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Zhang W, Du N, Wang L, Yu J, Yang M, Zhang W, Qu X, Luo J, Yan Z. Effects of HepaSphere microsphere encapsule epirubicin with a new loading method transarterial chemoembolization: in vitro and in vivo experiments. Discov Oncol 2023; 14:209. [PMID: 37993734 PMCID: PMC10665283 DOI: 10.1007/s12672-023-00831-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
METHODS HS microspheres were loaded in a solution of hypertonic saline and contrast medium at different ratios. Morphology, size distribution, and drug loading capacity of the microsphere were evaluated. Rabbits with hepatic VX2 tumors underwent conventional TACE, drug-eluting beads TACE with HS microsphere loading epirubicin by recommended method (dTACE) or a new loading method (ndTACE). The plasma and tissue epirubicin concentration, tumor necrosis, and the microsphere distribution within the tumor were assessed. RESULTS It was found that the mean diameter of HS microspheres was effectively reduced to 102 ± 14 μm after loading with 10.0% NaCl and Ultravist (370 mg I /mL) at a ratio of 2: 8 ml. The loading capacity reached 78.7%. It was noted that the concentration of tumor epirubicin was significantly higher (p = 0.016) in the ndTACE group (11,989.8 ± 5776.6 ng/g) than the concentration in the dTACE (6516.5 ± 3682.3 ng/g) and in cTACE groups (1564.1 ± 696.1 ng/g, p < 0.001). Further, the tumor necrosis in group with the new loading method (ndTACE) was 92.4%. CONCLUSIONS The size of HS microsphere can be effectively reduced when it is loaded with a mixture of hypertonic saline and non-ionic contrast material. HS microsphere loaded with epirubicin using the new method (ndTACE) can increase the drug concentration in tumor and hence exert better improved antitumor effect.
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Affiliation(s)
- Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Liangwen Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Jiaze Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Wei Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Xvdong Qu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200041, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China.
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Microspheres as a Carrier System for Therapeutic Embolization Procedures: Achievements and Advances. J Clin Med 2023; 12:jcm12030918. [PMID: 36769566 PMCID: PMC9917963 DOI: 10.3390/jcm12030918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
The targeted delivery of anti-cancer drugs and isotopes is one of the most pursued goals in anti-cancer therapy. One of the prime examples of such an application is the intra-arterial injection of microspheres containing cytostatic drugs or radioisotopes during hepatic embolization procedures. Therapy based on the application of microspheres revolves around vascular occlusion, complemented with local therapy in the form of trans-arterial chemoembolization (TACE) or radioembolization (TARE). The broadest implementation of these embolization strategies currently lies within the treatment of untreatable hepatocellular cancer (HCC) and metastatic colorectal cancer. This review aims to describe the state-of-the-art TACE and TARE technologies investigated in the clinical setting for HCC and addresses current trials and new developments. In addition, chemical properties and advancements in microsphere carrier systems are evaluated, and possible improvements in embolization therapy based on the modification of and functionalization with therapeutical loads are explored.
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3
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Yang SH, Ju XJ, Deng CF, Cai QW, Su YY, Xie R, Wang W, Liu Z, Pan DW, Chu LY. Controllable Fabrication of Monodisperse Poly(vinyl alcohol) Microspheres with Droplet Microfluidics for Embolization. Ind Eng Chem Res 2022. [DOI: 10.1021/acs.iecr.2c02173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shi-Hao Yang
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Xiao-Jie Ju
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Chuan-Fu Deng
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Quan-Wei Cai
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Yao-Yao Su
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Rui Xie
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Wei Wang
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Zhuang Liu
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Da-Wei Pan
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Liang-Yin Chu
- School of Chemical Engineering, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, Sichuan 610065, China
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Wang CY, Hu J, Sheth RA, Oklu R. Emerging Embolic Agents in Endovascular Embolization: An Overview. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2020; 2:012003. [PMID: 34553126 PMCID: PMC8455112 DOI: 10.1088/2516-1091/ab6c7d] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Courtney Y. Wang
- The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., Hourson, TX 77030, USA
| | - Jingjie Hu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
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Kennoki N, Saguchi T, Sano T, Takara Y, Moriya T, Shirota N, Otaka J, Chiba N, Kawachi S, Serizawa H, Koizumi K, Tokuuye K. Long-term Histopathologic Follow-up of a Spherical Embolic Agent; Observation of the Transvascular Migration of HepaSphere TM. BJR Case Rep 2019; 5:20180066. [PMID: 31131132 PMCID: PMC6519504 DOI: 10.1259/bjrcr.20180066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 11/05/2022] Open
Abstract
Very few studies have been published on the long-term histopathologic follow-up of spherical embolic agents after their injection. To our knowledge, there are no reports in the literature regarding pathological analysis of the transvascular migration of HepaSphere particles. We here report a case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation 12 months after drug eluting microsphere transcatheter arterial chemoembolization (DEM-TACE), and long-term histopathologic follow-up of the microspheres was performed. Furthermore, to our knowledge, this is the first report in which transvascular migration of a HepaSphere particle was confirmed histologically. A 60-year-old male with chronic hepatitis B was treated with entecavir and seroconversion was obtained. The patient had decompensated cirrhosis, and desired to undergo living donor liver transplantation (LDLT). However, 2 HCC tumors of 3 cm or less were detected in his liver. The transplantation surgeon proposed DEM-TACE as a bridge therapy. The HCCs were located in the right lobe and lateral segment of the liver. A 1.9 F preshaped microcatheter (ProgreatΣ, Terumo, Japan) was selectively inserted into the A3 and anterior segmental branch, 10 mg of epirubicin was injected into each artery, and the arteries were embolized with 7 mg and 13 mg of HepaSphere loaded with epirubicin, respectively. Two months later, contrast-enhanced CT displayed a complete response. At that time, lung metastasis was suspected, but after partial lung resection, the patient was diagnosed as having inflammatory granuloma. One year after DEM-TACE treatment, LDLT was performed. No cancerous cells were detected in the area where the tumor was present, but 22 HepaSphere particles were detected. All particles were present in the interstitium. Furthermore, the transvascular migration of a HepaSphere particle was histologically confirmed. The largest and smallest HepaSphere diameters were 241.6 ± 52.5 µm and 186.5 ± 41.4 µm, respectively, and deformity was 22.6% ± 13.0 %. All the HepaSpheres detected in the examined pathological specimen were noted to be extravascular.
