Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response.

Ernst, Olivier; Sergent, Géraldine; Mizrahi, David; Delemazure, O; Paris, J. C.; L’Herminé, C

doi:10.2214/ajr.172.1.9888740

Cited by 105 publications

(53 citation statements)

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“…Seventeen patients (50%) had solitary lesions, while 12 patients (35%) had two to three lesions and five patients (15%) had more than four lesions. Regarding the maximum tumor size, the median [range] maximum [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] cm. In Group 1, eight patients died during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Patients with Hepatocellular Carcinoma Treated Solely with Transcatheter Arterial Chemoembolization: Risk Factors for One-year Recurrence and Two-year Mortality (Preliminary Data)

et al. 2013

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Objective Transcatheter arterial chemoembolization (TACE) is an essential therapy for patients with hepatocellular carcinoma (HCC) in whom administering other treatments such as liver transplantation, resection or local therapy is not feasible. The purpose of our study was to determine the independent risk factors for oneyear recurrence and two-year mortality in patients treated solely with TACE. Methods We conducted a retrospective cohort study of 34 consecutive patients (Group 1) with incident HCC who were treated solely with epirubicin-based TACE between April 2004 and March 2009. A subgroup analysis was performed among 24 patients (Group 2) who underwent complete TACE confirmed with abdominal computed tomography (CT) one month later. Tumor recurrence was evaluated using contrast CT every three months after the initial TACE. We calculated Kaplan-Meier estimates and performed a multiple regression analysis using a Cox-proportional hazard model. Results The patients in Group 1 (men, 59%), all of whom had liver cirrhosis, underwent TACE as the sole therapy for HCC. Kaplan-Meier estimates revealed a two-year survival rate [95% CI] of 70% [48-84%]. For the non-Child A patients, the adjusted hazard ratio (HR) [95% CI] for two-year survival was 7.1 [1. 06-51.7]. In Group 2, the Kaplan-Meier estimate of the one-year recurrence rate [95% CI] was 61% [42-81%]. The adjusted HRs [95% CIs] for one-year recurrence for age and indocyanine green (ICG) 15-min >30% were 1.1 [1.0-1.26] and 7.87 [1.94-45.1], respectively. Conclusion Non-Child A cirrhosis is an independent risk factor for two-year mortality in patients treated solely with TACE. For ICG 15-min >30%, careful monitoring for HCC recurrence at one year, even after complete TACE, is warranted.

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Section: Discussionmentioning

confidence: 99%

Prognosis of Patients with Hepatocellular Carcinoma Treated Solely with Transcatheter Arterial Chemoembolization: Risk Factors for One-year Recurrence and Two-year Mortality (Preliminary Data)

et al. 2013

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“…Correlation between iodized-oil CT findings and HCC lesion relapse. Complete lesions 3 23 26 Incomplete lesions 10 0 10 Total 13 23 36 20). TACE causes some degree of ischemic hepatic damage, which has the potential to lead to hepatic decompensation (21,22).…”

Section: Discussionmentioning

confidence: 99%

Role of diffusion-weighted imaging in evaluating therapeutic efficacy after transcatheter arterial chemoembolization for hepatocellular carcinoma

Kubota

Yamanishi²,

Itoh³

et al. 2010

Oncol Rep

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Abstract. The decision to repeat transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is based on correct evaluation of response to therapy. The purpose of this study was to investigate whether apparent diffusion coefficient (ADC), a quantitative parameter of diffusionweighted imaging (DWI), can predict early HCC recurrence after TACE. Results obtained using this method were compared with those using iodized-oil computed tomography (CT). DWI was performed on 25 patients with 36 HCCs before and 5-7 days after TACE to calculate the ADC of HCC. Patients were also evaluated with iodized-oil CT immediately after TACE. Contrast-enhanced CT was performed 3 months after TACE to confirm early relapse of HCC lesion. After TACE, the percent change in ADC (%ADC) from before to after therapy was significantly increased in non-relapsed lesions (85.2±12.4%) compared to relapsed lesions (8.0±56.7%, p=0.0004). However, no difference in area under the curve was seen for receiver operating characteristic analysis to predict early relapse after TACE between %ADC from DWI (95% confidence interval, 0.743-1.026) and iodized-oil CT (95% confidence interval, 0.703-1.016). ADC from DWI can evaluate the efficacy of TACE for HCC as effectively as iodized-oil CT, and may help in deciding whether to repeat TACE.

