1
|
Trans-Arterial Chemoembolization with 50 μm Degradable Starch Microspheres Versus 300–500 μm Drug Eluting Beads in Hepatocellular Carcinoma: A Comparative Analysis of Initial Treatment Outcomes. J Belg Soc Radiol 2022; 106:10. [PMID: 35434518 PMCID: PMC8916059 DOI: 10.5334/jbsr.2594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Aims: Trans-arterial chemoembolization (TACE) has become a widely accepted treatment in unresectable hepatocellular carcinoma (HCC). We aimed at comparing the efficacy of Degradable Starch Microspheres (DSMs)-TACE with 50 ± 7 µm versus 300–500 μm Drug Eluting Beads (DEB)-TACE in terms of initial clinical and radiological treatment response parameters. Material and Methods: A total of 54 patients with unresectable HCC who underwent DEB-TACE (n = 25) or DSMs-TACE (n = 29) were included in this retrospective study. Baseline demographic and clinical characteristics, duration of follow-up, local recurrence and survival status, as well as treatment outcome including treatment response via modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria, viable and total tumor diameter and serum alpha-fetoprotein (AFP) levels were analyzed in both study groups. Results: No significant difference was noted between the two groups in terms of local recurrence (31.6 vs. 16.7%) or mortality (73.9 vs. 85.7%) rates after 36-month and 12-month follow-up, respectively. DSMs-TACE vs. DEB-TACE was associated with significantly higher complete response rate (27.6 vs. 0.0%, p = 0.011) and significant decrease in serum AFP levels (p = 0.013). Conclusion: Both DSMs-TACE with 50 ± 7 µm microspheres and 300–500 μm DEB-TACE are effective for local control of unresectable HCC. Our findings revealed superiority of DSMs-TACE over DEB-TACEnin terms of initial clinical and radiological tumor response; though no significant difference was noted between the two patient groups in terms of local recurrence or mortality during follow up.
Collapse
|
2
|
Wang H, Wang H, Yu Z, Liu H. Alternative treatment strategies to sorafenib in patients with advanced hepatocellular carcinoma: a meta-analysis of randomized Phase III trials. Onco Targets Ther 2018; 11:5195-5201. [PMID: 30214225 PMCID: PMC6118246 DOI: 10.2147/ott.s171918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction This meta-analysis was conducted to evaluate efficacy and safety in patients treated with sorafenib vs other tyrosine-kinase inhibitors (TKIs) or selective internal radiotherapy (SIRT) for advanced hepatocellular carcinoma (HCC). Methods Electronic databases were systematically reviewed for randomized Phase III trials comparing sorafenib with other TKIs or SIRT in advanced HCC. Sorafenib was defined as the control arm. Other TKIs or SIRT was defined as the experimental arm. Overall survival (OS), time to progression (TTP), objective response rate (ORR), disease-control rate (DCR), and adverse events (AEs) were reviewed. Four trials in the other-TKI group (n=4,218) and two in the SIRT group (n=819) were eligible. Results Compared with sorafenib, other TKIs showed similar benefit on OS (HR 1.08, 95% CI 0.93–1.24; P=0.31) and TTP (HR 0.86, 95% CI 0.66–1.12; P=0.26) for advanced HCC. A significant increase in ORR (RR 1.67, 95% CI 1.15–2.43; P=0.008) was found with other TKIs, but no increase in DCR (RR 1.11, 95% CI 0.98–1.26; P=0.11) was observed. Other TKIs were associated with more frequent grade 3/4 AEs than sorafenib, including hypertension (P<0.00001), thrombocytopenia (P=0.002), fatigue (P<0.00001), decreased appetite (P<0.00001), and vomiting (P<0.0001). For locally advanced HCC, neither OS (HR 1.14, 95% CI 0.98–1.32; P=0.09) nor TTP (HR 0.87, 95% CI 0.74–1.02; P=0.10) differed significantly in SIRT and sorafenib. There was an increase in ORR (RR 2.60, 95% CI 1.69–4.00; P<0.0001), but no improvement in DCR (RR 0.91, 95% CI 0.81–1.02; P=0.11) in the SIRT group. Fewer patients treated with SIRT had grade 3/4 AEs than those treated with sorafenib, including diarrhea (P<0.0001), fatigue (P=0.0006), and hand–foot syndrome (P=0.0002). Other TKIs were noninferior to sorafenib in OS and TTP in advanced HCC, but with increased risk of toxicities. Conclusion Patients with locally advanced HCC treated with SIRT got similar efficacy with less toxicity to those treated with sorafenib.
Collapse
Affiliation(s)
- Hui Wang
- Department of Radiation Oncology, Yancheng First People's Hospital, Yancheng, Jiangsu 224005, China,
| | - Hefang Wang
- Department of Radiation Oncology, Yancheng First People's Hospital, Yancheng, Jiangsu 224005, China,
| | - Zhichong Yu
- Department of Radiation Oncology, Yancheng First People's Hospital, Yancheng, Jiangsu 224005, China,
| | - Honghao Liu
- Department of Radiation Oncology, Yancheng First People's Hospital, Yancheng, Jiangsu 224005, China,
| |
Collapse
|
3
|
Orlacchio A, Chegai F, Francioso S, Merolla S, Monti S, Angelico M, Tisone G, Mannelli L. Repeated Transarterial Chemoembolization with Degradable Starch
Microspheres (DSMs-TACE) of Unresectable Hepatocellular Carcinoma: A Prospective Pilot Study. Curr Med Imaging 2018; 14:637-645. [PMID: 30197583 PMCID: PMC6110039 DOI: 10.2174/1573405613666170616123657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aims of this study were to: a) evaluate tumor response rates using modified-Response-evaluation-criteria-in-solid-tumors (mRecist) criteria, b) evaluate safety of Degradable Starch Microspheres Trans-arterial-chemo-embolization (DSMs-TACE) for unresectable hepatocellular-carcinoma (HCC) treatment. MATERIALS AND METHODS We prospectively enrolled 24 HCC cirrhotic patients (21/3 M/F, mean age 66.3 years) to be treated with repeated DSMs-TACE procedures, performed at 4-6 week intervals on the basis of tumor response and patients tolerance. Clinical and biochemical evaluations were performed before and after each procedure. Treatment response was also assessed by Computed-tomography (CT) or Magnetic-resonance-imaging (MRI)-scan 4-6 weeks following each procedure. RESULTS In our experience, DSMs-TACE was both safe and effective. A total of 53 DSMs-TACE procedures were performed (2.2 per patient). No procedure-related death was observed. Complete Response (CR) was observed in 5/24 (20.8%), 4/17 (23.5%) and 5/12 (41.6%) patients after the first, second and third procedure, respectively. At the end of each treatment, all patients experienced at least a partial response. At the end of the repeated procedures, no differences between mono- or bi-lobar disease were observed in patients with CR (64.2% vs 50%; p=ns). In most cases, treatment discontinuation was due to worsening liver function. CONCLUSION DSMs-TACE is a valid, well-tolerated alternative treatment to Lipiodol-TACE or DEB-TACE, as it has demonstrated to achieve a relatively high percentage of complete tumor necrosis. CR rates were similar between patients with mono- or bi-lobar disease indicating the possibility of carrying-out repeated procedure in a safe and effective way in both types of patients.
