Modification of Arterial and Portal Hemodynamics after Injection of Iodized Oils and Different Emulsions of Iodized Oils in the Hepatic Artery: An Experimental Study

Baère, Thierry De; Denys, Alban; Briquet, Renè; Chevallier, P.; Dufaux, J.; Roche, Alain

doi:10.1016/s1051-0443(98)70273-8

Cited by 26 publications

(20 citation statements)

References 18 publications

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“…Specifically, a subgroup analysis in cTACE patients who fulfilled the SHARP trial inclusion criteria revealed a MOS of 8.1 months (with a shorter MOS of 5.3 months for the DEB-TACE group), thus matching the life expectancy of comparable patients treated with sorafenib within the SHARP trial [9, 20]. 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].…”

Section: Discussionmentioning

confidence: 99%

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%

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

et al. 2016

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“…This is a result of vascular relaxation produced by the oil's viscosity and permeation of the abnormal tumor arterial vasculature. 16,17 Streptozotocin, which has been demonstrated to have efficacy as a systemic agent for treating metastatic NET, has not been shown to be as effective as doxorubicin or doxorubicin based chemoembolization regimens and is associated with a poorer side effect profile. 18 Drug-eluting beads (DEBs) are polyvinyl embolic spheres which contain a sulfonate that may be loaded with doxorubicin via an ion-exchange mechanism.…”

Section: Bland and Chemoembolizationmentioning

confidence: 99%

Embolotherapy for Neuroendocrine Tumors

Nadolski

Soulen

2019

Dig Dis Interv

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The most frequent solid organ involved in metastatic neuroendocrine tumors (NET) is the liver. Hepatic metastases occur during the lifetime of 46% to 93% of patients with NETs. Intra-arterial embolotherapies are palliative and should be used for patients with unresectable disease not amenable to resection or ablation. The most widely accepted indications for liver embololization for NET metastases are progression of unresectable hepatic metastases threatening liver function and palliation of hormone-related symptoms uncontrolled by somatostatin analogues. This article will discuss patient selection and administration of all embolotherapies currently used for palliation of neuroendocrine liver metastases.

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“…The water droplets in the emulsion eventually separated from the oil phase and were swept away by the perfusing blood. There was a higher content of oil in the liver tissue, slower clearance (removal) of oil from the liver, increased embolizing effects (as blood flow was reduced), and more water droplets in the oil phase after a w/o emulsion than after an oilin-water (o/w) emulsion infusion [8,52]. When a w/o emulsion was infused into the HA in tumor-bearing rats and mice, the oil phase was preferentially located in the liver tumor vessels [52].…”

Section: Lipmentioning

confidence: 99%

“…The preparation technique chosen will probably influence both the in vitro and the in vivo release of DOX from the emulsion, as the intensity of mixing influences the droplet size of the inner phase, irrespective of whether the inner phase is aqueous or LIP. Homogenization created emulsions with inner droplet sizes of 10-40 μm, and the pumping technique created emulsions with inner droplet sizes of 30-120 μm in one study [8]. Emulsification via ultrasound, a less used option, generated smaller droplets and more stable emulsions than homogenization created emulsions [72].…”

Section: Release Of Dox From Lipdox In Vitromentioning

confidence: 99%

“…LIP is an iodized poppy seed oil derivative visible on x-ray, and after administration, the contrast is preferentially retained in tumor tissue [6,7]. The combination of the cytostatic agent emulsified in LIP can be administered with or without additional embolizing materials, generating complete or partial embolization of the targeted tumor-feeding vessel(s) [3,8]. DC Bead ® (DCB) is one of several commercially available drug-eluting embolizing bead systems [9].…”

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confidence: 99%

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Treatment of Intermediate Stage Hepatocellular Carcinoma: A Review of Intrahepatic Doxorubicin Drug-Delivery Systems

Dubbelboer

Lilienberg

Ahnfelt

et al. 2014

Therapeutic Delivery

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The biopharmaceutical properties of doxorubicin delivered via two drug-delivery systems (DDSs) for the palliative treatment of unresectable hepatocellular carcinoma were reviewed with relation to the associated liver and tumor (patho)physiology. These two DDSs, doxorubicin emulsified with Lipiodol ® and doxorubicin loaded into DC Bead ® are different regarding tumor delivery, release rate, local bioavailability, if and how they can be given repeatedly, biodegradability, length of embolization and safety profile. There have been few direct head-to-head comparisons of these DDSs, and in-depth investigations into their in vitro and in vivo performance is warranted.The global incidence of liver cancer is increasing and this type of cancer has a poor prognosis and is ranked as the third most common lethal cancer form [1,2]. The recommended treatment for hepatocellular carcinoma (HCC), a primary liver cancer, is dependent on the stage of the disease [3]. For unresectable, intermediate stage HCC, transarterial chemoembolization (TACE) is recommended. TACE involves the delivery of the cytostatic agent(s) in a drug-delivery system (DDS) to the tumor via the hepatic artery (HA) [3]. In contrast to normal liver tissue, which has a dual blood supply from the HA and the portal vein [4], HCC is typically mainly vascularized by the HA. Local drug administration by the TACE DDS is expected to increase the specificity of the tumor response while reducing the frequency of side effects and morbidity compared with systemic dosed treatments [4]. Embolization, caused by the DDS, obstructs the blood flow in the tumor, induces hypoxia, and results in increased drug concentrations and prolonged residence times in the tumortarget area [4]. Patients with untreated HCC that has not invaded the portal vein or spread extrahepatically have an expected median survival of approximately 16 months. With current palliative TACE strategies, the expected median survival is prolonged by approximately 4 months [3].To date, several DDSs delivering various chemotherapeutic drug(s) and pharmaceutical excipients have been developed and clinically evaluated for TACE therapy [5]. A review of these options of TACE DDSs is warranted in that it would form the basis for optimizing tumor-targeted therapy for HCC treatment, and subsequent development of novel, tumor-targeted DDSs and dosing strategies. Two common DDSs used for TACE therapy for intermediate stage HCC involve cytostatic agents emulsified in Lipiodol ® (LIP) or loaded into drugeluting beads. LIP is an iodized poppy seed oil derivative visible on x-ray, and after administration, the contrast is preferentially retained in tumor tissue [6,7]. The combination of the cytostatic agent emulsified in LIP can be administered with or without additional embolizing materials, generating complete or partial embolization of the targeted tumor-feeding vessel(s) [3,8]. DC Bead ® (DCB) is one of several commercially available drug-eluting embolizing bead systems [9]. Positively charged chemotherapeutic drugs can be ...

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Modification of Arterial and Portal Hemodynamics after Injection of Iodized Oils and Different Emulsions of Iodized Oils in the Hepatic Artery: An Experimental Study

Cited by 26 publications

References 18 publications

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

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

Embolotherapy for Neuroendocrine Tumors

Treatment of Intermediate Stage Hepatocellular Carcinoma: A Review of Intrahepatic Doxorubicin Drug-Delivery Systems

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