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Embolization Therapy for Liver Cancer

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Abstract

Transarterial chemoembolization (TACE) is a relatively new endovascular treatment based on the minimally invasive induction of tumor necrosis by a high local concentration of a chemotherapeutic agent and an embolic effect. The embolic effect causes ischemia on the one hand and an increased local dwell time of the chemotherapeutic agent in the tumor on the other. Nowadays TACE represents one of the most used treatments for unresectable hepatocellular carcinoma and is the treatment of first choice for patients with intermediate HCC stage BCLC B. However, there is no consensus about the choice of the best embolotherapy technique.

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References

  1. Hidaka H, Kobayashi H, Ohyama M, et al. Transarterial chemoembolization therapy of hepatocellular carcinoma using anticancer agents (mitomycin C and/or adriamycin) suspended in lipiodol. Nihon Igaku Hoshasen Gakkai zasshi Nippon acta radiologica. 1985;45(11):1430–40.

    CAS  PubMed  Google Scholar 

  2. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182. https://www.sciencedirect.com/science/article/pii/S0168827818302150. Accessed January 31, 2019.

    Article  Google Scholar 

  3. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38. https://doi.org/10.1055/s-2007-1007122.

    Article  CAS  PubMed  Google Scholar 

  4. Raoul J-L, Sangro B, Forner A, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37:212–20. https://doi.org/10.1016/j.ctrv.2010.07.006.

    Article  PubMed  Google Scholar 

  5. Frangakis C, Geschwind J-F, Kim D, et al. Chemoembolization decreases drop-off risk of hepatocellular carcinoma patients on the liver transplant list. Cardiovasc Intervent Radiol. 2011;34:1254–61. https://doi.org/10.1007/s00270-010-0077-7.

    Article  PubMed  Google Scholar 

  6. Pompili M, Francica G, Ponziani FR, Iezzi R, Avolio AW. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation. World J Gastroenterol. 2013;19:7515–30. https://doi.org/10.3748/wjg.v19.i43.7515.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Prajapati HJ, Kim HS. Treatment algorithm based on the multivariate survival analyses in patients with advanced hepatocellular carcinoma treated with trans-arterial chemoembolization. PLoS One. 2017;12:e0170750. https://doi.org/10.1371/journal.pone.0170750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hackl C, Neumann P, Gerken M, Loss M, Klinkhammer-Schalke M, Schlitt HJ. Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma. BMC Cancer. 2014;14:810. https://doi.org/10.1186/1471-2407-14-810.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Massmann A, Rodt T, Marquardt S, et al. Transarterial chemoembolization (TACE) for colorectal liver metastases--current status and critical review. Langenbecks Arch Surg. 2015;400:641–59. https://doi.org/10.1007/s00423-015-1308-9.

    Article  PubMed  Google Scholar 

  10. Gillmore R, Stuart S, Kirkwood A, et al. EASL and mRECIST responses are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial embolization. J Hepatol. 2011;55(6):1309–16.

    Article  Google Scholar 

  11. Stone PA, Campbell JE. Complications related to femoral artery access for transcatheter procedures. Vasc Endovascular Surg. 2012;46:617–23. https://doi.org/10.1177/1538574412457475.

    Article  PubMed  Google Scholar 

  12. Lupattelli T, Clerissi J, Clerici G, et al. The efficacy and safety of closure of brachial access using the AngioSeal closure device: experience with 161 interventions in diabetic patients with critical limb ischemia. J Vasc Surg. 2008;47:782–8. https://doi.org/10.1016/j.jvs.2007.11.050.

    Article  PubMed  Google Scholar 

  13. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465–76. https://doi.org/10.1016/S0140-6736(15)60292-6.

    Article  PubMed  Google Scholar 

  14. Patel VG, Brayton KM, Kumbhani DJ, Banerjee S, Brilakis ES. Meta-analysis of stroke after transradial versus transfemoral artery catheterization. Int J Cardiol. 2013;168:5234–8. https://doi.org/10.1016/j.ijcard.2013.08.026.

    Article  PubMed  Google Scholar 

  15. Miyayama S, Yamashiro M, Ikuno M, Okumura K, Yoshida M. Ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinoma guided by automated tumor- feeders detection software: technical success and short-term tumor response. Abdom Imaging. 2014;39(3):645–56.

    Article  Google Scholar 

  16. Cammà C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology. 2002;224:47–54. https://doi.org/10.1148/radiol.2241011262.

    Article  PubMed  Google Scholar 

  17. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology (Baltimore, Md). 2003;37:429–42. https://doi.org/10.1053/jhep.2003.50047.

    Article  CAS  Google Scholar 

  18. Kirstein MM, Voigtländer T, Schweitzer N, Hinrichs JB, Marquardt J, Wörns MA, Kloeckner R, Fründt TW, Ittrich H, Wacker F, Rodt T, Manns MP, Wege H, Weinmann A, Vogel A. Transarterial chemoembolization versus sorafenib in patients with hepatocellular carcinoma and extrahepatic disease. U Eur Gastroenterol J. 2018;6(2):238–46.

