Therapeutic Response Assessment of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Ultrasonography, CT and MR Imaging

Minami, Yasunori; Kudo, Masatoshi

doi:10.1159/000345891

Cited by 23 publications

(16 citation statements)

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“…We regarded lipiodol accumulation in targeted tumors seen on CT scans as indicating necrosis. This was due to the fact that it had been previously reported in several studies that the lipiodol retention areas observed on CT corresponded to necrotic areas (25)(26)(27). Complete response (CR) was defined as the disappearance of all targeted tumors or 100% tumor necrosis, partial response (PR) was defined as a ≥50% reduc-tion in tumor size and/or necrosis, and progressive disease (PD) was defined as >25% tumor enlargement and/or the appearance of any new HCC tumors.…”

Section: Methodsmentioning

confidence: 88%

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

et al. 2013

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Abstract. The aim of the present study was to compare clinical outcomes in patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent the following treatments: transcatheter arterial chemoembolization (TACE) using an epirubicin-mitomycin-lipiodol (EML) emulsion at initial therapy (TACE group; n=145), and transcatheter chemotherapy infusion (TACI) using an EML emulsion at initial therapy (TACI group; n=81). Overall survival (OS) and treatment efficacy in the TACE and TACI groups were retrospectively compared. Prognostic factors associated with OS were examined using univariate and multivariate analyses. Treatment-related mortality was also calculated. The median observation periods were 1.8 years (range, 0.2-9.0 years) in the TACE group and 2.0 years (range, 0.2-8.7 years) in the TACI group. The median survival time and the 1-, 2-, 3-and 5-year cumulative OS rates were 2.68 years and 81.5, 63.4, 43.9 and 32.7%, respectively, in the TACE group, and 2.64 years and 85.0, 60.0, 43.2 and 26.0%, respectively, in the TACI group (P=0.691). The objective response rate was significantly higher in the TACE group compared to the TACI group (80.0 vs. 66.7%; P=0.009). Using multivariate analysis, the Child-Pugh classification (P= 0.017), tumor number ≤5 (P= 0.045) and des-γ-carboxy prothrombin level >100 mAU/ml (P=0.002) were found to be significant predictors linked to OS. In all subgroup analyses involving Child-Pugh classification, maximum tumor size and tumor distribution, the differences in the two groups did not reach statistical significance in terms of OS. Treatment mortality was 0% in the two groups. In conclusion, patients with intermediate-stage HCC had a comparable prognosis when treated with TACI or TACE. IntroductionHepatocellular carcinoma (HCC) is a major health problem; it is the fifth most common type of cancer worldwide and the third most common cause of cancer-related mortality (1-3). The prognosis for untreated HCC is generally poor and the curative treatments for this disease consist of surgical resection, radiofrequency ablation and liver transplantation (1-3). Non-curative therapies for HCC include transcatheter arterial chemoembolization (TACE), transcatheter arterial chemotherapy infusion (TACI), continuous arterial chemoinfusion therapy, radioembolization, molecular targeting therapies such as sorafenib and radiation therapy (1-12).TACE is a procedure whereby an embolic agent is injected into the tumor feeding artery to deprive it of its major nutrient source by means of embolization; this results in ischemic necrosis of the targeted tumor (11,12). The survival benefit of TACE for unresectable HCC was established in two randomized controlled trials (RCTs) and in one meta-analysis (13-15). Thus, TACE plays an important role in treating unresectable HCC. It is clearly defined as a first-line therapy with an improved 2-year survival rate as compared with conservative therapy (16).The Barcelona Clinic Liver Cancer (BCLC) classification is regarded as one of the most reliable staging an...

