Experience of combined treatment of advanced hepatocellular carcinoma with intrahepatic metastasis with cTACE and D-TACE_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Fanghua ^1,2 , XU Jie ¹ , MIAO Chunmu ¹ ,  GONG Jianping ¹

1. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;
2. Department of Surgery, The Second People’s Hospital of Yubei District, Chongqing 401147, P. R. China;

Corresponding author：

GONG Jianping, Email: gongjianping11@126.com

Keywords：

hepatocellular carcinoma; intrahepatic metastasis; transcatheter arterial chemoembolization; multidisciplinary treatment

DOI：

10.7507/1007-9424.201904031

Video：

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Objective To summarize the experience of combined treatment of conventional transcatheter arterial chemoembolization (cTACE) and drug-eluting-bead chemoembolization(D-TACE) in a case of advanced hepatocellular carcinoma with intrahepatic metastasis.Methods A patient with advanced hepatocellular carcinoma who was admitted to The Second Affiliated Hospital of Chongqing Medical University in October 2018 was treated with TACE for three times.Results After MDT discussion, three interventional operations were performed on this patient in The Second Affiliated Hospital of Chongqing Medical University. CT examination after the first treatment with cTACE showed that lipiodol deposited in liver lesions and the lesions were more stable than before; after the second treatment with cTACE and D-TACE, CT examination showed more lipiodol deposited in the tumors, and the tumors were more limited and significantly reduced; after the third treatment with cTACE, CT examination showed that the tumors were effectively controlled and no progress was made. This patient was followed-up for 2 months after the fourth cTACE, tumors were effectively controlled and no progress occurred.Conclusions In advanced hepatocellular carcinoma with intrahepatic metastasis, TACE is the best treatment. Combination of D-TACE and cTACE can achieve better clinical efficacy.

Citation： WANG Fanghua, XU Jie, MIAO Chunmu, GONG Jianping. Experience of combined treatment of advanced hepatocellular carcinoma with intrahepatic metastasis with cTACE and D-TACE. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 980-984. doi: 10.7507/1007-9424.201904031 Copy

