Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients.

BACKGROUND: To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH). METHODS: This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7 cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated. RESULTS: Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5 cm to 1.9 cm (P < 0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients. CONCLUSIONS: TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.

Comparison of Polyvinyl Alcohol Versus Combination of Lipiodol-Bleomycin Emulsion and NBCA-Lipiodol Emulsion for Renal Angiomyolipoma Embolization: A Prospective Randomized Study.

BACKGROUND. Consensus is lacking regarding optimal embolic agents for transcatheter arterial embolization (TAE) of renal angiomyolipomas (AMLs). OBJECTIVE. The purpose of our study was to compare the safety and efficacy of TAE with polyvinyl alcohol (PVA) and TAE with a combination of ethiodized oil (Lipiodol)-bleomycin emulsion and N-butyl cyanoacrylate (NBCA)-Lipiodol emulsion for the treatment of patients with large or symptomatic AMLs. METHODS. This prospective study enrolled patients referred for TAE of a large (> 4 cm) or symptomatic renal AML from July 2007 to December 2018. Patients were randomized to undergo TAE using PVA particles or a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Patients underwent serial clinical follow-up visits and follow-up CT or MRI examinations after TAE. Outcomes were compared between groups. RESULTS. Seventy-eight patients were enrolled. After exclusions, the analysis included 72 patients (15 men, 57 women; mean age, 35.0 years; 51 patients with hematuria, 66 patients with flank pain): 35 patients were randomized to treatment by PVA and 37 were randomized to treatment by a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Complete occlusion of all angiographically visible arterial supply was achieved in all patients. No major adverse event occurred in any patient. The mean follow-up after TAE was 77 ± 45 (SD) months (range, 37-180 months). The frequency of resolution of hematuria after initial TAE without recurrence was greater after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 80.0%, respectively; p = .03). At 12-month follow-up, the frequency of complete resolution of flank pain was higher after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 75.0%, p = .03). Mean reduction in AML volume at 36 months or longer after TAE versus at baseline was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than in those treated by PVA (98.0% vs 85.7%, respectively; p = .04). The frequency of complete response by modified RECIST (mRECIST) criteria at 36 months or longer after TAE was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (94.6% vs 74.3%, p = .04). The rate of repeat TAE was higher among patients treated by PVA than among those treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion (25.7% vs 8.1%, p = .04). CONCLUSION. Superior outcomes after TAE of AML were achieved using Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than using PVA. CLINICAL IMPACT. TAE using a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion is a safe and effective treatment option for large or symptomatic AMLs. TRIAL REGISTRATION. Chinese Clinical Trial Registry ChiCTR2100053296.

Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer.

OBJECTIVES: To evaluate the safety and efficacy transcatheter arterial chemoembolization (TACE) for the treatment of refractory gross hematuria (RGH) and urinary retention (UR) secondary to localized advanced prostate cancer (PCa). PATIENTS AND METHODS: Thirty-two patients (mean age 72.5 years, range 60-89) with advanced PCa-related RGH that failed conventional therapy were included. Twenty-two of these patients had catheter-dependent due to PCa-related UR. TACE was performed with epirubicin (EPI)-eluting HepaSpheres (HS) plus intra-arterial (IA) infusion of docetaxel. Technical success, adverse events (AEs), overall survival (OS), control of RGH, removal of indwelling catheters, and local disease control, were evaluated. RESULTS: Technical success was achieved in 100% without major AEs. Mean follow up post-TACE was 27 months (range 8-56 months) with a mean OS of 30 months. GRH stopped within 5 days after TACE in all patients, 26 (86.7%) of these patients exhibited good bleeding control during a mean follow-up of 24 months; 17 (77.3%) of the 22 patients with UR had recovered spontaneous urination, 15 (88.2%) patients were catheter-free at their last follow-up with a mean of 24 months. BS was obtained in 73.3% (22/30) of patients at a mean follow-up of 29 months. At the last visit, 22 patients had a mean of 36 months follow-up and the mean percentage reduction in prostate volume was 55.5%, with a statistically different from baseline (P = 0.022). Negative biopsy results were obtained in 84.2% (16/19) of the patients at 12-47 months after TACE. Compared with baseline values, there was a significant improvements in IPSS, QoL, Qmax, and PVR (all P < 0.05). CONCLUSIONS: TACE using EPI-eluting HS plus IA infusion of docetaxel is a safe and effective treatment option for the advanced PCa patients with GRH and UR, and it could be considered as an alternative if there was no other therapeutic choice.

Long-term outcomes of transarterial embolization with lipiodol-bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score-matched analysis.

