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Transarterial Chemoembolization in Hepatocellular Carcinoma


Authors: M. Varga;  A. Valsamis;  I. Matia;  J. Peregrin *;  E. Honsová **;  M. Šafanda ***;  M. Oliverius
Authors‘ workplace: Klinika transplantační chirurgie IKEM, přednosta: prof. MUDr. M. Adamec, CSc. ;  Pracoviště radiodiagnostiky a intervenční radiologie IKEM, přednosta: prof. MUDr. J. Peregrin, CSc. *;  Pracoviště klinické a transplantační patologie IKEM, přednostka: MUDr. E. Honsová, Ph. D. **;  Oddělení klinické onkologie Nemocnice Na Homolce, primář: MUDr. M. Šafanda ***
Published in: Rozhl. Chir., 2009, roč. 88, č. 8, s. 434-438.
Category: Monothematic special - Original

Overview

Introduction:
Hepatocelullar carcinoma (HCC) is the fifth most common cancer in the world. It mostly occurs in patients with cirrhosis. In the Czech Republic, about 250 new cases are reported per year. Surgery, i.e. liver resection or transplantation, as the only potentially curable method is possible in 15–20% of them. For the rest, palliative treatment is indicated. This includes ablative methods (radiofrequency ablation, alcoholization), transarterial chemoembolization (TACE), systemic chemotherapy or biological treatment by sorafenib. TACE is method of choice in patients unsuitable for surgery and ablative treatment. Another indication is embolization of HCC before liver transplantation to prevent tumour progression. In combination with other methods, down staging of the tumour and curable treatment afterward is possible.

Aims:
To assess the outcome of transarterial chemoembolisation in patients with hepatocellular carcinoma.

Methods:
Between 2004–2008 we performed 30 TACE. Of that number, 28 TACE were performed in 20 patients with HCC. We super selectively catheterized the tumour via arteria femoralis and used Doxorubicin with Lipiodol as embolic material. In follow up, we carried out laboratory studies and CT.

Results:
We have not noticed any major complications. Post-embolization syndrome with fever, nausea and right upper quadrant pain occurred after 10 TACE (33%). One-, two- and three years survival of the patients was 53%, 40% a 20%.

Conclusion:
TACE is safe method prolonging patients’ survival with unresectable HCC. For the correct treatment of HCC, its concentration to cancer centres and the cooperation between multiple specialists is necessary.

Key words:
hepatocellular carcinoma – transarterial chemoembolization


Sources

1. Parkin, D. M., Bray, F., Ferlay, J., Pisani, P. Estimating the world cancer burden: Globocan 2000. Int. J. Cancer, 2001; 94(2): 153–156.

2. Donato, F., Tagger, A., Chiesa, R., et al. Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: a case-control study in Italy. Brescia HCC Study. Hepatology, 1997; 26(3): 579–584.

3. Llovet, J. M., Burroughs, A., Bruix, J. Hepatocellular carcinoma. Lancet, 2003; 362(9399): 1907–1917.

4. Ryder, S. D. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut, 2003; 52 Suppl. 3: iiil–8.

5. Jaeck, D., Bachellier, P., Oussoultzoglou, E., Weber, J. C., Wolf, P. Surgical resection of hepatocellular carcinoma. Post-operative outcome and long-term results in Europe: an overview. Liver Transpl., 2004;10 (2 Suppl. l): S58–63.

6. Llovet, J. M., Bruix, J., Gores, G. J. Surgical resection versus transplantation for early hepatocellular carcinoma: clues for the best strategy. Hepatology, 2000; 31(4): 1019–1021.

7. Llovet, J. M., Ricci, S., Mazzaferro, V., et al. Sorafenib in advanced hepatocellular carcinoma. N. Engl. J. Med., 2008; 359(4): 378–390.

8. Okuda, K., Ohtsuki, T., Obata, H., et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer, 1985; 56(4): 918–928.

9. Takayasu, K., Arii, S., Ikai, I., et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology, 2006; 131 (2): 461–469.

10. Lo, C. M., Ngan, H., Tso, W. K., et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology, 2002; 35(5): 1164–1171.

11. Llovet, J. M., Real, M. I., Montana, X., et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 2002; 359(9319): 1734–1739.

12. Belghiti, J., Carr, B. I., Greig, P. D., Lencioni, R., Poon, R. T. Treatment before liver transplantation for HCC. Ann. Surg. Oncol., 2008; 15(4): 993–1000.

13. St Peter, S. D., Moss, A. A., Huettl, E. A., Leslie, K. O., Mulligan, D. C. Chemoembolization followed by orthotopic liver transplant for epithelioid hemangioendothelioma. Clin. Transplant., 2003; 17(6): 549–543.

14. Doyon, D., Mouzon, A., Jourde, A. M., Regensberg, C., Frileux, C. [Hepatic, arterial embolization in patients with malignant liver tumours (author_transl)]. Ann. Radiol. (Paris), 1974; 17(6): 593–603.

15. Ackerman, N. B. The blood supply of experimental liver metastases. IV. Changes in vascularity with increasing tumor growth. Surgery, 1974; 75(4): 589–596.

16. Kan, Z., Ivancev, K., Lunderquist, A., et al. In vivo microscopy of hepatic tumors in animal models: a dynamic investigation of blood supply to hepatic metastases. Radiology, 1993; 187(3): 621–626.

17. Bhattacharya, S., Novell, J. R., Winslet, M. C., Hobbs, K. E. Iodized oil in the treatment of hepatocellular carcinoma. Br. J. Surg., 1994; 81(11): 1563–1571.

18. Konno, T. Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium. Cancer, 1990; 66(9): 1897–1903.

19. Nakamura, H., Hashimoto, T., Oi, H., Sawada, S. Transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology, 1989; 170(3 Pt l): 783–786.

20. Gates, J., Hartnell, G. G., Stuart, K. E., Clouse, M. E. Chemoembolization of hepatic neoplasms: safety, complications, and whento worry. Radiographics, 1999; 19(2): 399–414.

21. Ikeda, M., Maeda, S., Shibata, J., et al. Transcatheter arterial chemotherapy with and without embolization in patients with hepatocellular carcinoma. Oncology, 2004; 66(1): 24–31.

22. Maeda, S., Fujiyama, S., Tanaka, M., Ashihara, H., Hirata, R., Tomita, K. Survival and local recurrence rates of hepatocellular carcinoma patients treated by transarterial chemolipiodolization with and without embolization. Hepatol. Res., 2002; 23(3): 202–210.

23. Suzuki, M., Suzuki, H., Yamamoto, T., et al. Indication of chemoembolization therapy without gelatin sponge for hepatocellular carcinoma. Semin. Oncol., 1997; 24(2 Suppl 6): S6-110–S6-115.

24. Nerenstone, S., Friedman, M. Medical treatment of hepatocellular carcinoma. Gastroenterol. Clin. North Am., 1987; 16(4): 603–612.

25. Bronowicki, J. P., Vetter, D., Dumas, F., et al. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer, 1994; 74(1): 16–24.

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Perspectives in Surgery

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2009 Issue 8

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