Transcatheter Oily Chemoembolization for Unresectable Malignant Liver Tumors in Children

Optimal Strategy of Preoperative Transcatheter Arterial Chemoembolization for Hepatoblastoma

“…3,20,22 Iodized oil, which was originally an oily lymphographic contrast medium, was found to selectively accumulate and remain in the tumor tissue and to induce microembolization of the tumor vasculature when injected into the tumor feeding artery. 3,4,14,[17][18][19][20][21] The selective accumulation of iodized oil in the tumor is considered to be due to the siphoning effect created by increased blood flow in a hypervascular tumor, 17,18 and long-term retention is considered to be due to the lack of reticuloendothelial or lymphatic flow in the tumor which may inhibit the decomposition and absorption of the oil. 17,18 At least some proportion of the injected iodized oil must flow into the normal liver tissue; however, it is washed away by the blood-stream shortly after injection.…”

“…17,18 At least some proportion of the injected iodized oil must flow into the normal liver tissue; however, it is washed away by the blood-stream shortly after injection. 3,18 For the purpose of chemoembolization, this iodized oil is conjugated with an anticancer drug such as DOX, and an emulsion is made and injected. The selectively accumulated emulsion releases the anticancer drug slowly and decreases the transit time of the drug through the tumor vasculature, thus resulting in an increased local concentration, local retention time, and tumor contact time of the drug.…”

“…Consequently, preoperative TACE for the patients with distant metastases could not improve their prognoses. The effect of TACE is limited to controlling a primary tumor confirmed in the liver, 3,4 which is one of its pitfalls; therefore, the complete eradication of distant metastases with systemic chemotherapy prior to TACE is unavoidable to employ delayed TACE as a preoperative treatment.…”

“…It is well known that the resectability of the primary tumor is the most important factor for the long-term survival of children with HB, and a complete surgical resection of the primary tumor is absolutely vital to achieve an HB cure. [1][2][3][4][5][6][7][8] However, about half of all children with HB have unresectable tumors at presentation. [3][4][5] Hepatoblastoma was previously thought to be a chemoresistive tumor similar to hepatocellular carcinoma (HCC).…”

“…[1][2][3][4][5][6][7][8] However, about half of all children with HB have unresectable tumors at presentation. [3][4][5] Hepatoblastoma was previously thought to be a chemoresistive tumor similar to hepatocellular carcinoma (HCC). As a result, an extended hepatectomy was therefore frequently attempted to achieve a complete surgical resection of the huge tumor, thus resulting in a high morbidity and mortality.…”