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Affiliation(s)
- Norifumi Kennoki
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yuki Takara
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Tomohisa Moriya
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Natsuhiko Shirota
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Jun Otaka
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiromi Serizawa
- Department of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kiyoshi Koizumi
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
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Englert C, Brendel JC, Majdanski TC, Yildirim T, Schubert S, Gottschaldt M, Windhab N, Schubert US. Pharmapolymers in the 21st century: Synthetic polymers in drug delivery applications. Prog Polym Sci 2018. [DOI: 10.1016/j.progpolymsci.2018.07.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Melchiorre F, Patella F, Pescatori L, Pesapane F, Fumarola E, Biondetti P, Brambillasca P, Monaco C, Ierardi AM, Franceschelli G, Carrafiello G. DEB-TACE: a standard review. Future Oncol 2018; 14:2969-2984. [PMID: 29987957 DOI: 10.2217/fon-2018-0136] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a relative new endovascular treatment based on the use of microspheres to release chemotherapeutic agents within a target lesion with controlled pharmacokinetics. This aspect justifies the immediate success of DEB-TACE, that nowadays represents one of the most used treatments for unresectable hepatocellular carcinoma. However, there is no consensus about the choice of the best embolotherapy technique. In this review, we describe the available microspheres and report the results of the main comparative studies, to clarify the role of DEB-TACE in the hepatocellular carcinoma management. We underline that there is no evidence about the superiority of DEB-TACE over conventional TACE in terms of efficacy, but there may be some benefits with respect to safety especially with the improvement of new technologies.
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Affiliation(s)
- Fabio Melchiorre
- Diagnostic & Interventional Radiology Service, Sant'Andrea Hospital, Vercelli, Italy
| | - Francesca Patella
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Lorenzo Pescatori
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Filippo Pesapane
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Enrico Fumarola
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | | | - Cristian Monaco
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic & Interventional Radiology Service, San Paolo Hospital, Milan, Italy
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8
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Bonne L, Verslype C, Laenen A, Cornelissen S, Deroose CM, Prenen H, Vandecaveye V, Van Cutsem E, Maleux G. Safety and efficacy of doxorubicin-eluting superabsorbent polymer microspheres for the treatment of liver metastases from neuroendocrine tumours: preliminary results. Radiol Oncol 2017; 51:74-80. [PMID: 28265235 PMCID: PMC5330173 DOI: 10.1515/raon-2017-0007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background The aim of the study was to retrospectively evaluate the symptom control, tumour response, and complication rate in patients with liver-predominant metastatic neuroendocrine tumours treated with transarterial chemoembolization using doxorubicin-eluting superabsorbent polymer (SAP) microspheres. Patients and methods Patients with neuroendocrine liver metastases who underwent hepatic transarterial chemoembolization using doxorubicin-eluting SAP-microspheres (50–100 μm Hepasphere/Quadrasphere Microsphere® particles, Merit Medical, South Jordan, Utah, USA) were included in this study. Pre-and post-procedure imaging studies were evaluated to assess short and intermediate-term tumour response using modified RECIST criteria. Symptom relief and procedure-related complications were evaluated. Results A total of 27 embolization procedures were performed on 17 patients. Twelve of 17 patients (70%) were symptomatic, including carcinoid syndrome (n = 8) and severe, uncontrollable hypoglycemia (n = 4). Eight of 12 patients (67%) had complete symptom relief, and the remaining 4 (33%) had partial relief. One patient developed ischemic cholecystitis (6%). No other hepatobiliary complications occurred. Short-term and intermediate-term imaging follow-up was available for 15/17 patients (88%) and 12/14 patients (86%) respectively. At short-term follow-up (< 3 months), 14 patients (93%) showed partial response and the remaining patient had progressive disease (7%). At intermediate-term imaging follow-up (> 3 months), partial response, stable disease and progressive disease were found respectively in 7 (58%), 3 (25%) and 2 (17%) patients. Conclusions Chemoembolization with doxorubicin-eluting SAP-microspheres is a safe and effective treatment option for neuroendocrine liver metastases and is associated with a low complication rate. In particular, no clinically evident liver necrosis or bile duct complications were encountered.
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Affiliation(s)
- Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Chris Verslype
- Department of Hepatology and Gastroenterology, University Hospitals Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and University Hasselt, Belgium
| | | | | | - Hans Prenen
- Department of Hepatology and Gastroenterology, University Hospitals Leuven, Belgium
| | | | - Eric Van Cutsem
- Department of Hepatology and Gastroenterology, University Hospitals Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
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Morimoto M, Kobayashi S, Moriya S, Ueno M, Tezuka S, Irie K, Goda Y, Ohkawa S. Short-term efficacy of transarterial chemoembolization with epirubicin-loaded superabsorbent polymer microspheres for hepatocellular carcinoma: comparison with conventional transarterial chemoembolization. Abdom Radiol (NY) 2017; 42:612-619. [PMID: 27624498 DOI: 10.1007/s00261-016-0900-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to compare the short-term efficacy of transarterial chemoembolization (TACE) with epirubicin-loaded superabsorbent polymer embolics (SAP) and conventional TACE in TACE-naïve patients with unresectable hepatocellular carcinoma (HCC). METHODS Fifty consecutive patients (mean age, 72.8 years; hepatitis C, 46%; BCLC-A or B, 52% or 48%) treated with TACE with SAP during 2013-2015 and 55 consecutive patients (mean age, 71.8 years; hepatitis C, 40%; BCLC-A or B, 51% or 49%) treated with conventional TACE during 2011-2013 were evaluated. Safety evaluations were based on CTCAE ver. 4.0. Short-term efficacies, i.e., at 1 month after TACE, were assessed using the European Association for the Study of the Liver criteria. Overall survival rates were calculated using the Kaplan-Meier method. Short-term response markers were analyzed by univariate and multivariate analyses. RESULTS There was no significant difference in the incidence of any grade of adverse events. The objective response rates were 50% and 62% in patients treated with TACE with SAP and with conventional TACE, respectively (P = 0.358). The overall survival rates were not significantly different (P = 0.810); the 1-year survival rates and the median survival time of the patients treated with TACE with SAP and with conventional TACE were 76% and 74%, and 18 months and 21 months, respectively. Overall survival was related to the short-term response. An alpha-fetoprotein level <1,000 ng/mL was a significant short-term response marker on multivariate analysis. CONCLUSIONS For TACE-naïve patients, TACE with SAP and conventional TACE had comparable safety and short-term efficacies.
