Quality Improvement Guidelines for Transarterial Chemoembolization and Embolization of Hepatic Malignancy

Gaba, Ron C.; Lokken, R. Peter; Hickey, Ryan; Lipnik, Andrew J.; Lewandowski, Robert J.; Salem, Riad; Brown, Daniel B.; Walker, T. Gregory; Silberzweig, James E.; Baerlocher, Mark O.; Echenique, Ana; Midia, Mehran; Mitchell, Jason W.; Padia, Siddharth A.; Ganguli, Suvranu; Ward, Thomas J.; Weinstein, Jeffrey L.; Nikolic, Boris; Dariushnia, Sean R.

doi:10.1016/j.jvir.2017.04.025

Cited by 127 publications

(94 citation statements)

References 240 publications

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“…[15][16][17] For these reasons, the Society of Interventional Radiology (SIR) recognizes transarterial LDTs as a vital component of management of patients with HCC. 18…”

Section: Traditional Cancer Treatments For Hepatocellular Carcinomamentioning

confidence: 99%

Hepatocellular Carcinoma: Combined Transarterial Chemoembolization and Ablation

Herren

DiSomma

Ray

2019

Semin intervent Radiol

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“…[15][16][17] For these reasons, the Society of Interventional Radiology (SIR) recognizes transarterial LDTs as a vital component of management of patients with HCC. 18…”

Section: Traditional Cancer Treatments For Hepatocellular Carcinomamentioning

confidence: 99%

Hepatocellular Carcinoma: Combined Transarterial Chemoembolization and Ablation

Herren

DiSomma

Ray

2019

Semin intervent Radiol

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“…The amplitude of the curve reaches a fraction ε of its initial value after a time to stabilization given by (12).…”

Section: Pump Modulementioning

confidence: 99%

Selective embolization with magnetized microbeads using magnetic resonance navigation in a controlled‐flow liver model

Michaud

Plantefève

et al. 2018

Medical Physics

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Purpose The purpose of this study was to demonstrate the feasibility of using a custom gradient sequence on an unmodified 3T magnetic resonance imaging (MRI) scanner to perform magnetic resonance navigation (MRN) by investigating the blood flow control method in vivo, reproducing the obtained rheology in a phantom mimicking porcine hepatic arterial anatomy, injecting magnetized microbead aggregates through an implantable catheter, and steering the aggregates across arterial bifurcations for selective tumor embolization. Materials and Methods In the first phase, arterial hepatic velocity was measured using cine phase‐contrast imaging in seven pigs under free‐flow conditions and controlled‐flow conditions, whereby a balloon catheter is used to occlude arterial flow and saline is injected at different rates. Three of the seven pigs previously underwent selective lobe embolization to simulate a chemoembolization procedure. In the second phase, the measured in vivo controlled‐flow velocities were approximately reproduced in a Y‐shaped vascular bifurcation phantom by injecting saline at an average rate of 0.6 mL/s with a pulsatile component. Aggregates of 200‐μm magnetized particles were steered toward the right or left hepatic branch using a 20‐mT/m MRN gradient. The phantom was oriented at 0°, 45°, and 90° with respect to the B0 magnetic field. The steering differences between left–right gradient and baseline were calculated using Fisher's exact test. A theoretical model of the trajectory of the aggregate within the main phantom branch taking into account gravity, magnetic force, and hydrodynamic drag was also designed, solved, and validated against the experimental results to characterize the physical limitations of the method. Results At an injection rate of 0.5 mL/s, the average flow velocity decreased from 20 ± 15 to 8.4 ± 5.0 cm/s after occlusion in nonembolized pigs and from 13.6 ± 2.0 to 5.4 ± 3.0 cm/s in previously embolized pigs. The pulsatility index measured to be 1.7 ± 1.8 and 1.1 ± 0.1 for nonembolized and embolized pigs, respectively, decreased to 0.6 ± 0.4 and 0.7 ± 0.3 after occlusion. For MRN performed at each orientation, the left–right distribution of aggregates was 55%, 25%, and 75% on baseline and 100%, 100%, and 100% (P < 0.001, P = 0.003, P = 0.003) after the application of MRN, respectively. According to the theoretical model, the aggregate reaches a stable transverse position located toward the direction of the gradient at a distance equal to 5.8% of the radius away from the centerline within 0.11 s, at which point the aggregate will have transited through a longitudinal distance of 1.0 mm from its release position. Conclusion In this study, we showed that the use of a balloon catheter reduces arterial hepatic flow magnitude and variation with the aim to reduce steering failures caused by fast blood flow rates and low magnetic steering forces. A mathematical model confirmed that the reduced flow rate is low enough to maximize steering ratio. After reproducing the flow rate in a vascular bifur...

