Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization.

Bartolozzi, Carlo; Lencioni, Riccardo; Caramella, Davide; Vignali, C; Cioni, Roberto; Mazzeo, Salvatore; Carrai, Maura; Maltinti, G.; Capria, A; Conte, Pierfranco

doi:10.1148/radiology.197.3.7480761

Cited by 174 publications

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“…The remaining 47 studies were excluded, either because they compared 2 active antitumoral treatments in 35 cases (involving percutaneous treatments [5], [22][23][24][25][26] …”

Section: Selection Of Trialsmentioning

confidence: 99%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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There is no standard treatment for patients with unresectable hepatocellular carcinoma (HCC). Survival benefits derived from medical interventions are controversial. The aim of this systematic review was to assess the evidence of the impact of medical treatments on survival. Randomized controlled trials (RCTs) that were published as full papers assessing survival for primary treatments of HCC were included. MEDLINE, the Cochrane Library, CANCERLIT, and a manual search from 1978 to May 2002 were used. The primary end point was survival, and the secondary end point was response to treatment. Estimates of effect were calculated according to the random effects model. Sensitivity analysis included methodological quality. We identified 61 randomized trials, but only 14 met the criteria to perform a meta-analysis assessing arterial embolization (7 trials, 545 patients) or tamoxifen T he incidence of hepatocellular carcinoma (HCC) is increasing worldwide. 1 Liver cancer is the fifth most common cancer in the world and the third most common cause of cancer-related death. 2 Cohort studies and cost-efficiency modeling have suggested that surveillance of well-defined cirrhotic patients may decrease tumor-related mortality. However, only 30% of patients benefit from curative therapies such as resection, transplantation, or percutaneous ablation 3 and achieve 5-year survival rates of 50% to 75%. 4 Most patients with HCC are diagnosed at intermediate to advanced stages, and there is no standard treatment for these patients. 3,4 The most reliable method to show survival advantages is to perform large randomized controlled trials (RCTs) that include more than 1,000 patients comparing treatment versus no treatment in a well-defined strata of individuals. 5-10 These investigations are lacking in patients with HCC. On the contrary, several medical interventions have been tested in the setting of small RCTs. However, the reduced size of these studies may cause questions of their statistical power when detecting survival differences, which, as in many areas of health care and oncology, are unlikely to be large. This raises the need for a systematic meta-analysis assessment, with a major role to integrate valid information and provide estimates of treatment effects when RCTs themselves are not of sufficient size. 9,10 Two systematic reviews published years ago 11,12 suggested a potential benefit for at Abbreviations: HCC, hepatocellular carcinoma; RCT, randomized controlled trial; OR, odds ratio; CI, confidence interval.

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“…The remaining 47 studies were excluded, either because they compared 2 active antitumoral treatments in 35 cases (involving percutaneous treatments [5], [22][23][24][25][26] …”

Section: Selection Of Trialsmentioning

confidence: 99%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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“…Transhepatic portal catheterization for PVE is effective in pre-operative embolization for patients with primary or metastatic liver cancer, or as a palliative treatment combined with chemotherapy for non-surgical cases (8)(9)(10)(11)(12). For patients receiving pre-operative embolization, embolization of the branch of the partial portal vein can cause the atrophy of liver tissue lesions, reduced tumor size and lead to hepatic tissue hyperplasia within the non-embolization area, thereby widening the extent of the surgical excision and surgical indications.…”

Section: A B C D Discussionmentioning

confidence: 99%

Experimental research of Fuaile medical adhesive for portal vein embolization in white rabbit models

