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Query: UMLS:C0345904 (liver cancer)
 15,188 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transcatheter arterial chemo-embolization with lipiodol and anticancer agents (LP-TACE) is a highly effective therapeutic method for treating liver cancer. It has been difficult, however, to evaluate how lipiodol, an oil, and anticancer agents dissolved in an aqueous contrast medium are retained in tumors. This paper reports the study on the dynamics of anticancer agents administered in LP-TACE both in vitro and in tumor-bearing animals using emulsions produced by mixing lipiodol and adriamycin (ADM) dissolved in Gd-DTPA. The results were as follows. 1) ADM was dissolved in contrast mediums (60% Urografin and Gd-DTPA) and each solution was emulsified by mixing with lipiodol. The emulsion separated into two distinct layers 5 min. after mixing. From this observation it is guessed that lipiodol and anticancer agents also separate in tumors after administration in LP-TACE. 2) Rabbits with VX2 carcinoma implanted in their lower limbs were treated by chemo-embolization and subjected to serial observations for changes in signals on MRI. The signal intensity markedly increased, persisting until one week after administration, when the tumor was resected. This change may have been owing to Gd-DTPA retained in the tumor, indicating that the anticancer agent is not washed out, even after separating from lipiodol, but is retained in the tumor. 3) When ADM was dissolved in Gd-DTPA and intraarterially infused without being mixed with lipiodol, the intensity of the signal on MRI was the same as that in LP-TACE immediately after the administration, and gradually decreased thereafter. This result indicates earlier washout of the anticancer agent when administered without being combined with lipiodol. Quantitative analysis of the tumor resected one week after the treatment also revealed ADM levels with less than 10% of those in LP-TACE, suggesting the possibility of estimating intratumoral concentration of anticancer agents. This was evaluated on the basis of the signal intensity in the tumor using MRI. 4) A comparison of lipiodol accumulation on CT and signal changes induced by Gd-DTPA on MRI suggested that even after separation from lipiodol, the anticancer agent extends to microvessels in the interior part of the tumor.
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PMID:[Experimental studies on the dynamics of anticancer agents in transcatheter arterial chemo-embolization. Magnetic resonance imaging using emulsions containing lipiodol and Gd-DTPA]. 165 93

An investigation was carried out into the effects of lipiodol-transcatheter arterial chemoembolization (L-TACE) therapy on hepatocellular carcinoma (HCC) and metastatic liver cancer, as well as the effects of oral 5-fluorouracil administration after L-TACE. For L-TACE, lipiodol mixed with adriamycin (doxorubicin) was injected through a catheter inserted into the tumor feeding artery and this was followed by embolization with a gelatin sponge. Twenty national hospitals throughout Japan participated in this multicenter co-operative open trial. A total of 102 patients became the subjects of study, including 75 HCC patients, 12 metastatic liver cancer patients treated with L-TACE, and 15 HCC patients who had hepatectomy after L-TACE. In 22% of the HCC patients and in 42% of the metastatic liver cancer patients, the tumor size was reduced by more than 50% after L-TACE. 73% of the 63 HCC patients showed a more than 50% reduction of the levels of serum alpha-fetoprotein. Although the survival rates of the HCC patients who had a hepatic resection were better than those who had not, there was no statistically significant difference between the survival rates of the HCC patients and those of the metastatic liver cancer patients treated with L-TACE. The survival rates of the HCC patients after L-TACE did not change as a result of oral 5-fluorouracil administration. It was therefore concluded that L-TACE is an effective way of treating both HCC patients and metastatic liver cancer patients, and that repeated L-TACE should be considered for some patients whose serum levels of alpha-fetoprotein rose again after L-TACE. Further follow-up studies will be needed to discover the effects of oral chemotherapy after L-TACE.
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PMID:Effects of transcatheter arterial chemoembolization with oral chemotherapy on hepatic neoplasms. 246 82

