Evaluation of transcatheter arterial embolization with epirubicin-lipiodol emulsion for hepatocellular carcinoma

Abstract

A total of 18 patients with hepatocellular carcinoma (HCC) were treated by transcatheter arterial embolization (TAE) with a 4'-epi-doxorubicin (EDX)-lipiodol emulsion. Infusion of the EDX-lipiodol emulsion (EDX-L) via the hepatic artery was followed by the injection of gelatin sponge in 12 cases. The response and survival of these 12 patients following EDX-L treatment were compared with those of 42 subjects treated with a doxorubicin-lipiodol emulsion (DX-L) and those of 23 patients treated by TAE with gelatin sponge (GS) only. In the group treated with EDX-L, nine cases were AFP-positive in sera and four showed a decrease in serum AFP values to less than 10% of the pretreatment level. Seven cases showed a partial response, and nine cases showed no change in the size of the tumor. In the group treated with EDX-L, nine cases are alive, and the oldest has survived for more than 431 days since the treatment. The half-year survival value was 57%, and the 1-year survival value was 49%. These values did not differ significantly from those calculated for the group treated with DX-L. The 1-year survival value determined for patients treated with a lipiodol emulsion (EDX-L or DX-L) followed by GS was 65%, and the 2-year survival value was 39%. These results rates are significantly better than those obtained in patients treated with GS only (1-year survival, 39%; 2-year survival, 13%.

A Comparison of Lipiodol Chemoembolization and Conservative Treatment for Unresectable Hepatocellular Carcinoma

“…7,8 Treatment combining intraarterial chemotherapy with Lipiodol and embolization, or Lipiodol chemoembolization, is considered the most effective of these methods on the basis of reports of a decrease in tumor size in nonrandomized trials. [9][10][11][12][13] Although this method is widely used, severe side effects have been reported 9,14,15 and improved survival, as suggested by case-control studies, has not been clearly demonstrated.…”

Effects of Repeated Transcatheter Arterial Embolization in Patients with Hepatocellular Carcinoma

“…In all studies, a fall in AFP level is accepted as a response and as a good prognostic factor, especially a reduction >75% is considered a good prognosis [1,3,5]. In many studies, the decreases in AFP values are reported to be between 13 and 90% [1,3,5,6,8,10]. In our study, with TAE treat ment a decrease in AFP values in patients with high AFP levels before treatment is noted.…”

“…In another study [14] with TAE treatment, reductions in tumor size in 7 out of 11 patients were noted. Other authors [6,8,15] reported tumor size reductions of between 47 and 60%. Treatment with TAE results in a reduction of the tumor size in 80% of the patients when the tumor measures <5 cm in diame ter; this response rate decreases to only 25% when the tumor is >6 cm in diameter.…”

“…However, extracapsular infiltrations and small nodules do not always respond, even when Lipiodol is also used, because portal blood flow is in volved in these lesions [7], Many drug delivery methods have been applied for the purpose of slow release of drugs and for selective targeting of tumors. Especially, suspen sions and emulsions containing an oily contrast medium (Lipiodol) have been used and have yielded good clinical effects [8]. In many studies prognostic factors after treat ment of HCC with TAE were investigated.…”

“…In our study in order to obtain a wider anticancer effect, we preferred to use the cisplatin -mitomycin C combination. Hepatic parenchyma ischemia, cholecysti tis, vasculitis, nausea, ache, leukocytosis, fever, rises in hepatic function tests, alopecia, pulmonal embolism, rises in blood urea nitrogen, and decreases in hemoglobin are reported as side effects of TAE treatment [3,5,8,10,14,17], Ache and fever are reported in almost all studies. In our study, no serious complication was faced.…”