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Section: Methodsmentioning

confidence: 88%

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

et al. 2013

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“…is useful for diagnosing residual and recurrent tumors in HCC cases after Lp-TACE, because Lipiodol has been thought not to affect MRI signal intensity [17][18][19] . However, some studies have suggested that Lipiodol itself induces MRI signal changes with normal imaging methods, possibly due to its oil-based nature 7,8 , while other reports indicate that Lipiodol hardly affects MRI signals [9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…CT is also useful in the post-Lp-TACE management of HCCs 15,16 . However, once a high density of Lipiodol has accumulated in the tumor, evaluating whether tumor-enhancing effects are present by contrast-enhanced CT and diagnosing residual or recurrent tumors can be dif cult 17,18 . It is also worth noting that artifacts are created when…”

Section: Originalmentioning

confidence: 99%

“…Some studies have reported in cases such as this that MRI is very useful in determining treatment effects and assessing recurrence in HCCs after Lp-transcatheter arterial embolization TAE . This is because artifacts are less likely to be present when the evaluation of contrast effects is easy and not affected by the presence of Lipiodol [17][18][19] .…”

Section: Originalmentioning

confidence: 99%

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Chemical-shift Magnetic Resonance Imaging Performed after Chemoembolization of Hepatocellular Carcinoma

修

Miyagami

2015

Showa Univ J Med Sci

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: We investigated whether the Lipiodol-derived signal accumulated in hepatocellular carcinoma HCC after transcatheter arterial chemoembolization TACE using Lipiodol oil-based contrast agent mixed with an anticancer agent, known as Lp-TACE, could be evaluated with chemical-shift magnetic resonance imaging MRI . The subjects were 25 HCC patients n 45 tumors who had undergone Lp-TACE and chemical-shift MRI of the abdominal region from April 1, 2000 to March 31, 2012. The regions of interest ROIs were set as large as possible to include the Lipiodol accumulation region on computed tomography CT images and the hyperintense signal region in double-echo fast low-angle shot FLASH , automatic-subtracted images on MRI. We then used both modalities to measure the CT value and signal intensity for each specimen. The MRI signal intensity was calculated by subtracting the background signal intensity from the measured value. The mean CT value for the 45 tumors in the 25 patients of 710 Houns eld units HU ; range, 139-3,062 HU was positively correlated with the mean MRI signal intensity of 43.5 0-212 . Tumors with a diameter ≥ 2 cm exhibited a stronger correlation between CT values and MRI signal intensity in areas of Lipiodol accumulation than tumors smaller than 2 cm. A weaker correlation was observed between the CT values and MRI signal intensity in areas of Lipiodol accumulation when the period from Lp-TACE to MRI was shorter than a week compared to one week or over. Our ndings suggest that chemical-shift MRI can detect Lipiodol accumulation in HCCs and could therefore be useful in evaluating such types of accumulation.

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“…By referring to the doses used in systemic chemotherapy, traditional TACE performs embolization after intra-arterial infusion plus chemotherapy drugs in terms of chemotherapy drug doses (Cui et al, 2012;Kong et al, 2012;Minami et al, 2013;Murata et al, 2013;Wang et al, 2013). It is still controversial with regard to chemotherapy drug doses at present.…”

Section: Discussionmentioning

confidence: 99%

Application of Lobaplatin in Trans-catheter Arterial Chemoembolization for Primary Hepatic Carcinoma

Wang

Lv²,

Xu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Objective: To explore the efficiency of single application of lobaplatin in tran-scatheter arterial chemoembolization (TACE) for patients with a primary hepatic carcinoma who were unable or unwilling to undergo surgery. Methods: 173 patients with primary hepatic carcinoma diagnosed by imaging or pathology were randomly divided into experimental and control groups and respectively treated with lobaplatin and pirarubicin hydrochloride as chemotherapeutic drugs for TACE. The amount of iodipin was regulated according to the tumor number and size, and then gelatin sponge or polyvinyl alcohol particles were applied for embolisms. The efficiency of treatment in the two groups was compared with reference to survival time and therapeutic response. Results: The experimental group (single lobaplatin as chemotherapy drug) was superior to control group (single pirarubicin hydrochloride as chemotherapy drug) in the aspects of survival time and therapeutic response, with statistical significance. Conclusions: Single lobaplatin can be as a chemotherapy drug in TACE and has better efficiency in the aspects of mean survival time and therapeutic response, deserving to be popularized in the clinic.

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Therapeutic Response Assessment of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Ultrasonography, CT and MR Imaging

Cited by 23 publications

References 95 publications

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

Chemical-shift Magnetic Resonance Imaging Performed after Chemoembolization of Hepatocellular Carcinoma

Application of Lobaplatin in Trans-catheter Arterial Chemoembolization for Primary Hepatic Carcinoma

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