Collapse
Affiliation(s)
- Antonio Orlacchio
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Fabrizio Chegai
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Simona Francioso
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Stefano Merolla
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Serena Monti
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mario Angelico
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Giuseppe Tisone
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lorenzo Mannelli
- 1Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology University Hospital Tor Vergata, Viale Oxford 81, 00133Rome, Italy; 2Liver Unit, University Hospital Tor Vergata, Rome, Italy; 3IRCCS SDN, Naples, Italy; 4Organ Transplantation Unit, University Hospital Tor Vergata, Rome, Italy; 5Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
4
|
Lewis AL, Willis SL, Dreher MR, Tang Y, Ashrafi K, Wood BJ, Levy EB, Sharma KV, Negussie AH, Mikhail AS. Bench-to-clinic development of imageable drug-eluting embolization beads: finding the balance. Future Oncol 2018; 14:2741-2760. [PMID: 29944007 DOI: 10.2217/fon-2018-0196] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This review describes the historical development of an imageable spherical embolic agent and focuses on work performed in collaboration between Biocompatibles UK Ltd (a BTG International group company) and the NIH to demonstrate radiopaque bead utility and bring a commercial offering to market that meets a clinical need. Various chemistries have been investigated and multiple prototypes evaluated in search of an optimized product with the right balance of handling and imaging properties. Herein, we describe the steps taken in the development of DC Bead LUMI™, the first commercially available radiopaque drug-eluting bead, ultimately leading to the first human experience of this novel embolic agent in the treatment of liver tumors.
Collapse
Affiliation(s)
- Andrew L Lewis
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Sean L Willis
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Matthew R Dreher
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Yiqing Tang
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Koorosh Ashrafi
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, NIH Clinical Center, National Institute of Biomedical Imaging & Bioengineering, & National Cancer Institute Center for Cancer Research, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Elliot B Levy
- Center for Interventional Oncology, Radiology & Imaging Sciences, NIH Clinical Center, National Institute of Biomedical Imaging & Bioengineering, & National Cancer Institute Center for Cancer Research, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Karun V Sharma
- Department of Radiology & Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC 20010, USA
| | - Ayele H Negussie
- Center for Interventional Oncology, Radiology & Imaging Sciences, NIH Clinical Center, National Institute of Biomedical Imaging & Bioengineering, & National Cancer Institute Center for Cancer Research, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Andrew S Mikhail
- Center for Interventional Oncology, Radiology & Imaging Sciences, NIH Clinical Center, National Institute of Biomedical Imaging & Bioengineering, & National Cancer Institute Center for Cancer Research, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| |
Collapse
|
5
|
Cai R, Song R, Pang P, Yan Y, Liao Y, Zhou C, Wang S, Zhou X, Wang H, Zhang H, Sun H, Ma H. Transcatheter arterial chemoembolization plus sorafenib versus transcatheter arterial chemoembolization alone to treat advanced hepatocellular carcinoma: a meta-analysis. BMC Cancer 2017; 17:714. [PMID: 29110700 PMCID: PMC5674853 DOI: 10.1186/s12885-017-3707-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many studies have combined sorafenib with transcatheter arterial chemoembolization (TACE) to treat patients with advanced hepatocellular carcinoma (HCC), but the results are disputable. Thus, we conducted this meta-analysis to assess the efficacy and safety of the combination treatment in patients with advanced HCC. METHODS Clinical data were collected from a computer search of literature published from January 2009 to June 2016 in PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang and the China Science and Technology Journal Database (CSTJ). The final analysis included 14 studies and 1670 patients. The primary endpoints were overall survival (OS), the objective response rate (ORR) and the disease control rate (DCR). RESULTS The combination group exhibited significantly more improvement than the group treated with TACE alone in ORR (RR =1.62, 95% confidence interval (CI) = 1.34-1.94, p < 0.00001), DCR (RR = 1.43, 95% CI = 1.26-1.62, p < 0.00001), 0.5-year OS (OR = 2.60, 95% CI = 1.57-4.29, p = 0.0002) and 1-year OS (OR = 1.88, 95% CI =1.39-2.53, p < 0.0001). The incidence of adverse events from combination therapy was increased compared to that from treatment with TACE alone, and the most commonly reported adverse events were fatigue, hand-foot skin reaction and diarrhoea, which were bearable. CONCLUSIONS The meta-analysis indicated that combination therapy is safe and efficient for clinical application.
Collapse
Affiliation(s)
- Rong Cai
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Rongfeng Song
- Department of Gastroenterology, Cancer Hospital of Jiangxi Province, Nanchang, Jiangxi, 330029, China
| | - Pengfei Pang
- Center for Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
- Guangdong Provincial Engineering Research Center for Molecular Imaging, Zhuhai, Guangdong, 519000, China
- Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Yan Yan
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Yifeng Liao
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Cuiling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Shuncong Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Xiuling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Huaping Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Hongyu Zhang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Huanhuan Sun
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China.
| | - Haiqing Ma
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China.
| |
Collapse
|
6
|
Neuzillet C, de Mestier L, Rousseau B, Mir O, Hebbar M, Kocher HM, Ruszniewski P, Tournigand C. Unravelling the pharmacologic opportunities and future directions for targeted therapies in gastro-intestinal cancers part 2: Neuroendocrine tumours, hepatocellular carcinoma, and gastro-intestinal stromal tumours. Pharmacol Ther 2017; 181:49-75. [PMID: 28723416 DOI: 10.1016/j.pharmthera.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Until the 1990s, cytotoxic chemotherapy has been the cornerstone of medical therapy for gastrointestinal (GI) cancers. Better understanding of the cancer cell molecular biology has led to the therapeutic revolution of targeted therapies, i.e. monoclonal antibodies or small molecule inhibitors directed against proteins that are specifically overexpressed or mutated in cancer cells. These agents, being more specific to cancer cells, were expected to be less toxic than conventional cytotoxic agents. However, their effects have sometimes been disappointing, due to intrinsic or acquired resistance mechanisms, or to an activity restricted to some tumour settings, illustrating the importance of patient selection and early identification of predictive biomarkers of response to these therapies. Targeted agents have provided clinical benefit in many GI cancer types. Particularly, some GI tumours are considered chemoresistant and targeted therapies have offered a new therapeutic base for their management. Hence, somatostatin receptor-directed strategies, sorafenib, and imatinib have revolutioned the management of neuroendocrine tumours (NET), hepatocellular carcinoma (HCC), and gastrointestinal stromal tumours (GIST), respectively, and are now used as first-line treatment in many patients affected by these tumours. However, these agents face problems of resistances and identification of predictive biomarkers from imaging and/or biology. We propose a comprehensive two-part review providing a panoramic approach of the successes and failures of targeted agents in GI cancers to unravel the pharmacologic opportunities and future directions for these agents in GI oncology. In this second part, we will focus on NET, HCC, and GIST, whose treatment relies primarily on targeted therapies.
