Intraarterial therapies for primary liver cancer: state of the art

Chapiro, Julius; Tacher, Vania; Geschwind, Jean François H.

doi:10.1586/14737140.2013.845528

Cited by 11 publications

(7 citation statements)

References 76 publications

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“…Even though the shorter MOS of DEB-TACE is not significant, we suggest that this might be explained with the unique characteristics of Lipiodol, which functions both as an embolic agent as well as a drug carrier with the ability to deliver the chemotherapeutic component of the payload deep inside of the tumor and through arterioportal communication such as the peribiliary vascular plexus into the portal vein and thus potentially within the portal-venous thrombus [14, 39, 45–48]. As for DEB-TACE, our protocol utilized beads with diameters of 100–300 μm that are known for their ability to deliver the drug selectively to the tumor while reducing systemic toxicity [7]. However, these microsphere carriers may not be able to penetrate their target deep enough and beyond the arterioles in order to exhibit sufficient anti-tumoral effects within the PVT.…”

Section: Discussionmentioning

confidence: 99%

“…According to the European Association for the Study of the Liver (EASL) guidelines, catheter-based intra-arterial therapies (IAT) and systemic chemotherapy with sorafenib are the recommended standard of care for patients with BCLC stage B and C, respectively [1, 5, 6]. The dual benefit of IAT lies in their ability to deliver a high concentration of chemotherapeutic agents or local radiation directly to the tumor, while reducing the systemic toxicity of the delivered payload [5, 7]. …”

Section: Introductionmentioning

confidence: 99%

“…Contrary to the BCLC recommendations, the recently introduced Hong Kong Liver Cancer (HKLC) staging system proposed a more aggressive therapeutic algorithm by recommending IAT in patients with intrahepatic vascular invasion and differentiate between intra- and extrahepatic vascular invasion as opposed to BCLC [8, 15]. Yet, there is no consensus regarding the choice between conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in this subset of patients, and until today, no study has answered this question [7, 16]. …”

Section: Introductionmentioning

confidence: 99%

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Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

et al. 2016

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Objectives Our study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE. Methods This retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria. Results The median overall survival (MOS) of the entire cohort was 4.53 months (95 % CI, 3.63–6.03). MOS was similar across treatment arms, no significant difference between cTACE (N =95) and DEB-TACE (N =38) was observed (MOS of 5.0 vs. 3.33 months, respectively; p = 0.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [N =57 (30.0 %) and N =38 (61.3 %)], diarrhea [N =3 (1.6 %) and N =3 (4.8 %)], and encephalopathy [N =11 (5.8 %) and N=2 (3.2 %)]. Conclusion Our retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

et al. 2016

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“…With more than 700 000 newly diagnosed cases per year and a dismal prognosis, it continues to be the leading cause of cancer-related death in patients with liver cirrhosis (2,3). In many cases, imaging-guided intraarterial therapies such as transarterial chemoembolization (TACE) represent the only therapeutic option for controlling the disease and improving patient survival rates (4,5). Although overall survival is the ultimate end point in cancer research, other imaging-based surrogate end points, such as time to progression and tumor response rates, have become indispensable for both clinical trials and everyday therapeutic decisions (6,7).…”

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confidence: 99%

Radiologic-Pathologic Analysis of Contrast-enhanced and Diffusion-weighted MR Imaging in Patients with HCC after TACE: Diagnostic Accuracy of 3D Quantitative Image Analysis

Chapiro¹,

et al. 2014

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Purpose To evaluate the diagnostic performance of three-dimensional (3D) quantitative enhancement-based and diffusion-weighted volumetric magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) lesions in determining the extent of pathologic tumor necrosis after transarterial chemoembolization (TACE). Materials and Methods This institutional review board–approved retrospective study included 17 patients with HCC who underwent TACE before surgery. Semiautomatic 3D volumetric segmentation of target lesions was performed at the last MR examination before orthotopic liver transplantation or surgical resection. The amount of necrotic tumor tissue on contrast material–enhanced arterial phase MR images and the amount of diffusion-restricted tumor tissue on apparent diffusion coefficient (ADC) maps were expressed as a percentage of the total tumor volume. Visual assessment of the extent of tumor necrosis and tumor response according to European Association for the Study of the Liver (EASL) criteria was performed. Pathologic tumor necrosis was quantified by using slide-by-slide segmentation. Correlation analysis was performed to evaluate the predictive values of the radiologic techniques. Results At histopathologic examination, the mean percentage of tumor necrosis was 70% (range, 10%–100%). Both 3D quantitative techniques demonstrated a strong correlation with tumor necrosis at pathologic examination (R2 = 0.9657 and R2 = 0.9662 for quantitative EASL and quantitative ADC, respectively) and a strong intermethod agreement (R2 = 0.9585). Both methods showed a significantly lower discrepancy with pathologically measured necrosis (residual standard error [RSE] = 6.38 and 6.33 for quantitative EASL and quantitative ADC, respectively), when compared with non-3D techniques (RSE = 12.18 for visual assessment). Conclusion This radiologic-pathologic correlation study demonstrates the diagnostic accuracy of 3D quantitative MR imaging techniques in identifying pathologically measured tumor necrosis in HCC lesions treated with TACE.

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“…Injection of chemotherapeutic agents into a tumour's feeding artery is a therapy described for several cancers [58] including retinoblastoma, and thus may be performed in quite young children [59]. Access is obtained via the femoral artery, and chemotherapeutic agents are injected specifically into the affected ophthalmic artery.…”

Section: Intra-arterial Chemotherapymentioning

confidence: 99%