A randomized trial of intrahepatic arterial infusion of 4?-epidoxorubicin with Lipiodol versus 4?-epidoxorubicin alone in the treatment of hepatocellular carcinoma

Yoshikawa, Masaharu; Saisho, Hiromitsu; Ebara, Masaaki; Iwamoto, Toshihiko; Iwama, Shosuke; Endo, Fumio; Kimura, Michio; Shimamura, Yoshiyuki; Suzuki, Yasutoshi; Nakano, Toshihiko; Fukuyama, Yoshio; Fujise, Kiyotaka; Nambu, Masayuki; Ohto, Masao

doi:10.1007/bf00686689

Cited by 64 publications

(37 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, further studies should be published to ensure a solid assessment, mainly in reference to therapies with acceptable response rates, such as internal radiation [54][55][56] or arterial chemotherapy. [44][45][46][47][48][49][50] In summary, the present systematic review provides consistent evidence that arterial chemoembolization may benefit a subset of patients with unresectable HCC and thus proposes this therapy as the standard intervention in these cases. The data are relevant for the decision-making process of these patients, who at present do not have any option for cure.…”

Section: Discussionsupporting

confidence: 63%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

View full text Add to dashboard Cite

There is no standard treatment for patients with unresectable hepatocellular carcinoma (HCC). Survival benefits derived from medical interventions are controversial. The aim of this systematic review was to assess the evidence of the impact of medical treatments on survival. Randomized controlled trials (RCTs) that were published as full papers assessing survival for primary treatments of HCC were included. MEDLINE, the Cochrane Library, CANCERLIT, and a manual search from 1978 to May 2002 were used. The primary end point was survival, and the secondary end point was response to treatment. Estimates of effect were calculated according to the random effects model. Sensitivity analysis included methodological quality. We identified 61 randomized trials, but only 14 met the criteria to perform a meta-analysis assessing arterial embolization (7 trials, 545 patients) or tamoxifen T he incidence of hepatocellular carcinoma (HCC) is increasing worldwide. 1 Liver cancer is the fifth most common cancer in the world and the third most common cause of cancer-related death. 2 Cohort studies and cost-efficiency modeling have suggested that surveillance of well-defined cirrhotic patients may decrease tumor-related mortality. However, only 30% of patients benefit from curative therapies such as resection, transplantation, or percutaneous ablation 3 and achieve 5-year survival rates of 50% to 75%. 4 Most patients with HCC are diagnosed at intermediate to advanced stages, and there is no standard treatment for these patients. 3,4 The most reliable method to show survival advantages is to perform large randomized controlled trials (RCTs) that include more than 1,000 patients comparing treatment versus no treatment in a well-defined strata of individuals. 5-10 These investigations are lacking in patients with HCC. On the contrary, several medical interventions have been tested in the setting of small RCTs. However, the reduced size of these studies may cause questions of their statistical power when detecting survival differences, which, as in many areas of health care and oncology, are unlikely to be large. This raises the need for a systematic meta-analysis assessment, with a major role to integrate valid information and provide estimates of treatment effects when RCTs themselves are not of sufficient size. 9,10 Two systematic reviews published years ago 11,12 suggested a potential benefit for at Abbreviations: HCC, hepatocellular carcinoma; RCT, randomized controlled trial; OR, odds ratio; CI, confidence interval.

show abstract

Section: Discussionsupporting

confidence: 63%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

View full text Add to dashboard Cite

show abstract

“…comparison studies of Tae and Tac have shown that Tae treatment is associated with a higher survival rate than Tac in unresectable hepatic carcinoma patients (20,6). on the other hand, in a randomized prospective trial conducted to evaluate the efficacy of epirubicin alone vesus lipiodol emulsion containing the same dose of epirubicin in intrahepatic arterial infusion chemotherapy for hepatic carcinoma patients, lipiodol emulsion with epirubicin was shown to be more effective than epirubicin alone (11). The results of studies on the treatment of locally advanced cervical cancer were consistent with those on hepatic carcinoma: the tumor reduction ratio was significantly higher for the combination of intra-arterial cisplatin and gelfoam compared to gelfoam used alone, and cisplatin combined with other anticancer agents infused via the arteries had similar efficacy (12).…”

