Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization.

Abstract

The effectiveness of subsegmental transcatheter arterial embolization (TAE) therapy for small hepatocellular carcinomas (HCCs) was retrospectively analyzed. TAE was performed in 100 patients with liver cirrhosis. There was a total of 124 nodular-type HCCs less than 4 cm in diameter. TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by gelatin sponge particles or a mixture of iodized oil and absolute ethanol into the more distal branches of the subsegmental artery. Complete necrosis was seen at histologic examination in seven of 11 resected lesions. Among the remaining 113 lesions in 90 patients followed up without surgery, the 1-and 4-year local recurrence rates after TAE were 18% and 33%, respectively. The 1- and 4-year survival rates for 82 patients with Child class A or B disease were 100% and 67%, respectively. No substantial deterioration of liver function was observed. Subsegmental TAE improved the prognosis of the patients with liver cirrhosis associated with small HCCs.

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…The dose of lipiodol and chemotherapeutic agent depends on the size and vascularity of the tumor. The end point for the mixture administration is stasis in tumor-feeding arteries or appearance of lipiodol in portal vein branches near the tumor [321,326,327]. In general, the end point of the TACE procedure is the visualization of the complete blockage of the tumor-feeding branch [327].…”

“…Less than 2% of treated patients achieve a complete response [333]. However, subsegmental TACE may increase percentage of complete necrosis compared with TACE through lobar branches of hepatic artery [326,327]. Although there are many reports suggesting satisfactory survival rates at institutions where TACE is performed on follow-up when tumor growth is detected or the tumor marker levels increase, no RCT have compared repeated TACE at regular, short intervals of 2-3 months, with TACE repeated only when tumor growth is detected [316].…”

Forcible Intraarterial Injection of a Nonadhesive Liquid Embolic Agent under Microballoon Occlusion: Experimental Study in Swine Liver

“…Transcatheter arterial embolization (TAE) is an effective therapeutic option for hepatocellular carcinoma (HCC) (1,2,3). However, local recurrence often occurs due to insufficient embolization of tumor and surrounding vessels (2,3,4).…”

“…However, local recurrence often occurs due to insufficient embolization of tumor and surrounding vessels (2,3,4). In hypervascular HCCs, the blood supply from feeding hepatic arteries drains into the surrounding portal venules and hepatic sinusoids which communicate with tumor blood sinusoids (5,6,7).…”

“…It has been speculated that particulate TAE often allows the peripheral portion of the HCC to survive probably due to reversed blood flow from the hepatic sinusoids and/or portal venules surrounding the tumor. A theoretical advantage of using a liquid agent such as ethiodized oil (Lipiodol, Andre Guerbet, Aulnay-sous-Bois, France) for embolization of hypervascular HCCs is its tendency to flow into the peritumoral portal vein or surrounding hepatic sinusoids through the peribiliary plexus (PBP) (3,8,9,10) and drainage routes from the tumor (7). However, the embolization effect of ethiodized oil is often temporary and thus insufficient (3,11).…”