Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation

Sommer, Christof M.; Pallwein-Prettner, Leo; Vollherbst, Dominik F; Seidel, Roland; Rieder, Christian; Radeleff, Boris; Kauczor, Hans Ulrich; Wacker, Frank; Richter, G. M.; Bücker, Arno; Rodt, Thomas; Maßmann, Alexander; Pereira, Philippe L.

doi:10.1016/j.ejrad.2016.10.024

Cited by 25 publications

(15 citation statements)

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“…Radiopacity of embolic agents is potentially beneficial [ 6 , 27 , 28 ]. The intratumoral vascular distribution of the embolic agent determined by peri- and post-interventional imaging can be used for objective treatment control and to guide subsequent procedures, such as repeated embolization or thermal ablation procedures [ 6 ]. Furthermore, as already shown for iodized oil, non-enhancing areas may be an imaging biomarker of viable tumor or ineffective treatments [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…An important issue for effective tumor embolization is the embolic agent being capable of reaching the tumor vasculature for complete devascularization and the chemotherapeutic agent being distributed homogeneously throughout the target volume [ 2 , 3 , 6 ]. Generally, the smaller the diameter of a particulate embolic agent, the deeper its penetration into the tumor and the greater the treatment effect [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…In this context, embolization with the smallest available embolic agents, such as iodized oil (Lipiodol Ultra-Fluide; Guerbet, Roissy, France) and microspheres (e.g., Embozene 40 [CeloNova BioSciences, San Antonio, USA/Boston Scientific, Marlborough, USA]) bear the risk of complications, such as bile duct injury due to occlusion of the peribilliary plexus, non-target embolization due to arterio-venous shunts or occult arterial collateralization, and fulminant tumor necrosis with subsequent embolism of necrotic tissue [ 2 , 8 , 9 ]. In order to obtain a controllable level of distal arterial occlusion, narrow-size calibrated small microspheres with a defined and uniform diameter of ≤75μm are increasingly being used [ 6 , 7 , 10 ]. Embozene 40 and Tandem 40 microspheres (CeloNova BioSciences, San Antonio, USA/Boston Scientific, Marlborough, USA) are currently the smallest commercially available permanent microspheres that are clinically used for transarterial embolization [ 2 , 8 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model

Vollherbst

Gockner

et al. 2018

PLoS ONE

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PurposeThe present study compared standard computed tomography (CT) and histopathological findings after endovascular embolization using a prototype of inherently radiopaque 40μm-microspheres with both standard 40μm-microspheres and iodized oil in a porcine liver model.Materials and methodsTwelve pigs were divided into six study groups, of two pigs each. Four pigs were embolized with iodized oil alone and four with radiopaque microspheres; two animals in each group were sacrificed at 2 hours and two at 7 days. Two pigs were embolized with radiopaque microspheres and heparin and sacrificed at 7 days. Two pigs were embolized with standard microspheres and sacrificed at 2 hours. CT was performed before and after segmental embolization and before sacrifice at 7 days. The distribution of embolic agent, inflammatory response and tissue necrosis were assessed histopathologically.ResultsRadiopaque microspheres and iodized oil were visible on standard CT 2 hours and 7 days after embolization, showing qualitatively comparable arterial and parenchymal enhancement. Quantitatively, the enhancement was more intense for iodized oil. Standard microspheres, delivered without contrast, were not visible by imaging. Radiopaque and standard microspheres similarly occluded subsegmental and interlobular arteries and, to a lesser extent, sinusoids. Iodized oil resulted in the deepest penetration into sinusoids. Necrosis was always observed after embolization with microspheres, but never after embolization with iodized oil. The inflammatory response was mild to moderate for microspheres and moderate to severe for iodized oil.ConclusionRadiopaque 40μm-microspheres are visible on standard CT with qualitatively similar but quantitatively less intense enhancement compared to iodized oil, and with a tendency towards less of an inflammatory reaction than iodized oil. These microspheres also result in tissue necrosis, which was not observed after embolization with iodized oil. Both radiopaque and standard 40μm-microspheres are found within subsegmental and interlobar arteries, as well as in hepatic sinusoids.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model

