Skip to main content

Advertisement

SpringerLink
Log in

Pilot study of transcatheter arterial ethanol embolization under closed renal circuit for large renal cell carcinomas

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The safety of a new technique, designated “transcatheter arterial embolization (TAE) with aspiration via a balloon-occluded renal drainage vein” (TAE-ABOD), for the management of large renal cell carcinomas (RCCs). The subjects were 25 patients with RCC who underwent a total of 27 sessions of TAE-ABOD. This TAE-ABOD technique incorporates two procedures: balloon occlusion of renal drainage vein and infusion of absolute ethanol into the tumor-feeding arteries during aspiration of blood via a balloon catheter, thereby reducing leakage of absolute ethanol into the systemic circulation. Our primary endpoint was to establish a safe regimen for high-dose ethanol injection therapy, and our secondary endpoint was to assess global survival of the patients. The administered dose of ethanol ranged from 0.2 to 0.5 ml/kg [median: 0.34 (SD: 0.10) ml/kg], increased in a stepwise manner. The systemic ethanol concentration was measurable in 14 patients, and was less than 0.1 mg/ml in 12 and from 0.1 to less than 0.2 mg/ml in two. There were no major complications such as renal failure or renal abscess. TAE-ABOD can safely deliver a high dose of absolute ethanol for the treatment of large RCCs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–e
Fig. 2a–d
Fig. 3A–C

Similar content being viewed by others

References

  1. Almgard LE, Fernstrom I, Haverling M, Ljungqvist A (1973) Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol 45:474–479

    CAS  PubMed  Google Scholar 

  2. Goldstein HM, Medellin H, Beydoun MT, Wallace S, Ben-Menachem Y, Bracken RB, Johnson DE (1975) Transcatheter embolization of renal cell carcinoma. AJR Am J Roentgenol 123:557–562

    CAS  Google Scholar 

  3. Ekelund L, Mansson W, Olsson AM, Stigsson L (1979) Palliative embolization of arterial renal tumor supply. Acta Radiol Diagn (Stockh) 20:323–336

    CAS  Google Scholar 

  4. Kalman D, Varenhorst E (1999) The role of arterial embolization in renal cell carcinoma. Scand J Urol Nephrol 33:162–170

    Article  CAS  PubMed  Google Scholar 

  5. Ellman BA, Green CE, Eigenbrodt E, Garriott JC, Curry TS (1980) Renal infarction with absolute ethanol. Invest Radiol 15:318–322

    Article  CAS  PubMed  Google Scholar 

  6. Ellman BA, Parkhill BJ, Curry TS, Marcus PB, Peters PC (1981) Ablation of renal tumors with absolute ethanol: a new technique. Radiology 141:619–626

    CAS  PubMed  Google Scholar 

  7. Klimberg I, Hunter P, Hawkins IF, Drylie DM, Wajsman Z (1985) Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol. J Urol 133:21–24

    CAS  PubMed  Google Scholar 

  8. Haapanen AA, Dean PB (1986) Renal vein ethanol concentration during ablation of renal cell carcinoma. Cardiovasc Intervent Radiol 9:205–208

    Article  CAS  PubMed  Google Scholar 

  9. Lanigan D, Jurriaans E, Hammonds JC, Wells IP, Choa RG (1992) The current status of embolization in renal cell carcinoma—a survey of local and national practice. Clin Radiol 46:176–178

    Article  CAS  PubMed  Google Scholar 

  10. Park JH, Kim SH, Han JK, Chung JW, Han MC (1994) Transcatheter arterial embolization of unresectable renal cell carcinoma with a mixture of ethanol and iodized oil. Cardiovasc Intervent Radiol 17:323–327

    Article  CAS  PubMed  Google Scholar 

  11. Onishi T, Oishi Y, Suzuki Y, Asano K (2001) Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int 87:312–315

    Article  CAS  PubMed  Google Scholar 

  12. Mebust WK, Weigel JW, Lee KR, Cox GG, Jewell WR, Krishnan EC (1984) Renal cell carcinoma—angioinfarction. J Urol 131:231–235

    CAS  PubMed  Google Scholar 

  13. Lammer J, Justrich E, Schreyer H, Petteck R (1985) Complications of renal tumor embolization. Cardiovasc Intervent Radiol 8:31–35

    Article  CAS  PubMed  Google Scholar 

  14. Sutherland PD, Howard PR, Marshall VR (1986) Colonic infarction following ethanol embolisation of the kidney. Br J Urol 58:337

    CAS  PubMed  Google Scholar 

  15. Zack JR, Ferral H (2002) Case report: transient complete heart block complicating renal ethanol embolization. Clin Radiol 57:853–854

    CAS  PubMed  Google Scholar 

  16. Creech O, Krementz ET, Ryan RF, Winblad JN (1958) Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg 148:616–632

    Article  PubMed  Google Scholar 

  17. Austen WA, Monaco AP, Richardson GS, Baker WH, Shaw RS, Raker JW (1959) Treatments of malignant pelvic tumors by extracorporeal perfusion with chemotherapeutic agents. N Engl J Med 261:1037–1045

    Article  CAS  PubMed  Google Scholar 

  18. Beheshti MV, Denny DF Jr, Glickman MG, Bodden W, Marsh JC, Strair R, Ravikumar TS (1992) Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report. J Vasc Interv Radiol 3:453–458

