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Research and Future Directions in Oncology Embolotherapy

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Vascular Embolotherapy

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

17.5 Conclusion

Several questions remain unanswered, such as which is the best embolization agent, which is the best chemotherapeutic drug, or how can we increase the intratumoral concentration of the drug. The lack of large prospective randomized trials and the current difficulty in conducting meta-analyses on hepatic oncology embolotherapy, along with the absence of effective systemic therapy for unresectable primary and metastatic liver disease, urge intense efforts and the continuation of research on oncology embolotherapy. New developments in drug regimens, embolization materials and new variations in the embolization technique are rapidly changing the image of oncology embolotherapy and hopefully, will positively influence the outcome of treatment and patient survival.

The interventional radiologist should also bear in mind that successful embolotherapy depends on factors beyond the embolic agent selection, or the choice chemotherapeutic cocktail. Technical skills, experience, familiarity with the underlying pathologic processes, and appreciation of the importance for constructive collaboration with other specialties, are also essential for every successful oncology embolotherapy treatment.

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References

  1. Ball DS, Heckman R, et al. (2003) In vitro stability of trisacryl gelatin microspheres in a multipharmaceutical chemoembolization solution. J Vasc Interv Radiol 14:83–88

    PubMed  Google Scholar 

  2. Bretagne JF, Raoul JL, et al. (1988) Hepatic artery injection of I-131-labeled lipiodol. Part II. Preliminary results of therapeutic use in patients with hepatocellular carcinoma and liver metastases. Radiology 168:547–550

    PubMed  CAS  Google Scholar 

  3. Brigger I, Dubernet C, et al. (2002) Nanoparticles in cancer therapy and diagnosis. Adv Drug Deliv Rev 54:631–651

    Article  PubMed  CAS  Google Scholar 

  4. Britten C, Finn RS, Gomes AS, Amado R, Yonemoto L, Bentley G, Mass R, Bussutil RW, Slamon DJ (2005) A pilot study of IV bevacizumab in hepatocellular carcinoma patients undergoing chemoembolization. 2005 ASCO Annual Meeting, Orlando, Florida

    Google Scholar 

  5. Bruix J, Llovet JM, et al. (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27:1578–1583

    Article  PubMed  CAS  Google Scholar 

  6. Bruix J, Sala M, et al. (2004) Chemoembolization for hepatocellular carcinoma. Gastroenterology 127[Suppl 1]:S179–S188.

    PubMed  CAS  Google Scholar 

  7. Camma C, Schepis F, et al. (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54

    PubMed  Google Scholar 

  8. Carr BI (2004) Hepatocellular carcinoma: current management and future trends. Gastroenterology 127:S218

    Article  PubMed  Google Scholar 

  9. Chang JM, Tzeng WS, et al. (1994) Transcatheter arterial embolization with or without cisplatin treatment of hepatocellular carcinoma: a randomized controlled study. Cancer 74:2449

    PubMed  CAS  Google Scholar 

  10. Cheng HY, Shou Y, et al. (2004) Adjustment of lipiodol dose according to tumor blood supply during transcatheter arterial chemoembolization for large hepatocellular carcinoma by multidetector helical CT. World J Gastroenterol 10:2753–2755

    PubMed  Google Scholar 

  11. Chiras J, Adem C, et al. (2004) Selective intra-arterial chemoembolization of pelvic and spine bone metastases. European Radiology 14:1774

    Article  PubMed  Google Scholar 

  12. Chung JW, Park JH, et al. (1996) Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 198:33–40

    PubMed  CAS  Google Scholar 

  13. Clouse ME, Perry L, et al. (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 55[Suppl 3]:92–97

    PubMed  Google Scholar 

  14. Constantin M, Fundueanu G, et al. (2004) Preparation and characterisation of poly(vinyl alcohol)/cyclodextrin microspheres as matrix for inclusion and separation of drugs. Int J Pharm 285:87–96

    Article  PubMed  CAS  Google Scholar 

  15. de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V (1996) Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 24:1386–1391

    PubMed  Google Scholar 

  16. Denkbas EB, Seyyal M, et al. (1999) 5-Fluorouracil loaded chitosan microspheres for chemoembolization. J Microencapsul 16:741–749

    PubMed  CAS  Google Scholar 

  17. Foubister V (2002) Energy blocker to treat liver cancer. Drug Discovery Today 7:934

    PubMed  Google Scholar 

  18. Fujimoto S, Miyazaki M, et al. (1985) Biodegradable mitomycin C microspheres given intra-arterially for inoperable hepatic cancer. With particular reference to a comparison with continuous infusion of mitomycin C and 5-fluorouracil. Cancer 56:2404–2410

