Standardization of conventional chemoembolization for hepatocellular carcinoma

Renzulli, Matteo; Peta, Giuliano; Vasuri, Francesco; Marasco, Giovanni; Caretti, Daniele; Bartalena, Laura; Spinelli, Daniele; Giampalma, Emanuela; D’Errico, Antonietta; Golfieri, Rita

doi:10.1016/j.aohep.2020.10.006

Cited by 32 publications

(24 citation statements)

References 36 publications

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“…All the cTACE procedures were performed by interventional radiologists with more than 15 years of experience in cTACE. The angiographic procedures were performed as described in our previous papers [ 38 , 39 ]. In particular, after microcatheter placement in tumor-feeding vessels, a mixture of 10 mL of standard iodized oil (Lipiodol ® ; Guerbet, Milan, Italy) and a 50 mg of epirubicin powder (Farmorubicin; Pfizer, Latina, Italy), manually shaken, was injected under fluoroscopic control, followed by embolization with Spongel (Spongostan, Ferrosan Medical Devices A/S, Søborg, Denmark) particles until there was complete stasis in the vessels.…”

Section: Methodsmentioning

confidence: 99%

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

Granito

Facciorusso

Sacco

et al. 2021

JPM

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The aim of the present study was to correlate laboratory data and postprocedural parameters after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) with the radiological response. The study consisted of a retrospective analysis of prospectively collected data from 70 consecutive patients who underwent cTACE. Laboratory parameters were assessed daily after cTACE and compared to pretreatment values. Post-treatment radiological response was assessed using mRECIST at one month from cTACE, and factors associated with treatment response (complete and objective response) were assessed by logistic regression analysis. The optimal cutoff points in predicting the complete response of target lesions were a 52% ALT and a 46% AST increase after cTACE compared to the pre-treatment values. Using multivariate analyses, >46% AST and >52% ALT increases with respect to the pre-treatment value were significantly correlated with the objective response (p = 0.03 and p = 0.04, respectively) and the complete response (p = 0.02 and p = 0.02, respectively). No patients experienced liver function deterioration after cTACE, and no specific treatment was required. This study showed that post-treatment transient transaminase elevation was predictive of objective response to superselective cTACE in clinical practice, representing a simple tool to guide treatment strategy of HCC patients in a tailored approach.

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Section: Methodsmentioning

confidence: 99%

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

Granito

Facciorusso

Sacco

et al. 2021

JPM

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“…Nevertheless, it was essential to demand standardization starting from the choice of anticancer agents until the embolization endpoint. 32 Many factors, including tumor size, vessel collateral and liver function, defined the dosages of the anticancer agents and the lipiodol injection. 31 , 32 To minimize impairment of non-cancerous liver tissues, small microspheres were recommended owing to running distally in the vessels to release the chemotherapeutic agent very tightly into the tumor, with the superiority in tumor response and toxic effects.…”

Section: Methodsmentioning

confidence: 99%

“… 32 Many factors, including tumor size, vessel collateral and liver function, defined the dosages of the anticancer agents and the lipiodol injection. 31 , 32 To minimize impairment of non-cancerous liver tissues, small microspheres were recommended owing to running distally in the vessels to release the chemotherapeutic agent very tightly into the tumor, with the superiority in tumor response and toxic effects. 33 Moreover, it was reported that the preparation of the lipiodol chemotherapeutic drug emulsion was required to be mixed multiple times to avoid aggregation into larger droplets, which was not conducive to terminal embolization or catheter blockage.…”

Section: Methodsmentioning

confidence: 99%

“… 33 Moreover, it was reported that the preparation of the lipiodol chemotherapeutic drug emulsion was required to be mixed multiple times to avoid aggregation into larger droplets, which was not conducive to terminal embolization or catheter blockage. 32 Enhanced CT was carried 4–6 weeks after TACE to evaluate the therapeutic effectiveness of tumor embolism. Antiemetic and liver protection treatments were routinely administered after surgery.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of the Benefits of TACE Combined with Sorafenib for Hepatocellular Carcinoma Based on Untreatable TACE (unTACEable) Progression