Collapse
Affiliation(s)
- Cindy Neuzillet
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France; Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Tumour Biology Laboratory, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom; Barts and The London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom.
| | - Louis de Mestier
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France; Department of Gastroenterology and Pancreatology, Beaujon University Hospital (AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Benoît Rousseau
- Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Institut Mondor de Recherche Biomédicale, INSERM UMR955 Team 18, Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Olivier Mir
- Department of Cancer Medicine - Sarcoma Group, Department of Early Drug Development (DITEP) - Phase 1 Unit, Gustave Roussy Cancer Campus, University of Paris Sud, 114, Rue Edouard Vaillant, 94800 Villejuif, France
| | - Mohamed Hebbar
- Department of Medical Oncology, Lille University Hospital, 1, Rue Polonovski, 59037 Lille, France
| | - Hemant M Kocher
- Tumour Biology Laboratory, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom; Barts and The London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom
| | - Philippe Ruszniewski
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| |
Collapse
|
7
|
Zhao GS, Liu Y, Zhang Q, Li C, Zhang YW, Ren ZZ, Zhou J, Zhang M. Transarterial chemoembolization combined with Huaier granule for the treatment of primary hepatic carcinoma: Safety and efficacy. Medicine (Baltimore) 2017; 96:e7589. [PMID: 28723799 PMCID: PMC5521939 DOI: 10.1097/md.0000000000007589] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To evaluate the safety and efficacy of transarterial arterial chemoembolization (TACE) with gelatin sponge particles (GSPs-TACE) and Huaier granule to treat primary hepatic carcinoma (PHC).A series of 62 patients with PHC were included between June 2009 and December 2011, and randomly assigned to a control (n = 31) or an experimental group (n = 31). The control patients received TACE with 350 to 560 μm GSPs plus lobaplatin chemotherapy. Patients in the experimental group received TACE plus Huaier granule. Treatment safety and mid-to-long-term efficacy were evaluated.Follow-up ranged from 12 to 24 months with a mean of 28.7 months. The 6- and 12-month overall survivals were 100% and 93.5% in the experimental group and 90.3% and 80.6% in control group, respectively. The difference in overall survival at 12 months was significant (χ = 5.213, P < .05), but the difference in median survival in the experimental group (20.6 months) and control group (17.1 months) patients was not significant (χ = 0.745, P > .05). The number of TACE procedures in the experimental group (2.9 ± 8.7) and control group (4.1 ± 7.3) patients was significantly different (χ = 7.262, P < .05). The 6-month (87.1% vs. 73.3%, χ = 5.945) and 12-month (72.4% vs. 64.3%, χ = 6.384) tumor objective response rates in the experimental and control groups were significantly different (P < .05). There were no statistically significant differences in the occurrence of treatment-related adverse reactions in the 2 groups.Transarterial chemoembolization with GSPs and Huaier granule was safe and effective for treating PHC patients.
Collapse
Affiliation(s)
- Guang Sheng Zhao
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Ying Liu
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning
| | - Qing Zhang
- Central Laboratory, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning
| | - Chuang Li
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning
| | - Yue Wei Zhang
- Department of Hepatobiliary Intervention, Beijing Tsinghua Changgung Hospital, Changping, Beijing, China
| | - Zhi Zhong Ren
- Department of Hepatobiliary Intervention, Beijing Tsinghua Changgung Hospital, Changping, Beijing, China
| | - Jun Zhou
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning
| | - Ming Zhang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi
| |
Collapse
|
8
|
Poursaid A, Jensen MM, Huo E, Ghandehari H. Polymeric materials for embolic and chemoembolic applications. J Control Release 2016; 240:414-433. [PMID: 26924353 PMCID: PMC5001944 DOI: 10.1016/j.jconrel.2016.02.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 12/18/2022]
Abstract
Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.
Collapse
Affiliation(s)
- Azadeh Poursaid
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Mark Martin Jensen
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Eugene Huo
- Veterans Affairs Hospital, Salt Lake City, UT 84108, USA
| | - Hamidreza Ghandehari
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA.
| |
Collapse
|
9
|
Makramalla A, Itri JN, Choe KA, Ristagno RL. Transarterial Therapies for Hepatocellular Carcinoma. Semin Roentgenol 2016; 51:95-105. [DOI: 10.1053/j.ro.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
10
|
Geschwind JF, Kudo M, Marrero JA, Venook AP, Chen XP, Bronowicki JP, Dagher L, Furuse J, Ladrón de Guevara L, Papandreou C, Sanyal AJ, Takayama T, Ye SL, Yoon SK, Nakajima K, Lehr R, Heldner S, Lencioni R. TACE Treatment in Patients with Sorafenib-treated Unresectable Hepatocellular Carcinoma in Clinical Practice: Final Analysis of GIDEON. Radiology 2016; 279:630-40. [PMID: 26744927 DOI: 10.1148/radiol.2015150667] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate transarterial chemoembolization (TACE) use prior to and concomitantly with sorafenib in patients with unresectable hepatocellular carcinoma (HCC) across different global regions. MATERIALS AND METHODS GIDEON is an observational registry study of more than 3000 HCC patients. Patients with histologically, cytologically, or radiographically diagnosed HCC, and for whom a decision had been made to treat with sorafenib, were eligible. Patients were enrolled into the registry from 39 countries beginning in January 2009, with the last patient follow-up in April 2012. Detailed data on treatment history, treatment patterns, adverse events, and outcomes were collected. All treatment decisions were at the discretion of the treating physicians. Documented approval from local ethics committees was obtained, and all patients provided signed informed consent. Descriptive statistics, including minimum, median, and maximum, were calculated for metric data, and frequency tables for categorical data. Kaplan-Meier estimates with 95% confidence intervals were calculated for survival end points. RESULTS A total of 3202 patients were eligible for safety analysis, of whom 2631 (82.2%) were male. Median age was 62 years (range, 15-98 years). A total of 1511 (47.2%) patients underwent TACE prior to sorafenib; 325 (10.1%) underwent TACE concomitantly. TACE prior to sorafenib was more common in Japan and Asia-Pacific compared with all other regions (362 [71.3%] and 560 [60.3%] vs 12-209 [13.3%-37.1%]). Adverse events were reported in 2732 (85.3%) patients overall, with no notable differences in the incidence of adverse events, regardless of TACE treatment history. Overall survival was 12.7 months in prior-TACE patients, 9.2 months in non-prior-TACE patients, 21.6 months in concomitant-TACE patients, and 9.7 months in non-concomitant-TACE patients. CONCLUSION Global variation exists in TACE use in sorafenib-treated HCC patients. The combination of TACE with sorafenib appears to be a well-tolerated and viable therapeutic approach.