    PubMed  CAS  Google Scholar 

  19. Geschwind J-F H, Ko YH, et al. (2002) Novel therapy for liver cancer: direct intraarterial injection of a potent inhibitor of ATP production. Cancer Res 62:3909–3913

    PubMed  CAS  Google Scholar 

  20. Geschwind JF, Ramsey DE, et al. (2003) Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol 26:111

    Article  PubMed  Google Scholar 

  21. Geschwind JF, Georgiades CS, et al. (2004) Recently elucidated energy catabolism pathways provide opportunities for novel treatments in hepatocellular carcinoma. Expert Rev Anticancer Ther 4:449–457

    Article  PubMed  CAS  Google Scholar 

  22. Geschwind JF, Khwaja A, Hong K (2005) New intraarterial drug delivery system: Pharmacokinetics and tumor response in an animal model of liver cancer. 2005 ASCO Annual Meeting, Orlando, Florida.

    Google Scholar 

  23. Gobin YP, Vinuela F, et al. (2000) Embolization with radiopaque microbeads of polyacrylonitrile hydrogel: evaluation in swine. Radiology 214:113–119

    PubMed  CAS  Google Scholar 

  24. Hanahan D, Folkman J (1996) Patterns and emerging mechanisms of the angiogenic switch during tumorigenesis. Cell 86:353–364

    Article  PubMed  CAS  Google Scholar 

  25. Horst JJ, Ulrich-Martin M, et al. (1996) Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol 19:388

    Google Scholar 

  26. Kerr DJ, Willmott N, et al. (1988) Target organ disposition and plasma pharmacokinetics of doxorubicin incorporated into albumin microspheres after intrarenal arterial administration. Cancer 62:878–883

    PubMed  CAS  Google Scholar 

  27. Kobayashi N, Ishii M, et al. (1999) Co-expression of Bcl-2 protein and vascular endothelial growth factor in hepatocellular carcinomas treated by chemoembolization. Liver 19:25–31

    PubMed  CAS  Google Scholar 

  28. Konno T, Maeda H, et al. (1983) Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: a preliminary report. Eur J Cancer Clin Oncol 19:1053–1065

    Article  PubMed  CAS  Google Scholar 

  29. Konya A, Van Pelt CS, et al. (2004) Ethiodized oil-ethanol capillary embolization in rabbit kidneys: temporal histopathologic findings. Radiology 232:147–153

    PubMed  Google Scholar 

  30. Kovacs AF (2005) Chemoembolization using Cisplatin crystals as neoadjuvant treatment of oral cancer. Cancer Biother Radiopharm 20:267–279

    Article  PubMed  CAS  Google Scholar 

  31. Lambert B, Praet M, et al. (2005) Radiolabeled lipiodol therapy for hepatocellular carcinoma in patients awaiting liver transplantation: pathology of the explant livers and clinical outcome. Cancer Biother Radiopharm 20:209–214

    Article  PubMed  CAS  Google Scholar 

  32. Laurent A, Beaujeux R, et al. (1996) Trisacryl gelatin microspheres for therapeutic embolization, I: development and in vitro evaluation. AJNR Am J Neuroradiol 17:533–540

    PubMed  CAS  Google Scholar 

  33. Laurent A, Wassef M, et al. (2004) Location of vessel occlusion of calibrated tris-acryl gelatin microspheres for tumor and arteriovenous malformation embolization. J Vasc Interv Radiol 15:491–496

    PubMed  Google Scholar 

  34. Li C, Yang DJ, et al. (1994) Formation and characterization of cisplatin-loaded poly(benzyl l-glutamate) microspheres for chemoembolization. Pharm Res 11:1792–1799

    PubMed  CAS  Google Scholar 

  35. Li X, Feng GS, et al. (2004) Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol 10:2878–2882

    PubMed  CAS  Google Scholar 

  36. Link DP, Strandberg JD, et al. (1996) Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine. J Vasc Interv Radiol 7:897–905

    PubMed  CAS  Google Scholar 

  37. Llovet JM (2005) Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 40:225

    Article  PubMed  Google Scholar 

  38. Llovet JM, Real MI, et al. (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739

    Article  PubMed  Google Scholar 

  39. Lo CM, Ngan H, et al. (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171

    Article  PubMed  CAS  Google Scholar 

  40. Loewe C, Cejna M, et al. (2002) Arterial embolization of unresectable hepatocellular carcinoma with use of cyanoacrylate and lipiodol. J Vasc Interv Radiol 13:61–69

    PubMed  Google Scholar 

  41. Loewe C, Schindl M, et al. (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using yyanoacrylate and lipiodol: assessment of mid-and long-term results. Am J Roentgenol 180:1379–1384

    Google Scholar 

  42. Maini CL, Scelsa MG, et al. (1996) Superselective intra-arterial radiometabolic therapy with I-131 lipiodol in hepatocellular carcinoma. Clin Nucl Med 21:221