Vollherbst

Gockner

et al. 2018

PLoS ONE

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“…The combination of resolution of coagulation thrombus, resolution of arterial spasm, microsphere redistribution, and others, explain the complex mechanisms of arterial recanalization. 5,33 Parenchymal necrosis occurred in all kidneys one week after embolization consisting of marked cortical necrosis, interstitial calcification and necrosis of glomeruli. Arterial wall necrosis was noted for all types of microspheres.…”

Section: Discussionmentioning

confidence: 99%

In vivo characterization of a new type of biodegradable starch microsphere for transarterial embolization

et al. 2017

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Transarterial embolization is an established minimally invasive treatment for solid tumors. Unintended inflammation, foreign body reactions and ischemia-triggered neoangiogenesis are clinical drawbacks of permanent embolic materials. The aim of the current study was to characterize a new type of biodegradable starch microsphere with regard to angiographic and histopathological features such as patterns of acute arterial occlusion as well as induction of tissue necrosis, microsphere biodegradation, and inflammation and foreign body reactions during follow-up. Key characteristics of both biodegradable prototypes (L1 and L2; prototype groups) were as follows: microspheres are biodegradable by serum α-amylase, produced from chemically crosslinked potato starch to different extents, in a diameter range of ∼300-800 µm, differing in size distribution and featuring a microsphere deformation of ∼1%. In vivo transarterial embolization with L1 and L2, while applying clinical standard techniques, was performed and compared with clinically established permanent microspheres (Embosphere®500-700 and Embosphere®700-900; control groups). Twenty-four pig kidneys were embolized with the different embolic materials by following the study protocol, and there were no technical failures or complications. Parenchymal necrosis with interstitial calcification was observed in all kidneys independent of the type of embolic material used. Compared with the permanent embolic materials, biodegradable microspheres showed complete (L1) or partial (L2) biodegradation within one week after transarterial embolization, and induced a comparable (L1) or a lower (L2) degree of arterial wall necrosis and a lower degree of inflammation and foreign body reactions. In conclusion, the presented new type of biodegradable microsphere is promising, and could be further evaluated in terms of clinical translation.

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“…The mechanism of drugeluting microsphere drug includes absorption of positive and negative ions, which enables the slow and continuous release of chemotherapeutic drugs into the lesion as well as occlusion of tumor blood vessels by the microspheres. In 2004, British BTG plc developed and launched DC Bead, the world's first drug-eluting bead onto which doxorubicin and irinotecan can be loaded, which then quickly obtained approval from various European and American organizations for application in the treatment of primary and secondary liver cancer (15)(16)(17)(18). In the years that followed, several drug-eluting microspheres were launched successively, including HepaSphere (19), CalliSpheres (20) and TANDEM (21).…”

Section: Introductionmentioning

confidence: 99%

Chinese expert consensus on technical recommendations for the standard operation of drug-eluting beads for transvascular embolization

et al. 2021

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Liver cancer is among the 10 most common tumors globally. In China, liver cancer ranks 4 th for prevalence and 3 rd for mortality among all malignant tumors. With respect to the treatment of primary liver cancer, there are a number of therapies currently available, including surgical resection, liver transplantation, ablation, transarterial chemoembolization (TACE), systemic chemotherapy, radiation therapy, targeted drug therapy and immunotherapy. Clinical practice and research have shown that, compared with conventional TACE (cTACE), drug-eluting bead TACE (DEB-TACE) can achieve a higher response rate and longer survival time in patients with primary liver cancer. Compared with that of cTACE, DEB-TACE has more favorable basic conditions for achieving uniformity, which could facilitate the standardization of operation techniques. China is the country with the highest incidence of primary liver cancer, accounting for more than 50% of the global patients, and its etiology and epidemiology in Chinese patients differ from those in Europeans and Americans. Therefore, experts in China have drafted these technical recommendations for the standard operation of drug-eluting beads for the treatment of liver cancer on the basis of accumulated abundant clinical experience and evidence-based medical data.

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Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation

Cited by 25 publications

References 92 publications

Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model

Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model

In vivo characterization of a new type of biodegradable starch microsphere for transarterial embolization

Chinese expert consensus on technical recommendations for the standard operation of drug-eluting beads for transvascular embolization

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