Experimentelle Untersuchung zur Effektivit t der Transarteriellen Chemoembolisation im Tiermodell des hepatozellul ren Karzinoms

Ziel: Evaluation der Effektivit t verschiedener Methodiken der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms. Material und Methoden: Bei mannlichen ACI Ratten erfolgte die Implantation eines soliden Morris Hepatom 3924A subkapsular in den Leberlappen. 12—14 Tage nach Implantation wurden die Tumorvolumina kernspintomographisch bestimmt. Nach Laparotomie und retrograder Katheterisierung der Arteria gastroduodenalis wurden anschlieend unterschiedliche Therapieprotokolle der TACE angewendet: Mitomycin C , Degradiere Starke Mikrospharen , Mitomycin C+DSM , Mitomycin C + Ligatur , Mitomycin C+Lipiodol , Mitomycin C+Lipiodol+Ligatur , Mitomycin C+DSM+Ligatur , Mitomycin C+Poly Laktide co Glykolide , DSM + Ligatur , Lipiodol + Ligatur , Ligatur , Lipiodol , 0,9% NaCl . Zur Effektivitatsbeurteilung der verschiedenen Methodiken erfolgte 12—14 Tage nach Therapie eine erneute kernspintomographische Volumenbestimmung der Tumoren. Ergebnisse: Im Vergleich zur Kontrollgruppe zeigten Gruppe D, E, F, G, H und J eine statistisch signifikant geringere Tumorvolumenzunahme, wahrend Gruppe A, B, C, I, K, L keine statistisch signifikanten Unterschiede hinsichtlich der Tumorvolumenzunahme zeigten. Schlufolgerung: Die Effektivitat der TACE im tierexperimentellen Modell des hepatozellularen Karzinoms wird nur bei kombinierter Applikation von Zytostatikum und Carrier/Ligatur signifikant erhoht. Die alleinige Applikation des Zytostatikums/der Carrier/Ligatur hatte keinen signifikanten Effekt bezuglich der Effektivitat.

Permanente Chemoembolisation des Leberkarzinoms mit dem chinesischen Heilmittel Bletilla striata: Langzeitergebnisse im Vergleich mit Lipiodol-MMC-Gelfoam

Von Mai 1990 bis September 1993 wurden 106 Patienten mit hepatozellularem Karzinom (HCC) durch 354 repetitiv durchgefuhrte transarterielle Chemoembolisation behandelt. Die Beobachtungszeit variierte zwischen 10-50 Monaten bei allen Patienten. Je nach dem Embolisationsmaterial wurde n106 Patienten in zwei Gruppen geteilt, namlich Lipiodol-MMC mit Gelfoam als vorlaufige Embolisationsmethode (Gruppe A, n=50) und Lipiodol-MMC mit Bletilla striata-Pulver (BS; chinesisches traditionelles Medikament fur Koagulation)als permanente Embolisationsmethode (Gruppe B,n=56), Bei der Analyse zeigte sich,daβ auβer anderen wichtigen Faktoren,wie der Infiltration der Portalvene und dem klinischen Stadium der Patienten sowie dem Wachstumstyp des Tumors, die klinischen Effekte eng von den Embolisationsmethoden abhangig waren. Die Uberlebenraten betrugen bei Gruppe A 48, 9%,16,0% nach 1, 2, 3Jahren, bei Gruppe B 81,9 %, 44,9 %, 33,6 % nach 1, 2, 3 Jahren. Die Uberlebensraten zwischen der beiden Gruppen zeigten beim U-Test einen signifikanten Unterschied

Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas

AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment.RESULTS: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.

Comprehensive treatments for hepatocellular carcinoma with tumor thrombus in major portal vein

AIM: To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein.METHODS: From 2009 to 2013, a total of 418 HCC patients with tumor thrombus extending to the main portal vein were enrolled in this study and divided into four groups. These groups underwent different treatments as follows: TACE (n = 307), surgical intervention (n = 54), sorafenib (n = 15) and palliative treatment (n = 42). Overall survival rates were determined by Kaplan-Meier method, and differences between the groups were identified through log-rank analysis. Cox&#x02019;s proportional hazard model was used to identify the risk factors for survival.RESULTS: The mean survival periods for patients in the TACE, surgical intervention, sorafenib and palliative treatment groups were 10.39, 4.13, 5.54 and 2.82 mo, respectively. For the TACE group, the 3-, 6-, 12- and 24-mo survival rates were 94.1%, 85.9%, 51.5% and 0.0%, respectively. The corresponding rates were 60.3%, 22.2%, 0.0% and 0.0% for the surgical intervention group and 50.9%, 29.5%, 0.0% and 0.0% for the sorafenib group. Evidently, the results in the TACE group were significantly higher than those in the other groups (P &#x0003c; 0.0001). Furthermore, no significant difference among survival rates was observed between TACE with/without sorafenib (10.22 mo vs 10.52 mo, P = 0.615). No significant difference in survival rates was also found among the surgical intervention, sorafenib and palliative treatment groups (P &#x0003e; 0.05). These values significantly increased after TACE with/without sorafenib compared with other treatments (P &#x0003c; 0.05).CONCLUSION: For HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.

Novel biomarkers GEP/ABCB5 regulate response to adjuvant transarterial chemoembolization after curative hepatectomy for hepatocellular carcinoma

Background: Transarterial chemoembolization(TACE) is the most commonly used adjuvant therapy for hepatocellular carcinoma(HCC) after curative resection. Responses to TACE are variable due to tumor and patient heterogeneity. We had previously demonstrated that expression of Granulin-epithelin precursor(GEP) and ATP-dependent binding cassette(ABC)B5 in liver cancer stem cells was associated with chemoresistance. The present study aimed to evaluate the association between GEP/ABCB5 expression and response to adjuvant TACE after curative resection for HCC. Methods: Patients received adjuvant TACE after curative resection for HCC and patients received curative resection alone were identified from a prospectively collected database. Clinical samples were retrieved for biomarker analysis. Patients were categorized into 3 risk groups according to their GEP/ABCB5 status for survival analysis: low(GEP-/ABCB5-), intermediate(either GEP +/ABCB5-or GEP-/ABCB5 +) and high(GEP +/ABCB5 +). Early recurrence(recurrence within 2 years after resection) and disease-free survival were analyzed. Results: Clinical samples from 44 patients who had followed-up for more than 2 years were retrieved for further biomarker analysis. Among them, 18 received adjuvant TACE and 26 received surgery alone. Patients with adjuvant TACE in the intermediate risk group was associated with significantly better overall survival and 2-year disease-free survival than those who had surgery alone( P = 0.036 and P = 0.011, respectively). Adjuvant TACE did not offer any significant differences in the early recurrence rate, 2-year disease-free survival and overall survival for patients in low and high risk groups. Conclusions: Adjuvant TACE can only provide survival benefits for patients in the intermediate risk group(either GEP +/ABCB5-or GEP-/ABCB5 +). A larger clinical study is warranted to confirm its role in patient selection for adjuvant TACE.