Primary treatment of hepatocellular carcinoma by arterial chemoembolization

Bismuth, H; Morino, Mario; Sherlock, David; Castaing, Denis; Miglietta, C; Cauquil, P; Roche, Alain

doi:10.1016/0002-9610(92)90039-t

Cited by 257 publications

(133 citation statements)

References 25 publications

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“…Unfortunately, we are unable to comment on the prevalence of intimal dissection in our study. In summary, the study by Panaro et al provides insight into the underlying mechanisms of arterial wall injury induced by TACE, 5 and our findings provide the clinical correlation to these histologic findings.…”

supporting

confidence: 69%

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Goel

Terrault

2015

Liver Transpl

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supporting

confidence: 69%

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Goel

Terrault

2015

Liver Transpl

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“…One to three treatments by arterial chemoembolization using doxorubicin according to a protocol reported previously by us (Bismuth et al, 1992), were performed in 105 patients. All the patients were tested for presence of circulating anti-p53 antibodies at least once before beginning chemotherapy.…”

Section: Study Populationmentioning

confidence: 99%

Clinical significance of circulating anti-p53 antibodies in European patients with hepatocellular carcinoma

et al. 1999

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Summary p53 alterations are considered to be predictive of poor prognosis in hepatocellular carcinoma (HCC) and may induce a humoral response. Anti-p53 serum antibodies were assessed by enzyme-linked immunosorbent assay (ELISA) using purified recombinant human p53 on 130 European HCC patients before treatment and during the clinical course of the disease. p53 immunohistochemistry was performed on tumours from the 52 patients who underwent surgery, and DNA sequencing analysis was initiated when circulating anti-p53 antibodies were detected. Nine (7%) HCC patients had anti-p53 serum antibodies before treatment. During a mean period of 30 months of follow-up, all the negative patients remained negative, even when recurrence was observed. Of the nine positive patients, eight were still positive 12-30 months after surgery. The presence of anti-p53 serum antibodies was correlated neither with mutation of the p53 gene nor the serum alphafetoprotein levels and clinicopathological characterics of the tumours. However, a greater incidence of vascular invasion and accumulation of p53 protein were observed in the tumours of these patients (P < 0.03 and P < 0.01 respectively) as well as a better survival rate without recurrence (P = 0.05). In conclusion, as was recently shown in pancreatic cancer, anti-p53 serum antibodies may constitute a marker of relative 'good prognosis' in a subgroup of patients exhibiting one or several markers traditionally thought to be of bad prognosis.

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Section: Commentsmentioning

confidence: 99%

“…TACE was first investigated retrospectively in patients with unresectable HCC and appeared to improve survival compared with patients who had no treatment. [3][4][5] Two prospective randomized trials of TACE for unresectable HCC showed no survival benefit. 6,7 Unfortunately, the variety of chemotherapeutic agents and techniques used in these studies makes the results difficult to interpret.…”

Section: Commentsmentioning

confidence: 99%

“…8 Bismuth et al reported that 29% of those receiving chemotherapy with LT or LR had clinical downstaging (defined as a decrease in the maximum diameter of tumor on CT imaging by 25% or more.) 4 Unfortunately, downstaging did not specifically correlate with tumor necrosis as examination of pathologic specimens in Bismuth' s series revealed 74% of patients had 50% to 100% necrosis of tumor.The recent publication by Majno et al from Paris describes a nonrandomized, retrospective study of surgical therapy in 197 patients with HCC. Chemoembolization was performed as preoperative treatment in 63% of patients undergoing liver resection and in 49% of patients undergoing liver transplantation.…”

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confidence: 99%

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Without victory there is no survival: Transarterial lipiodol chemoembolization and hepatocellular carcinoma

Sudan

Schafer

et al. 1998

Hepatology

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OBJECTIVE: To investigate the impact of preoperative transarterial lipiodol chemoembolization (TACE) in the management of patients undergoing liver resection or liver transplantation for hepatocellular carcinoma. PATIENTS AND METHODS: TACE was performed before surgery in 49 of 76 patients undergoing resection and in 54 of 111 patients undergoing liver transplantation. Results were retrospectively analyzed with regard to the response to treatment, the type of procedure performed, the incidence of complications, the incidence and pattern of recurrence, and survival. ). Multivariate analysis of the factors associated with response to TACE showed that downstaging occurred more frequently for tumors G 5 cm. CONCLU-SIONS: Downstaging or total necrosis of the tumor induced by TACE occurred in 62% of the cases and was associated with improved disease-free survival both after liver resection and transplantation. In liver resection, TACE was also useful to improve the resectability of primarily unresectable tumors. In liver tranplantation, downstaging in patients with tumors G 3 cm was associated with survival similar to that in patients with less extensive disease. COMMENTSHepatocellular carcinoma (HCC) can only be cured by surgical resection or liver transplantation. Resection has generally been considered first line therapy, with transplantation being reserved for patients with tumors that are unresectable because of location or severity of underlying liver disease. Both surgical approaches have inherent limitations because most patients with HCC have locally advanced or metastatic disease at the time of diagnosis. An additional limitation of liver transplantation is the scarcity of donor organs and long waiting times between diagnosis and treatment. Liver resection (LR) and liver transplantation (LT) can offer patients with HCC a 1-year survival of 66% to 70%; this is better than no treatment, but recurrence is frequent and 5-year survival is poor (35% after LR and 31% after LT). 1 In an attempt to increase survival in patients with unresectable HCC, systemic chemotherapy, radiation therapy, and hepatic arterial infusion of chemotherapy have been investigated. As a whole, these modalities have shown no survival advantage and are associated with substantial morbidity. One promising nonsurgical therapy for HCC is percutaneous ethanol injection (PEI); however, the efficacy of PEI is limited to tumors smaller than 3 cm in diameter that can be identified radiographically and accessed percutaneously. 2 Transarterial chemoembolization (TACE) involves the administration of a chemotherapeutic agent (usually doxorubicin, mitomycin C, or cisplatin) into the hepatic artery followed by hepatic artery embolization (usually with gelatin sponge). In some cases an oily contrast medium, lipiodol, is also administered. Lipodiol is selectively retained by neoplastic tissue for an extended period of time and may enhance visualization of small satellite lesions. As liver tumors preferentially receive their blood supply from the he...

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Primary treatment of hepatocellular carcinoma by arterial chemoembolization

Cited by 257 publications

References 25 publications

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Clinical significance of circulating anti-p53 antibodies in European patients with hepatocellular carcinoma

Without victory there is no survival: Transarterial lipiodol chemoembolization and hepatocellular carcinoma

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