Chemoembolization of Hepatic Neoplasms: Safety, Complications, and When to Worry

Gates, Julia; Hartnell, George G.; Stuart, Keith; Clouse, Melvin E.

doi:10.1148/radiographics.19.2.g99mr08399

Cited by 120 publications

(54 citation statements)

References 26 publications

(32 reference statements)

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“…20 Hence, the presence of portal vein occlusion with or without hepatofugal flow was considered to be a significant contraindication in selection of patients for TAE and TACE therapy when these treatment modalities were first introduced. 5,[21][22][23] Clinical experience has shown that intraarterial hepatic regional therapies can be performed in the presence of PVT. Investigators have demonstrated that TACE can be performed safely in patients with PVT and cavernous transformation or patients with partial portal vein occlusion and hepatopedal flow providing modified techniques are used such as (1) low-dose, segmental; or (2) use of partial arterial occlusion as the endpoint.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Kulik¹,

Carr²,

Mulcahy³

et al. 2007

Hepatology

550

349

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This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization with Yttrium ( 90 Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Kulik¹,

Carr²,

Mulcahy³

et al. 2007

Hepatology

550

349

View full text Add to dashboard Cite

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“…Although the exact rate of cystic artery embolization remains controversial, recent reports have stated a much lower rate of 14% [12]. Though technological advancements in imaging equipment and familiarity with the procedure may account for some of the discrepancy, initial reports may have overstated the risks.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis

Patti

Neeman

Wood

2003

CardioVascular and Interventional Radiology

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Initial reports have suggested that proximity of liver tumors to the gallbladder may increase the risk for cholecystitis after radiofrequency ablation. A colon adenocarcinoma metastasis to the liver in contact with the gallbladder was successfully treated with radiofrequency ablation without subsequent cholecystitis. KeywordsCholecystitis; Radiofrequency ablation; RFA; Gallbladder; Liver Radiofrequency ablation is quickly becoming a valuable option in the treatment of certain unresectable liver tumors. Recent studies have shown the cost effectiveness [1], relatively low complication rates [2] and short hospital stays associated with thermal ablation. Early results suggest a high rate of local control of small or isolated liver lesions [3,4]. Local application of radiofrequency to tissue can create a controlled and predictable area of coagulation necrosis with little collateral damage. Currently, pre-procedural imaging studies are used to determine the spatial relationship of the tumor to organs such as gallbladder, diaphragm, major vessels and bowel. Proximity of tumor to adjacent structures often influences the treatment plan. Although no controlled clinical studies have directly assessed the risk of cholecystitis after ablations adjacent to the gallbladder, reports of post-ablative cholecystitis have been influential in planning the treatment of liver tumors [3,4]. Some have noted that when treating tumors adjacent to the gallbladder and bowel, an open or laparoscopic technique provides the ability to mobilize adjacent vital structures away from the treatment area, thus decreasing the risk [4][5][6]. A more recent report by Chopra et al. [5], demonstrated in 8 patients who were followed for a mean of 8 months, that radiofrequency ablation near the gallbladder is feasible and appears to be safe. Case ReportA 58-year-old man with a history of T3N1M1 adenocarcinoma of the colon presented with metastases to the liver 10 months after diagnosis and subsequent right hemicolectomy. Surgical history included a left thoracotomy for the repair of a hiatal hernia and duodenal ulcer 33 years prior to admission. The patient had no history of liver disease or alcoholism. MRI and CT of the liver revealed a small (1 cm) hypervascular enhancing lesion adjacent to the gallbladder within the right lobe of the liver (Fig. 1) and a smaller (>1 cm) lesion in the posterior aspect of the right lobe of the liver.

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“…Furthermore, the medical team caring for the patient must be well-versed in possible complications and likely toxicities in order to help the patient during a difficult recovery [123]. Careful selection of appropriate patients should be done to restrict the procedure to those who are likely to tolerate it and benefit from such an aggressive intervention.…”

Section: Resultsmentioning

confidence: 99%

Chemoembolization in the Management of Liver Tumors

Stuart

2003

The Oncologist

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The dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver.While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations. The Oncologist 2003;8:425-437 The Oncologist 2003;8:425-437 www.TheOncologist.com

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Chemoembolization of Hepatic Neoplasms: Safety, Complications, and When to Worry

Cited by 120 publications

References 26 publications

Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis

Chemoembolization in the Management of Liver Tumors

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