Jiang¹,

Wang²,

Li³

et al. 2015

Oncology Letters

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Abstract. The aim of the present study was to investigate the feasibility and efficacy of Fuaile medical adhesive for portal vein embolization in the treatment of a rabbit model. This study used 26 white rabbits, 14 of which were selected and assigned into seven groups (n=2) for the preliminary experiment. Fuaile medical adhesive was mixed with lipiodol at different ratios of 1:0, 1:1, 1:2, 1:3, 1:4, 1:5 and 0:1, respectively, and administered via the portal trunk. The remaining 12 white rabbits were randomly divided into two groups (n=6). The evaluation of the results included the degree of adhesion to the vessels, the extent of embolization and the reaction of the rabbit. Hepatic and renal functions were detected prior to and at 1, 7 and 14 days post-embolization, respectively. Angiography, CT scans and pathological examinations were conducted at post-embolization. Histological examinations revealed that the topical swollen lesions were darker. Light microscopy showed embolic agents in the portal venous blood vessels and the formation of a secondary thrombus. Hepatic necrosis appeared surrounding the embolization area. Inflammatory cell infiltration of different degrees occurred in the early stage and inflammatory fibroplasia occurred in the late stage. Alanine aminotransferase and aspartate aminotransferase levels increased at 1 day post-embolization, peaked at 7 days and was in the normal range at 14 days. The levels of blood urea nitrogen and ceruloplasmin were elevated at 1 day post-embolization and lowered to normal at 7 days. Fuaile medical adhesive is an effective, safe and inexpensive agent, used for effectively inducing embolization in the portal trunk, and the first and second branches of rabbit portal veins. The use of Fuaile therefore merits widespread application in clinical practice.

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“…Generally, the natural survival time of patients with PHC is 1-4 mo and the majority of PHC patients may not be fit for surgical resection [4] . HAI and HAE may prolong the survival of patients with PHC and make it possible for some patients to become fit for secondary surgical resection.…”

Section: Efficacy Of Hai and Haementioning

confidence: 99%

Hepatic arterial infusion chemotherapy and embolization in the treatment of primary hepatic carcinoma

Zheng

Gao

Zhou

et al. 2011

WJG

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AIM:To study the effects of hepatic arterial infusion chemotherapy (HAI) or embolization (HAE) in the treatment of primary hepatic carcinoma (PHC) and the factors influencing these effects. METHODS:A retrospective analysis of 188 patients (166 males and 22 females) with PHC treated with HAI (n = 82) or HAE (n = 106) was conducted. RESULTS:In the group as a whole, the percentage of patients experiencing therapeutic outcomes was as follows: Symptomatic relief (59.6%); Tumor shrinkage (55%); A decrease in blood alpha fetoprotein (AFP) (37.8%) and overall survival rates at 0.5, 1.0, 2.0, and 3.0 years of 75.4%, 46%, 23.5% and 14.7%, respectively. The mean survival time in the entire group was 12.2 mo, and the longest survival period was 50 mo. In the HAI group the survival rates at 0.5, 1.0. 2.0 and 3.0 years of follow-up were 61.0%, 25.4%, 4.5% and 0%, respectively, with a mean survival time of 7.7 mo. In the HAE group the corresponding survival rates were 86.8%, 61.7%, 37.8% and 26.1%, respectively, with a mean survival time of 15.7 mo. Eighteen patients received secondary surgery. Factors that had a favorable effect on therapeutic outcomes were presence of no or only mild liver cirrhosis, presence of stage Ⅰ or Stage Ⅱ disease, presence of only a single tumor, a tumor size less than 10 cm in diameter, an absence cancerous thrombus within the portal vein or hepatic arterio venous fistula, and HAE treatment. CONCLUSION: This study helped identify the effects of HAI andHepatic arterial infusion chemotherapy and embolization in the treatment of primary hepatic carcinoma 104June 15, 1997|Volume 3|Issue 2| WJG|www.wjgnet.com HAE in patients with PHC, and identified some important factors which influence such treatment.

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Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization.

Abstract: Use of a single TACE session combined with PEI is more effective than repeated TACE in the treatment of large HCC.

Cited by 174 publications

References 0 publications

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Experimental research of Fuaile medical adhesive for portal vein embolization in white rabbit models

Hepatic arterial infusion chemotherapy and embolization in the treatment of primary hepatic carcinoma

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