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Affiliation(s)
- Manabu Morimoto
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
| | - Satoshi Kobayashi
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Satoshi Moriya
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Makoto Ueno
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Shun Tezuka
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Kuniyasu Irie
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Yoshihiro Goda
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Shinichi Ohkawa
- Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
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Sommer C, Pallwein-Prettner L, Vollherbst D, Seidel R, Rieder C, Radeleff B, Kauczor H, Wacker F, Richter G, Bücker A, Rodt T, Massmann A, Pereira P. Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation. Eur J Radiol 2017; 86:143-162. [DOI: 10.1016/j.ejrad.2016.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023]
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Kennoki N, Hori S, Hori A, Takeo Y, Oshiro H. Transcatheter arterial chemoembolization with spherical embolic material for locally advanced breast cancer: first report of HepaSphere™ treatment for primary breast cancer. BJR Case Rep 2016; 2:20150417. [PMID: 30460025 PMCID: PMC6243306 DOI: 10.1259/bjrcr.20150417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/26/2016] [Indexed: 11/05/2022] Open
Abstract
A 57-year-old female was diagnosed as having primary breast cancer (invasive carcinoma of no special type), which was immunohistochemically negative for oestrogen receptor, androgen receptor and human epidermal growth factor receptor Type 2. The main tumour was 54 × 35 mm in size and was located in the internal upper area of the left breast. The tumour had markedly invaded the skin and a daughter nodule was observed in the external upper area of the ipsilateral breast. An enlarged lymph node measuring 12mm in diameter was present in the axilla and an affected parasternal lymph node was also observed. A blood test showed no abnormalities and the patient was negative for tumour markers. We performed three sessions of transcatheter arterial chemoembolization with docetaxel-loaded HepaSphere™. The treatment procedure was successfully performed in all the three sessions. No adverse events higher than Grade 3 were observed. The sizes of the primary lesion and axillary lymph node decreased to 26 × 14 mm (37% reduction) and 10mm, respectively. The parasternal lymph node completely resolved. 2 months later, left total mastectomy and axillary lymph node dissection were performed. The histopathological post-therapy effect was considered to be a mild response (Grade 1a) in the breast lesion and a complete response (Grade 3) in the axillary lymph node. The mean±standard deviation of the minor axis of the vessels embolized with spherical particles was 183.0±96.5 μm. Our results indicate that transcatheter arterial chemoembolization used together with HepaSphere can be an alternative and effective therapy for locally advanced breast cancer.
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Affiliation(s)
- Norifumi Kennoki
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shinichi Hori
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, Osaka, Japan
| | - Atsushi Hori
- Department of Radiology, Rinku Dejima Clinic, Osaka, Japan
| | - Yuki Takeo
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, Osaka, Japan
| | - Hisashi Oshiro
- Department of Pathology, Tokyo Medical University Hospital, Tokyo, Japan
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12
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de Silva S, Mackie S, Aslan P, Cade D, Delprado W. Histological Comparison of Kidney Tissue Following Radioembolization with Yttrium-90 Resin Microspheres and Embolization with Bland Microspheres. Cardiovasc Intervent Radiol 2016; 39:1743-1749. [PMID: 27743088 DOI: 10.1007/s00270-016-1482-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intra-arterial brachytherapy with yttrium-90 (90Y) resin microspheres (radioembolization) is a procedure to selectively deliver high-dose radiation to tumors. The purpose of this research was to compare the radioembolic effect of 90Y-radioembolization versus the embolic effect of bland microspheres in the porcine kidney model. METHODS In each of six pigs, ~25-33 % of the kidney volume was embolized with 90Y resin microspheres and an equivalent number of bland microspheres in the contralateral kidney. Kidney volume was estimated visually from contrast-enhanced fluoroscopy imaging. Morphologic and histologic analysis was performed 8-9 weeks after the procedure to assess the locations of the microspheres and extent of tissue necrosis from 90Y-radioembolization and bland embolization. A semi-quantified evaluation of the non-acute peri-particle and perivascular tissue reaction was conducted. All guidelines for the care and use of animals were followed. RESULTS Kidneys embolized with 90Y-radioembolization decreased in mass by 30-70 % versus the contralateral kidney embolized with bland microspheres. These kidneys showed significant necrosis/fibrosis, avascularization, and glomerular atrophy in the immediate vicinity of the 90Y resin microspheres. By contrast, glomerular changes were not observed, even with clusters of bland microspheres in afferent arterioles. Evidence of a foreign body reaction was recorded in some kidneys with bland microspheres, and subcapsular scarring/infarction only with the highest load (4.96 × 106) of bland microspheres. CONCLUSION This study showed that radioembolization with 90Y resin microspheres produces localized necrosis/fibrosis and loss of kidney mass in a porcine kidney model. This result supports the study of 90Y resin microspheres for the localized treatment of kidney tumors.