Two hundred and eight cirrhotic patients with HCC underwent TACE with a standardized technique. Kaplan-Meier survival rates and 12, 24 at 36 months were 62%, 44% and 25%, respectively. Compared with 407 untreated patients, our series had a longer life expectancy, i.e., from 15 months after treatment on. Life experience was statistically different with the L-R test between the groups selected by Child-Pugh cirrhosis staging (p = 0.00000); all 8 Child-Pugh C patients died within 7 months; a high statistical difference was found between Child-Pugh A and B groups (p = 0.00012). Life experience was statistically different with the L-R test between the four groups selected by tumor size and spread (p = 0.012); statistical significance was not reached between contiguous groups in group vs. group comparisons. The patients with monofocal tumors, regardless of size, survive longer than those with multifocal and infiltrative (p = 0.0010) and those with multifocal (p = 0.0029) lesions. Hazard analysis, according to the stratified Cox model, proved tumor-size and Child-Pugh staging to be prognostic factors (p = 0.00027; p = 0.00000) which exhibit a highly significant correlation with each other (p = 0.00000). With the proportional hazard Cox model, tumor characteristics and Child-Pugh stage resulted to be highly significant independent prognostic factors (p = 0.013 and p = 0.000, respectively). Patient survival rates were graphically plotted against literature rates in 407 untreated patients classified by tumor size and by the Child-Pugh method: the two-year survival rates were higher in the subgroups of patients submitted to TACE. To conclude, TACE is an effective treatment not only for multifocal HCCs, but also for large monofocal and infiltrative HCCs. In contrast, TACE is quite useless in the patients with Child-Pugh C cirrhosis.
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PMID:[Transcatheter arterial chemoembolization technique in cirrhotic patients with hepatocarcinoma. Considerations on the procedure and evaluation of survival]. 787 44

Liver cirrhosis with hypersplenism is often associated with HCC. In many such cases, chemoembolization (TACE) may be very difficult because of the high incidence of hemorrhagic complications due to treatment and/or following portal hypertension, as well as for poor hematologic tolerance to antiblastic drugs in cirrhotic patients. Six patients with nodular HCC and cirrhosis (Child B) with hypersplenism were treated by combined TACE and partial splenic embolization (PSE) to reduce splenic size and to improve hematologic and hepatic function rates. Actual and long-lasting (up to 6 months since TACE/PSE) positive results were observed in splenic size and in hepatic function synthesis, as well as on hematologic and hemocoagulation factors. The clinical-laboratory improvement following TACE/PSE allowed TACE to be completed in all cases, following the usual protocol based on 3 procedures. Therefore, in the patients with advanced/decompensated cirrhosis and hypersplenism associated with HCC, the combined one-step TACE/PSE treatment can be said to improve patients' tolerance to antiblastic drugs and to reduce the risk of hemorrhagic complications due to invasive radiologic procedures and/or to portal hypertension.
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PMID:[Splenic embolization and hepatic chemoembolization: combined transcatheter treatment of hepatocellular carcinoma in cirrhosis with hypersplenism]. 839 Jul 5

Despite remarkable progress of diagnostic imaging and operative procedures radiological interventions play a major role in diagnostic and therapeutic liver tumor interventions. Percutaneous biopsies should be taken by 16-20 g needles. CT control is indicated in cases when sonographically guidance is impossible or of risk. MR guidance is still seldom. Accuracy rates of percutaneous biopsies are high (>90%), and safe with complications (e.g. bleeding) of less than 1%. Palliative percutaneous therapeutic interventions of primary or secondary liver malignancies are thermoablative procedures of laser (LITT), cryoablation or radio-frequency, percutaneous ethanol injection (PEI) and intraarterial chemotherapy via port system or repetitive catheterisation with perfusion or embolization (TACE). For metastatic disease with less than five tumors of less than 4 cm LITT and PEI are recommended, more advanced cases should be treated by intra-arterial port system chemotherapy. For HCC best results are shown for PEI, in cases of UICC stage IIIB and IV only TACE is adequate.
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PMID:[Image-guided interventions in liver tumors]. 1052 32

