Transarterial Chemoembolization of Child-A hepatocellular carcinoma: Drug-eluting bead TACE (DEB TACE) vs. TACE with Cisplatin/Lipiodol (cTACE)

Wiggermann, Philipp; Sieroń, Dominik; Brosche, C; Brauer, Thomas; Scheer, F; Platzek, Ivan; Wawrzynek, Wojciech; Stroszczynski, Christian

doi:10.12659/msm.881714

Cited by 71 publications

(59 citation statements)

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“…In a small cohort of 53 patients, Orsi et al were able to achieve satisfactory results for TAE with respect to local tumor control and patient survival [5]. In the PRECISION V study a significantly higher tumor response for DEB-TACE compared to conventional TACE was not able to be shown but significantly lower systemic side effects were seen [12,13]. There is no standardized dosage schedule for the chemotherapeutic agent but beads with a diameter of 100 -150 μm loaded with 150 mg of doxorubicin are usually used.…”

Section: Discussionmentioning

confidence: 99%

Transarterial Chemoembolization - Status Quo in Germany

Niessen

Wiggermann

Velandia

et al. 2013

Fortschr Röntgenstr

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Purpose: Against the background of the current preparation of the national disease management guideline for the diagnosis and treatment of hepatocellular carcinoma (HCC), the German Society for Interventional Radiology (DEGIR) launched a statewide survey in order to evaluate the current status of transarterial chemoembolization (TACE) in Germany. Materials and Methods: In April 2012 an e-mail questionnaire relating to TACE practices in patients with intermediate-stage HCC was sent to all chief physicians of interventional radiology departments in Germany that were members of DEGIR. Results: 96 questionnaires were completed and evaluated statistically. The most frequent combinations of embolic agents and cytotoxic drugs are drug-eluting beads combined with doxorubicin or epirubicin as well as lipiodol plus doxorubicin, epirubicin or cisplatin. 60?% of the interventionalists prefer superselective chemoembolization. In most cases more than one chemoembolization per patient is performed (95.5?%). The most common (77?%) time interval between two interventions ranges between one and two months. Conclusion: The results of this survey show the often stated criticism in Germany regarding the substantial differences in TACE protocols and highlight the importance of standards of practice for TACE in patients with HCC. Key Points: Citation Format:

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Section: Discussionmentioning

confidence: 99%

Transarterial Chemoembolization - Status Quo in Germany

Niessen

Wiggermann

Velandia

et al. 2013

Fortschr Röntgenstr

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“…Panašus dažnis buvo ir kituose tyrimuose: 44-66 proc. [19,9]. Mūsų tyrimo pacientų didžiausio navikinio židinio dydžio vidurkis buvo 5,6 (2,8) cm.…”

Section: Rezultatų Aptarimasunclassified

“…pacientų -C. Pagal Barselonos algoritmą pacientams su Childo ir Pugho C funkcine klase TACE neturėtų būti taikoma. Didžioji dalis tyrimų tokių pacientų neįtraukė [9,19,20,23]. JAV atliktame tyrime dalyvavo 22,6 proc.…”

Section: Rezultatų Aptarimasunclassified

“…procedūrų. Panašūs rezultatai, kai vyrauja I-II laipsnio nepageidaujamos reakcijos, buvo ir kituose tyrimuose [9,10,19,20]. PRECISION V tyrime postembolinis sindromas pasireiškė 25,9 proc.…”

Section: Rezultatų Aptarimasunclassified

“…Kituose tyrimuose išgyvenamu-mo mediana buvo nuo 13,4 mėn., kai į tyrimą buvo įtrauk-ta 22,6 proc. pacientų su Childo ir Pugho C funkcine klase [18], iki 21,7 mėn., kai visi pacientai buvo tik A funkcinės klasės [19]. Mūsų tyrime palyginti pacientų išgyvenamumo medianas skirtingose Childo ir Pugho kepenų funkcinėse klasėse neįmanoma dėl per mažos pacientų imties, tačiau remiantis kitų tyrimų duomenimis galima teigti, kad pacientų išgyvenamumas priklauso nuo kepenų funkcijos prieš gydymą DEB TACE.…”