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Affiliation(s)
- Suresh de Silva
- Radiology Department Sutherland Hospital, Southern Radiology Group, The Kingsway Caringbah, Sydney, NSW, 2229, Australia.
| | - Simon Mackie
- Department of Urology, Western General Hospital, Crewe Road, Edinburgh, Scotland, EH42XU, UK
| | - Peter Aslan
- Department of Urology, St George Hospital, South Street, Kogarah, NSW, Australia
| | - David Cade
- Sirtex Technology Pty Ltd, Level 33, 101 Miller Street, North Sydney, NSW, 2060, Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia
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Spatiotemporal dynamics of doxorubicin elution from embolic beads within a microfluidic network. J Control Release 2015; 214:62-75. [DOI: 10.1016/j.jconrel.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 01/25/2023]
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A Single-Center Retrospective Comparison of Doxorubicin-Loaded HepaSphere Transarterial Chemoembolization with Conventional Transarterial Chemoembolization for Patients with Unresectable Hepatocellular Carcinoma. J Vasc Interv Radiol 2015; 26:1622-9. [PMID: 26321015 DOI: 10.1016/j.jvir.2015.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 07/19/2015] [Accepted: 07/19/2015] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To compare doxorubicin-loaded HepaSphere transarterial chemoembolization versus conventional transarterial chemoembolization in terms of survival, time to recurrence, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. MATERIALS AND METHODS One hundred twenty-six patients (103 men, 23 women; mean age, 64.3 y) with unresectable hepatocellular carcinoma (HCC) who underwent conventional chemoembolization between January 2007 and March 2011 or drug-eluting embolic (DEE) chemoembolization (after the protocol change) between March 2011 and October 2014 were included in a retrospective analysis. Primary outcome measures were survival and time to recurrence. Secondary outcome measures were frequency of recurrence, technical success, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. RESULTS The technical success rate was 97.1%. There were no significant differences between the conventional and DEE chemoembolization groups with regard to mean survival duration (39.0 vs 37.4 mo), recurrence (32.9% vs 39.6%), postembolization syndrome (90% vs 89%), and chemoembolization-related mortality (5.5% vs 1.9%) and morbidity (9.6% vs 9.4%; P > .05). The time to recurrence was shorter in DEE chemoembolization-treated patients than in conventional chemoembolization-treated patients (5.0 vs 11.5 mo; P = .006), and acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization (P = .019). CONCLUSIONS Conventional chemoembolization and DEE chemoembolization were safe and effective interventions for unresectable HCC. DEE chemoembolization was not better than conventional chemoembolization in terms of survival and was associated with a shorter time to recurrence. Acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization.
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Hiraki T, Koizumi J, Arai Y, Sakurai Y, Kumada H, Nambu Y, Hori S. Transcatheter arterial embolization of hypervascular tumors with HepaSphere: prospective multicenter open label clinical trial of microspheres in Japan. Jpn J Radiol 2015; 33:479-86. [DOI: 10.1007/s11604-015-0448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Malagari K, Pomoni A, Filippiadis D, Kelekis D. Chemoembolization of hepatocellular carcinoma with HepaSphere™. Hepat Oncol 2015; 2:147-157. [PMID: 30190994 PMCID: PMC6095161 DOI: 10.2217/hep.15.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This review discusses the current data on Hepasphere™ in the treatment of hepatocellular carcinoma. HepaSphere is a drug-loadable microsphere that can be bound with doxorubicin, epirubicin, cisplatin or oxaliplatin. In vitro and in vivo studies confirm lower systemic exposure to the drug and fewer systemic doxorubicin-related side effects. Studies suggest that this technique is better tolerated than conventional lipiodol-based chemoembolization (c-TACE). In intermediate and early stage hepatocellular carcinoma - nonresponsive to curative treatments - complete response and partial response rates range from 22.2 to 48% and 43.7 to 51%, respectively. Studies with survival as an end-point are needed and head-to-head comparisons with other drug-eluting beads are necessary.
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Affiliation(s)
- Katerina Malagari
- Research & Imaging Unit, Evgenidion Hospital University of Athens, Medical School, Greece
- Department of Radiology, University of Athens, Medical School, Greece
| | - Anastasia Pomoni
- Research & Imaging Unit, Evgenidion Hospital University of Athens, Medical School, Greece
| | | | - Dimitrios Kelekis
- Research & Imaging Unit, Evgenidion Hospital University of Athens, Medical School, Greece
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In Vivo Evaluation of Irinotecan-Loaded QuadraSphere Microspheres for Use in Chemoembolization of VX2 Liver Tumors. J Vasc Interv Radiol 2014; 25:1727-35.e1. [DOI: 10.1016/j.jvir.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 01/01/2023] Open
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18
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Guiu B, Schmitt A, Reinhardt S, Fohlen A, Pohl T, Wendremaire M, Denys A, Blümmel J, Boulin M. Idarubicin-loaded ONCOZENE drug-eluting embolic agents for chemoembolization of hepatocellular carcinoma: in vitro loading and release and in vivo pharmacokinetics. J Vasc Interv Radiol 2014; 26:262-70. [PMID: 25311967 DOI: 10.1016/j.jvir.2014.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present in vitro loading and release characteristics of idarubicin with ONCOZENE (CeloNova BioSciences, Inc, San Antonio, Texas) drug-eluting embolic (DEE) agents and in vivo pharmacokinetics data after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in patients with hepatocellular carcinoma. MATERIALS AND METHODS Loading efficacy of idarubicin with ONCOZENE DEE agents 100 µm and DC Bead (Biocompatibles UK Ltd, Farnham, United Kingdom) DEE agents 100-300 µm was monitored at 10, 20, and 30 minutes loading time by high-pressure liquid chromatography. A T-apparatus was used to monitor the release of idarubicin from the two types of DEE agents over 12 hours. Clinical and 24-hour pharmacokinetics data were recorded after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in four patients with unresectable hepatocellular carcinoma. RESULTS Idarubicin loading in ONCOZENE DEE agents was > 99% at 10 minutes. Time to reach 75% of the release plateau level was 37 minutes ± 6 for DC Bead DEE agents and 170 minutes ± 19 for ONCOZENE DEE agents both loaded with idarubicin 10 mg/mL. After transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents, three partial responses and one complete response were observed with only two asymptomatic grade 3 biologic adverse events. Median time to maximum concentration for idarubicin in patients was 10 minutes, and mean maximum concentration was 4.9 µg/L ± 1.7. Mean area under the concentration-time curve from 0-24 hours was equal to 29.5 µg.h/L ± 20.5. CONCLUSIONS ONCOZENE DEE agents show promising results with very fast loading ability, a favorable in vivo pharmacokinetics profile with a sustained release of idarubicin during the first 24 hours, and encouraging safety and responses. Histopathologic and clinical studies are needed to evaluate idarubicin release around the DEE agents in tumor tissue and to confirm safety and efficacy.
