Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study.

Baere, T. de; Dufaux, J.; Roche, Alain; Counnord, J L; Berthault, M F; Denys, Alban; Pappas, Peter W.

doi:10.1148/radiology.194.1.7997545

Cited by 91 publications

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“…(31)(32)(33)(34)(35) Use of lipiodol TACE in the treatment of HCC is based on meta-analyses of RCTs comparing embolization or chemoembolization versus conservative management. (14,15) A recent Cochrane meta-analysis (36) whose methodology has been criticized by several experts (37,38) -questioned the evidence supporting the beneficial effect of TACE over no intervention on survival in patients with HCC.…”

Section: Discussionmentioning

confidence: 99%

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

et al. 2016

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Transarterial chemoembolization (TACE) using lipiodol-based regimens, including the administration of an anticancer-in-oil emulsion followed by embolic agents, is widely used in the treatment of hepatocellular carcinoma (HCC). This approach has been supported by meta-analyses of randomized, controlled trials (RCTs) performed more than a decade ago. We performed a systematic review to understand current efficacy and safety data of lipiodol TACE in treatment of HCC. A search of the literature published between January 1, 1980 and June 30, 2013 was performed using MEDLINE and EMBASE databases. All potentially relevant publications were reviewed and articles were selected based on predefined inclusion and exclusion criteria. Of a total of 1,564 articles reviewed, 101 articles, including a total of 10,108 patients treated with lipiodol TACE, were selected for the efficacy analysis. Objective response rate was 52.5% (95% confidence interval [CI]: 43.6-61.5). Overall survival (OS) was 70.3% at 1 year, 51.8% at 2 years, 40.4% at 3 years, and 32.4% at 5 years. Median OS was 19.4 months (95% CI: 16.2-22.6). A total of 217 articles presenting precise description on numbers of adverse events (AEs) were selected for the safety review: In these studies, a total of 21,461 AEs were reported in 15,351 patients. Liver enzyme abnormalities were the most commonly observed AE, followed by the symptoms associated with postembolization syndrome. Overall mortality rate was 0.6% and the most common cause of death was related to acute liver insufficiency. Conclusions: In a systematic literature review, survival figures of HCC patients undergoing lipiodol TACE appear to be in line with those reported in previous RCTs, and no new or unexpected safety concerns were identified. (HEPATOLOGY 2016;64:106-116) SEE EDITORIAL ON PAGE 23H epatocellular carcinoma (HCC) is the thirdleading cause of cancer-related death worldwide. (1) Unlike most solid cancers, future incidence and mortality rates for HCC were projected to largely increase in several regions around the world over the next several years, mostly as a result of the dissemination of hepatitis C virus infection. (2,3) Despite the widespread implementation of surveillance programs of at-risk populations, the majority of patients with HCC are diagnosed late, when curative treatments-including liver transplantation, hepatic resection, and image-guided ablation-cannot be applied. (4) Transarterial chemoembolization (TACE) is widely used in treatment of HCC patients unsuitable for radical therapies. The data collected in the Global Investigation of therapeutic DEcisions in hepatocellular

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Section: Discussionmentioning

confidence: 99%

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

et al. 2016

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“…Currently, abrogation of the blood supply to liver metastases of GEP tumors, which derive their blood from the hepatic artery, is achieved using radiological control. Arguments in favor of a combination of intra-arterial chemotherapy with embolization or surgical ligation of the hepatic artery include: certain drugs such as doxorubicin, mitomycin C and STZ are more efficacious in anoxic cells [12]and anoxia and reduced vascularization can increase intra-tumoral drug concentrations and dwelling times in cancer cells [13, 14]. …”

Section: Vascular Occlusive Strategiesmentioning

confidence: 99%

Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors

Ruszniewski

O’Toole²

2004

Neuroendocrinology

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Hepatic metastases are frequent in patients with gastroenteropancreatic (GEP) endocrine tumors. The presence of hepatic metastases affects overall prognosis and quality of life especially in the presence of debilitating functional syndromes. Surgery, although the method of choice for hepatic metastases, is usually impossible due to disease extent. Results of systemic chemotherapy are also disappointing especially in patients with metastases from midgut GEP tumors. These latter patients usually have carcinoid syndrome which can be controlled by somatostatin analogues. Other therapeutic options in the treatment of highly vascular liver metastases from GEP tumors are locoregional strategies by inducing vascular occlusion resulting in ischemia and necrosis of tumoral tissue. Surgical ligation of the hepatic artery or transient hepatic ischemia has been replaced by transcatheter arterial chemoembolization (TACE). TACE has proven effective in controlling symptoms and gives objective tumor response in about half of patients. Other regional destructive methods, used either alone or in combination with surgery, include radiofrequency ablation and cryotherapy. The latter strategies are poorly evaluated to date and are usually adjuncts to surgery and reserved for limited disease.

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“…Subsequently, if the tumor is progressive, or bulky (invasion of >50% of the liver), or symptomatic despite medical treatment, cytotoxic or locoregional treatment can be proposed [12]. Arterial hypervascularisation of liver metastases from digestive endocrine tumors argues in favor of chemoembolization [13]. …”

Section: Rationale For Chemoembolizationmentioning

confidence: 99%

Hepatic Arterial Chemoembolization in the Management of Advanced Digestive Endocrine Tumors

Ruszniewski

Malka²

2000

Digestion

107

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The management of advanced digestive endocrine tumors is often challenging. Liver metastases are usually diffuse at the time of diagnosis, and surgical resection is rarely feasible. Objective response rates with systemic chemotherapy are disappointing. Arterial hypervascularization of most liver metastases from digestive endocrine tumors argues in favor of hepatic arterial chemoembolization (HACE). It is assumed that embolization-induced ischemia sensitizes tumor cells to cytotoxic drugs, whose tumor concentrations are increased by blood flow slowing down. The aims of HACE are: (1) to control otherwise untractable hormone-related symptoms, particularly the carcinoid syndrome (>50% urinary 5-HIAA decrease: 57–91%) and insulinoma-related life-threatening hypoglycemias; (2) to inhibit tumor growth (objective response rates: 33–80%; mean duration: 6–42.5 months), and (3) to improve patients’ survival. The postembolization syndrome, usually mild and transient, is the commonest side effect. Major extrahepatic complications are rare. In conclusion, HACE seems to be an attractive alternative treatment for diffuse (unresectable) and progressive metastases confined to the liver in patients with digestive endocrine tumors, mainly following unsuccessful systemic chemotherapy. Further studies assessing the long-term results of HACE and comparing it to other treatments, particularly systemic chemotherapy, are needed.

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Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study.

Abstract: Changes in the formulation of emulsions obtained with the same proportions of drug and iodized oil change the distribution of iodized oil in the arterial tree, the location at which the drug is released, and the embolic effect.

Cited by 91 publications

References 0 publications

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors

Hepatic Arterial Chemoembolization in the Management of Advanced Digestive Endocrine Tumors

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