[Chemoembolization of hepatocellular carcinomas: which factors determine therapeutic response and survival?]. / Chemoembolisation des hepatozellulären Karzinoms: Welche Faktoren bestimmen Therapieansprechen und Uberleben?

PURPOSE: To determine independent prognostic factors influencing the survival of patients with hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Ninety-one patients with unresectable HCC were treated with 269 repetitive TACE. The dosages of epirubicin (40-60 mg) and ethiodized oil (8-20 ml) were adjusted to tumor size and liver function. The impact of tumor size, macroscopic tumor type, tumor location, portal vein infiltration, capsular infiltration, tumor vascularization, uptake of ethiodized oil within the tumors, Child-Pugh-Class and Okuda-Stage on patient survival were evaluated by means of univariate and multivariate regression analysis. RESULTS: The following independent prognostic factors were found: tumor type (nodular vs. infiltrating, p = 0 008), tumor size (p = 0.01), Child-Pugh-Class (A vs. B; p = 0.02) and grade of tumor vascularization (p = 0.04). In 57 patients with HCC of the nodular type, the median survival time was significant longer than in 32 patients with HCC of the infiltrating type (17.0 months vs. 7.9 months; p < 0.003; 2 tumors could not be classified). The 1-, 2- and 3-year-survival rates were significantly higher in 57 patients with Okuda-Stage I disease, compared to 34 patients with Okuda-Stage II and III disease (73%, 31% and 8% vs. 23%, 6% and 4% p < 0.0001). CONCLUSIONS: Tumor type, tumor size and grade of liver cirrhosis have an independent impact on prognosis of patients with HCC treated by TACE. An appropriate selection of patients is necessary to improve patients survival.

[Animal experiment studies on the effectiveness of permanent occlusion of the hepatic artery in transarterial chemoembolization]. / Tierexperimentelle Untersuchungen zur Effektivität der permanenten Okklusion der Arteria hepatica bei der Transarteriellen Chemoembolisation.

PURPOSE: To evaluate the effect of permanent occlusion of the hepatic artery on the efficacy of transarterial chemoembolization (TACE) in an animal model. MATERIAL AND METHODS: 12 days after inoculation of the Morris hepatoma 3924 A in 15 male ACI rats, TACE with Mitomycin C (0.25 mg/kgBW) + Lipiodol (0.2 ml/kgBW) without (n = 5) and with permanent occlusion of the hepatic artery (n = 5) was performed. Control group consisted of 5 rats. Tumor volume was determined by MRI (1.0 T, T1 [TR/TE, 400/14 ms]) before and 12 days after therapy. RESULTS: Compared to the control group, TACE without and with permanent occlusion of the hepatic artery showed a significant reduced tumor growth after 12 days (p = 0.017 and p = 0.005). However, permanent occlusion did not improve the retarding effect on tumor growth (p = 0.9). CONCLUSION: The effectiveness of TACE in an animal model using a cytostatic-/lipiodol-emulsion is not improved by permanent occlusion of the hepatic artery.

[Precise MR-guided preoperative marking of breast lesions with an embolization coil using a standard MR coil]. / Präzise MR-gestützte präoperative Markierung von Mammaläsionen mit einer Embolisationsspirale unter Verwendung einer Standard-MR-Spule.

PURPOSE: To develop and test a new technique for MR-guided localisation of breast lesions. MATERIALS AND METHODS: The examinations were performed on a 1.0 T imager in prone position, using a sagittally oriented oval spine coil. The localization device consisted of a perforated lateral plate which can be angulated. The plate contained an "M" shaped tube filled with oil. This enabled exact localization of the lesion in relation to the bore holes on the MR images. After needle placement through a sterile bushing, the 5 mm marking coil was placed through the needle adjacent to the lesion. Then a suspension of charcoal, Gd-DTPA, and water was injected. Suspicious lesions that could be visualised only by MR were localised preoperatively and marked in 6 patients. RESULTS: The lesion size ranged from 0.5 to 3.5 cm (median 1.2 cm). Three benign lesions (intraductal hyperplasia twice, radial scar once) and three malignant lesions (ductal invasive cancer twice, DCIS once) were found. Angulation of the plate was beneficial in three cases. CONCLUSION: With the new marking technique, exact MR-guided localization of breast lesions using an add-on device is feasible. Construction of an additional MR coil is not necessary. Excision of the lesion is proven by the concomitant excision of the marking coil.

[The chemoembolization of hepatocellular carcinoma: the computed tomographic findings and clinical results in prospective repetitive therapy]. / Chemoembolisation des hepatozellulären Karzinoms: computertomographische Befunde und klinische Resultate bei prospektiv repetitiver Therapie.

Between April 1989 and March 1993 162 transarterial chemoembolizations (TACE) were performed repeatedly (mean interval: 2.9 months) in 52 patients with hepatocellular carcinoma (HCC): An emulsion of Lipiodol and epirubicin was injected as selectively as possible in a dosage proportional to liver function and tumour size. Before and after each TACE the size of tumours and ratio of tumour volume containing Lipiodol (RTVCL) were determined in CT and the grade of tumour vascularisation was assessed angiographically. The RTVCL increased from 58% after the first treatment to 73% after the third treatment. RTVCL and Lipiodol retention were higher in responders than in non-responders. Tumours with expansive growth pattern showed a higher response rate (56%) than infiltrating tumours (20%). Mean survival of these patients was different (19 and 8 months; p < 0.01), respectively. Survival rates of all patients were 54, 22, and 11% after 1, 2 and 3 years, respectively. Repeated TACE shows local effectiveness. Three treatments during a period of one year are recommended for patients with Child-Pugh class A cirrhosis.