Hepatocellular carcinoma (HCC) remains the fourth leading cause of cancer-related death in the world. The progression of HCC after previously effective TACE is quite often local. This article describes our experience with repeated TACE in patients with local progression of HCC. We analyzed 125 patients with HCC, for the period from 2009 to 2015. TACE was performed for intrahepatic manifestations of HCC. Progression of HCC after TACE-1 was observed in 88.8 % (n = 111) patients. Disease progression after TACE‑2 was registered in 40 (32 %) patients. TACE‑3 was performed in 8 (6.4 %) patients. The analysis showed that isolated local intrahepatic progression of HCC with the growth of intrahepatic tumor nodes previously subjected to TACE‑1 (without new foci) does not affect OS. The efficiency of re-embolization (TACE‑2) is somewhat lower than for TACE of the first stage. Independent factors of overall survival increase in patients receiving TACE: satisfactory objective status according to ECOG, efficacy of the first stage of TACE, late progression and objective effect after re-embolization.

Modeling of a transarterial chemoembolization (TACE) is carried out on rats (n = 6) with hepatocellular cancer of liver RS1 (Vcp = 4.5 cm3) which has developed in muscles of the leg (i.m.). Sensitivity of a tumor to the single introduction of substance of doxorubicine (sDOX) in maximum tolerated doses (MTD) of 5-12 mg/kg with the achievement of significantly tumor growth inhibition on 55-77% (p = 0.001) is previously shown. TACE is executed with the elastic polyvinyl alcohol microspheres in size of 0.2 mm in diameter loaded with doxorubicine (MS/sDOX) with the release within 7 days. MS/sDOX in the volume of 0.034-0.1 ml (a cumulative dose of sDOX of 3.3-10.5 mg/kg) was introduced into a femoral artery (i/a) with a diameter of 0.16 mm under control of an embolization (MS or arterial ligature) and chemotherapy (sDOX). TACE gave rise in the cytoreductive effect of the tumor nodule by 67% (T/C = 33%, p = 0.0004) with the single regression and the development of the grade 1 therapeutical pathomorphosis (TP). The therapeutic gain of MC/sDOX manifested in coupled with the cytoreduction the decline of the tumor growth rate («т» = 11-16 against 1.9-2.0 days in the control group) and at the equal inhibiting action with sDOX dose reduced by 20% against MTD. Side effects of TACE (a necrosis of soft tissues, 7th-16th days) were not associated with the full stagnation of a regional blood flow due to the discrepancy of MS to diameter of the artery. The whole of the revealed effects has allowed to consider the modeling of i/m tumor on rats to be suitable for the screening of the specific activity of agents clients for TACE. The preclinical study of the method is rational to execute on the corresponding model on large animals with regional artery of the sufficient cross section of the vessel permitting to perform TACE satisfactory.

Aim: to study the effectiveness of the use of transarterial chemoembolization (TACE) in the treatment of patients with metastatic uveal melanoma. Material and methods: in N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia in the period from 2000 to 2019 72 patients received treatment (TACE) for metastases of uveal melanoma in the liver. Of these: men – 22 (30,6%), women – 50 (69,4%). Average age 46,28±10,32 years, range 23–84 years. The time of detection of metastatic liver lesions after treatment of the primary tumor ranged from 2 to 252 months, the median was 24 months. The volume of liver damage was up to 25% in 19 patients, from 25% to 50% in 33 patients, from 50% to 75% in 20 patients. A total of 134 TACE interventions were performed. Depending on the volume of the lesion, the nature of the blood supply to the tumors and the response to treatment, patients underwent 1 to 5 sessions of TACE: in 27 patients one TACE, in 35 – two, in 5 – three, in 3 – four, and in 2 – five TACE. As an embolizing component, lipiodol 10 ml was used in 106 cases, microspheres in 16 cases (particle sizes varied from 100 to 500 μm), in 12 TACEs, combinations of the presented embolizing materials were used. Carboplatin, doxorubicin or gemcitabine were used as chemotherapy drugs. Results: 58 patients (80,6%) had a moderate postembolization syndrome, expressed by pain, febrile temperature, nausea, and vomiting. A local response (including complete response, partial response, or stabilization by mRECIST criteria) was observed in 53/72 (73,6%) patients with metastases of uveal melanoma. The duration of observation of patients after TACE was from 2 to 60 months. The median follow-up was 12,5 months. The group that responded to treatment, including stabilization, achieved a 1-year Kaplan-Meier overall survival rate of 72% and a 2-year rate of 45,6%. In patients with continued growth of lesions, the 1-year overall survival rate according to the Kaplan-Meier method was 42,6%, and the 2-year survival rate was not achieved. 48 patients were alive at the time of the study, 24 died from disease progression. Conclusions: the use of TACE in metastatic lesions of the liver by choroidal melanoma in combined treatment or in mono-regimen led to an objective response or stabilization of the process in 73,6% of patients. This method increases the overall survival of patients and is well tolerated.