Nonresectable Hepatocellular Carcinoma: Long-term Toxicity in Patients Treated with Transarterial Chemoembolization—Single-Center Experience

Buijs, Manon; Vossen, Josephina A.; Frangakis, Constantine; Hong, Kelvin; Georgiades, Christos; Yong, Chen; Liapi, Eleni; Geschwind, Jean François H.

doi:10.1148/radiol.2483071902

Cited by 54 publications

(40 citation statements)

References 36 publications

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“…Nonetheless, previous studies have shown that first-pass hepatic clearance of Dox is between 50% and 70% [5]. Moreover, Dox is known to cause irreversible cardiac failure at cumulative doses above 360 mg, thereby limiting the amount of Dox dose safely deliverable during IAC [6]. Thus, there has been focus on further maximizing local delivery of chemotherapy to targets while minimizing systemic exposure.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical Study

Patel

Saeed

Yee

et al. 2014

Journal of Medical Devices

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Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical StudyTo develop a novel endovascular chemotherapy filter (CF) able to remove excess drug from the blood during intra-arterial chemotherapy delivery (IAC), thus preventing systemic toxicities and thereby enabling higher dose IAC. A flow circuit containing 2.5 mL of ion-exchange resin was constructed. Phosphate-buffered saline (PBS) containing 50 mg doxorubicin (Dox) was placed in the flow model with the hypothesis that doxorubicin would bind rapidly to resin. To simulate IAC, 50 mg of doxorubicin was infused over 10 min into the flow model containing resin. Similar testing was repeated with porcine serum. Doxorubicin concentrations were measured over 60 min and compared to controls (without resin). Single-pass experiments were also performed. Based on these experiments, an 18F CF was constructed with resin in its tip. In a pilot porcine study, the device was deployed under fluoroscopy. A control hepatic doxorubicin IAC model (no CF placed) was developed in another animal. A second CF device was created with a resin membrane and tested in the infrarenal inferior vena cava (IVC) of a swine. In the PBS model, resin bound 76% of doxorubicin in 10 min, and 92% in 30 min (P < 0.001). During IAC simulation, 64% of doxorubicin bound in 10 min and 96% in 60 min (P < 0.001). On average, 51% of doxorubicin concentration was reduced during each pass in single pass studies. In porcine serum, 52% of doxorubicin bound in 10 min, and 80% in 30 min (P < 0.05). CF device placement and administration of IAC were successful in three animals. No clot was present on the resin within the CF following the in vivo study. The infrarenal IVC swine study demonstrated promising results with up to 85% reduction in peak concentration by the CF device. An endovascular CF device was developed and shown feasible in vitro. An in vivo model was established with promising results supporting high-capacity rapid doxorubicin filtration from the blood that can be further evaluated in future studies.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical Study

Patel

Saeed

Yee

et al. 2014

Journal of Medical Devices

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“…Buijs et al (26) followed 190 HCC patients who received TACE and analyzed the long-term adverse effects. Their results demonstrated that the incidence of grade 3/4 thrombocytopenia was 13% at 6 months and 23% at 12 months, which was significantly lower compared with the rates following systemic chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

Zhou

Zhang

Wang

et al. 2017

Molecular and Clinical Oncology

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Abstract.Patients with hepatocellular carcinoma (HCC) exhibit a high incidence of concomitant cirrhosis with leukopenia and/or thrombocytopenia. In the present study, perioperative changes in the white blood cell (WBC) and platelet (PLT) counts and associated complications were investigated to assess the safety of transcatheter arterial chemoembolization (TACE) for HCC patients with preprocedural leukopenia or thrombocytopenia. The records of 1,461 HCC patients who received TACE between January 2012 and December 2013 were retrospectively reviewed. The incidence of complications during the perioperative period and changes in the WBC and PLT counts were recorded. A Chi -squared test was used to evaluate the associations between postoperative infection and preprocedural WBC count and between bleeding at the puncture site and preprocedural PLT count. The WBC count of the majority of the patients increased within 3 days and returned to the preprocedural level within 30 days after TACE. The PLT count decreased within 3 days and returned to the preprocedural level within 30 days after TACE. The major complications were liver decompensation (n=66), puncture site bleeding (n=45), infection (n=33), severe thrombocytopenia (n=8), upper gastrointestinal bleeding (n=6), tumor bleeding (n=4) and agranulocytosis (n=3). A Chi-squared test revealed that postoperative infection was not associated with preprocedural WBC count and puncture site bleeding was not associated with decreased PLT count due to hypersplenism. Therefore, TACE was found to be safe for HCC patients with preprocedural thrombocytopenia or leukopenia due to hypersplenism, with a low incidence of major complications during the perioperative period.

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“…cTACE is safe and well tolerated with a favourable long-term toxicity profile. 31 While no consensus exists about the number of cTACE procedures to achieve satisfactory target lesion treatment, at least two sessions of chemoembolization should be performed before further treatment is abandoned or alternative therapies are considered. 32 Patients are typically followed up 6 weeks after the procedure for clinical, blood work and cross-sectional imaging evaluation.…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Systematic review of catheter-based intra-arterial therapies in hepatocellular carcinoma: state of the art and future directions

Durán¹,

Chapiro²,

Schernthaner³

et al. 2015

BJR

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Intra-arterial therapies (IATs) play a pivotal role in the management of patients with primary and secondary liver malignancies. The unique advantages of these treatments are their ability to selectively deliver a high dose of anticancer treatment while preserving healthy liver tissue. The proven efficacy of these catheter-based locoregional therapies in a highly systemic chemoresistant cancer such as hepatocellular carcinoma (HCC), along with the minimally invasive nature of these treatments, quickly yielded wide acceptance in the medical community and revolutionized the field of Interventional Oncology. In this article, we describe the clinical rationale and background of catheter-based IATs. We provide an overview of clinical achievements of these treatments alone and in combination with sorafenib in patients with HCC.

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Nonresectable Hepatocellular Carcinoma: Long-term Toxicity in Patients Treated with Transarterial Chemoembolization—Single-Center Experience

Cited by 54 publications

References 36 publications

Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical Study

Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical Study

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

Systematic review of catheter-based intra-arterial therapies in hepatocellular carcinoma: state of the art and future directions

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