Collapse
Affiliation(s)
- Jean-François Geschwind
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Masatoshi Kudo
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Jorge A Marrero
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Alan P Venook
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Xiao-Ping Chen
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Jean-Pierre Bronowicki
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Lucy Dagher
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Junji Furuse
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Laura Ladrón de Guevara
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Christos Papandreou
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Arun J Sanyal
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Tadatoshi Takayama
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Sheng-Long Ye
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Seung Kew Yoon
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Keiko Nakajima
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Robert Lehr
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Stephanie Heldner
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| | - Riccardo Lencioni
- From Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD 21287 (J.F.G.); Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan (M.K.); Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.M.); University of California-San Francisco, San Francisco, Calif (A.P.V.); Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.P.C.); Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine, Nancy, France (J.P.B.); Policlínica Metropolitana, Caracas, Venezuela (L.D.); Kyorin University School of Medicine, Mitaka, Tokyo, Japan (J.F.); Hospital Angeles Clínica Londres, Mexico City, Mexico (L.L.d.G.); University Hospital of Larissa, Larissa, Greece (C.P.); Virginia Commonwealth University Medical Center, Richmond, Va (A.J.S.); Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan (T.T.); Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China (S.L.Y.); The Catholic University of Korea, Seoul, Korea (S.K.Y.); Global Medical Affairs, Bayer Healthcare Pharmaceuticals, Whippany, NJ (K.N.); Clinical Statistics, Bayer Healthcare Pharmaceuticals, Whippany, NJ (R.L.); Global Medical Affairs and Pharmacovigilance, Bayer Pharma AG, Berlin, Germany (S.H.); and Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy (R.L.)
| |
Collapse
|
11
|
Chegai F, Orlacchio A, Merolla S, Monti S, Mannelli L. Intermediate hepatocellular carcinoma: the role of transarterial therapy. Hepat Oncol 2015; 2:399-408. [PMID: 26998220 DOI: 10.2217/hep.15.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
According to Barcelona Clinic Liver Cancer, the recommended first-line treatment for patients with intermediate stage of hepatocellular carcinoma (HCC) is transarterial chemoembolization. Patients with intermediate stage of HCC represent 20% with a 2-year survival of approximately 50%. Nowadays, transarterial therapies have proved precious in the treatment of hepatic malignancies. During the last years, there were important developments in practiced transarterial therapies and their efficacy is still controversial. The purpose of this review is to discuss in further details these transarterial therapies that have been used to treat cases of HCC.
Collapse
Affiliation(s)
- Fabrizio Chegai
- Department of Diagnostic & Molecular Imaging, Radiation Therapy & Interventional Radiology, University Hospital Tor Vergata, Rome, Italy; Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
| | - Antonio Orlacchio
- Department of Diagnostic & Molecular Imaging, Radiation Therapy & Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | - Stefano Merolla
- Department of Diagnostic & Molecular Imaging, Radiation Therapy & Interventional Radiology, University Hospital Tor Vergata, Rome, Italy
| | | | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
| |
Collapse
|
12
|
Abstract
Transarterial chemoembolization is a minimally invasive procedure that deprives the tumor of its blood supply, and is especially used for the treatment of unresectable hepatocellular carcinoma. Metabolic evaluation of interventional therapies such as transarterial chemoembolization in hepatocellular carcinoma is proving to be a valuable tool in choosing therapies that are better targeted to patients, especially because of its likely contribution in predicting treatment response in unresectable lesions after these therapies.
Collapse
Affiliation(s)
- Nayelli Ortega López
- Department of Nuclear Medicine, Instituto Nacional de Cancerología, Av. San Fernando, no. 22, Colonia Sección XVI, C.P. 0400, Mexico City, Mexico; PET/CT Unit, Imagenus, Advanced Diagnostics in Healthcare, Av. México-Coyoacán, no. 346, Colonia General Anaya, Mexico City 03340, Mexico.
| |
Collapse
|
13
|
Orlacchio A, Chegai F, Merolla S, Francioso S, Giudice CD, Angelico M, Tisone G, Simonetti G. Downstaging disease in patients with hepatocellular carcinoma outside up-to-seven criteria: Strategies using degradable starch microspheres transcatheter arterial chemo-embolization. World J Hepatol 2015; 7:1694-1700. [PMID: 26140089 PMCID: PMC4483551 DOI: 10.4254/wjh.v7.i12.1694] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/20/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the downstaging rates in hepatitis C virus-patients with hepatocellular carcinoma (HCC), treated with degradable starch microspheres transcatheter arterial chemoembolization (DSM-TACE), to reach new-Milan-criteria (nMC) for transplantation.
METHODS: This study was approved by the Ethics Committee of our institution. From September 2013 to March 2014 eight patients (5 men and 3 women) with liver cirrhosis and multinodular HCC, that did not meet nMC at baseline, were enrolled in this study. Patients who received any other type of treatment such as termal ablation or percutaneous ethanol injection were excluded. DSM-TACE was performed in all patients using EmboCept® S and doxorubicin. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed measuring the longest enhancing axial dimension of each tumor according to the modified Response Evaluation Criteria In Solid Tumors measurements, and medical records were reviewed.
RESULTS: DSM-TACE was successfully performed in all patients without major complication. We treated 35 lesions (mean 4.3 per patient). Six of eight patients (75%) had their HCC downstaged to meet nMC. Every patient whose disease was downstaged eventually underwent transplantation. The six patients who received transplant were still living at the time of this writing, without recurrence of HCC. Baseline age (P = 0.25), Model for End-stage Liver Disease score (P = 0. 77), and α-fetoprotein level (P = 1.00) were similar between patients with and without downstaged HCC.
CONCLUSION: DSM-TACE represents a safely and effective treatment option with similar safety and efficacy of conventional chemoembolization and could be successfully performed also for downstaging disease in patients without nMC, allowing them to reach liver transplantation.