    Article  CAS  Google Scholar 

  19. Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind J-FH. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016;64:106–16.

    Article  CAS  Google Scholar 

  20. Ogasawara S, Chiba T, Ooka Y, Kanogawa N, Motoyama T, Suzuki E, et al. A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology. 2017;

    Google Scholar 

  21. Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol. 2007;46:474–81.

    Article  CAS  Google Scholar 

  22. Ronot M, Abdel-Rehim M, Hakimé A, Kuoch V, Roux M, Chiaradia M, et al. Cone-beam CT angiography for determination of tumor-feeding vessels during chemoembolization of liver tumors: comparison of conventional and dedicated-software analysis. J Vasc Interv Radiol. 2016;27:32–8.

    Article  Google Scholar 

  23. Burrel M, Reig M, Forner A, et al. Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design. J Hepatol. 2012;56(6):1330–5.

    Article  Google Scholar 

  24. Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2010;33(1):41–52.

    Article  Google Scholar 

  25. Golfieri R, Giampalma E, Renzulli M, et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer. 2014;111(2):255–64.

    Article  CAS  Google Scholar 

  26. Poon RT, Lau C, Yu WC, Fan ST, Wong J. High serum levels of vascular endothelial growth factor predict poor response to transarterial chemoembolization in hepatocellular carcinoma: a prospective study. Oncol Rep. 2004;11:1077–84.

    CAS  PubMed  Google Scholar 

  27. Håkansson L, Håkansson A, Morales O, Thorelius L, Warfving T. Spherex (degradable starch microspheres) chemo-occlusion—enhancement of tumor drug concentration and therapeutic efficacy: an overview. Semin Oncol. 1997;24:S6–100–S6-109.

    PubMed  Google Scholar 

  28. Schicho A, Pereira PL, Haimerl M, et al. Transarterial chemoembolization (TACE) with degradable starch microspheres (DSM) in hepatocellular carcinoma (HCC): multi-center results on safety and efficacy. Oncotarget. 2017;8:72613–20.

    Google Scholar 

  29. Orlacchio A, Chegai F, Francioso S, et al. Repeated transarterial chemoembolization with degradable starch microspheres (DSMs-TACE) of unresectable hepatocellular carcinoma: a prospective pilot study. Curr Med imag Rev. 2018;14:637–45.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital Regensburg, Regensburg, Germany

    Lukas Luerken & Lukas Beyer

Authors
  1. Lukas Luerken
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  2. Lukas Beyer
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Corresponding author

Correspondence to Lukas Luerken .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Which statement is correct:

    1. (a)

      According to the EASL guidelines for HCC, TACE should primarily be performed in patients with advanced HCC stage BCLC C.

    2. (b)

      TACE may be considered for patients with early HCC stage BCLC A.

    3. (c)

      The evidence for benefits of TACE in patients with intermediate HCC Stage BCLC B compared to system therapy with sorafenib is scarce.

    4. (d)

      If, after two treatments with TACE, tumor progression is observed, at least a third treatment session should be performed.

  2. 2.

    Which statement is correct:

    1. (a)

      DSM-TACE has a vessel occlusion time of approximately 6 weeks.

    2. (b)

      DEB-TACE is more suitable for lesser selective embolizations in disseminated disease than cTACE.

    3. (c)

      Transradial approach has a lower risk for adverse events compared to brachial and femoral approach.

    4. (d)

      To induce maximum tumor-necrosis, chemoembolization with DSM must be followed by embolizing particles like calibrated microspheres or gelfoam.

1.2 Answers

  1. 1.

    Which statement is correct:

    1. (a)

      TACE is the treatment of choice for patients with HCC BCLC B. Recent studies suggest, that patients with HCC stage BCLC C and segmental portal vein infiltration may profit from TACE.

    2. (b)

      Patients with early HCC stage BCLC A may be treated with TACE if resection or ablation is not possible, this procedure is called stage migration. CORRECT.

    3. (c)

      Evidence for TACE as first line treatment in patients with intermediate HCC Stage BCLC B is strong.

    4. (d)

      If tumor progression or a non-response to TACE is observed after two treatments, no further TACE should be administered and therapy should be switched to system therapy.

  2. 2.

    Which statement is correct:

    1. (a)

      Vessel occlusion time of DSM-TACE is approximately 35–50 min.

    2. (b)

      Tumor feeders should be probed as superselective as possible when performing cTACE and DEB-TACE.

    3. (c)

      Transradial approach has a significantly lower risk for adverse events compared to brachial and femoral approach. CORRECT.

    4. (d)

      Application of embolizing particles like absorbable gelatin, degradable starch microspheres or permanent materials including polyvinyl alcohols, uncalibrated and calibrated microspheres

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Luerken, L., Beyer, L. (2020). Embolization Therapy for Liver Cancer. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_60

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_60

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24431-6

  • Online ISBN: 978-3-030-24432-3

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