Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse

Zangos, Stephan; Gille, Torsten; Eichler, K.; Engelmann, K.; Woitaschek, Dirk; Balzer, J. O.; Mack, Martin G.; Thalhammer, A.; Vogl, Thomas J.

doi:10.1007/s001170170062

Cited by 11 publications

(3 citation statements)

References 46 publications

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“…In the western world, TACE is currently the most frequently used treatment option for patients with advanced HCC. There is evidence that this procedure – usually combined with other interventional therapies (20) – delays tumor progression and vascular invasion in selected patients with preserved liver function (10, 21, 22). Moreover, TACE is routinely used as a bridge to OLT for patients on the waiting list (23, 24), despite an ongoing discussion on its efficacy and efficiency (25).…”

Section: Discussionmentioning

confidence: 99%

Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis

Schaudt¹,

Kriener

Schwarz

et al. 2009

Clinical Transplantation

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Several authors suggest that local ablative therapies, specifically transarterial chemoembolization (TACE), may control tumor progression of hepatocellular carcinoma (HCC) in patients who are on the waiting list for liver transplantation (orthotopic liver transplantation, OLT). There is still no evidence if TACE followed by OLT is able to prevent recurrence of tumor, to prolong survival rate of the patients on the waiting list, or to improve the survival after OLT. We report 27 patients with HCC who underwent OLT. From these patients, 15 were pre-treated with TACE alone or in combination with percutaneous ethanol injection (PEI) or laser-induced thermo therapy (LITT). Mean time on the waiting list was 214 d for treated patients and 133 d for untreated patients. Comparing pre-operative imaging and histopathological staging post-transplant, we found 13 patients with tumor progression out of which five were treated with TACE. In two of the TACE patients a decrease of lesions could be achieved. In a single patient, there was no evidence of any residual tumor. Only one patient displayed tumor progression prior to OLT despite undergoing TACE. Comparison of outcome in patients undergoing TACE or having no TACE was not statistically significant (p = 0.5). In addition, our analysis showed that progression either in the total study population or in the TACE group alone is associated with a significant poorer outcome concerning overall survival (p = 0.02 and p = 0.02).

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Section: Discussionmentioning

confidence: 99%

Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis

Schaudt¹,

Kriener

Schwarz

et al. 2009

Clinical Transplantation

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“…To date, the resection rate for HCC is unfortunately less than 30% [3,5,6] . Since HCC's blood supply is derived almost exclusively from hepatic arteries, transcatheter arterial embolization (TAE) of the hepatic artery has been accepted as an effective treatment for unresectable HCC [5][6][7][8][9][10] . Although embolic materials and technique have been improved during the last decade, the outcome of TAE is not satisfactory.…”

Section: Introductionmentioning

confidence: 99%

Vascular endothelial growth factor antisense oligodeoxynucleotides with lipiodol in arterial embolization of liver cancer in rats

Wu¹,

Gao²,

Liang³

et al. 2004

WJG

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AIM:Transcatheter arterial embolization (TAE) of the hepatic artery has been accepted as an effective treatment for unresectable hepatocellular carcinoma (HCC). However, embolized vessel recanalization and collateral circulation formation are the main factors of HCC growth and recurrence and metastasis after TAE. Vascular endothelial growth factor (VEGF) plays an important role in tumor angiogenesis. This study was to explore the inhibitory effect of VEGF antisense oligodeoxynucleotides (ODNs) on VEGF expression in cultured Walker-256 cells and to observe the anti-tumor effect of intra-arterial infusion of antisense ODNs mixed with lipiodol on rat liver cancer. METHODS:VEGF antisense ODNs and sense ODNs were added to the media of non-serum cultured Walker-256 cells. Forty-eight hours later, VEGF concentrations of supernatants were detected by ELISA. Endothelial cell line ECV-304 cells were cultured in the supernatants. Seventy-two hours later, growth of ECV-304 cells was analyzed by MTT method. Thirty Walker-256 cell implanted rat liver tumor models were divided into 3 groups. 0.2 mL lipiodol (LP group, n=10), 3OD antisense ODNs mixed with 0.2 mL lipiodol (LP+ODNs group, n=10) and 0.2 mL normal saline (control group, n=10) were infused into the hepatic artery. Volumes of tumors were measured by MRI before and 7 d after the treatment. VEGF mRNA in cancerous and peri-cancerous tissues was detected by RT-PCR. Microvessel density (MVD) and VEGF expression were observed by immunohistochemistry.

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“…Üblicherweise werden Cisplatin, Doxorubicin, Epirubicin, Fluoruracil, Mitomycin C und Zytokine als Chemotherapeutika mit Lipiodol als Trägersubstanz eingesetzt [15].…”

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Hepatozelluläres Karzinom: Bridging-Verfahren vor der Lebertransplantation

Zangos¹,

Ulrich²,

Eichler³

et al. 2012

Viszeralmedizin

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Hintergrund: Lange Wartezeiten vor einer Lebertransplantation führen bei Patienten mit hepatozellulärem Karzinom (HCC) aufgrund eines Tumorprogresses zunehmend zu einem Ausschluss von der Transplantationsliste und damit auch zu einem reduzierten Langzeitüberleben. Methode und Ergebnisse: Aus diesem Grund werden heute verschiedene lokale Therapien wie die transarterielle Chemoembolisation (TACE) und verschiedene lokal ablative Verfahren einschließlich der perkutanen Alkoholinjektion (PEI), der Radiofrequenzablation (RFA), der MR-gesteuerten Laserablation (LITT) und der Mikrowellenablation (MWA) zum Bridging vor einer Lebertransplantation eingesetzt. Die Auswahl der geeigneten Verfahren ist hierbei abhängig von der Anwendbarkeit, den Limitationen und den spezifischen Risiken der verschiedenen Techniken. Insbesondere das Management von HCC-Patienten mit Leberzirrhose ist komplex, sodass die Auswahl der therapeutischen Maßnahmen interdisziplinär abgestimmt werden sollte. Schlussfolgerung: Auch wenn für die Bridging-Therapien derzeit keine evidenzbasierten Daten vorliegen, zeigen sich die verschiedenen interventionellen Therapien als vielversprechende therapeutische Optionen zum Bridging vor einer Lebertransplantation.

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Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse

Abstract: Chemoembolization is a minimal invasive and outpatient treatment protocol for HCC. TACE might be indicated as a palliative treatment to control the diseased liver. If repeated TACE alters the size and structure of primary unresectable HCC TACE expands the indication for MR-guided LITT.

Cited by 11 publications

References 46 publications

Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis

Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis

Vascular endothelial growth factor antisense oligodeoxynucleotides with lipiodol in arterial embolization of liver cancer in rats

Hepatozelluläres Karzinom: Bridging-Verfahren vor der Lebertransplantation

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