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Affiliation(s)
- Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France.
| | - Antonin Schmitt
- Department of Pharmacy, Georges-François Leclerc Anticancer Center, Dijon, France
| | | | - Audrey Fohlen
- Department of Radiology, University Hospital, Caen, France
| | | | - Maëva Wendremaire
- Department of Pharmacology-Toxicology, University Hospital, Dijon, France
| | - Alban Denys
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mathieu Boulin
- Department of Pharmacy, University Hospital, Dijon, France
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Zhou X, Kong M, Cheng X, Li J, Li J, Chen X. Investigation of acetylated chitosan microspheres as potential chemoembolic agents. Colloids Surf B Biointerfaces 2014; 123:387-94. [PMID: 25311962 DOI: 10.1016/j.colsurfb.2014.07.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/27/2022]
Abstract
The aim was to investigate the potential of chitosan microspheres (CMs) with different acetylation using as a chemoembolic agent. Chitosan microspheres (CMs) were prepared via water-in-oil (W/O) emulsification cross-linking method, and acetylated chitosan microspheres (ACMs) were obtained by acetylation of CMs. Next, we characterized the morphology, size, composition and degrees of deacetylation using scanning electron microscopy (TEM), dynamic laser light scattering (DLS), and Fourier transform infrared spectrometer (FTIR). All microspheres had smooth surfaces and good mechanical flexibility, and all could pass through a 5F catheter. The swelling rate (SR) of CMs decreased significantly with the increase of pH (4.0-10.0) but ACMs did not change under the same conditions. Protein absorption assays suggested that albumin was more greatly adsorbed on CMs than on ACMs. Furthermore, CMs caused more blood clots than ACMs. ACMs caused hemolysis less than CMs (<5% of the time). Data indicated that ACMs had more hemocompatibility. Cytotoxicity tests indicated that ACMs initially had less cell attached proliferation but increased with incubation. In contrast, the relative growth rate of mouse embryo fibroblasts (MEFs) on CMs decreased gradually. The results suggested that ACMs could stimulate the growth of MEFs, and CMs were not cytotoxic to MEFs. Thus, ACMs were more biocompatible with greater potential to be used as chemoembolic material.
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Affiliation(s)
- Xuan Zhou
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China; Key Laboratory for Nano-Bio Interface Research, Suzhou Key Laboratory for Nanotheranostics, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou 215123, China.
| | - Ming Kong
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China
| | - Xiaojie Cheng
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China
| | - Jingjing Li
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China; College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100022, China
| | - Jing Li
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China
| | - Xiguang Chen
- College of Marine Life Science, Ocean University of China, Qingdao 266003, China.
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Feasibility of temporary protective embolization of normal liver tissue using degradable starch microspheres during radioembolization of liver tumours. Eur J Nucl Med Mol Imaging 2013; 41:231-7. [PMID: 24030669 DOI: 10.1007/s00259-013-2550-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/14/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe a new approach to protect nontarget healthy liver tissue using degradable starch microspheres (DSM) as a short-term embolizate during radioembolization of liver tumours with (90)Y microspheres. METHODS Between December 2011 and July 2012 radioembolization was performed in 54 patients. Five of these patients (three women, two men; mean age 67 years) underwent protective temporary embolization using DSM (EmboCept® S) of normal liver tissue that could not be excluded from the area treated by radioembolization through catheter repositioning. Clinical symptoms, laboratory findings, preinterventional imaging, and (99m)Tc-MAA and bremsstrahlung SPECT/CT, as well as baseline and follow-up imaging with (18)F-FDG PET/CT and MRI, were evaluated in relation to the technical and clinical success of the protective embolization. RESULTS Temporary embolization of arteries supplying normal liver tissue using DSM was technically successful in all five patients. (99m)Tc-MAA SPECT/CT performed in the first two patients after DSM injection showed no increased pulmonary shunting compared to the MAA test injection without DSM. Bremsstrahlung SPECT/CT after radioembolization demonstrated satisfactory irradiation of the tumour and successful protection of normal liver tissue. There were only mild hepatotoxic effects (grade 1) on laboratory follow-up examinations, and no adverse events associated with DSM embolization or radioembolization were recorded. CONCLUSION Temporary embolization with DSM before radioembolization is feasible and can effectively protect areas of normal liver tissue from irradiation and avoid permanent embolization if other methods such as catheter repositioning are not possible due to the location of the metastases.
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Huppert P, Wenzel T, Wietholtz H. Transcatheter Arterial Chemoembolization (TACE) of Colorectal Cancer Liver Metastases by Irinotecan-Eluting Microspheres in a Salvage Patient Population. Cardiovasc Intervent Radiol 2013; 37:154-64. [DOI: 10.1007/s00270-013-0632-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/14/2013] [Indexed: 10/26/2022]
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Seki A, Hori S, Sueyoshi S, Hori A, Kono M, Murata S, Maeda M. Transcatheter arterial embolization with spherical embolic agent for pulmonary metastases from renal cell carcinoma. Cardiovasc Intervent Radiol 2013; 36:1527-1535. [PMID: 23430025 DOI: 10.1007/s00270-013-0576-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/12/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). METHODS Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 μm [n = 14], 50-100 μm [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. RESULTS The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. CONCLUSION TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.
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Affiliation(s)
- Akihiko Seki
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan.