Collapse
|
14
|
Park KH, Kwon SH, Lee YS, Jeong SW, Jang JY, Lee SH, Kim SG, Cha SW, Kim YS, Cho YD, Kim HS, Kim BS, Kim YJ. Predictive factors of contrast-enhanced ultrasonography for the response to transarterial chemoembolization in hepatocellular carcinoma. Clin Mol Hepatol 2015; 21:158-64. [PMID: 26157753 PMCID: PMC4493359 DOI: 10.3350/cmh.2015.21.2.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 12/19/2022] Open
Abstract
Background/Aims The predictive role of contrast-enhanced ultrasonography (CEUS) before performing transarterial chemoembolization (TACE) has not been determined. We assessed the possible predictive factors of CEUS for the response to TACE. Methods Seventeen patients with 18 hepatocellular carcinoma (HCC) underwent TACE. All of the tumors were studied with CEUS before TACE using a second-generation ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy). The tumor response to TACE was classified with a score between 1 and 4 according to the remaining enhancing-tumor percentage based on modified response evaluation criteria in solid tumors (mRECIST): 1, enhancing tumor <25%; 2, 25%≤enhancing tumor<50%; 3, 50%≤enhancing tumor<75%; and 4, enhancing tumor≥75%). A score of 1 was defined as a "good response" to TACE. The predictive factors for the response to TACE were evaluated during CEUS based on the maximum tumor diameter, initial arterial enhancing time, arterial enhancing duration, intensity of arterial enhancement, presence of a hypoenhanced pattern, and the feeding artery to the tumor. Results The median tumor size was 3.1 cm. The distribution of tumor response scores after TACE in all tumors was as follows: 1, n=11; 2, n=4; 3, n=2; and 4, n=1. Fifteen tumors showed feeding arteries. The presence of a feeding artery and the tumor size (≤5 cm) were the predictive factors for a good response (P=0.043 and P=0.047, respectively). Conclusions The presence of a feeding artery and a tumor size of less than 5 cm were the predictive factors for a good response of HCC to TACE on CEUS.
Collapse
Affiliation(s)
- Kil Hyo Park
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Soon Ha Kwon
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Yong Sub Lee
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Soung Won Jeong
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Jae Young Jang
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Sae Hwan Lee
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Sang Gyune Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Sang-Woo Cha
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Young Seok Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Young Deok Cho
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Hong Soo Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Boo Sung Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Yong Jae Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| |
Collapse
|
15
|
Knox JJ, Cleary SP, Dawson LA. Localized and Systemic Approaches to Treating Hepatocellular Carcinoma. J Clin Oncol 2015; 33:1835-44. [DOI: 10.1200/jco.2014.60.1153] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jennifer J. Knox
- All authors: University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sean P. Cleary
- All authors: University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Laura A. Dawson
- All authors: University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
16
|
Keane FK, Tanguturi SK, Zhu AX, Dawson LA, Hong TS. Radiotherapy for liver tumors. Hepat Oncol 2015; 2:133-146. [PMID: 30190993 PMCID: PMC6095425 DOI: 10.2217/hep.15.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Many patients with primary hepatic malignancies present with advanced disease that is not suitable for surgical resection, orthotopic liver transplantation, or radiofrequency ablation. Outcomes are particularly dismal in patients with large, unresectable tumors and/or tumor venous thrombosis. Liver-directed radiotherapy, including stereotactic body radiotherapy (SBRT), is able to treat a variety of tumor sizes and tumors with venous involvement and has demonstrated excellent safety and control outcomes. SBRT should be considered a standard option in patients with early-stage hepatocellular carcinoma who are not candidates for surgical resection, orthotopic liver transplantation or radiofrequency ablation. SBRT should be strongly considered in patients with larger tumors and/or tumors with tumor venous thrombosis who have adequate liver function. Radiotherapy should remain a focus of hepatocellular carcinoma research.
Collapse
Affiliation(s)
- Florence K Keane
- Harvard Radiation Oncology Program, Harvard Medical School, 75 Francis Street, Brigham & Women's Hospital, ASB1 L2, Boston, MA 02215, USA
| | - Shyam K Tanguturi
- Harvard Radiation Oncology Program, Harvard Medical School, 75 Francis Street, Brigham & Women's Hospital, ASB1 L2, Boston, MA 02215, USA
| | - Andrew X Zhu
- Massachusetts General Hospital, Division of Hematology-Oncology, Department of Medicine; 32 Fruit St, Yawkey 7, Boston, MA 02114, USA
| | - Laura A Dawson
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, USA
| | - Theodore S Hong
- Massachusetts General Hospital, Department of Radiation Oncology, 32 Fruit St, Yawkey 7, Boston, MA 02114, USA
| |
Collapse
|
17
|
Cuestas ML, Oubiña JR, Mathet VL. Hepatocellular carcinoma and multidrug resistance: Past, present and new challenges for therapy improvement. World J Pharmacol 2015; 4:96-116. [DOI: 10.5497/wjp.v4.i1.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/02/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most frequent form of liver cancer and the third most common cause of cancer-related death in the world. The main risk factor worldwide for this type of malignancy is chronic hepatitis caused by hepatitis B virus and hepatitis C virus infections. Advances in early detection and treatment have improved life expectancy of patients with HCC. However, this disorder remains as a disease with poor prognosis. In fact, epidemiological studies have revealed that there is an 8-mo median survival rate in patients, approximately 20% of whom survive one year while only 5% remain alive after three years. Additionally, HCC is particularly difficult to treat because of its high recurrence rate, and its resistance to conventional chemotherapy is due, among other mechanisms, to several members of the ATP-Binding Cassette protein family involved in drug transport being overexpressed. Fortunately, there is evidence that these patients may benefit from alternative molecular-targeted therapies. This manuscript intends to provide further insight into the etiology and molecular mechanisms related to HCC development and the latest therapeutic approaches to treat this malignancy. The development of effective delivery systems of antitumor drugs able to target the liver parenchyma is also assessed. Finally, the prospects in the development of more efficient drug therapies to overcome multidrug resistance are also examined.
Collapse
|
18
|
Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P. Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine. EPMA J 2014; 5:16. [PMID: 25538797 PMCID: PMC4274760 DOI: 10.1186/1878-5085-5-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/07/2014] [Indexed: 12/18/2022]
Abstract
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.