OBJECTIVES: To compare the efficacy of transarterial embolization (TAE) with polyvinyl alcohol (PVA) particles alone and lipiodol-bleomycin emulsion (LBE) plus PVA particles for patients with unresectable large symptomatic focal nodular hyperplasia (FNH). METHODS: We performed a retrospective analysis of patients who underwent TAE either with PVA particles alone (group A, n = 46) or LBE plus PVA particles (group B, n = 35) for large (≥ 7 cm) symptomatic FNH between January 2002 and February 2019. Propensity score matching (PSM) (1:1) was performed to adjust for potential baseline confounders. Technical success, adverse events (AEs), symptom relief, and changes in the lesion size after TAE were evaluated. Statistical analysis included Wilcoxon rank sum test and χ2 test. RESULTS: After PSM, no significant differences in baseline characteristics were found between the groups (31 in group A and 31 in group B, with a mean age of 31 years). Technical success was achieved in all patients (100%), without major AEs in both groups. Complete resolution of the abdominal symptoms was reported in 77.4% in group A and 100% in group B (p = 0.037) during a mean follow-up period of 72 months; complete resolution (CR) of the FNH rate was significantly higher in group B than in group A (93.6% vs. 67.7%; p = 0.019). CONCLUSION: Compared with the use PVA particles alone, TAE with LBE plus PVA particles in the treatment of patients with large symptomatic FNH had a significantly higher rates of CR of the FNH and complete relief of the symptoms. KEY POINTS: • Transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus PVA particles for the large symptomatic FNH yielded better results than with PVA particles alone, in terms of complete resolution of FNH lesions (93.6% vs 67.7%) and complete relief of the abdominal symptoms (100% vs 77.4%) during a mean follow-up period of 72 months (38-170 months). • No major complications were recorded in both groups, and no significant difference in the incidence of postembolization syndrome were observed between the two groups.

General versus local anesthesia for percutaneous radiofrequency ablation of hepatocellular carcinoma at unusual regions.

AIMS: The aim of this study is to compare the efficacy and safety of percutaneous radiofrequency ablation (RFA) under general anesthesia or local anesthesia plus intraoperative analgesia in the treatment of hepatocellular carcinoma (HCC) at unusual regions. SUBJECTS AND METHODS: From July 2012 to October 2019, 83 consecutive patients with 107 HCC lesions were treated with interventional radiology therapy. The lesions were located at some unusual regions such as diaphragmatic surface, hepatic hilum, hepatic subcapsular region, tissues near inferior vena cava, and tissues near the colon. General anesthesia was applied in 57 cases (general anesthesia group) and local anesthesia plus intraoperative analgesia was used in 26 cases (local anesthesia group). All patients were treated with transcatheter arterial chemoembolization, followed immediately by RFA. The rate of tumor inactivation, time used for placing RF needles to the scheduled sites, pain score, and complications were analyzed. STATISTICAL ANALYSIS USED: All continuous variables were tested for the normal/nonnormal distribution by Kolmogorov-Smirnov test. The t-test was used to analyze the normal distribution variables; the Mann-Whitney U-test was used to measure nonnormal distribution variables; and the Chi-square test for categorical variables. P < 0.05 was considered statistically significant. RESULTS: The treatments were successful in all patients, including 51 cases of complete response (CR) and 6 cases of partial response (PR) in the general anesthesia group and 18 cases of CR and 8 cases of PR in the local anesthesia group (P = 0.049). The time used for placing the needles to the scheduled sites was 1-5 min (mean 2 min) in the general anesthesia group and 2-9 min (mean 4 min) in the local analgesia group (P < 0.001). The pain scores ranged from 0 to 2 points (mean 1 point) in the general anesthesia group and 2-9 points (mean 5 points) in the local anesthesia group (P < 0.001). With regard to complications, seven cases had pneumothorax and four cases had slight hepatic subcapsular hemorrhage in the general anesthesia group and four cases of pneumothorax and three cases of slight hepatic subcapsular hemorrhage in the local anesthesia group, and the difference was not statistically significant between the two groups (P = 0.715). CONCLUSIONS: For HCC located at unusual regions, general anesthesia is superior to local anesthesia plus intraoperative analgesia in percutaneous RFA in reducing the difficulty of the procedure and improving the safety of RFA.

Angio-Computed Tomograph-Guided Immediate Lipiodol Computed Tomograph for Diagnosis of Small Hepatocellular Carcinoma Lesions during Transarterial Chemoembolization.

