Targeted Transarterial Oily Chemoembolization for Small Foci of  Hepatocellular Carcinoma Using a Unified Helical CT and Angiography  system

Takayasu, Kenichi; Muramatsu, Yoshihisa; Maeda, Takeyasu; Iwata, Ryoko; Furukawa, Hiroyoshi; Muramatsu, Yukio; Moriyama, Noriyuki; Okusaka, Takuji; Okada, Shuichi; Ueno, Hideki

doi:10.2214/ajr.176.3.1760681

Cited by 140 publications

(102 citation statements)

References 30 publications

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“…22 TACE was used first in Japan as a treatment method for typical HCCs with rich arterial vascularization [14][15][16][17][18][19][20][21] and currently is the most common treatment method in the world. 23 The original method of TACE has been modified to subsegmental TACE 16,18 and now to AS 21 or ultraselective TACE 20 by the development of an angio-CT system and microcatheters. In typical HCCs fed by arterial flow, however, embolization of the artery alone was not satisfactory, so Nakamura et al 17,19 tried simultaneous embolization of the artery and portal vein.…”

Section: Discussionmentioning

confidence: 99%

“…There are many treatment methods for HCC, such as liver transplantation, surgical resection, locoregional treatment, and transcatheter arterial chemoembolization (TACE). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, each treatment method has some shortcomings. Liver transplantation requires a donor and is a high-cost procedure, and death while awaiting a suitable donor remains problematic [5][6][7][8][9] .…”

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confidence: 99%

“…13 Therefore, an improvement in treatment methods clearly is needed. TACE was developed initially in Japan [14][15][16][17][18][19][20][21] and currently is the most common treatment method for HCC worldwide. However, its efficacy is no greater than the efficacy of treatment for unresectable HCC.…”

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confidence: 99%

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Excellent outcomes with angiographic subsegmentectomy in the treatment of typical hepatocellular carcinoma

Iwamoto

Yamaguchi²,

Hongo³

et al. 2009

Cancer

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BACKGROUND:The authors successfully adopted an interesting and effective treatment for hepatocellular carcinoma (HCC) referred to as angiographic subsegmentectomy (AS). This treatment involved simultaneous embolization of the peripheral feeding artery and the portal vein. The result was that almost all of the HCC and peripheral liver parenchyma developed complete anatomic necrosis. METHODS: To determine the effectiveness of this method, the authors retrospectively studied the local recurrence rates of 49 solitary HCCs and the long-term survival rates of 120 patients with HCC between 2000 and 2008. RESULTS: The results indicated that, in 31 small, solitary HCCs (<2.0 cm), the local recurrence rate was only 9.6%; and, in 10 slightly larger HCCs (<3.0 cm), the local recurrence rate was only 10%. The 5-year, 8-year, and 10-year survival rates for patients with stage I and stage I/Child-Pugh grade A HCC were 74.27% and 77.65%, 53.05% and 51.76%, and 53% and 51.76%, respectively; and the 5-year, 8-year, and 10-year survival rates for patients with stage II and stage II/Child-Pugh grade A HCC were 66.21% and 71.41%, 39.9% and 39.60%, and 29.92% and 25%), respectively. There were no severe complications. CONCLUSIONS: AS should be investigated further as potential first-line therapy for the treatment of patients with stage I and II HCC. Cancer 2010;116:393-9.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Excellent outcomes with angiographic subsegmentectomy in the treatment of typical hepatocellular carcinoma

Iwamoto

Yamaguchi²,

Hongo³

et al. 2009

Cancer

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“…5,6 Unfortunately, surgical indications for HCC usually are very limited, and transcatheter arterial chemoembolization (TACE) has been practiced worldwide as a palliative treatment. [8][9][10][11] It is not clear whether the systems that are appropriate for surgical group also can work well for predicting the survival of patients who undergo TACE.…”

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confidence: 99%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

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BACKGROUND.Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS.In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood‐ratio chi‐square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan‐Meier estimation and the log‐rank test.RESULTS.The 5‐year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α‐fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS.In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.

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“…Hepatocellular carcinomas show variable hemodynamic features depending on histological grading (17). Targeted transarterial chemoembolization therapy can be used to treat hepatocellular carcinomas with a low local recurrence rate and minimum damage to nontumorous liver parenchyma (18). However, because this technique is usually effective only for hypervascular hepatocellular carcinomas (19), the detection of hypervascularity in hepatocellular carcinomas is important for planning treatment when transarterial chemoembolization therapy is being considered.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

Hori

Murakami

Kim

et al. 2006

Magnetic Resonance Imaging

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Purpose:To investigate the role of ferucarbotran-enhanced dynamic MR imaging using multishot spin-echo echo-planar sequence in the evaluation of hemodynamics of focal hepatic lesions. Materials and Methods:Sixty-three focal hepatic lesions (24 benign and 39 malignant) from 53 consecutive patients who underwent both ferucarbotran-enhanced MR imaging and dynamic computed tomography (CT) were included in this study. MR imaging was performed with a 1.5-T scanner with a phased-array coil. T2-weighted multishot spin-echo echo-planar sequences (TR/TE ϭ 1714 -2813/80 msec) were obtained during a single breathhold before and 15, 60, 120, 180, and 600 seconds after intravenous injection of ferucarbotran. The enhancement patterns of lesions were classified into three categories by a study coordinator on the basis of dynamic CT images as hypervascular, hypovascular, and hemangioma type. The study coordinator created mean contrast-to-noise ratio of lesions vs. time curves for each enhancement pattern for quantitative analyses. Moreover, three radiologists separately and blindly reviewed MR images, and then assigned three confidence scores for the three enhancement patterns to each lesion. Sensitivity, specificity, and receiver operating characteristic analyses were performed. Results:Quantitative analyses showed characteristic enhancement curves for each enhancement pattern. Mean sensitivities/specificities were 0.816/0.882, 0.897/0.863, and 0.800/0.989 for hypervascular, hypovascular, and hemangioma types, respectively. Mean areas under the receiver operating characteristic curve were 0.886 for hypervascular type and 0.913 for hypovascular type. Conclusion:Ferucarbotran-enhanced dynamic MR imaging can be used to successfully characterize the hemodynamics of focal hepatic lesions.

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Targeted Transarterial Oily Chemoembolization for Small Foci of Hepatocellular Carcinoma Using a Unified Helical CT and Angiography system

Cited by 140 publications

References 30 publications

Excellent outcomes with angiographic subsegmentectomy in the treatment of typical hepatocellular carcinoma

Excellent outcomes with angiographic subsegmentectomy in the treatment of typical hepatocellular carcinoma

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

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