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Principles of Liver Embolization

Chapter

Abstract

The basic principles of embolization can be widely applied to many applications in patients with hepatic malignancies, ranging from direct tumor devascularization, flow redistribution, and induction of preoperative liver hypertrophy. Tumor devascularization using the transarterial hepatic approach relies on the knowledge that liver tumors derive their blood supply primarily from the hepatic arterial system. Portal vein embolization has become a key intervention to address the increased perioperative risks of hepatic dysfunction and hepatic insufficiency. This technique is a safe and viable means of causing hypertrophy of the intended future liver remnant. The use of this novel procedure has ultimately led to a reduction in morbidity and mortality and increased the number of patients considered for liver resection.

Keywords

Portal Vein Embolization Uveal Melanoma Future Liver Remnant Radiation Pneumonitis Embolic Agent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sun JH, Wang LG, Bao HW, et al. Emergency embolization in the treatment of ruptured hepatocellular carcinoma following transcatheter arterial chemoembolization. Hepatogastroenterology. 2010;57(99–100):616–9.PubMedGoogle Scholar
  2. 2.
    Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94(11):1386–94.PubMedCrossRefGoogle Scholar
  3. 3.
    Allison DJ, Modlin IM, Jenkins WJ. Treatment of carcinoid liver metastases by hepatic-artery embolisation. Lancet. 1977;2(8052–8053):1323–5.PubMedCrossRefGoogle Scholar
  4. 4.
    ackerman NB. Alteration of intra-hepatic circulation due to increased tumour growth. Proc. VIII Cong. Eur. Soc. Exp. Surg. 1972:182.Google Scholar
  5. 5.
    Taylor I, Bennett R, Sherriff S. The blood supply of colorectal liver metastases. Br J Cancer. 1978;38(6):749–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Chuang VP, Wallace S. Hepatic artery embolization in the treatment of hepatic neoplasms. Radiology. 1981;140(1):51–8.PubMedGoogle Scholar
  7. 7.
    Chuang VP, Wallace S, Soo CS, Charnsangavej C, Bowers T. Therapeutic Ivalon embolization of hepatic tumors. AJR Am J Roentgenol. 1982;138(2):289–94.PubMedGoogle Scholar
  8. 8.
    Wallace S, Charnsangavej C, Carrasco CH, Bechtel W. Ethanol for hepatic artery embolization. Radiology. 1984;152(3):821–2.PubMedGoogle Scholar
  9. 9.
    Hemingway AP, Allison DJ. Complications of embolization: analysis of 410 procedures. Radiology. 1988;166(3):669–72.PubMedGoogle Scholar
  10. 10.
    Eriksson BK, Larsson EG, Skogseid BM, Löfberg AM, Lörelius LE, Oberg KE. Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer. 1998;83(11):2293–301.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown KT, Koh BY, Brody LA, et al. Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol. 1999;10(4):397–403.PubMedCrossRefGoogle Scholar
  12. 12.
    Maluccio MA, Covey AM, Porat LB, et al. Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol. 2008;19(6):862–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Yamada R, Nakatsuka H, Nakamura K, et al. Hepatic artery embolization in 32 patients with unresectable hepatoma. Osaka City Med J. 1980;26(2):81–96.PubMedGoogle Scholar
  14. 14.
    Kan Z. Dynamic study of iodized oil in the liver and blood supply to hepatic tumors. An experimental investigation in several animal species. Acta Radiol Suppl. 1996;408:1–25.PubMedGoogle Scholar
  15. 15.
    Maeda H, Seymour LW, Miyamoto Y. Conjugates of anticancer agents and polymers: advantages of macromolecular therapeutics in vivo. Bioconjug Chem. 1992;3(5):351–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Malagari K, Pomoni M, Kelekis A, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2010;33(3):541–51.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Dhanasekaran R, Kooby DA, Staley CA, Kauh JS, Khanna V, Kim HS. Comparison of conventional transarterial chemoembolization (TACE) and chemoembolization with doxorubicin drug eluting beads (DEB) for unresectable hepatocellular carcinoma (HCC). J Surg Oncol. 2010;101(6):476–80.PubMedGoogle Scholar
  19. 19.
    Poon RT, Tso WK, Pang RW, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol. 2007;5(9):1100–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol. 2007;46(3):474–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359(9319):1734–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Ajani JA, Carrasco CH, Charnsangavej C, Samaan NA, Levin B, Wallace S. Islet cell tumors metastatic to the liver: effective palliation by sequential hepatic artery embolization. Ann Intern Med. 1988;108(3):340–4.PubMedGoogle Scholar
  24. 24.
    Bloomston M, Al-Saif O, Klemanski D, et al. Hepatic artery chemoembolization in 122 patients with metastatic carcinoid tumor: lessons learned. J Gastrointest Surg. 2007;11(3):264–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Gupta S, Johnson MM, Murthy R, et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer. 2005;104(8):1590–602.PubMedCrossRefGoogle Scholar