Zou¹,

Fan²,

Xue³

et al. 2021

CMAR

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Purpose: Outcomes after the treatment for unresectable or advanced-stage hepatocellular carcinoma (HCC) are unsatisfied. We evaluated the therapeutic benefits of a combination therapy strategy for these patients through transarterial chemoembolization (TACE) plus sorafenib. Patients and Methods: In total, 85 patients with HCC classified as intermediate and advanced stage from June 2012 to November 2017 were retrospectively investigated. We divided patients into the monotherapy (n=43; TACE alone) and combined therapy (n=42; TACE plus sorafenib) groups. Results: Compared with the TACE alone group, the TACE plus sorafenib experienced significantly prolonged progression-free survival (PFS) (mean 21 months vs 12 months; P = 0.0005) and overall survival (OS) (mean 32 months vs 21 months; P = 0.0157). The disease control rate (DCR) of TACE plus sorafenib group was 80.95%, which was significantly increased than the TACE alone group (55.81%) (P<0.05), as well as objective response rate (ORR) (23.81% vs 16.28%). Besides, the rates of liver-related AEs and liver failure in the TACE plus sorafenib group were not increased in contrast to TACE alone group, and there were no new safety concerns. To sum up, the superiority of combination therapy with significantly prolonging progression-free and overall survival was observed, meanwhile finding a significant increase in tumor response rate and manageable safety in the combined therapy in contrast to the monotherapy group. Conclusion:Based on unTACEble progression, the superiority of the combination therapy is that TACE plus sorafenib has been bringing about significantly better outcomes compared with TACE alone for HCC patients.

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“…In clinical treatment, some HCC patients are suitable for direct surgical treatment [17]; performing the surgery following transcatheter arterial embolization (TAE) was a critical combined strategy for patients with advanced HCC [18][19][20]. Lipiodol is the most common embolic agent and exerts an excellent curative effect of tumor-feeding artery embolization and better biological safety, which bene ted from the speci c uptake of lipiodol by tumor cells and in situ drug administration [21,22]. In addition, uorescent iodized emulsions could accomplish imaging-guided surgical navigation after TAE [23,24].…”

Section: Introductionmentioning

confidence: 99%

A Pure NanoICG-Based Homogeneous Lipiodol Formulation: Toward Precise Surgical Navigation of Hepatocellular Carcinoma After Long-Term Transcatheter Arterial Embolization

Zhang

Cheng

Chen

et al. 2021

Preprint

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Purpose To surmount the critical issues of clinical hepatectomy and achieve a precise surgical navigation of hepatocellular carcinoma after long-term transcatheter arterial embolization (TAE).Methods A facile and green pure-nanomedicine formulation technology was developed to construct carrier-free indocyanine green nanoparticles (nanoICG). The nanoICG was dispersed into lipiodol via a super-stable homogeneous lipiodol formulation technology (SHIFT nanoICG) for TAE combined with near-infrared fluorescence-guided precise hepatectomy.Results We demonstrate that SHIFT nanoICG integrates excellent anti-photobleaching capacity, great optical imaging properties, and specific tumoral deposition to recognize tumor regions, featuring sufficient physical stability for fluorescence-guided precise hepatectomy. Importantly, SHIFT nanoICG is capable of visualizing all lesions in rabbit-bearing VX2 orthotopic hepatocellular carcinoma models, even the tiny focus to 0.6 × 0.4 mm.Conclusion Our findings indicate that SHIFT nanoICG provides a promising avenue to address the clinical issue of hepatectomy and has excellent potential for a translational pipeline.

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Standardization of conventional chemoembolization for hepatocellular carcinoma

Cited by 32 publications

References 36 publications

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

Evaluation of the Benefits of TACE Combined with Sorafenib for Hepatocellular Carcinoma Based on Untreatable TACE (unTACEable) Progression

A Pure NanoICG-Based Homogeneous Lipiodol Formulation: Toward Precise Surgical Navigation of Hepatocellular Carcinoma After Long-Term Transcatheter Arterial Embolization

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