Section: Rezultatų Aptarimasunclassified

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Hepatoceliulinės Karcinomos Gydymo Transarterine Chemoembolizacija Doksorubicinu Impregnuotomis Mikrosferomis (Deb Tace) Lietuvos Sveikatos Mokslų Universiteto Ligoninėje Kauno Klinikose Analizė

Pranculis

Kievišas

Kievišienė

et al. 2015

Medicinos Teorija Ir Praktika

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SANTRAUKAReikšminiai žodžiai: transarterinė chemoembolizacija (TACE), transarterinė chemoembolizacija doksorubicinu impregnuotomis mikrosferomis (DEB TACE), hepatoceliulinė karcinoma (HCC). Hepatoceliulinė karcinoma (HCC) -dažniausias pirminis kepenų navikas. Kepenų rezekcija, transplantacija arba radiodaž-ninė abliacija galimos tik kai yra labai ankstyvos arba ankstyvos vėžio stadijos. Transarterinė chemoembolizacija (TACE) yra pirmo pasirinkimo gydymo metodas daugiažidininiu kepenų vėžiu sergantiems pacientams. Tikslas. Išanalizuoti transarterinės chemoembolizacijos doksorubicinu impregnuotomis mikrosferomis (DEB TACE) būdu dėl hepatoceliulinės karcinomos gydytų pacientų gydymo išeitis Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose (LSMUL KK).Tyrimo medžiaga ir metodai. Atliktas retrospektyvinis tyrimas, įtraukta 20 HCC sergančių ir DEB TACE gydytų pacientų. Visiems pacientams nuo 2012 m. birželio mėn. iki 2015 m. kovo mėn. LSMUL KK atliktos superselektyvios DEB TACE procedūros naudojant doksorubicinu impregnuotas "Embozene TANDEM®" ("CeloNova", "BioScience", San Antonijus, JAV) mikrosferas. Gydymo išeitims vertinti analizuotas pacientų išgyvenamumas (mediana ir bendras išgyvenamumas), radiologinis atsakas į gydymą ir a-fetoproteino (AFP) koncentracijos pokytis lyginant reikšmes prieš pirmąjį DEB TACE ciklą ir po jo. Radiologiniam atsakui vertinti taikyti modifikuoti solidinių navikų atsako į gydymą vertinimo kriterijai (mRECIST). Išgyvenamumas vertintas taikant Kaplano ir Mejerio (Kaplan-Meier) metodą. Rezultatai. Išgyvenamumo mediana nuo diagnozės datos ir nuo pirmosios DEB TACE buvo atitinkamai 31,5 ± 9 mėn. ir 19,5 ± 3,9 mėn., bendras išgyvenamumas po 6 mėn. -100 proc. ir 93,3 proc., po 1 m. -80 proc. ir 79 proc., po 2 m. -56,1 proc. ir 29,6 proc. Objektyvus radiologinis atsakas po 1 ir 3 mėn. pasiektas atitinkamai 78,6 proc. ir 77,8 proc. AFP kon-

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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...

show abstract

Transarterial Chemoembolization of Child-A hepatocellular carcinoma: Drug-eluting bead TACE (DEB TACE) vs. TACE with Cisplatin/Lipiodol (cTACE)

Cited by 71 publications

References 23 publications

Transarterial Chemoembolization - Status Quo in Germany

Transarterial Chemoembolization - Status Quo in Germany

Hepatoceliulinės Karcinomos Gydymo Transarterine Chemoembolizacija Doksorubicinu Impregnuotomis Mikrosferomis (Deb Tace) Lietuvos Sveikatos Mokslų Universiteto Ligoninėje Kauno Klinikose Analizė

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

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