| | - Shinichi Hori
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Satoru Sueyoshi
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Atsushi Hori
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Michihiko Kono
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Shinichi Murata
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Masahiko Maeda
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
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23
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Zhao H, Zheng C, Feng G, Zhao Y, Liang H, Wu H, Zhou G, Liang B, Wang Y, Xia X. Temperature-sensitive poly(N-isopropylacrylamide-co-butyl methylacrylate) nanogel as an embolic agent: distribution, durability of vascular occlusion, and inflammatory reactions in the renal artery of rabbits. AJNR Am J Neuroradiol 2013; 34:169-76. [PMID: 22859278 DOI: 10.3174/ajnr.a3177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE We have developed a new thermosensitive liquid embolic agent, PIB nanogel, that can be solidified at body temperature. We thus further investigated the distribution, durability of vascular occlusion, and inflammatory reactions of PIB in embolization of the renal artery of rabbits. MATERIALS AND METHODS The bilateral renal arteries of 9 rabbits were first embolized with PIB at different injection rates. The distribution pattern of PIB was investigated by contact radiography and histology 1 hour after embolization. The right renal arteries of 20 rabbits were then embolized with PIB at the proper injection rate. Angiography and pathologic examination of the kidneys were performed at 1 week and 1, 2, and 3 months after embolization to evaluate the long-term outcomes. RESULTS With the injection rate increasing, PIB could reach the more distal branch of the renal artery. The proper injection rate was chosen as 0.10 mL/s due to the homogeneous distribution of PIB from the main renal artery to the precapillary level at this rate. During a 3-month follow-up observation period, no angiographic recanalization was observed. Histologically, we found no disruption of the vessel wall or subintimal bleeding, no extravasation of PIB, and no evidence of neovascularization. Moreover, there was only a mild inflammatory response, manifested by few lymphocytic and monocellular infiltration, without foreign body granuloma formation. CONCLUSIONS Embolization of the renal artery with PIB was easy and controllable, which could lead to a homogeneous and persistent occlusion without severe inflammatory changes. PIB might be a suitable material for intravascular embolization.
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Affiliation(s)
- H Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Wuhan, China
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24
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Abstract
Image-guided drug delivery provides a means for treating a variety of diseases with minimal systemic involvement while concurrently monitoring treatment efficacy. These therapies are particularly useful to the field of interventional oncology, where elevation of tumor drug levels, reduction of systemic side effects and post-therapy assessment are essential. This review highlights three such image-guided procedures: transarterial chemoembolization, drug-eluting implants and convection-enhanced delivery. Advancements in medical imaging technology have resulted in a growing number of new applications, including image-guided drug delivery. This minimally invasive approach provides a comprehensive answer to many challenges with local drug delivery. Future evolution of imaging devices, image-acquisition techniques and multifunctional delivery agents will lead to a paradigm shift in patient care.
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Carugo D, Capretto L, Willis S, Lewis AL, Grey D, Hill M, Zhang X. A microfluidic device for the characterisation of embolisation with polyvinyl alcohol beads through biomimetic bifurcations. Biomed Microdevices 2012; 14:153-63. [PMID: 21987002 DOI: 10.1007/s10544-011-9593-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A microfluidic based device has been developed for the characterisation of embolisation behaviour with polyvinyl alcohol (PVA) hydrogel beads within a microchannel network with bifurcations which mimic the blood vessel network. Both distal and proximal embolisations were achieved within the PMMA-made microdevice exhibiting comparable embolisation characteristics with those observed in vivo. Results showed that small beads allowed more distal embolisations with a reduced control of the spatial location of occlusion sites. In contrast, large beads generated effective proximal embolisations with an improved reproducibility of embolisation performance. Embolic bead hydrodynamics, partitioning at bifurcations, penetration through microchannels and embolisation locations across the channel network were characterised by quantifying the effects of embolic bead size, bead concentration, channel geometry and fluidic conditions. This development provided further insights into the physical principles governing embolisation performances within the constructed microdevices allowing the improvement of the predictability and controllability of the clinical process outcomes. Furthermore, it can potentially provide a useful platform for preclinical research as an alternative to animal models, with an ultimate goal to reduce the amount of animal testing.
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Affiliation(s)
- Dario Carugo
- School of Engineering Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
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Impact économique de la chimioembolisation avec microsphères chargées dans le traitement du carcinome hépatocellulaire. Bull Cancer 2011; 98:671-8. [DOI: 10.1684/bdc.2011.1370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hepatic Arterial Embolization with Doxorubicin-Loaded Superabsorbent Polymer Microspheres in a Rabbit Liver Tumor Model. Cardiovasc Intervent Radiol 2011; 34:1021-30. [DOI: 10.1007/s00270-011-0154-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 12/10/2010] [Indexed: 01/25/2023]
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28
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Liver Hypertrophy After Percutaneous Portal Vein Embolization: Comparison of N-Butyl-2-Cyanocrylate Versus Sodium Acrylate–Vinyl Alcohol Copolymer Particles in a Swine Model. Cardiovasc Intervent Radiol 2010; 34:1042-9. [DOI: 10.1007/s00270-010-0046-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/29/2010] [Indexed: 12/24/2022]
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Liapi E, Geschwind JFH. Transcatheter arterial chemoembolization for liver cancer: is it time to distinguish conventional from drug-eluting chemoembolization? Cardiovasc Intervent Radiol 2010; 34:37-49. [PMID: 21069333 DOI: 10.1007/s00270-010-0012-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/07/2010] [Indexed: 12/15/2022]
Abstract
Conventional transcatheter arterial chemoembolization and chemoembolization with drug-eluting beads are increasingly being performed interchangeably in many institutions throughout the world. As both therapies continue to being tested in many phase II and III studies and in combination with other therapies, especially targeted agents, for treatment of primary and metastatic liver cancer, it is imperative to review their current status and evaluate their impact on patient survival. This review critically assesses patient selection, indications, contraindications, techniques, materials, safety, and clinical outcomes of patients treated with conventional chemoembolization and chemoembolization with drug-eluting beads.
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Affiliation(s)
- Eleni Liapi
- Division of Cardiovascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Gadaleta CD, Ranieri G. Trans-arterial chemoembolization as a therapy for liver tumours: New clinical developments and suggestions for combination with angiogenesis inhibitors. Crit Rev Oncol Hematol 2010; 80:40-53. [PMID: 21067940 DOI: 10.1016/j.critrevonc.2010.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 09/15/2010] [Accepted: 10/05/2010] [Indexed: 12/14/2022] Open
Abstract
The liver is the primary site of metastases for many malignancies. Gastrointestinal cancers are especially prone to spread to the liver and other tumours, as breast cancer and melanoma often spread to the liver. On the other hand, hepatocellular cancer (HCC) is the fifth most common malignancy in the world due to its common etiology from chronic liver damage caused by hepatitis or cirrhosis. Treatments of liver tumours vary according to histology and liver invasion and until now trans-arterial chemoembolization (TACE) has represented a main approach in the therapy of liver tumours. This review takes into consideration: (i) the background to utilizing TACE in liver tumours; (ii) TACE methods and the biological rationale for utilizing chemotherapeutic agents coated to a new micro-particle such as DC-Beads and HepaSphere; (iii) clinical experiences employing TACE in different liver tumours; (iv) the pivotal role of angiogenesis and hypoxia-induced angiogenesis following TACE with special references to HCC. Finally, the rationale for the combination of TACE with angiogenesis inhibitors is also discussed.
