Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion

Abstract

Transarterial chemoembolization with Lipiodol (Lipiodol TACE), also called conventional TACE, was developed in the early 1980s and widely adopted worldwide after randomized control trials and meta-analysis demonstrated superiority of Lipiodol TACE to best supportive care. Presently, there is no level one evidence that other TACE techniques are superior to Lipiodol TACE for intermediate stage hepatocellular carcinoma (HCC), which includes patients with preserved liver function and nonsurgical large or multinodular HCC without distant metastases. In addition, TACE is part of the treatment for progressive or symptomatic liver metastases from gastroenteropancreatic neuroendocrine tumors. When injected into the hepatic artery, Lipiodol has the unique property of selective uptake and retention in hyperarterialyzed liver tumors. Lipiodol/drug emulsion followed by particle embolization has been demonstrated to improve the pharmacokinetic of the drug and tumor response. Radio opacity of Lipiodol helps to monitor treatment delivery, with retention of Lipiodol serving as an imaging biomarker for tumor response. For 30 years, Lipiodol TACE has been inconsistently referenced in many publications with various levels of details for the method of preparation and administration, with reported progressive outcomes following improvements in the technique and the devices used to deliver the treatment and better patient selection. Consequently, there is no consensus on the standard method of TACE regarding the use of anticancer agents, embolic material, technical details, and the treatment schedule. In order to develop an internationally validated technical recommendation to standardize the Lipiodol TACE procedure, a worldwide panel of experts participated in a consensus meeting held on May 10, 2014 .

Combined transcatheter arterial chemoembolization and radiofrequency ablation in single‐session for solitary hepatocellular carcinoma larger than 7 cm

“…9,20 Theoretically, the rate of complications should be higher in the combined TACE and RFA than that of TACE or RFA monotherapy. 38 However, the common procedure-related complications of the combined therapy such as hepatic infarction, biloma, abscess and hepatic arterial bleeding, reported by others, 27,31,34,39 did not occur in our study. In our study, posttreatment syndrome and transient increase in liver enzymes slightly were observed in all patients within 1 week after the treatment, which were comparable with those reported in other studies [8][9][10][11] ; these symptoms were usually self-limited and reversible without special treatment.…”

Superselective Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma: Rationale, Technique, and Outcome

“…The dose in milliliters of ethiodized oil used for a single conventional transarterial chemoembolization session is approximately equal to the sum of the target tumor diameters in centimeters (8). The reported maximum dose of ethiodized oil per session is 10 mL (8,47) or 15 mL (48). The endpoint of conventional transarterial chemoembolization is the occlusion of tumor feeders and disappearance of staining of target tumors on digital subtraction angiography.…”

Which Criteria Applied in Multi-Phasic CT Can Predict Early Tumor Response in Patients with Hepatocellular Carcinoma Treated Using Conventional TACE: RECIST, mRECIST, EASL or qEASL?

“…No whole liver cTACE was performed. An emulsion containing up to 50 mg doxorubicin (Adriamycin, Zhejiang HISUN Pharmaceutical Co. Ltd., Taizhou, China) and 2–20 ml Lipiodol (Lipiodol Ultra-Fluide, Laboratoire Guerbet, Aulnay-sous-Bois, France) was infused, followed by bland embolization with 100–300 µm polyvinyl alcohol particles (Cook Medical Inc., Bloomington, USA) until arterial inflow was substantially reduced as seen on fluoroscopy [1, 8, 19]. In all cases, either a selective or a super-selective approach was chosen.…”