Chemoembolisation des hepatozellulären Karzinoms: Computertomographische Befunde und klinische Resultate bei prospektiv repetitiver Therapie

Abstract

Between April 1989 and March 1993 162 transarterial chemoembolizations (TACE) were performed repeatedly (mean interval: 2.9 months) in 52 patients with hepatocellular carcinoma (HCC): An emulsion of Lipiodol and epirubicin was injected as selectively as possible in a dosage proportional to liver function and tumour size. Before and after each TACE the size of tumours and ratio of tumour volume containing Lipiodol (RTVCL) were determined in CT and the grade of tumour vascularisation was assessed angiographically. The RTVCL increased from 58% after the first treatment to 73% after the third treatment. RTVCL and Lipiodol retention were higher in responders than in non-responders. Tumours with expansive growth pattern showed a higher response rate (56%) than infiltrating tumours (20%). Mean survival of these patients was different (19 and 8 months; p < 0.01), respectively. Survival rates of all patients were 54, 22, and 11% after 1, 2 and 3 years, respectively. Repeated TACE shows local effectiveness. Three treatments during a period of one year are recommended for patients with Child-Pugh class A cirrhosis.

Prospective Study on the Survival of HCC Patients Treated with Transcatheter Arterial Lipiodol Chemoembolization

“…The TACE usually used for the unresectable HCC to lengthen the half-life and increase the average concentration of drug in the tumor, as well as allow more dose-intense delivery in comparison with intravenous administration of chemotherapy (Raoul et al, 1992). These theoretical advantages have made TACE particularly appealing for treatment of HCC patients not amenable to surgical therapy or local ablation (Nakamura et al, 1983;Ikeda et al, 1991;Choi et al, 1992;Bruix et al, 1994;Huppert et al, 1994). Although the TACE has been used since 1983, and there was few studies provide survival benefit of TACE, one study conducted in Barcelona showed the survival probabilities at 1 and 2 years were 82% and 63% for patients who underwent TACE (Llovet et al, 2002).…”

Chemoembolisation des hepatozellulären Karzinoms: Welche Faktoren bestimmen Therapieansprechen und Überleben?

“…Zur Vermeidung kumulativer toxischer Effekte auf das Leberparenchym sind Abstände zwischen mehreren Chemoembolisationen von drei Monaten zu empfehlen. Unter diesen Bedingungen tritt keine progrediente Verschlechterung der Lebersynthesefunktion auf [29,31]. Regelhafte Wiederholungen der TACE ohne Nachweis von Resttumor sind dagegen nicht von Vorteil [32].…”

Feasibility of assessing pulmonary blood volume using C-arm CT during transpulmonary chemoperfusion and chemoembolization in primary and secondary lung tumours

“…A locally applied chemotherapeutic agent is combined with an application of microspheres and ethiodized oil to occlude tumourous arteries, leading to necrotizing tumour tissue and prolonged drug persistence. 8 Since this treatment targets the tumour blood supply, common evaluation criteria such as the criteria of the response evaluation criteria in solid tumours (RECIST) 9 may not be appropriate to assess the response to treatment. 10 That is due to the commonly recognized limitations of basic concepts of tumour measurement that do not detect early functional response.…”