    Article  PubMed  CAS  Google Scholar 

  43. McNair AM (1996) Using hydrogel polymers for drug delivery. Med Device Technol 7:16–22

    PubMed  CAS  Google Scholar 

  44. Mondazzi L, Bottelli R, et al. (1994) Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology 19:1115–1123

    Article  PubMed  CAS  Google Scholar 

  45. Nakakuma K, Tashiro S, et al. (1983) Studies on anticancer treatment with an oily anticancer drug injected into the ligated feeding hepatic artery for liver cancer. Cancer 52:2193–2200

    PubMed  CAS  Google Scholar 

  46. Nakao N, Uchida H, et al. (1992) Effectiveness of Lipiodol in transcatheter arterial embolization of hepatocellular carcinoma. Cancer Chemother Pharmacol 31[Suppl]: S72–76

    PubMed  Google Scholar 

  47. National Cancer Institute (2002) Chemoembolization and Bevacizumab in treating patients with liver cancer that cannot be removed with surgery. NCI trials database (record first received November 12, 2002)

    Google Scholar 

  48. National Cancer Institute (2003) Bevacizumab in treating patients with unresectable nonmetastatic liver cancer. NCI trials database (record first received March 6, 2003)

    Google Scholar 

  49. Nijsen JF, Seppenwoolde JH, et al. (2004) Liver tumors: MR imaging of radioactive holmium microspheres — phantom and rabbit study. Radiology 231:491–499

    PubMed  Google Scholar 

  50. Novell JR, Dusheiko G, et al. (1991) Selective regional chemotherapy of unresectable hepatic tumours using lipiodol. HPB Surg 4:223–234; discussion 234—236

    PubMed  CAS  Google Scholar 

  51. Okamura J, Kawai S, et al. (1992) Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma — a comparison of L-TAE with Farmorubicin and LTAE with Adriamycin (second cooperative study). Cancer Chemother Pharmacol (Historical Archive) 31:S20

    Article  PubMed  Google Scholar 

  52. Osuga K, Khankan AA, et al. (2002) Transarterial embolization for large hepatocellular carcinoma with use of supera-bsorbent polymer microspheres: initial experience. J Vasc Interv Radiol 13:929–934

    PubMed  Google Scholar 

  53. Park BH, Lee JH, et al. (2005) Vascular administration of adenoviral vector soaked in absorbable gelatin sponge particles (GSP) prolongs the transgene expression in hepatocytes. Cancer Gene Ther 12:116–1121

    Article  PubMed  CAS  Google Scholar 

  54. Peppas NA, Huang Y, et al. (2000) Physicochemical foundations and structural design of hydrogels in medicine and biology. Annu Rev Biomed Eng 2: 9–29

    Article  PubMed  CAS  Google Scholar 

  55. Peter B, Franz P, et al. (1998) Arterial hepatic embolization of unresectable hepatocellular carcinoma using a cyanoacrylate/lipiodol mixture. Cardiovasc Intervent Radiol 21:214

    Google Scholar 

  56. Poon RT, Ng IO, et al. (2001) Serum vascular endothelial growth factor predicts venous invasion in hepatocellular carcinoma: a prospective study. Ann Surg 233:227–235

    Article  PubMed  CAS  Google Scholar 

  57. Poon RT, Ho JW, et al. (2004) Prognostic significance of serum vascular endothelial growth factor and endostatin in patients with hepatocellular carcinoma. Br J Surg 91:1354–1360

    Article  PubMed  CAS  Google Scholar 

  58. Ramsey DE, Kernagis LY, et al. (2002) Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 13:211S–2221

    Google Scholar 

  59. Rand T, Loewe C, et al. (2005) Arterial embolization of unresectable hepatocellular carcinoma with use of microspheres, lipiodol, and cyanoacrylate. Cardiovasc Intervent Radiol 28:313–318

    Article  PubMed  Google Scholar 

  60. Raoul JL, Bourguet P, et al. (1988) Hepatic artery injection of I-131-labeled lipiodol. Part I. Biodistribution study results in patients with hepatocellular carcinoma and liver metastases. Radiology 168:541–545

    PubMed  CAS  Google Scholar 

  61. Raoul JL, Guyader D, et al. (1997) Prospective randomized trial of chemoembolization versus intra-arterial injection of 131I-labeled-iodized oil in the treatment of hepatocellular carcinoma. Hepatology 26:1156–1161

    PubMed  CAS  Google Scholar 

  62. Reid T, Galanis E, et al. (2001) Intra-arterial administration of a replication-selective adenovirus (dl1520) in patients with colorectal carcinoma metastatic to the liver: a phase I trial. Gene Ther 8:1618–1626