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8.	Ramsey DE, Kernagis LY, Soulen MC, et al. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol, 2002, 13(9 Pt 2): S211-S221.
9.	Konno T, Maeda H, Iwai K, et al. Selective targeting of anti-cancer drug and simultaneous image enhancement in solid tumors by arterially administered lipid contrast medium. Cancer, 1984, 54(11): 2367-2374.
10.	Konno T, Maeda H, Iwai K, et al. Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: a preliminary report. Eur J Cancer Clin Oncol, 1983, 19(8): 1053-1065.
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12.	Chung GE, Lee JH, Kim HY, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology, 2011, 258(2): 627-634.
13.	Lee HS, Kim JS, Choi IJ, et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer, 1997, 79(11): 2087-2094.
14.	Luo J, Guo RP, Lai EC, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol, 2011, 18(2): 413-420.
15.	Xue TC, Xie XY, Zhang L, et al. Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol, 2013, 13: 60.
16.	Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology, 2003, 37(2): 429-442.
17.	Kang JY, Choi MS, Kim SJ, et al. Long-term outcome of preoperative transarterial chemoembolization and hepatic resection in patients with hepatocellular carcinoma. Korean J Hepatol, 2010, 16(4): 383-388.
18.	Poyanli A, Rozaneş I, Acunaş B, et al. Palliative treatment of hepatocellular carcinoma by chemoembolization. Acta Radiol, 2001, 42(6): 602-607.
19.	Douhara A, Namisaki T, Moriya K, et al. Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization. Oncol Lett, 2017, 14(3): 3028-3034.
20.	Poon RT, Tso WK, Pang RW, et al. A phase Ⅰ/Ⅱ trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol, 2007, 5(9): 1100-1108.
21.	Nicolini A, Martinetti L, Crespi S, et al. Transarterial chemoembolization with epirubicin-eluting beads versus transarterial embolization before liver transplantation for hepatocellular carcinoma. J Vasc Interv Radiol, 2010, 21(3): 327-332.
22.	Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol, 2007, 46(3): 474-481.
23.	Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol, 2010, 33(1): 41-52.
24.	Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology, 2012, 262(1): 43-58.
25.	杨建东, 孔曼, 黄希芬, 等. 应用海藻酸钠微球联合碘化油经导管肝动脉化疗栓塞治疗肝癌. 中国介入影像与治疗学, 2010, 7(3): 225-227.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2. Thomas MB, Jaffe D, Choti MM, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol, 2010, 28(25): 3994-4005.
3. Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology, 2011, 53(3): 1020-1022.
4. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 2012, 56(4): 908-943.
5. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet, 2012, 379(9822): 1245-1255.
6. Gosalia AJ, Martin P, Jones PD. Advances and future directions in the treatment of hepatocellular carcinoma. Gastroenterol Hepatol (N Y), 2017, 13(7): 398-410.
7. 赵建农. 肝癌介入治疗的基本原理. 中华肝脏病杂志, 2005, 13(10): 784.
8. Ramsey DE, Kernagis LY, Soulen MC, et al. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol, 2002, 13(9 Pt 2): S211-S221.
9. Konno T, Maeda H, Iwai K, et al. Selective targeting of anti-cancer drug and simultaneous image enhancement in solid tumors by arterially administered lipid contrast medium. Cancer, 1984, 54(11): 2367-2374.
10. Konno T, Maeda H, Iwai K, et al. Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: a preliminary report. Eur J Cancer Clin Oncol, 1983, 19(8): 1053-1065.
11. Jinno K, Moriwaki S, Tanada M, et al. Clinicopathological study on combination therapy consisting of arterial infusion of lipiodol-dissolved SMANCS and transcatheter arterial embolization for hepatocellular carcinoma. Cancer Chemother Pharmacol, 1992, 31 Suppl: S7-S12.
12. Chung GE, Lee JH, Kim HY, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology, 2011, 258(2): 627-634.
13. Lee HS, Kim JS, Choi IJ, et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer, 1997, 79(11): 2087-2094.
14. Luo J, Guo RP, Lai EC, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol, 2011, 18(2): 413-420.
15. Xue TC, Xie XY, Zhang L, et al. Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol, 2013, 13: 60.
16. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology, 2003, 37(2): 429-442.
17. Kang JY, Choi MS, Kim SJ, et al. Long-term outcome of preoperative transarterial chemoembolization and hepatic resection in patients with hepatocellular carcinoma. Korean J Hepatol, 2010, 16(4): 383-388.
18. Poyanli A, Rozaneş I, Acunaş B, et al. Palliative treatment of hepatocellular carcinoma by chemoembolization. Acta Radiol, 2001, 42(6): 602-607.
19. Douhara A, Namisaki T, Moriya K, et al. Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization. Oncol Lett, 2017, 14(3): 3028-3034.
20. Poon RT, Tso WK, Pang RW, et al. A phase Ⅰ/Ⅱ trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol, 2007, 5(9): 1100-1108.
21. Nicolini A, Martinetti L, Crespi S, et al. Transarterial chemoembolization with epirubicin-eluting beads versus transarterial embolization before liver transplantation for hepatocellular carcinoma. J Vasc Interv Radiol, 2010, 21(3): 327-332.
22. Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol, 2007, 46(3): 474-481.
23. Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol, 2010, 33(1): 41-52.
24. Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology, 2012, 262(1): 43-58.
25. 杨建东, 孔曼, 黄希芬, 等. 应用海藻酸钠微球联合碘化油经导管肝动脉化疗栓塞治疗肝癌. 中国介入影像与治疗学, 2010, 7(3): 225-227.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of combined treatment of advanced hepatocellular carcinoma with intrahepatic metastasis with cTACE and D-TACE

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