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Affiliation(s)
- C Damiano Gadaleta
- Interventional Radiology Unit, Integrated Section of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari, Italy.
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31
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Abstract
Transcatheter arterial chemoembolization (TACE) is one of the most commonly performed procedures in interventional radiology and is currently used for the palliative treatment of primary and metastatic hepatic malignancies. A new type of TACE is TACE with drug-eluting microspheres, which is currently gaining wide acceptance worldwide. In this article, we will review some technical components, patient selection, current results, and future directions of TACE and TACE with drug-eluting microspheres for primary and metastatic liver cancer.
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Observation of intravascular changes of superabsorbent polymer microsphere (SAP-MS) with monochromatic X-ray imaging. Cardiovasc Intervent Radiol 2010; 33:1016-21. [PMID: 20429004 DOI: 10.1007/s00270-010-9857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
This study was designed to evaluate the intravascular transformation behavior of superabsorbent polymer microsphere (SAP-MS) in vivo macroscopically by using monochromatic X-ray imaging and to quantitatively compare the expansion rate of SAP-MS among different kinds of mixtures. Fifteen rabbits were used for our study and transcatheter arterial embolization (TAE) was performed for their auricular arteries using monochromatic X-ray imaging. We used three kinds of SAP-MS (particle diameter 100-150 mum) mixture as embolic spherical particles: SAP-MS(H) absorbed with sodium meglumine ioxaglate (Hexabrix 320), SAP-MS(V) absorbed with isosmolar contrast medium (Visipaque 270), and SAP-MS(S) absorbed with 0.9% sodium saline. The initial volume of SAP-MS particles just after TAE and its final volume 10 minutes after TAE in the vessel were measured to calculate the expansion rate (ER) (n = 30). Intravascular behavior of SAP-MS particles was clearly observed in real time at monochromatic X-ray imaging. Averaged initial volumes of SAP-MS (H) (1.24 x 10(7) microm(3)) were significantly smaller (p < 0.001) than those of SAP-MS (V) (5.99 x 10(7) microm(3)) and SAP-MS (S) (5.85 x 10(7) microm(3)). Averaged final volumes of SAP-MS (H) were significantly larger than averaged initial volumes (4.41 x 10(7) microm(3) vs. 1.24 x 10(7) microm(3); p < 0.0001, ER = 3.55). There were no significant difference between averaged final volumes and averaged initial volumes of SAP-MS (V) and SAP-MS (S). SAP-MS (H), which first travels distally, reaches to small arteries, and then expands to adapt to the vessel lumen, is an effective particle as an embolic agent, causing effective embolization.
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Liapi E, Geschwind JFH. Intra-arterial therapies for hepatocellular carcinoma: where do we stand? Ann Surg Oncol 2010; 17:1234-46. [PMID: 20405328 DOI: 10.1245/s10434-010-0977-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE AND DESIGN Intra-arterial therapies for unresectable hepatocellular carcinoma (HCC) consist of a catheter-based group of treatments where therapeutic and/or embolic agents are intra-arterially directed to target tumors. Here we review these therapies, which may be classified into embolotherapy/chemotherapy-based and radiotherapy-based treatments. Embolotherapy/chemotherapy-based treatments include transcatheter arterial embolization, transarterial chemoembolization, transcatheter arterial chemoeinfusion, and chemoembolization with drug-eluting beads. Radiotherapy-based treatments include radioembolization with yttrium-90 and injection of iodine-131-labeled lipiodol. RESULTS AND CONCLUSION Interpretation of the results of clinical trials as well as implementation of meta-analyses involving the efficacy of intra-arterial therapies for unresectable HCC has been challenging and difficult to perform. The levels of evidence for treatment recommendations in oncology provide a common framework to understand the current status of intra-arterial therapies for HCC. Here we use an evidence-based approach to critically review and comprehend the current role and future potential of intra-arterial therapies in unresectable HCC.
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Affiliation(s)
- Eleni Liapi
- The Russell H Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA
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Lee KH, Liapi EA, Cornell C, Reb P, Buijs M, Vossen JA, Ventura VP, Geschwind JFH. Doxorubicin-loaded QuadraSphere microspheres: plasma pharmacokinetics and intratumoral drug concentration in an animal model of liver cancer. Cardiovasc Intervent Radiol 2010; 33:576-82. [PMID: 20087738 DOI: 10.1007/s00270-010-9794-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 12/31/2009] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate, in vitro and in vivo, doxorubicin-loaded poly (vinyl alcohol-sodium acrylate) copolymer microspheres [QuadraSphere microspheres (QSMs)] for transcatheter arterial delivery in an animal model of liver cancer. Doxorubicin loading efficiency and release profile were first tested in vitro. In vivo, 15 rabbits, implanted with a Vx-2 tumor in the liver, were divided into three groups of five rabbits each, based on the time of euthanasia. Twenty-five milligrams of QSMs was diluted in 10 ml of a 10 mg/ml doxorubicin solution and 10 ml of nonionic contrast medium for a total volume of 20 ml. One milliliter of a drug-loaded QSM solution containing 5 mg of doxorubicin was injected into the tumor feeding artery. Plasma doxorubicin and doxorubicinol concentrations, and intratumoral and peritumoral doxorubicin tissue concentrations, were measured. Tumor specimens were pathologically evaluated to record tumor necrosis. As a control, one animal was blandly embolized with plain QSMs in each group. In vitro testing of QSM doxorubicin loadability and release over time showed 82-94% doxorubicin loadability within 2 h and 6% release within the first 6 h after loading, followed by a slow release pattern. In vivo, the doxorubicin plasma concentration declined at 40 min. The peak doxorubicin intratumoral concentration was observed at 3 days and remained detectable till the study's end point (7 days). Mean percentage tumor cell death in the doxorubicin QSM group was 90% at 7 days and 60% in the bland QSM embolization group. In conclusion, QSMs can be efficiently loaded with doxorubicin. Initial experiments with doxorubicin-loaded QSMs show a safe pharmacokinetic profile and effective tumor killing in an animal model of liver cancer.