  26. 26.
    Gupta S, Yao JC, Ahrar K, et al. Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. Cancer J. 2003;9(4):261–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Leung TW, Lau WY, Ho SK, et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys. 1995;33(4):919–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Moertel CG, Johnson CM, McKusick MA, et al. The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med. 1994;120(4):302–9.PubMedGoogle Scholar
  29. 29.
    Ruutiainen AT et al. Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol. 2007;18(7):847–55.PubMedCrossRefGoogle Scholar
  30. 30.
    Bedikian AY, Legha SS, Mavligit G, et al. Treatment of uveal melanoma metastatic to the liver: a review of the MD. Anderson Cancer Center experience and prognostic factors. Cancer. 1995;76(9):1665–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Gupta S, Bedikian AY, Ahrar J, et al. Hepatic artery chemoembolization in patients with ocular melanoma metastatic to the liver: response, survival, and prognostic factors. Am J Clin Oncol. 2010;33(5):474–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Patel K, Sullivan K, Berd D, et al. Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res. 2005;15(4):297–304.PubMedCrossRefGoogle Scholar
  33. 33.
    Sharma KV, Gould JE, Harbour JW, et al. Hepatic arterial chemoembolization for management of metastatic melanoma. AJR Am J Roentgenol. 2008;190(1):99–104.PubMedCrossRefGoogle Scholar
  34. 34.
    Agarwala SS, Panikkar R, Kirkwood JM. Phase I/II randomized trial of intrahepatic arterial infusion chemotherapy with cisplatin and chemoembolization with cisplatin and polyvinyl sponge in patients with ocular melanoma metastatic to the liver. Melanoma Res. 2004;14(3):217–22.PubMedCrossRefGoogle Scholar
  35. 35.
    Poggi G, Amatu A, Montagna B, et al. OEM-TACE: a new therapeutic approach in unresectable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol. 2009;32(6):1187–92.PubMedCrossRefGoogle Scholar
  36. 36.
    Gusani NJ, Balaa FK, Steel JK, et al. Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter arterial chemoembolization (TACE): a single-institution experience. J Gastrointest Surg. 2008;12(1):129–37.PubMedCrossRefGoogle Scholar
  37. 37.
    Aliberti C, Benea G, Tilli M, Fiorentini G. Chemoembolization (TACE) of unresectable intrahepatic cholangiocarcinoma with slow-release doxorubicin-eluting beads: preliminary results. Cardiovasc Intervent Radiol. 2008;31(5):883–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Albert M, Kiefer MV, Sun W, et al. Chemoembolization of colorectal liver metastases with cisplatin, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol. Cancer. 2011;117(2):343–52.PubMedCrossRefGoogle Scholar
  39. 39.
    Nabil M, Gruber T, Yakoub D, Ackermann H, Zangos S, Vogl TJ. Repetitive transarterial chemoembolization (TACE) of liver metastases from renal cell carcinoma: local control and survival results. Eur Radiol. 2008;18(7):1456–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Yayoi E, Furukawa J, Sekimoto M, et al. A comparison of intra-arterial chemoembolization and infusion chemotherapy for liver metastases of breast cancer. Gan To Kagaku Ryoho. 1995;22(11):1519–22.PubMedGoogle Scholar
  41. 41.
    Kobayashi K, Gupta S, Trent JC, et al. Hepatic artery chemoembolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer. 2006;107(12):2833–41.PubMedCrossRefGoogle Scholar
  42. 42.
    Fromigué J, De Baere T, Baudin E, Dromain C, Leboulleux S, Schlumberger M. Chemoembolization for liver metastases from medullary thyroid carcinoma. J Clin Endocrinol Metab. 2006;91(7):2496–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Brown DB, Cardella JF, Sacks D, et al. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol. 2006;17(2 Pt 1):225–32.PubMedCrossRefGoogle Scholar
  44. 44.
    Sakamoto I, Aso N, Nagaoki K, et al. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics. 1998;18(3):605–19.PubMedGoogle Scholar
  45. 45.
    Song SY, Chung JW, Han JK, et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol. 2001;12(3):313–20.PubMedCrossRefGoogle Scholar
  46. 46.
    Geschwind JF, Kaushik S, Ramsey DE, et al. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol. 2002;13(11):1163–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Patel S, Tuite CM, Mondschein JI, Soulen MC. Effectiveness of an aggressive antibiotic regimen for chemoembolization in patients with previous biliary intervention. J Vasc Interv Radiol. 2006;17(12):1931–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Kennedy AS, Dezarn WA, McNeillie P, et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol. 2008;31(3):271–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Stubbs RS, Cannan RJ, Mitchell AW. Selective internal radiation therapy (SIRT) with 90Yttrium microspheres for extensive colorectal liver metastases. Hepatogastroenterology. 2001;48(38):333–7.PubMedGoogle Scholar
  50. 50.