    Article  CAS  PubMed  Google Scholar 

  19. Rothbarth J, Tollenaar RA, Schellens JH, Nortier JW, Kool LJ, Kuppen PJ, Mulder GJ, van de Velde CJ (2004) Isolated hepatic perfusion for the treatment of colorectal metastases confined to the liver: recent trends and perspectives. Eur J Cancer 40:1812–1824

    Article  CAS  PubMed  Google Scholar 

  20. Murata S, Tajima H, Kusakai G, Kumazaki T, Abe Y, Onozawa S, Komada Y, Kondo Y, Kimata R, Himeno S, Satake M (2005) Reduction of drug leakage by negative-balance isolated pelvic perfusion: correlation between leakage and in-out flow rate in a pig model. J Cancer Res Clin Oncol 131:575–580

    Article  CAS  PubMed  Google Scholar 

  21. Belliveau JF, Arevalo E, Griffin H, Wanebo HJ (2005) Isolated pelvic perfusion: plasma pharmacokinetics depend primarily on drug dosage and not the type of drug. Cancer Chemother Pharmacol 55:318–322

    Article  CAS  PubMed  Google Scholar 

  22. Murata S, Tajima H, Abe Y, Onozawa S, Uchiyama F, Hayashi H, Kimata R, Nomura K (2007) Changes in pelvic and systemic platinum concentrations during negative-balance isolated pelvic perfusion: correlation between platinum concentration and method of administration in a pig model. J Cancer Res Clin Oncol 133:417–422

    Article  CAS  PubMed  Google Scholar 

  23. Guinan P, Sobin LH, Algaba F, Badellino F, Kameyama S, MacLennan G, Novick A (1997) TNM staging of renal cell carcinoma. Cancer 80:992–993

    Article  CAS  PubMed  Google Scholar 

  24. http://ctep.cancer.gov/forms/CTCv20_4–30–992.pdf

  25. Sridhar SS, Hedley D, Siu LL (2005) Raf kinase as a target for anticancer therapeutics. Mol Cancer Ther 4:677–685

    Article  CAS  PubMed  Google Scholar 

  26. Gollob JA, Wilhelm S, Carter C, Kelly SL (2006) Role of Raf kinase in cancer: therapeutic potential of targeting the Raf/MEK/ERK signal transduction pathway. Semin Oncol 33:392–406

    Article  CAS  PubMed  Google Scholar 

  27. Grandinetti CA, Goldspiel BR (2007) Sorafenib and sunitinib: novel targeted therapies for renal cell cancer. Pharmacotherapy 27:1125–1144

    Article  CAS  PubMed  Google Scholar 

  28. Naito S, Kimiya K, Sakamoto N, Soejima T, Ueda T, Kumazawa J, Osada Y, Kurozumi T, Sagiyama K, Ariyoshi A (1991) Prognostic factors and value of adjunctive nephrectomy in patients with stage IV renal cell carcinoma. Urology 37:95–99

    Article  CAS  PubMed  Google Scholar 

  29. McLean GK, Meranze SG (1985) Embolization techniques in the urinary tract. Urol Clin N Am 12:743–754

    CAS  Google Scholar 

  30. Roy C, Tuchmann C, Morel M, Saussine C, Jacqmin D, Tongio J (1999) Is there still a place for angiography in the management of renal mass lesions? Eur Radiol 9:329–335

    Article  CAS  PubMed  Google Scholar 

  31. Munro NP, Woodhams S, Nawrocki JD, Fletcher MS, Thomas PJ (2003) The role of transarterial embolization in the treatment of renal cell carcinoma. BJU Int 92(3):240–244

    Article  CAS  PubMed  Google Scholar 

  32. Demirci D, Tatlisen A, Ekmekcioglu O, Ozcan N, Kaya R (2004) Does radical nephrectomy with immunochemotherapy have any superiority over embolization alone in metastatic renal cell carcinoma? A preliminary report. Urol Int 73:54–58

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from the Third Term Comprehensive Control Research for Cancer, the Program for Promotion of Fundamental Studies in Health Sciences of the Organization for Pharmaceuticals and Medical Devices Agency (PMDA) and the Grant-in-Aid for Cancer Research (1, 14–5) from the Ministry of Health, Labour and Welfare.

Author information

Authors and Affiliations

  1. Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, 1–1–5 Sendagi, Bunkyou-ku, Tokyo, 113–8602, Japan

    Satoru Murata, Hiroyuki Tajima, Shiro Onozawa & Shinichiro Kumita

  2. Department of Urology, Nippon Medical School, 1–1–5 Sendagi, Bunkyou-ku, Tokyo, 113–8602, Japan

    Yukihiro Kondo

  3. Tokyo Labor-Welfare Hospital, 4–13–21 Ohmori-minami, Ohta-ku, Tokyo, 104–0045, Japan

    Kazuhiro Nomura

Authors
  1. Satoru Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyuki Tajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiro Onozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinichiro Kumita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukihiro Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhiro Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Murata.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murata, S., Tajima, H., Onozawa, S. et al. Pilot study of transcatheter arterial ethanol embolization under closed renal circuit for large renal cell carcinomas. Eur Radiol 18, 1464–1472 (2008). https://doi.org/10.1007/s00330-008-0895-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-0895-z

Keywords

Search

Navigation