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“…A eficácia, entretanto, da terapêutica quimioembólica do hepatocarcinoma provavelmente varia conforme o estágio do tumor no início do tratamento, a reserva funcional do fígado e o esquema terapêu-tico adotado (6) . Assim sendo, dentre os diferentes esquemas quimioembólicos, foi necessária a seleção de um que trouxesse complicações de gravidade relativamente menor, uma vez que foram incluídos pacientes com grau de disfunção hepática Child A, B e C. Com este cuidado, utilizamos exclusivamente mitomicina C como agente quimioterápico e lipiodol como agente embólico, não fazendo o uso associado de esponja de gelatina ou outro material embolizante.…”

Section: Discussionunclassified

Contribuição da quimioembolização de hepatocarcinomas em pacientes cirróticos na espera pelo transplante hepático

et al. 2005

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Langer LF et al. OBJETIVO: Avaliar os resultados da quimioembolização arterial do hepatocarcinoma em pacientes portadores de fígado cirrótico candidatos ao transplante hepático. MATERIAIS E MÉTODOS: Vinte e três pacientes cirróticos e portadores de hepatocarcinoma, candidatos para o transplante hepático, foram submetidos a múltiplas sessões de quimioembolização hepática com mitomicina C associadamente com lipiodol, avaliando-se prospectivamente: a) níveis séricos de alfa-fetoproteína; b) tamanho tumoral; c) permanência do paciente dentro dos critérios de viabilidade para o transplante hepático; d) grau de disfunção hepática. RE-SULTADOS: O nível sérico médio de alfa-fetoproteína sofreu uma redução nos primeiros 13 meses, de 43%. O tamanho médio do tumor no maior eixo, após o seguimento médio de 13,5 meses, foi de 3,2 cm, e de acordo com os critérios da Organização Mundial da Saúde, este tamanho médio mostrou-se como doença estável neste período. O tempo médio de sobrevivência foi de 14 meses. CONCLUSÃO: O uso pré-transplante da quimioembolização com um esquema terapêutico adequadamente escolhido demonstrou, através do presente ensaio, apresentar poucas complicações e contra-indicações e considerável eficácia antitumoral. Embora a terapêutica adotada tenha aumentado a sobrevida, em comparação a dados históricos de evolução do hepatocarcinoma, este aumento não teve a mesma dimensão que o tempo médio de espera para a realização do transplante, sendo, dessa forma, necessária a associação de outras estratégias para prolongar o tempo de sobrevida ou a redução no tempo de espera do doente. Unitermos: Hepatocarcinoma; Quimioembolização; Lipiodol.Contribution of transcatheter arterial chemoembolization of hepatocellular carcinomas in cirrhotic patients awaiting liver transplantation. OBJECTIVE: To evaluate the results of hepatocellular carcinoma arterial chemoembolization in cirrhotic patients awaiting liver transplantation. MATERIALS AND METHODS: Twenty-three cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation were submitted to multiple sessions of chemoembolization using mitomycin C and lipiodol. A prospective evaluation of the following factors was performed: a) serum levels of alpha-fetoprotein; b) tumor size; c) maintenance of the viability criteria for hepatic transplantation; d) degree of liver dysfunction. RESULTS: The mean serum levels of alpha-fetoprotein were reduced by 43% during the first 13 months. The mean tumor size, as measured by the long axis, after a mean follow-up period of 13.5 months was 3.2 cm, which is considered stable for the period according to the World Health Organization criteria. The mean survival rate was 14 months. CONCLUSION: In this trial, pre-transplantation use of chemoembolization in combination with an adequately chosen therapy showed few complications and contra-indications as well as a considerable anti-tumor efficacy. Despite the fact that the adopted therapy increased survival rates in comparison to historical evolution data in hepatocellular carcino...

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Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response.

Cited by 105 publications

References 0 publications

Prognosis of Patients with Hepatocellular Carcinoma Treated Solely with Transcatheter Arterial Chemoembolization: Risk Factors for One-year Recurrence and Two-year Mortality (Preliminary Data)

Prognosis of Patients with Hepatocellular Carcinoma Treated Solely with Transcatheter Arterial Chemoembolization: Risk Factors for One-year Recurrence and Two-year Mortality (Preliminary Data)

Role of diffusion-weighted imaging in evaluating therapeutic efficacy after transcatheter arterial chemoembolization for hepatocellular carcinoma

Contribuição da quimioembolização de hepatocarcinomas em pacientes cirróticos na espera pelo transplante hepático

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