratio, especially in the detection of the microsatellite lesions (0.4 × 0.3 cm), which could not be detected by preoperative imaging, to realize a complete resection of hepatocellular carcinoma under fluorescence laparoscopy in a shorter period (within 2 h) and with less intraoperative blood loss (50 mL).ConclusionsThis simple and effective strategy integrates the diagnosis and treatment of hepatocellular carcinoma, and thus, it has great potential in various clinical applications.

Therapeutic effectiveness and safety of sintilimab-dominated triple therapy in unresectable hepatocellular carcinoma

Immune checkpoint inhibitor therapy has shown promising results in patients with unresectable hepatocellular carcinoma. This study aimed to evaluate the effectiveness and safety of sintilimab, a programmed cell death protein-1 (PD-1) blockade, combined with sorafenib and transhepatic arterial chemotherapy and embolization in this patient population, compared with sintilimab monotherapy and sintilimab-sorafenib duotherapy. This was a 22 months single center retrospective cohort study in China. 80 patients with unresectable hepatocellular carcinoma were included, with diagnosis confirmed by either histologic, cytologic or diagnostic imaging analysis. The patients were divided into three groups based on therapeutic regimen: sintilimab monotherapy (sintilimab group, n = 22), sintilimab-sorafenib duotherapy (duplex group, n = 23), sintilimab-sorafenib and transcatheter arterial chemoembolization combined therapy (triple group, n = 35). The principal evaluation criteria were overall survival and progression free survival in the population, assessed according to response evaluation criteria in solid tumors, version 1.1 (RECIST 1.1). Secondary evaluation criteria were safety, objective response rate and disease control rate. From March 1st, 2019 to December 31, 2020, 80 patients with unresectable hepatocellular carcinoma were included and divided into three treatment groups (22 received sintilimab monotherapy, 23 received sintilimab-sorafenib duotherapy, and 35 received sintilimab-sorafenib combined with transcatheter arterial chemoembolization). The median overall survival of all patients was 11.0 months (95% CI 7.7–14.3). Median overall survival was 13.0 months (95% CI NE–NE), 9.0 months(95% CI 6.3–11.7)and 3.0 months (95% CI 1.9–4.1, p < 0.0001) in the triple therapy, duplex and sintilimab groups respectively, while the corresponding median progression-free survival were 5.0 months (95% CI 2.9–7.1, p < 0.001), 4.0 months (95% CI 2.8–5.2) and 2.0 months (95% CI 1.7–2.3). Disease control and clinical benefits rates were higher in the triple therapy group (80%, 95% CI 63.1–91.6, p < 0.001; 54.3%, 95% CI 36.6–71.2, p < 0.01) compared to the sintilimab group. Median duration of disease control was 4.0 months (95% CI NE–NE, p < 0.01) in the triple therapy group, longer than that of the duplex group (2.0 months, 95% CI 0.9–3.1) and sintilimab group (2.0 months, 95% CI 0.8–3.2). Grade 3 or 4 treatment-related adverse events occurred in 26.3% of 80 patients with hypertension was the most common event observed (38, 47.5%), however, other severe toxic effects were infrequent. Sintilimab combined with sorafenib and transcatheter arterial chemoembolization might have more beneficial effects on overall and progression-free survival and on the duration of disease control outcomes than both sintilimab monotherapy and sintilimab-sorafenib duotherapy in patients with unresectable hepatocellular carcinoma. This triple therapy model might represent an innovative and effective option for inoperable liver cancer.

Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma: A Propensity Score Analysis

Background and AimsThere are no comparative studies on the efficacy of hepatic resection (HR) and CyberKnife stereotactic body radiation therapy (CK-SBRT) plus transhepatic arterial chemotherapy embolization (TACE) in the treatment of large hepatocellular carcinoma (HCC). Therefore, this study aimed to compare the efficacy of HR and CK-SBRT+TACE in large HCC.MethodsA total of one hundred and sixteen patients were selected from November 2011 to December 2016. Among them, 50 were allocated to the CK-SBRT+TACE group and 66 were allocated to the HR group. The Kaplan-Meier method was applied to calculate overall survival (OS) and progression-free survival (PFS) rates. Propensity score matching was performed to control for baseline differences between the groups.ResultsThirty-six paired patients were selected from the CK-SBRT+TACE and HR groups. After propensity score matching, the 1-, 2- and 3-year OS rates were 83.3%, 77.8% and 66.7% in the HR group and 80.6%, 72.2% and 52.8% in the CK-SBRT+TACE group, respectively. The 1-, 2- and 3-year PFS rates were 71.6%, 57.3% and 42.3% in the HR group and 66.1%, 45.8% and 39.3% in the CK-SBRT+TACE group, respectively (OS: p=0.143; PFS: p=0.445). Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS.ConclusionsCK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion. Moreover, the liver injury occurrence rate was acceptable in both groups.

Transhepatic arterial embolization with superparamagnetic iron oxide and lipiodol for the treatment of VX2 tumor in rabbits

To evaluate the feasibility and therapeutic efficacy of transhepatic arterial embolization with superparamagnetic iron oxide (SPIO) and lipiodol (LIP) for the treatment of VX2 tumor in rabbits. Methods: Twenty-four rabbits with hepatic VX2 tumors by surgical implantation were randomly divided into 4 groups and treated with transhepatic arterial embolization of 4 different agents as follows (n=6 each): doxorubicin (DOX) group, DOX-LIP group, SPIO-DOX group, and SPIO-DOX-LIP group. Liver function (AST and ALT) was measured at 0, 1, 3, 5 and 7 d after transhepatic arterial embolization. The serum DOX level was measured at 0, 5, 15, 30, 60, and 120 minutes after transhepatic arterial embolization. MRI was performed at 7 d after the treatment to assess the distribution of SPIO in the SPIO-DOX group and SPIO-DOX-LIP group, while CT was performed to assess the distribution of LIP in the DOX-LIP group and SPIO-DOX-LIP group. All the rabbits were sacrificed and their livers were removed at 7 d after treatment for the detection of tissue DOX level. The histopathologic examinations were performed including HE staining, Prussian blue staining and TUNEL assay, and then the tumor necrosis percentage and apoptosis index were calculated. Results: Compared to the DOX group, the levels of AST and ALT in other 3 groups were significantly elevated at 1 and 3 d after embolization (P<0.05). The levels of ALT and AST in the DOX group, DOX-LIP group or SPIO-DOX-LIP group returned to the baseline at day 7, there were no significant differences (P>0.05). The SPIO-DOX-LIP group exhibited the lowest serum DOX level at all time points up to 120 minutes after embolization (P<0.05). However, the tissue DOX level in the SPIO-DOX-LIP group was the highest among all groups at day 7 (P<0.05). The SPIO-DOX group and SPIO-DOX-LIP group showed significantly lower MRI signal intensity of tumors in T2 weighted imaging (T2WI) at day 7. Meanwhile DOX-LIP group and SPIO-DOX-LIP group showed that high-density lipiodol was deposited in the tumors in CT images. Histopathologic findings showed an almost complete central necrosis coagulation of tumors in the SPIO-DOX-LIP group, and the tumor necrosis percentage and tumor apoptosis index were significantly increased in the SPIO-DOX-LIP group compared to those in other 3 groups (P<0.05). Conclusion: This novel drug-delivery system of SPIO nano-drug carrier together with LIP is safe and feasible when it is used for transhepatic arterial embolization for liver tumor. It provides an excellent MR and CT visualization and improves the therapeutic efficacy for the treatment of rabbit VX2 liver tumor.

Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor.

The hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT) usually have no specific clinical symptoms at early stages. HCC with BDTT was usually misdiagnosed when the intrahepatic tumor was small, even undetectable.In this study, 5 cases of HCC with BDTT misdiagnosed as choledocholithiasis and cholangitis in the local hospital are described. We analyzed retrospectively and summarized our experiences of these 5 HCC patients with BDTT misdiagnosed in the local hospital during the past 5 years. The diagnosis, treatment, and outcome of the patients are discussed.Three patients underwent hepatectomy with thrombectomy and T-tube drainage. One patient underwent hepatectomy with the resection of the common bile duct and hepatojejunostomy, and palliative surgery was performed in 1 patient with portal vein tumor thrombus and intrahepatic metastasis. The patients were followed for 6–22 months; 4 patients died of tumor recurrence and metastasis or hepatic failure, despite 3 of these patients having received transhepatic arterial chemotherapy and embolization or radiofrequency ablation therapy.Early and accurate diagnosis of HCC with BDTT is very important. When patients have a history of abnormal recurrent cholangitis, HCC with BDTT should be highly suspected. Intraductal ultrasonography (US), intraoperative US, and histopathological examination are very valuable for the diagnosis. The prognosis of HCC patients with BDTT is dismal. Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

Systemic review of hepatocellular carcinoma in northeast China

Aims: To investigate the associated factors of the etiology of hepatocellular carcinoma(HCC) in Northeast China, to guide clinical treatment and reduce the occurrence and development of HCC.Methods: Retrospective analysis of a prospective database identified patients with HCC in northeast China who underwent multi-disciplinary consultation from 2010 to 2011.Results:Three hundred and sixty seven patients of HCC were included in the study. In these cases, male：302(82.3%), female: 65(17.7%), ratio is 4.65:1,and the incidence is higher in man(P< 0.01).Minimum age 24,maximum age 81,with mean age 55, patients above 40 years old are apparently more than patients below 40 years old(340(92.6%)vs 27(7.4%),P< 0.01). Twenty seven patients(7.4%)have hepatitis and 333 patients(90.7%)have liver cirrhosis, with 11 patients(3.0%)with no hepatic diseases(P< 0.01). Two hundred and sixty eight patients(73.0%)have HBV infection, 64 patients(17.4%)have HCV infection, 5 patients(1.36%) have HBV and HCV coinfection, 11 patients(3.0%)have alcoholic disease, 5 patients(1.36%)have HBV infection and alcoholic disease, 1 patient(0.27%)has HCV infection and alcoholic disease and 2 patients(0.54%)are diagnosed as PBC.There are more patients with HBV infection than others(P< 0.01). After multi-disciplinary consultation, 28(7.63%)underwent surgical treatment,45(12.3%) underwent radiofrequency ablation(RFA), 83(22.6%) underwent transhepatic arterial chemotherapy and embolization (TACE), 5(1.36%) underwent molecular targeted therapy,2(0.54%) underwent TACE and molecular targeted therapy together, 60(16.3%) underwent conservative medical therapy,1(2.72%) underwent radiotherapy, 1(2.72%) underwent Hydrogen argon knife therapy,143(39%) don't receive therapy for a variety of reasons. The number of Patients who underwent surgery, TACE and RFA is obviously more than the number of patients who underwent other therapies(156 vs 67, P< 0.01).Conclusions: In northeast china, there are more male patients with HCC than female, and more patients above 40 years old than below 40 years old. Patients with liver cirrhosis are more susceptible to HCC than hepatitis and other liver diseases. HBV infection is a high risk factor. The main treatment methods are still surgery radiofrequency ablation and interventional treatment. Aims: To investigate the associated factors of the etiology of hepatocellular carcinoma(HCC) in Northeast China, to guide clinical treatment and reduce the occurrence and development of HCC. Methods: Retrospective analysis of a prospective database identified patients with HCC in northeast China who underwent multi-disciplinary consultation from 2010 to 2011. Results:Three hundred and sixty seven patients of HCC were included in the study. In these cases, male：302(82.3%), female: 65(17.7%), ratio is 4.65:1,and the incidence is higher in man(P< 0.01).Minimum age 24,maximum age 81,with mean age 55, patients above 40 years old are apparently more than patients below 40 years old(340(92.6%)vs 27(7.4%),P< 0.01). Twenty seven patients(7.4%)have hepatitis and 333 patients(90.7%)have liver cirrhosis, with 11 patients(3.0%)with no hepatic diseases(P< 0.01). Two hundred and sixty eight patients(73.0%)have HBV infection, 64 patients(17.4%)have HCV infection, 5 patients(1.36%) have HBV and HCV coinfection, 11 patients(3.0%)have alcoholic disease, 5 patients(1.36%)have HBV infection and alcoholic disease, 1 patient(0.27%)has HCV infection and alcoholic disease and 2 patients(0.54%)are diagnosed as PBC.There are more patients with HBV infection than others(P< 0.01). After multi-disciplinary consultation, 28(7.63%)underwent surgical treatment,45(12.3%) underwent radiofrequency ablation(RFA), 83(22.6%) underwent transhepatic arterial chemotherapy and embolization (TACE), 5(1.36%) underwent molecular targeted therapy,2(0.54%) underwent TACE and molecular targeted therapy together, 60(16.3%) underwent conservative medical therapy,1(2.72%) underwent radiotherapy, 1(2.72%) underwent Hydrogen argon knife therapy,143(39%) don't receive therapy for a variety of reasons. The number of Patients who underwent surgery, TACE and RFA is obviously more than the number of patients who underwent other therapies(156 vs 67, P< 0.01). Conclusions: In northeast china, there are more male patients with HCC than female, and more patients above 40 years old than below 40 years old. Patients with liver cirrhosis are more susceptible to HCC than hepatitis and other liver diseases. HBV infection is a high risk factor. The main treatment methods are still surgery radiofrequency ablation and interventional treatment.