Collapse
Affiliation(s)
- Leonard Berliner
- New York Methodist Hospital, Brooklyn, NY 11215, USA
- Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Heinz U Lemke
- Technical University of Berlin, 10623 Berlin, Germany
- University of Southern California, Los Angeles, CA, 90089, USA
| | - Eric vanSonnenberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- University of Arizona College of Medicine, Tucson, AZ, 85724, USA
| | - Hani Ashamalla
- New York Methodist Hospital, Brooklyn, NY 11215, USA
- Weill Medical College of Cornell University, New York, NY 10021, USA
| | | | - David Dosik
- New York Methodist Hospital, Brooklyn, NY 11215, USA
- Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Hesham Hazin
- New York Methodist Hospital, Brooklyn, NY 11215, USA
| | - Syed Shah
- New York Methodist Hospital, Brooklyn, NY 11215, USA
- Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Smruti Mohanty
- New York Methodist Hospital, Brooklyn, NY 11215, USA
- Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Sid Verma
- New York Methodist Hospital, Brooklyn, NY 11215, USA
| | | | - Irene Bargellini
- University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy
| | | | - Davide Caramella
- University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy
| | - Carlo Bartolozzi
- University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy
| | | |
Collapse
|
19
|
Byam J, Renz J, Millis JM. Liver transplantation for hepatocellular carcinoma. Hepatobiliary Surg Nutr 2014; 2:22-30. [PMID: 24570911 DOI: 10.3978/j.issn.2304-3881.2012.11.03] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 11/28/2012] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and is considered an aggressive tumor with mean survival estimated between 6 and 20 months. Hepatitis B and C are the most common etiologies. Pathological, laboratory and radiologic imaging all aid in diagnosis but much controversy exists in the utilization of any given modality. Many treatment options exist for management of HCC, each has its own limitation. Liver transplantation offers the most reasonable expectation for curative treatment while simultaneously removing the burden of the diseased liver. Still, advancements in the field have thus far not yet matched its potential, although new immunosuppressive and chemotherapy regimen may allow transplantation to push the envelope once again.
Collapse
Affiliation(s)
- Jerome Byam
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
| | - John Renz
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
| | - J Michael Millis
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
20
|
Abstract
Transarterial chemoembolization (TACE) is the current standard of care for patients with intermediate-stage hepatocellular carcinoma (HCC) and relatively preserved liver function. In a meta-analysis of randomized controlled trials comparing conventional TACE regimens-including the administration of an anticancer-in-oil emulsion followed by embolic agents-versus best supportive care, TACE was shown to improve median survival from 16 to 20 months. Various strategies to improve outcomes for this patient group have become the subject of much ongoing clinical research. The introduction of an embolic drug-eluting bead (DEB) has been shown to substantially improve the pharmacokinetic profile of TACE, providing levels of consistency and repeatability not available with conventional regimens while concomitantly significantly diminishing systemic drug exposure. In randomized trials, DEB-TACE significantly reduced liver toxicity and drug-related adverse events compared with conventional TACE. In this article, technique, indications and contraindications, and clinical outcomes of conventional and DEB-TACE in the management of HCC are reviewed. In addition, scientific background and early clinical experience with the use of combination regimens including TACE and systemically active molecular-targeted agents with antiangiogenic properties are discussed. The combination of DEB-TACE and antiangiogenic therapy represents a potentially powerful approach that is currently undergoing clinical investigation in a phase 3 setting.
Collapse
Affiliation(s)
- Riccardo Lencioni
- Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Pisa, Italy
| | - Pasquale Petruzzi
- Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Pisa, Italy
| | - Laura Crocetti
- Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Pisa, Italy
| |
Collapse
|
21
|
Abusedera MA, Arafa UA, Ali EM. Transcatheter administration of buffered Lidocaine for pain relief due to transarterial chemoembolization for HCC. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
22
|
Xu W, Kwon JH, Moon YH, Kim YB, Yu YS, Lee N, Choi KY, Kim YS, Park YK, Kim BW, Wang HJ. Influence of preoperative transcatheter arterial chemoembolization on gene expression in the HIF-1α pathway in patients with hepatocellular carcinoma. J Cancer Res Clin Oncol 2014; 140:1507-15. [PMID: 24853275 DOI: 10.1007/s00432-014-1713-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/13/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE Although transcatheter arterial chemoembolization (TACE) is the most common treatment option in patients with hepatocellular carcinoma (HCC), its clinical benefits remain still controversial. Since TACE induces hypoxic necrosis in tumors, hypoxia-inducible factor 1α (HIF-1α) could critically affect biology in residual tumors after TACE treatment and subsequent prognosis. However, HIF-1α and its prognostic relevance in TACE have rarely been examined in human specimens. In the current study, we investigated the prognosis and expression of genes regulated by HIF-1α in HCC patients receiving preoperative TACE for the first time. METHODS In total, 35 patients with HCC (10 patients undergoing preoperative TACE) were retrospectively studied. The prognostic significance of TACE was analyzed using Kaplan-Meier and Cox regression models. Protein levels of HIF-1α and mRNA levels of HIF-1α-associated genes were examined using immunohistochemistry (IHC) and real-time RT-PCR, respectively. RESULTS Preoperative TACE was significantly associated with increased 2-year recurrence rate (80 vs. 36 %, P = 0.00402) and shorter disease-free survival (DFS) time (11.9 vs. 35.7 months, P = 0.0182). TACE was an independent prognostic factor for recurrence (P = 0.007) and poor DFS (P = 0.010) in a multivariate analysis. Immunohistochemical staining revealed in vivo activation of HIF-1α in human specimens treated with TACE. Notably, protein levels of HIF-1α were significantly increased in TACE tissues demonstrated by IHC. Transcriptional targets of HIF-1α showed mRNA expression patterns consistent with activation of HIF-1α in TACE tissues. CONCLUSIONS Our findings collectively demonstrate that preoperative TACE confers poor prognosis in HCC patients through activation of HIF-1α.
Collapse
Affiliation(s)
- Weiguang Xu
- Department of Surgery, Ajou University School of Medicine, Suwon, 443-721, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Fujiki M, Aucejo F, Choi M, Kim R. Neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation: Where do we stand? World J Gastroenterol 2014; 20:5308-5319. [PMID: 24833861 PMCID: PMC4017046 DOI: 10.3748/wjg.v20.i18.5308] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/08/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.
Collapse
|
24
|
McNamara MG, Knox JJ. Systemic therapy for hepatocellular carcinoma. Hepat Oncol 2014; 1:23-38. [PMID: 30190939 PMCID: PMC6114012 DOI: 10.2217/hep.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Optimal treatment of hepatocellular carcinoma (HCC) is clinically challenging. Systemic treatment for advanced HCC was limited until the approval of sorafenib. This discovery resulted in the advent of many clinical trials. An ongoing Phase III trial is examining the benefit of adjuvant sorafenib. Utilization of doxorubicin-eluting bead embolization may offer safer treatment in eligible HCC patients. The use of systemic treatment peritransarterial chemoembolization is also being investigated. Many targeted therapies are being explored as first-/second-line treatment options in advanced HCC. The potential benefit of c-MET inhibitors, particularly in those with advanced, MET high expression HCC, may result in new systemic patient-directed targeted medicinal approaches. Remaining dilemmas query the appropriate management of patients with advanced Child-Pugh B, HCC and those recurring post-transplant.
