Skip to main content
SpringerLink
Log in

Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma

  • Original Article
  • Published:
Radiation Medicine Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the incidence, degree, and predictors of hepatic arterial damage (HAD) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

Materials and methods

A total of 33 patients with unresectable HCC underwent TACE alone using a mixture of iodized oil, epirubicin, and gelatin sponge. A follow-up angiogram was available for 76 of 109 sessions, and HAD was evaluated at each subsegment of the hepatic artery using a three-grade scale (1, no or slight wall irregularity; 2, overt stenosis; 3, occlusion). Grades 2 and 3 were considered to indicate significant HAD. The predictors of HAD were analyzed by multivariate analysis.

Results

A total of 161 hepatic arteries were embolized from the lobar (n = 43), segmental (n = 40), subsegmental (n = 72), or more distal (n = 6) level. The follow-up period between the initial and last sessions ranged from 70 to 1505 days (median 497 days). Significant HAD occurred in 37 of 231 subsegmental hepatic arteries (16%) and in 16 of 33 patients (48%). The accumulated dose of epirubicin per artery (P = 0.001) and Child-Pugh score (P < 0.001) were significant predictors.

Conclusion

TACE is more likely to induce HAD in cirrhotic patients with impaired liver function and when a high dose of the chemotherapeutic agent was used.

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

Similar content being viewed by others

References

  1. Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004;127(Suppl 1):S5–S16.

    Article  PubMed  Google Scholar 

  2. Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment: study of 850 patients. Cancer 1985;56:918–928.

    Article  PubMed  CAS  Google Scholar 

  3. Adachi E, Maeda T, Matsumata T, Shirabe K, Kinukawa N, Sugimachi K, et al. Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology 1995;108:768–775.

    Article  PubMed  CAS  Google Scholar 

  4. Ko S, Nakajima Y, Kanehiro H, Hisanaga M, Aomatsu Y, Kin T, et al. Significance influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy: result of multivariate analysis. Ann Surg 1996;224:591–595.

    Article  PubMed  CAS  Google Scholar 

  5. Nakamura H, Hashimoto T, Oi H, Sawada S. Transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 1989;170:783–786.

    PubMed  CAS  Google Scholar 

  6. Geschwind JF, Ramsey DE, Cleffken B, van der Wal BC, Kobeiter H, Juluru K, et al. Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol 2003;26:111–117.

    Article  PubMed  Google Scholar 

  7. Liang K, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.

    Article  Google Scholar 

  8. Yamashita Y, Takahashi M, Koga Y, Saito R, Nanakawa S, Hatanaka Y, et al. Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion. Cancer 1991;67:385–391.

    Article  PubMed  CAS  Google Scholar 

  9. Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, et al. Transcatheter oily chemoembolization for hepatocellular carcinoma: a 4-year study of 127 French patients. Cancer 1994;74:16–24.

    Article  PubMed  CAS  Google Scholar 

  10. Harada T, Matsuo K, Inoue T, Tamesue S, Inoue T, Nakamura H. Is preoperative hepatic arterial chemoembolization safe and effective for hepatocellular carcinoma? Ann Surg 1996;224:4–9.

    Article  PubMed  CAS  Google Scholar 

  11. Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006;131:461–469.

    Article  PubMed  CAS  Google Scholar 

  12. Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734–1739.

    Article  PubMed  Google Scholar 

  13. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164–1171.

    Article  PubMed  CAS  Google Scholar 

  14. Camma C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 2002;224:47–54.

    Article  PubMed  Google Scholar 

  15. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429–442.

    Article  PubMed  CAS  Google Scholar 

  16. Uchida H, Ohishi H, Matsuo N, Nishimine K, Ohue S, Nishimura Y, et al. Transcatheter hepatic segmental arterial embolization using Lipiodol mixed with an anticancer drug and Gelfoam particles for hepatocellular carcinoma. Cardiovasc Intervent Radiol 1990;10:98–102.

    Google Scholar 

  17. Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993;188:79–83.

    PubMed  CAS  Google Scholar 

  18. Takayasu K, Muramatsu Y, Maeda T, Iwata R, Furukawa H, Muramatsu Y, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentgenol 2001;176:681–688.

    PubMed  CAS  Google Scholar 

  19. Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee HS, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996;198:10–12.

    Google Scholar 

  20. Oikawa T, Ojima H, Yamasaki S, Takayama T, Hirohashi S, Sakamoto M. Multistep and multicentric development of hepatocellular carcinoma: histological analysis of 980 resected nodules. J Hepatol 2005;42:225–229.

    Article  PubMed  Google Scholar 

  21. Miyoshi S, Minami Y, Kawata S, Imai Y, Saitoh R, Noda S, et al. Changes in hepatic functional reserve after transcatheter embolization of hepatocellular carcinoma: assessment by maximal removal rate of indocyanine green. J Hepatol 1988;6:332–336.

    Article  PubMed  CAS  Google Scholar 

  22. Khan KN, Nakata K, Kusumoto Y, Shima M, Ishii N, Koji T, et al. Evaluation of nontumorous tissue damage by transcatheter arterial embolization for hepatocellular carcinoma. Cancer Res 1991;51:5667–5671.

    PubMed  CAS  Google Scholar 

  23. Covey AM, Maluccio MA, Schubert J, BenPorat L, Brody LA, Sofocleous CT, et al. Particle embolization of recurrent hepatocellular carcinoma after hepatectomy. Cancer 2006;106:2181–2189.

    Article  PubMed  Google Scholar 

  24. 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;46:474–481.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Noboru Maeda, Keigo Osuga, Koji Mikami, Hiroki Higashihara, Hiromitsu Onishi, Yasuhiro Nakaya, Mitsuaki Tatsumi, Masatoshi Hori, Tonsok Kim, Kaname Tomoda & Hironobu Nakamura

Authors
  1. Noboru Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keigo Osuga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koji Mikami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroki Higashihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiromitsu Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuhiro Nakaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsuaki Tatsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masatoshi Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tonsok Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kaname Tomoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hironobu Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noboru Maeda.

About this article

Cite this article

Maeda, N., Osuga, K., Mikami, K. et al. Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma. Radiat Med 26, 206–212 (2008). https://doi.org/10.1007/s11604-007-0216-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-007-0216-5

Key words

Search

Navigation