    Article  PubMed  CAS  Google Scholar 

  63. Reid T, Galanis E, et al. (2002) Hepatic arterial infusion of a replication-selective oncolytic adenovirus (dl1520): phase II viral, immunologic, and clinical endpoints. Cancer Res 62:6070–6079

    PubMed  CAS  Google Scholar 

  64. Roche A, Girish B, et al. (2003) Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. European Radiology 13:136

    PubMed  Google Scholar 

  65. Siskin GP, Dowling K, et al. (2003) Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model. J Vasc Interv Radiol 14:89–98

    PubMed  Google Scholar 

  66. Spenlehauer G, Veillard M, et al. (1986) Formation and characterization of cisplatin loaded poly(d,l-lactide) microspheres for chemoembolization. J Pharm Sci 75:750–755

    PubMed  CAS  Google Scholar 

  67. Stuart K (2003) Chemoembolization in the management of liver tumors. Oncologist 8:425–437

    Article  PubMed  Google Scholar 

  68. Tadavarthy SM, Knight L, et al. (1974) Therapeutic transcatheter arterial embolization. Radiology 112:13–16

    PubMed  CAS  Google Scholar 

  69. Tancredi T, McCuskey PA, et al. (1999) Changes in rat liver microcirculation after experimental hepatic arterial embolization: comparison of different embolic agents. Radiology 211:177–181

    PubMed  CAS  Google Scholar 

  70. Vallee JN, Lo D, et al. (2003) In vitro study of the compatibility of tris-acryl gelatin microspheres with various chemotherapeutic agents. J Vasc Interv Radiol 14:621–628

    PubMed  Google Scholar 

  71. Vogl TJ, Wetter A, et al. (2005) Treatment of unresectable lung metastases with transpulmonary chemoembolization: preliminary experience. Radiology 234:917–922

    PubMed  Google Scholar 

  72. Winkelbauer FW, Niederle B, et al. (1995) Hepatic artery embolotherapy of hepatic metastases from carcinoid tumors: value of using a mixture of cyanoacrylate and ethiodized oil. AJR Am J Roentgenol 165:323–327

    PubMed  CAS  Google Scholar 

  73. Winkelbauer FW, Nierderle B, et al. (1995) Malignant insulinoma: permanent hepatic artery embolization of liver metastases — preliminary results. Cardiovasc Intervent Radiol 18:353–359

    Article  PubMed  CAS  Google Scholar 

  74. Yamamoto T, Hayakawa K, et al. (2003) Transcatheter arterial embolization using poly-L-lactic acid microspheres. Radiat Med 21:150–154

    PubMed  Google Scholar 

  75. Yoo HS, Park CH, et al. (1989) Radioiodinated fatty acid esters in the management of hepatocellular carcinoma: preliminary findings. Cancer Chemother Pharmacol 23[Suppl]: S54–58

    PubMed  Google Scholar 

  76. Yoo HS, Park CH, et al. (1994) Small hepatocellular carcinoma: high dose internal radiation therapy with superselective intra-arterial injection of I-131-labeled Lipiodol. Cancer Chemother Pharmacol 33: S128

    Article  PubMed  Google Scholar 

  77. Yoon CJ, Chung JW, et al. (2004) Transcatheter arterial embolization with 188Rhenium-HDD-labeled iodized oil in rabbit VX2 liver tumor. J Vasc Interv Radiol 15:1121–1128

    PubMed  Google Scholar 

  78. Yu J, Hafeli UO, et al. (2003) 90Y-oxine-ethiodol, a potential radiopharmaceutical for the treatment of liver cancer. Appl Radiat Isot 58:567–573

    Article  PubMed  CAS  Google Scholar 

  79. Zielhuis SW, Nijsen JF, et al. (2005) Surface characteristics of holmium-loaded poly(-lactic acid) microspheres. Biomaterials 26:925

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Eleni Liapi MD

  2. Division of Vascular and Interventional Radiology, 600 N Wolfe Street, Blalock 545, Baltimore, MD, 21287, USA

    Jean-Francois H. Geschwind MD (Associate Professor of Radiology, Surgery and Oncology)

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  1. Eleni Liapi MD
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  2. Jean-Francois H. Geschwind MD
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Editors and Affiliations

  1. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Jafar Golzarian MD (Professor of Radiology, Department of Radiology) & Shiliang Sun MD (Associate Professor of Radiology) (Professor of Radiology, Department of Radiology) &  (Associate Professor of Radiology)

  2. Departments of Radiology and Surgery, University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    M. J. Sharafuddin MD

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Liapi, E., Geschwind, JF.H. (2006). Research and Future Directions in Oncology Embolotherapy. In: Golzarian, J., Sun, S., Sharafuddin, M.J. (eds) Vascular Embolotherapy. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-33257-X_17

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