Chemoembolization and Radioembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) continues to represent a major worldwide problem. Although treatments such as resection, transplantation, and ablation may provide a chance for a cure, these options are often precluded because of advanced disease presentation. Palliative treatments include transarterial embolization and systemic therapies. This review will summarize the state of the science for embolic therapies in HCC (conventional and drug-eluting chemoembolization, radioembolization) as well as discuss related topics including HCC staging, assessment of response, and ongoing clinical trials.

Comparison of transcatheter arterial chemoembolization and microsphere embolization for treatment of unresectable hepatocellular carcinoma: a meta-analysis

Survival of patients with surgically unresectable hepatocellular carcinoma (HCC) is very poor due to the limited effective treatments available. Transhepatic arterial chemoembolization (TACE) and microsphere embolization may offer hope for such patients; however, to date, their efficacy has not been evaluated. This study was designed to compare the effectiveness of these two treatments for patients with unresectable HCC. This meta-analysis searched literature using various databases and revealed 13 studies on surgically unresectable HCC patients treated with TACE or microsphere embolization. Response rate, 1-year survival, overall survival, and time to progression were then analyzed and compared. These thirteen studies included 597 and 1,233 patients with unresectable HCC for microsphere embolization and chemoembolization treatments, respectively. The data showed that microsphere embolization therapy was significantly better for longer overall survival, 1-year survival, longer time to progression, and complete or partial response rate than that of chemoembolization treatment. These data demonstrated that microsphere embolization treatment of patients with surgically unresectable HCC provided much better survival and treatment response than that of TACE.

Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway

Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53-126 days after TAE in five patients and 74 days after EVL in one patient. When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.

Quality Improvement Guidelines for Transhepatic Arterial Chemoembolization, Embolization, and Chemotherapeutic Infusion for Hepatic Malignancy

Quality Improvement Guidelines for Transhepatic Arterial Chemoembolization, Embolization, and Chemotherapeutic Infusion for Hepatic Malignancy

Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model

Purpose To evaluate the therapeutic effect of heated (60 °C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. Materials and methods Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2–3 cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 °C) (1 mL), lipiodol (60 °C) (1 mL) or control (physiological saline (37 °C) (1 mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. Results The tumor growth rate in the lipiodol (60 °C) group (0.92 ± 0.21, tumor volume from 1811 ± 435 to 1670 ± 564 mm 3) was significantly lower than that in the control group (3.48 ± 1.17, tumor volume from 1808 ± 756 to 5747 ± 1341 mm 3) ( P < 0.05) and in the doxorubicin-lipiodol (37 °C) group (1.69 ± 0.26, tumor volume from 1881 ± 641 to 2428 ± 752 mm 3) ( P < 0.05). Consequently, the survival period of the animals in the lipiodol (60 °C) group (41.0 ± 3.0 days) was significantly greater than that in the doxorubicin-lipiodol (37 °C) group (38.0 ± 2.5 days) ( P < 0.05). On the other hand, there was no statistically significant difference in serum AST levels between the lipiodol (60 °C) group (148.2 ± 11.3 U L −1) and the doxorubicin-lipiodol (37 °C) group (139.7 ± 12.3 U L −1) ( P > 0.05). However, the serum AST level in the lipiodol (60 °C) group was significantly higher at 4 days after injection ( P < 0.05) than in the control group (68.6 ± 6.6 U L −1). Conclusions Treatment with lipiodol (60 °C) resulted in an effect on serum AST levels similar to that caused by treatment with doxorubicin-lipiodol (37 °C). Thus, lipiodol (60 °C) treatment could greatly prolong the survival period of rabbits with VX2 cancer by inhibiting tumor growth.

Emergency percutaneous treatment in iatrogenic hepatic arterial injuries

The purpose of this report is to present our experience in the emergency percutaneous treatment of patients with iatrogenic hepatic arterial injury (IHAI). Seven patients (six men, one woman; age range 19-78 years; mean age 63 years) with IHAI secondary to surgical or percutaneous procedures were treated with endovascular percutaneous procedures. We performed six transhepatic arterial embolization (TAE) and one placement of an endograft stent. Follow-up was carried out by ultrasound (US) or computed tomography (CT) after 1, 3, 6, and 12 months, yearly thereafter and by laboratory tests in the first 6 months to completely exclude occult and asymptomatic bleeding. All procedures had 100% technical success. No case of further bleeding was seen at follow-up. In one patient, we detected one abscess after 3 weeks, which was treated by antibiotic therapy. In conclusion, endovascular treatment currently represents a valid option in emergency settings, as it the enables diagnosis and treatment of IHAI in a single session.

Quality Improvement Guidelines for Transhepatic Arterial Chemoembolization, Embolization, and Chemotherapeutic Infusion for Hepatic Malignancy

THE membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies as well as the institutional affiliations and professional credentials of the authors of this document are available upon request from SIR, 3975 Fair Ridge Dr, Suite 400 North, Fairfax, VA 22033.

Functional CT Quantification of Tumor Perfusion after Transhepatic Arterial Embolization in a Rat Model

To quantify tumor perfusion after transcatheter arterial embolization (TAE) with functional computed tomography (CT) and to validate the reproducibility of quantification measurements. This study was conducted in accordance with an institutional animal care and use committee-approved protocol. Sixteen rats with liver tumors underwent TAE with 1 mg (group 1) or 3 mg (group 2) of polyvinyl alcohol particles. In each group, four rats underwent functional CT immediately after TAE (day 0) and four others underwent functional CT 2 days after TAE (day 2). Another four rats served as control rats. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product were measured by using a functional CT software program. For evaluation of reproducibility, six additional rats with mammary tumors underwent functional CT twice, with examinations 2 hours apart. The mixed-effect model was used to assess the TAE treatment effect, and the Pearson correlation test was used to determine measurement reproducibility. With the exception of BF in group 1 on day 2 (P = .41), BF and BV values in both groups on both days were significantly lower than BF and BV values in the control rats (with P values ranging from .018 to <.001). BF was significantly lower in group 2 than in group 1 on days 0 and 2 (P = .043 and P = .02, respectively). BV was significantly lower on day 2 than on day 0 in group 2 (P = .016). MTT was generally inversely related to BF. MTTs in group 2 on days 0 and 2 were significantly longer than those in the control rats (P < .001 and P = .03, respectively), and MTT was shorter on day 2 than on day 0 in group 2 (P = .02). Permeability-surface area product changes were similar to BF changes. There were no significant differences (P values ranged from .2 to .5) between perfusion parameters in the reproducibility study. The results of this study validate the use of functional CT in the quantification of tumor perfusion after TAE and the reproducibility of such quantification measurements.