Patients with advanced Stage IV-A primary liver cancer, hepatocellular carcinoma (HCC) can be divided into subgroups: those with involvement of a major branch of the portal (Vp3) or hepatic (Vv2, Vv3) veins and those having multiple tumors in both lobes without Vp3 or Vv2, Vv3. The prognosis of Stage IV-A patients with Vv2 or Vv3 may be improved by extended hepatectomy with resection and reconstruction of hepatic veins or IVC. In those with Vp3, multidisciplinary treatments consisting of extended hepatectomy and adjuvant chemotherapy, i.e. intra-arterial injection or TACE, are thought to be feasible at the present, but the outcomes are still poor. On the other hand, there are some Stage IV-A patients with multi-centrical tumors who have multiple tumors in both lobes without major vascular invasion, and their prognoses are improved by partial resection of each tumor. However, when there are multiple tumors caused by intrahepatic metastases, multidisciplinary treatments consisting of reduction surgery, microwave ablation, ethanol injection, and intra-arterial chemotherapy might be useful at present.
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PMID:[Up to date of multidisciplinary treatments centering around hepatectomy for advanced liver cancer in stage IV-A]. 1101 91

The selection of an appropriate treatment strategy for patients with HCC depends on careful tumor staging and assessment of the underlying liver disease (Fig. 5). All patients with localized HCC (involvement of one single lobe, no vascular invasion or extrahepatic disease) should be evaluated for the potentially curative therapeutic options of partial hepatectomy or OLT. Candidates for partial hepatectomy must have no liver disease or Child's A cirrhosis, normal portal pressure, and normal serum bilirubin. For patients not meeting these criteria, OLT should be considered if there is a solitary lesion smaller than 5 cm in diameter or fewer than three lesions smaller than 3 cm. Local ablative therapies such as PEI, RFA, and TACE offer palliation for patients for whom surgical approaches are contraindicated. Percutaneous alcohol injection and RFA are minimally invasive and can be used on an outpatient basis, usually for tumor nodules smaller than 3 cm. When these therapies are used for small tumors, the survival rates can be similar to those achieved by partial hepatectomy. Transcatheter [figure: see text] arterial chemoembolization may be used as an interim treatment for patients waiting for OLT. Although TACE is often used for the palliation of large tumors, significant survival benefits have not yet been demonstrated for this indication.
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PMID:Locoregional management of hepatocellular carcinoma. Surgical and ablation therapies. 1121 13

Most patients with HCC do not qualify for surgical interventions. In carefully selected patients, TACE may improve survival, reduce the rate of tumor growth, and decrease the incidence of portal vein occlusion. Since the introduction of TACE in the 1980s, the technical aspects of the procedure have significantly improved. Sophisticated angiographic equipment and techniques have made superselective arterial catheterization possible for more focused drug delivery. The use of ethiodized oil allows for more effective targeting of HCC and provides dual embolization of the hepatic artery and the portal venules supplying the tumor. Many important technical questions about TACE remain unanswered at this time: there are no reliable, standardized patient selection criteria, ideal cytotoxic agents have not yet been identified, the optimal dose of ethiodized oil has not been confirmed, and the optimal frequency and timing of repeat treatment sessions remain unknown. One major limitation of TACE--the need for repeated treatments, which can result in deterioration of liver function--may be avoided by use of a combination of interventional therapies. The combination of limited TACE with PEI or RFA may lead to improved survival and decreased risk of liver failure. More recently, two excellent randomized clinical trials have demonstrated significant survival benefit for patients treated with TACE when compared with those treated symptomatically.
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PMID:Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. 1273 33

This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients.
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PMID:Current role of portal vein embolization/hepatic artery chemoembolization. 1506 66

Treatment of the liver cancer (LC) patient is often problematic as the tumour is identified at an advanced stage: the frequent coexistence of cirrhosis limits the use of surgical resection, there is no efficacious chemotherapy, and in patients treatable with liver transplant, indication is rendered uncertain from the point of view of cost-effectiveness and the high risk of recurrence of the tumour and hepatitis infection. Surgical resection appears to be the treatment of choice in patients with a liver tumour in a ''healthy'' liver. Instead, orthotopic liver transplant is the most valid indication for patients with cirrhosis and tumours of dimensions smaller than 2-3 cm. Nevertheless, due to the lack of organs palliative treatments, like surgical resection, PEI and TACE are the most indicated in patients with advanced neoplastic disease, in practice patients with TNM III and IV; radiotherapy with protons and the coagulation of the tumour by microwaves or laser fibres are also used in the attempt to slow down the progress of the neoplastic process. These methods may increase the possibility of cure in well chosen patients. In some patients the most effective approach may be the combined use of various therapies, such as TACE, PEI and surgery.
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PMID:Hepatocellular carcinoma: screening and therapy. 1649 75


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