    Chua TC, Bester L, Saxena A, Morris DL. Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases. J Cancer Res Clin Oncol. 2011;137(5):865–73.PubMedCrossRefGoogle Scholar
  51. 51.
    Cao CQ, Yan TD, Bester L, Liauw W, Morris DL. Radioembolization with yttrium microspheres for neuroendocrine tumour liver metastases. Br J Surg. 2010;97(4):537–43.PubMedCrossRefGoogle Scholar
  52. 52.
    Jakobs TF, Hoffmann RT, Fischer T, et al. Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol. 2008;19(5):683–90.PubMedCrossRefGoogle Scholar
  53. 53.
    Bangash AK, Atassi B, Kaklamani V, et al. 90Y radioembolization of metastatic breast cancer to the liver: toxicity, imaging response, survival. J Vasc Interv Radiol. 2007;18(5):621–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Saxena A, Bester L, Chua TC, Chu FC, Morris DL. Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol. 2010;17(2):484–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Riaz A, Lewandowski RJ, Kulik LM, et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol. 2009;20(9):1121–30. quiz 1131.PubMedCrossRefGoogle Scholar
  56. 56.
    Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243(3):364–72.PubMedCrossRefGoogle Scholar
  57. 57.
    Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg. 2003;7(3):325–30.PubMedCrossRefGoogle Scholar
  58. 58.
    Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26(5):1176–81.PubMedGoogle Scholar
  59. 59.
    Azoulay D, Castaing D, Krissat J, et al. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg. 2000;232(5):665–72.PubMedCrossRefGoogle Scholar
  60. 60.
    Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg. 2007;31(2):367–74.PubMedCrossRefGoogle Scholar
  61. 61.
    Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521–7.PubMedGoogle Scholar
  62. 62.
    Vauthey JN, Abdalla EK, Doherty DA, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl. 2002;8(3):233–40.PubMedCrossRefGoogle Scholar
  63. 63.
    Makuuchi M, Kosuge T, Lygidakis NJ. New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma – an old problem revisited. Hepatogastroenterology. 1991;38(4):329–36.PubMedGoogle Scholar
  64. 64.
    Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology. 2005;234(2):625–30.PubMedCrossRefGoogle Scholar
  65. 65.
    Salem R, Lewandowski RJ, Mulcahy MF, et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology. 2010;138(1):52–64.PubMedCrossRefGoogle Scholar
  66. 66.
    Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant. 2009;9(8):1920–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Ramage JK, Davies AH, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005;54 Suppl 4:1–16.Google Scholar
  68. 68.
    King J, Quinn R, Glenn DM, et al. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer. 2008;113(5):921–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Saxena A, Chua TC, Bester L, Kokandi A, Morris DL. Factors predicting response and survival after yttrium-90 radioembolization of unresectable neuroendocrine tumor liver metastases: a critical appraisal of 48 cases. Ann Surg. 2010;251(5):910–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Kath R, Hayungs J, Bornfeld N, Sauerwein W, Höffken K, Seeber S. Prognosis and treatment of disseminated uveal melanoma. Cancer. 1993;72(7):2219–23.PubMedCrossRefGoogle Scholar
  71. 71.
    Maluccio MA, Covey AM, Schubert J, et al. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer. 2006;107(7):1617–23.PubMedCrossRefGoogle Scholar
  72. 72.
    Mavligit GM, Zukiwski AA, Salem PA, Lamki L, Wallace S. Regression of hepatic metastases from gastrointestinal leiomyosarcoma after hepatic arterial chemoembolization. Cancer. 1991;68(2):321–3.PubMedCrossRefGoogle Scholar
  73. 73.
    Mavligit GM, Zukwiski AA, Ellis LM, Chuang VP, Wallace S. Gastrointestinal leiomyosarcoma metastatic to the liver. Durable tumor regression by hepatic chemoembolization infusion with cisplatin and vinblastine. Cancer. 1995;75(8):2083–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Rajan DK, Soulen MC, Clark TW, et al. Sarcomas metastatic to the liver: response and survival after cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol chemoembolization. J Vasc Interv Radiol. 2001;12(2):187–93.PubMedCrossRefGoogle Scholar
  75. 75.
    Vogl TJ, Gruber T, Balzer JO, Eichler K, Hammerstingl R, Zangos S. Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology. 2009;250(1):281–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Mulcahy MF, Lewandowski RJ, Ibrahim SM, et al. Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer. 2009;115(9):1849–58.PubMedCrossRefGoogle Scholar
  77. 77.
    Gray B, Van Hazel G, Hope M, et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol. 2001;12(12):1711–20.PubMedCrossRefGoogle Scholar
  78. 78.
    Hendlisz A, Van den Eynde M, Peeters M, et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol. 2010;28(23):3687–94.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

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