Section: Discussionmentioning

confidence: 99%

“…randomized controlled trials have shown that Tace appears to be more effective than Tac in hepatocellular carcinoma and cervical cancer treatment (11,12). These studies reported the clinical effects of tumor reduction and the patient survival rate under Tace treatment.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic comparison between pelvic transarterial chemoembolization and transcatheter arterial chemotherapy in an animal model

Song

Wang²,

Liu³

et al. 2009

Mol Med Rep

View full text Add to dashboard Cite

Abstract. Transcatheter arterial chemotherapy (Tac) and transarterial chemoembolization (TACE) have greatly benefited patients suffering from gynecologic malignancies. in cervical cancer treatment, Tace appears to be more effective than Tac. We compared the pharmacokinetics of Tace with those of Tac in an animal study. Twelve female dogs were randomly divided into 2 groups (n=6), and carboplatin was applied at a concentration of 1.2 mg/kg. carboplatin and lipiodol-carboplatin were administered by perfusion into the bilateral internal iliac arteries of the animals in the two groups, respectively. Plasma and tissues from the ovaries and uterus were collected for analysis at various time points after Tac or Tace. Pharmacokinetic analysis indicated that the uterine tissue area under the concentration (auc) of carboplatin was approximately 2 times higher in the Tace group than in the Tac group (P<0.01). By contrast, the ovarian tissue auc of carboplatin was much lower in the Tace group than in the Tac group (P<0.01), and was much lower than the uterine tissue auc (P<0.01) in both groups. The plasma auc of carboplatin was more than 2 times higher in the Tace group than in the Tac group (P<0.01). in conclusion, a pharmacological advantage of Tace treatment with lipiodolcarboplatin for gynecologic malignancies was observed.

show abstract

“…Currently, Lipiodol is used in combination with chemolipiodolization and TACE as a carrier of a chemotherapeutic agent in order to enhance various effects, including tumor selectivity, as well as to maintain the drug concentration. It is known that by suspending Lipiodol and EPI (22) or CDDP (23) and then injecting the suspending agent into the artery, an efficacy higher than that of a single use of EPI or CDDP alone is achieved. Moreover, 131I-Lipiodol containing radioiodine demonstrated favorable effects against hepatocellular carcinoma with a response rate of 48% and a MST of 27 months (24).…”

Section: Chemolipiodolizationmentioning

confidence: 99%

Toxicity and efficacy of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma (Review)

2011

View full text Add to dashboard Cite

Abstract. The prognosis of advanced hepatocellular carcinoma (HCC) remains poor, particularly for patients with portal vein tumor thrombosis. Chemotherapy is one of the most significant treatment options for patients with advanced HCC not indicated for hepatic resection, percutaneous ablation and transcatheter arterial chemoembolization. Systemic chemotherapy does not play a central role in the treatment of HCC due to the issue of low sensitivity for chemotherapeutic agents and the difficulties in administering a sufficient dose due to chronic liver dysfunction. Therefore, patients with advanced HCC are usually treated with hepatic arterial infusion chemotherapy (HAIC), which is increasingly used as an approach to advanced HCC in Japan. HAIC provides moderate therapeutic efficacy and survival benefit with substantially tolerable toxicity profiles in patients with advanced HCC.

show abstract

A randomized trial of intrahepatic arterial infusion of 4?-epidoxorubicin with Lipiodol versus 4?-epidoxorubicin alone in the treatment of hepatocellular carcinoma

Cited by 64 publications

References 6 publications

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Pharmacokinetic comparison between pelvic transarterial chemoembolization and transcatheter arterial chemotherapy in an animal model

Toxicity and efficacy of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma (Review)

Contact Info

Product

Resources

About