Collapse
Affiliation(s)
- Mairéad G McNamara
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Jennifer J Knox
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| |
Collapse
|
25
|
Shaya FT, Breunig IM, Seal B, Mullins CD, Chirikov VV, Hanna N. Comparative and cost effectiveness of treatment modalities for hepatocellular carcinoma in SEER-Medicare. PHARMACOECONOMICS 2014; 32:63-74. [PMID: 24293197 DOI: 10.1007/s40273-013-0109-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) is increasing in the USA and worldwide. Several treatments are available for patients diagnosed at any disease stage. It remains unclear how medical expenditures vary across patients who remain untreated or undergo different modes of therapy. We evaluate the comparative and cost effectiveness of treatment modalities for HCC from a Medicare perspective. METHODS The Surveillance, Epidemiology, and End Results (SEER) registries and linked Medicare database with claims from Parts A/B were used to identify Medicare enrollees with initial diagnosis of HCC between 2000 and 2007 and followed through 2009. Patients were assigned to treatment modalities based on HCC staging systems: transplant, resection, liver directed, radiation, chemotherapy or no treatment. Survival benefits and cumulative Medicare expenditures were estimated in multivariate models, stratified by initial disease stage, to control for confounding. Cost-effectiveness ratios compared costs and benefits of the modalities across initial stages. RESULTS Cancer stages I, II, III, IV and unstaged represented 24, 9, 14, 17 and 37 % of 11,047 patients, respectively. Fewer than 40 % received any treatment. Relative to no treatment, transplant was most effective in reducing mortality, followed by resection, liver directed, and radiation or chemotherapy. Resection tended to be most cost effective in early staged and unstaged patients; transplant was least cost effective. In stage IV patients, liver directed therapy was more cost effective than chemotherapy or radiation. CONCLUSIONS Survival benefit was attributable to all treatment modalities. More effective treatments incurred greater Medicare expenditures, but resection patients incurred the least expenditures per year of life gained.
Collapse
Affiliation(s)
- Fadia T Shaya
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th floor, Baltimore, MD, 21201, USA,
| | | | | | | | | | | |
Collapse
|
26
|
Yu DS, Chang H, Sommer CM, Qu WL, Xu WJ, Yang RJ, Zhao P. Efficacy and safety of percutaneous microwave coagulation therapy followed by 125I seed brachytherapy for VX2 hepatic tumors in a rabbit model. Exp Ther Med 2013; 6:159-163. [PMID: 23935738 PMCID: PMC3735553 DOI: 10.3892/etm.2013.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 04/04/2013] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) followed by 125I seed brachytherapy for VX2 liver cancer in rabbits. Eighty New Zealand rabbits were injected with suspensions of VX2 tumor cells to create an animal model. The rabbits were randomly divided into 4 groups (n=20); the control, PMCT, 125I seed brachytherapy and combination groups. Group A was treated with PMCT at 40 W for 120 sec, group B was treated with 125I seed brachytherapy and group C was treated with PMCT followed by 125I seed brachytherapy. Group D were not treated and served as the control group. At 21 days after treatment, the rabbits were sacrificed for pathological assessment. The complete tumor necrosis rate was 19 out of 20 tumors (95%) in group C, 6 (30%) in group A, 0 (0%) in group B and 0 (0%) in the control group. The complete tumor necrosis rate was observed to be significantly different between groups C and A, and between groups C and B (P<0.01). No intraheptic metastasis occurred in group C, compared with an incidence of 7 (35%) in group A, 2 (10%) in group B and 20 (100%) in the control group. Between groups C and A, and between groups C and D, the intraheptic metastasis rate was statistically significant (P<0.01). PMCT followed by 125I seed brachytherapy increased the rate of carcinoma necrosis and decreased carcinoma metastasis in the VX2 rabbit model. This combined treatment is a safe, effective and minimally invasive therapeutic option for liver cancer.
Collapse
Affiliation(s)
- Dong-Sheng Yu
- Departments of Interventional Medicine, Qingdao University, Qingdao, Shandong 266003, P.R. China
| | | | | | | | | | | | | |
Collapse
|
27
|
Sinn M, Nicolaou A, Ricke J, Podrabsky P, Seehofer D, Gebauer B, Pech M, Neuhaus P, Dörken B, Riess H, Hildebrandt B. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with primary liver cancer: a phase II-study (NCT00356161). BMC Gastroenterol 2013; 13:125. [PMID: 23927554 PMCID: PMC3751555 DOI: 10.1186/1471-230x-13-125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 08/01/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatic arterial infusion (HAI) of chemotherapy requires the implantation of a transcatheter application system which is traditionally performed by surgery. This procedure, but particularly the adjacent drug application via pump or port is often hampered by specific complications and device failure. Interventionally implanted port catheter systems (IIPCS) facilitate the commencement of HAI without need for laparatomy, and are associated with favorable complication rates. We here present an evaluation of the most important technical endpoints associated with the use of IIPCS for HAI in patients with primary liver cancers. METHODS 70 patients (pts) with hepatocellular (HCC, n=33) and biliary tract cancer (BTC, n=37) were enrolled into a phase II -study. Of those, n=43 had recurrent disease and n=31 suffered from liver-predominant UICC-stage IVb. All pts were provided with IIPCSs before being treated with biweekly, intraarterial chemotherapy (oxaliplatin, 5-Flourouracil, folinic acid). The primary objective of the trial was defined as evaluation of device-related complications and port duration. RESULTS Implantation of port catheters was successful in all patients. Mean treatment duration was 5.8 months, and median duration of port patency was not reached. Disease-progression was the most common reason for treatment discontinuation (44 pts., 63%), followed by chemotherapy-related toxicity (12 pts., 17%), and irreversible device failure (5 pts., 7%). A total of 28 port complications occurred in 21 pts (30%). No unexpected complications were observed. CONCLUSIONS HAI via interventionally implanted port catheters can be safely applied to patients with primary liver tumors far advanced or/and pretreated.