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Affiliation(s)
- Kwang-Hun Lee
- Division of Vascular and Interventional Radiology, The Russell H Morgan Department of Radiology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Looking for the Ideal Particle: An Experimental Embolization Study. Cardiovasc Intervent Radiol 2009; 33:336-45. [DOI: 10.1007/s00270-009-9747-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Cianni R, Urigo C, Notarianni E, Saltarelli A, Salvatori R, Pasqualini V, Dornbusch T, Cortesi E. Selective internal radiation therapy with SIR-spheres for the treatment of unresectable colorectal hepatic metastases. Cardiovasc Intervent Radiol 2009; 32:1179-86. [PMID: 19680720 DOI: 10.1007/s00270-009-9658-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/22/2009] [Accepted: 06/22/2009] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level>1.8 mg/dl and pulmonary shunt>20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate.
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Affiliation(s)
- Roberto Cianni
- Diagnostic and Interventional Radiology Department, S. M. Goretti General Hospital, Via G. Reni, 04100, Latina, Italy
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Bilbao JI, de Martino A, de Luis E, Díaz-Dorronsoro L, Alonso-Burgos A, Martínez de la Cuesta A, Sangro B, García de Jalón JA. Biocompatibility, inflammatory response, and recannalization characteristics of nonradioactive resin microspheres: histological findings. Cardiovasc Intervent Radiol 2009; 32:727-36. [PMID: 19449060 PMCID: PMC2711916 DOI: 10.1007/s00270-009-9592-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/03/2009] [Accepted: 04/07/2009] [Indexed: 12/11/2022]
Abstract
Intra-arterial radiotherapy with yttrium-90 microspheres (radioembolization) is a therapeutic procedure exclusively applied to the liver that allows the direct delivery of high-dose radiation to liver tumors, by means of endovascular catheters, selectively placed within the tumor vasculature. The aim of the study was to describe the distribution of spheres within the precapillaries, inflammatory response, and recannalization characteristics after embolization with nonradioactive resin microspheres in the kidney and liver. We performed a partial embolization of the liver and kidney vessels in nine white pigs. The left renal and left hepatic arteries were catheterized and filled with nonradioactive resin microspheres. Embolization was defined as the initiation of near-stasis of blood flow, rather than total occlusion of the vessels. The hepatic circulation was not isolated so that the effects of reflux of microspheres into stomach could be observed. Animals were sacrificed at 48 h, 4 weeks, and 8 weeks, and tissue samples from the kidney, liver, lung, and stomach evaluated. Microscopic evaluation revealed clusters of 10–30 microspheres (15–30 μm in diameter) in the small vessels of the kidney (the arciform arteries, vasa recti, and glomerular afferent vessels) and liver. Aggregates were associated with focal ischemia and mild vascular wall damage. Occlusion of the small vessels was associated with a mild perivascular inflammatory reaction. After filling of the left hepatic artery with microspheres, there was some evidence of arteriovenous shunting into the lungs, and one case of cholecystitis and one case of marked gastritis and ulceration at the site of arterial occlusion due to the presence of clusters of microspheres. Beyond 48 h, microspheres were progressively integrated into the vascular wall by phagocytosis and the lumen recannalized. Eight-week evaluation found that the perivascular inflammatory reaction was mild. Liver cell damage, bile duct injury, and portal space fibrosis were not observed. In conclusion, resin microspheres (15–30 μm diameter) trigger virtually no inflammatory response in target tissues (liver and kidney). Clusters rather than individual microspheres were associated with a mild to moderate perivascular inflammatory reaction. There was no evidence of either a prolonged inflammatory reaction or fibrosis in the liver parenchyma following recannalization.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII, 36, Pamplona, 31008, Spain.
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Comparative Study of Four Different Spherical Embolic Particles in an Animal Model: A Morphologic and Histologic Evaluation. J Vasc Interv Radiol 2008; 19:1625-38. [DOI: 10.1016/j.jvir.2008.07.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 07/03/2008] [Accepted: 07/14/2008] [Indexed: 01/13/2023] Open
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Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres: preliminary results from an Italian multicentre study. Cardiovasc Intervent Radiol 2008; 31:1141-9. [PMID: 18696150 DOI: 10.1007/s00270-008-9409-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 01/10/2023]
Abstract
The purpose of this article is to present the early results of a multicentre trial using HepaSphere microspheres loaded with chemotherapeutic agents for transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma. From December 2005 to March 2007, 50 patients (36 male and 14 female, mean age 68.4 years) were treated by selective TACE using HepaSphere microspheres loaded with doxorubicin or epirubicin. The diameter of the treated lesions ranged from 20 to 100 mm (mean 42.5; maximum of 4 tumor nodules). Tumor response was evaluated by computed axial tomography according to the World Health Organization criteria as modified by the European Association for the Study of Liver Diseases. All of the procedures were technically successful, and there were no major complications. At 1-month follow-up, complete tumor response was observed in 24 of 50 (48%), partial response in 18 of 50 (36%), and stable disease in 8 of 50 (16%) patients, and there were no cases of disease progression. At 6-month follow-up (31 of 50 patients), complete tumor response was obtained in 16 of 31 (51.6%), partial response in 8 of 31 (25.8%), and progressive disease in 7 of 31 (22.6%) patients. Within the initial 9-month follow-up, TACE with HepaSphere was successfully repeated twice in 3 patients, whereas 3 patients underwent the procedure 3 times. Our initial multicentre experience demonstrates that TACE using HepaSphere is feasible, is well tolerated, has a low complication rate, and is associated with promising tumor response. When complete tumor response in not achieved, additional treatments can be performed without difficulties. Longer follow-up on larger series is mandatory to confirm these preliminary results.
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Liapi E, Lee KH, Georgiades CC, Hong K, Geschwind JFH. Drug-Eluting Particles for Interventional Pharmacology. Tech Vasc Interv Radiol 2007; 10:261-9. [DOI: 10.1053/j.tvir.2008.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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