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“…Hepatocellular carcinoma (HCC) is the most common primary liver tumor, with elevated morbidity and mortality rates all over the world. 1 Although surgical resection is a curative treatment, few cases are candidates for hepatectomy, because of advanced multifocal disease, extrahepatic tumoral invasion, deterioration of liver function, portal hypertension, and poor functional status. 1,2 Liver transplantation is another effective option for curative treatment, but it is limited to the following cases: one tumor less than 5 cm in diameter or three tumors less than 3 cm in diameter (Milan Criteria), in addition to difficulties with finding donors.…”

Section: Introductionmentioning

confidence: 99%

“…1 Although surgical resection is a curative treatment, few cases are candidates for hepatectomy, because of advanced multifocal disease, extrahepatic tumoral invasion, deterioration of liver function, portal hypertension, and poor functional status. 1,2 Liver transplantation is another effective option for curative treatment, but it is limited to the following cases: one tumor less than 5 cm in diameter or three tumors less than 3 cm in diameter (Milan Criteria), in addition to difficulties with finding donors. 1 Transcatheter arterial chemoembolization (TACE) is currently used as a palliative treatment for patients with tumors that cannot be resected 3,4 and also in cases of resectable tumors, to reduce tumor volume and dispersal of neoplastic cells during manipulation in surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Liver transplantation is another effective option for curative treatment, but it is limited to the following cases: one tumor less than 5 cm in diameter or three tumors less than 3 cm in diameter (Milan Criteria), in addition to difficulties with finding donors. 1 Transcatheter arterial chemoembolization (TACE) is currently used as a palliative treatment for patients with tumors that cannot be resected 3,4 and also in cases of resectable tumors, to reduce tumor volume and dispersal of neoplastic cells during manipulation in surgical procedure. 2 The mechanism through which TACE achieves its objective is induction of ischemia in the tumor (generally by injection of gelfoam or microspheres) through the cytotoxic action of a chemotherapy agent selectively administered with the aim of provoking long-lasting intratumoral retention.…”

Section: Introductionmentioning

confidence: 99%

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Quimioembolização arterial transcateter de carcinoma hepatocelular em paciente com oclusão de tronco celíaco: um desafio terapêutico

et al. 2019

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Resumo A quimioembolização arterial transcateter consiste em promover isquemia e ação citotóxica por meio da injeção de microesferas contendo quimioterápicos aplicada seletivamente nos vasos que nutrem o tumor. Paciente do sexo feminino, com 87 anos, em tratamento paliativo para carcinoma hepatocelular com indicação de quimioembolização, foi submetida a angiografia pré-procedimento, a qual identificou oclusão do tronco celíaco. A opção foi a cateterismo seletiva da artéria hepática própria por uma via alternativa para lançamento do agente quimioterápico, através da artéria mesentérica superior com comunicação utilizando a arcada pancreatoduodenal. Evidências de aumento da sobrevida demonstrados em estudos após a quimioembolização foram relatados, bem como redução da taxa de crescimento tumoral; entretanto, dificuldades em acessar e cateterizar a artéria nutrícia tumoral através do acesso alternativo tornam o procedimento um desafio, devido à tortuosidade da arcada pancreatoduodenal.

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Quality Improvement Guidelines for Transarterial Chemoembolization and Embolization of Hepatic Malignancy

Cited by 127 publications

References 240 publications

Hepatocellular Carcinoma: Combined Transarterial Chemoembolization and Ablation

Hepatocellular Carcinoma: Combined Transarterial Chemoembolization and Ablation

Selective embolization with magnetized microbeads using magnetic resonance navigation in a controlled‐flow liver model

Quimioembolização arterial transcateter de carcinoma hepatocelular em paciente com oclusão de tronco celíaco: um desafio terapêutico

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