Collapse
Affiliation(s)
- Marianne Sinn
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Breunig IM, Shaya FT, Hanna N, Seal B, Chirikov VV, Daniel Mullins C. Transarterial chemoembolization treatment: association between multiple treatments, cumulative expenditures, and survival. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:760-768. [PMID: 23947969 DOI: 10.1016/j.jval.2013.03.1630] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To examine cumulative survival and Medicaid-paid expenses associated with multiple courses of transarterial chemoembolization (TACE) as primary treatment for hepatocellular carcinoma (HCC). METHODS Medicare enrollees diagnosed with primary HCC from 2000 to 2007, ever treated with TACE, but not transplant/resection, followed through 2009 by using the Surveillance, Epidemiology and End-Results Program and linked Medicare databases. Cumulative all-cause/HCC-related survival was estimated by using multivariate Cox proportional hazards models stratified by the total number of TACE treatments. Multivariate weighted Cox regressions estimated the average risk of mortality faced with nonproportional hazards. Lin's inverse probability-weighted least squares regression method estimated cumulative Medicare expenditures adjusted for censoring and covariates. RESULTS Of 1228 patients, 34% were stage 1, 16% stage 2, 19% stage 3, 6% stage 4, and 26% unstaged. About 44% were aged 65 to 75 years, 69% were men, and 72% were Caucasian. Over half (57%) of the patients received one course, 24% two, 11% three, and 8% four courses of TACE. One-course patients incurred an average $74,788 (95% confidence interval [CI] $71,890-$77,686), two-course patients $101,126 (95% CI $94,395-$107,856), three-course patients $111,776 (95% CI $101,931-$121,621), and four-plus-course patients $148,878 (95% CI $136,346-$161,409). One-course patients lived (all-cause) an average 1.86 (95% CI 1.82-1.90), two-course patients 2.09 (95% CI 2.05-2.13), three-course patients 2.81 (95% CI 2.66-2.97), and four-plus-course patients 3.06 (95% CI 2.95-3.18) years after diagnosis. Average risk of all-cause mortality was not significantly different between one/two courses or three/four-plus courses. CONCLUSIONS Cumulative Medicare expenditures nearly doubled from one-course to four-plus-course patients. On average, four-plus-course patients lived over one more year than did one-course patients. Physician/patient decisions should be balanced with consideration of efficient use of limited resources, but payer's intervention in physician discretion may not be important in this setting.
Collapse
Affiliation(s)
- Ian M Breunig
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Xu LF, Sun HL, Chen YT, Ni JY, Chen D, Luo JH, Zhou JX, Hu RM, Tan QY. Large primary hepatocellular carcinoma: transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol 2013; 28:456-63. [PMID: 23216261 DOI: 10.1111/jgh.12088] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM To evaluate the clinical benefits of transarterial chemoembolization (TACE) monotherapy or TACE combined with percutaneous microwave coagulation therapy (PMCT) and the long-term survival rate of patients with large primary hepatocellular carcinoma (HCC) treated with these techniques. METHODS This is a retrospective study involving 136 patients with unresectable large HCC (189 tumor nodules, ≥ 5.0 cm in diameter) admitted to Sun Yat-Sen University Memorial Hospital (Guangzhou, China) between January 2004 and December 2011. The median follow-up time was 41 months (range, 6-96 months). Of these patients, 80 patients received TACE monotherapy and 56 patients received TACE combined with PMCT. The median interval between treatments and overall survival (OS) were hierarchically analyzed using log-rank tests. RESULTS All patients successfully underwent TACE alone or TACE with PMCT with no serious complications. The median survival time was 13 months (range, 3-84 months) for the TACE group and 25 months (range, 7-96 months) for the TACE-PMCT group. The 1-year, 3-year, and 5-year OS rates were 62.5%, 17.5%, and 5.0% in the TACE group, respectively. In contrast, in the TACE-PMCT group, the 1-year, 3-year, and 5-year OS rates were 87.5%, 50.0%, and 10.0%, respectively. This difference was statistically significant between the groups (P < 0.001). CONCLUSIONS TACE combined with PMCT had advantages in prolonging OS with satisfying time to progression and improving liver function in patients with large unresectable HCC. The results suggest that further prospective studies are required to confirm the findings of this study.
Collapse
Affiliation(s)
- Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Transcatheter arterial chemoembolization (TACE) is the standard of care for patients with preserved liver function and asymptomatic, noninvasive multinodular hepatocellular carcinoma (HCC) confined to the liver. However, the survival benefit of conventional TACE-including the administration of an anticancer agent-in-oil emulsion followed by embolic agents-reported in randomized controlled trials and meta-analyses was described as modest. Various strategies to improve outcomes for this patient group have become the subject of much ongoing clinical research. The introduction of embolic, drug-eluting beads (DEB) for transarterial administration has been shown to significantly reduce liver toxicity and systemic drug exposure compared to conventional regimens. The addition of molecular targeted drugs to the therapeutic armamentarium for HCC has prompted the design of clinical trials aimed at investigating the synergies between TACE and systemic treatments. Combining TACE with agents with anti-angiogenic properties represents a promising strategy, because TACE is thought to cause local hypoxia, resulting in a temporary increase in levels of vascular endothelial growth factor. Recently, a large phase II randomized, double-blind, placebo-controlled trial (the SPACE study) has shown that the concurrent administration of DEB-TACE and sorafenib has a manageable safety profile and has suggested that time to progression and time to vascular invasion or extrahepatic spread may be improved with respect to DEB-TACE alone. These data support the further evaluation of molecular targeted, systemically active agents in combination with DEB-TACE in a phase III setting.
Collapse
Affiliation(s)
- Riccardo Lencioni
- Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Pisa, Italy.
| |
Collapse
|
31
|
Abstract
Transcatheter arterial chemoembolization (TACE) is the standard of care for nonsurgical patients with preserved liver function with large or multinodular noninvasive hepatocellular carcinoma (HCC) confined to the liver. The administration of an anticancer-in-oil emulsion followed by embolic agents is the most popular TACE technique; however, the introduction of embolic, drug-eluting beads (DEB) has provided an alternative to conventional regimens. Experimental studies have shown that DEB-TACE results in a safe pharmacokinetic profile and effective tumor killing in animal models. Clinical experiences have confirmed that DEB-TACE provides a combined ischemic and cytotoxic effect locally, with significantly reduced drug-related toxicity and liver toxicity compared with conventional TACE. The addition of molecular targeted drugs to the therapeutic armamentarium for HCC has prompted the design of clinical trials aimed at investigating the synergies between TACE and systemic treatments. Combining TACE with antiangiogenic agents represents a promising strategy because TACE is thought to cause local hypoxia, resulting in a temporary increase in levels of vascular endothelial growth factor. Recently, a large phase 2, randomized, double-blind, placebo-controlled trial (the SPACE study) indicated that the concurrent administration of DEB-TACE and sorafenib has a manageable safety profile and suggested that the time to progression (TTP) and time to vascular invasion or extrahepatic spread may be improved compared with DEB-TACE alone. These data support the further evaluation of molecular targeted, systemically active agents in combination with DEB-TACE in a phase 3 setting.
Collapse
Affiliation(s)
- Riccardo Lencioni
- *Riccardo Lencioni, MD, FSIR, EBIR Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Building No. 29, 2nd floor, Via Paradisa 2, IT-56124 Pisa (Italy), Tel. +39 050 996 560, E-Mail
| |
Collapse
|