BACKGROUND: The diagnosis and treatment of small hepatocellular carcinoma (HCC) play a vital role in the prognosis of patients with HCC. The purpose of our study was to evaluate angio-computed tomography (angio-CT)-guided immediate lipiodol CT (a CT scan performed immediately after transarterial chemoembolization [TACE]) in the diagnosis of potential HCCs ≤1 cm in diameter. METHODS: This study retrospectively analyzed 31 patients diagnosed with HCCs after routine imaging (contrast-enhanced CT or magnetic resonance imaging) or pathologic examinations with undefined or undetermined tumor lesions (diameter ≤1 cm) from February 2016 to September 2016. After TACE guided by digital subtraction angiography of the angio-CT system, potential HCC lesions with a diameter ≤1 cm were diagnosed by immediate lipiodol CT. The number of well-demarcated lesions was recorded to calculate the true positive rate. The correlation between the number of small HCCs detected by immediate lipiodol CT and the size of HCC lesions (diameter >1 cm) diagnosed preoperatively was analyzed 1 month after TACE. A paired t-test was used to analyze differences in liver function. Pearson analysis was used to analyze correlation. Chi-square test was used to compare the rates. RESULTS: Fifty-eight lesions were detected on preoperative routine imaging examinations in 31 patients including 15 lesions with a diameter ≤1 cm. Ninety-one lesions were detected on immediate lipiodol CT, of which 48 had a diameter ≤1 cm. After 1 month, CT showed that 45 lesions had lipiodol deposition and three lesions had lipiodol clearance. Correlation analysis showed that the number of small HCCs detected by lipiodol CT was positively correlated with the size of HCC lesions diagnosed by conventional imaging examination (R2 = 0.54, P < 0.05). CONCLUSION: Immediate lipiodol CT may be a useful tool in the diagnosis of potential HCC lesions with a diameter of ≤1 cm.

Transarterial Embolization for Treatment of Symptomatic Polycystic Liver Disease: More than 2-year Follow-up.

BACKGROUND: Currently, treatment of symptomatic polycystic liver disease (PLD) is still a challenging problem, especially for these patients who are not feasible for surgery. Minimally invasive options such as laparoscopic fenestration and percutaneous cyst aspiration with sclerotherapy demonstrated disappointing results due to multiple lesions. Because the cysts in PLD are mostly supplied from hepatic arteries but not from portal veins, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply the major hepatic cysts can lead to shrinkage of the cyst and liver size, relieve symptoms, and improve nutritional status. This study aimed to evaluate the effectiveness of TAE with a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for patients with severe symptomatic PLD during a more than 2-year follow-up. METHODS: Institutional review board had approved this study. Written informed consent was obtained from all patients. From February 2007 to December 2014, twenty-three patients (20 women and 3 men; mean age, 49.0 ± 14.5 years) infeasible for surgical treatments underwent TAE. Changes in the abdominal circumferences, volumes of intrahepatic cysts, hepatic parenchyma volume, and whole liver, clinical symptoms, laboratory data, and complications were evaluated after TAE. RESULTS: Technical success was achieved in all cases. No procedure-related major complications occurred. The median follow-up period after TAE was 48.5 months (interquartile range, 30.0-72.0 months). PLD-related severe symptoms were improved remarkably in 86% of the treated patients; TAE failed to benefit in four patients (four patients did not benefit from TAE). The mean maximum abdominal circumference decreased significantly from 106.0 ± 8.0 cm to 87.0 ± 15.0 cm (P = 0.021). The mean intrahepatic cystic volume reduction rates compared with pre-TAE were 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE (P < 0.05). The mean liver volume reduction rates were 32% at 12 months, 31% at 24 months, and 33% at 36 months (P < 0.05). CONCLUSIONS: TAE with the mixture of NBCA and iodized oil appears to be a safe and effective treatment method for patients with symptomatic PLD, especially for those who are not good candidates for surgical treatments, to improve both hepatic volume and hepatic cysts volume.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population.

BACKGROUND: Currently, large prostate size (>80 mL) of benign prostatic hyperplasia (BPH) still pose technical challenges for surgical treatment. This prospective study was designed to explore the safety and efficacy of prostatic arterial embolization (PAE) as an alternative treatment for patients with lower urinary tract symptoms (LUTS) due to largeBPH. METHODS: A total of 117 patients with prostates >80 mL were included in the study; all were failure of medical treatment and unsuited for surgery. PAE was performed using combination of 50-µm and 100-µm particles in size, under local anaesthesia by a unilateral femoral approach. Clinical follow-up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow (Qmax), post-void residual volume (PVR), international index of erectile function short form (IIEF-5), prostatic specific antigen (PSA) and prostatic volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter. RESULTS: The prostatic artery origins in this study population were different from previously published results. PAE was technically successful in 109 of 117 patients (93.2%). Follow-up data were available for the 105 patients with a mean follow-up of 24 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 1, 3, 6, 12, and 24 months was 94.3%, 94.3%, 93.3%, 92.6%, and 91.7%, respectively. The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted. CONCLUSIONS: PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH. PAE may play an important role in patients in whom medical therapy has failed, who are not candidates for open surgery or TURP or refuse any surgical treatment.

Hepatic arterial administration of sorafenib and iodized oil effectively attenuates tumor growth and intrahepatic metastasis in rabbit VX2 hepatocellular carcinoma model.

AIM: To investigate the therapeutic effect of the hepatic arterial administration of sorafenib in rabbit VX-2 hepatocellular carcinoma (HCC) model. METHODS: Rabbit VX-2 HCC models were established via implanting VX-2 tumors into the livers, and randomly divided into four groups, respectively treated with (1) The hepatic arterial administration of iodized oil alone (TACE-i), (2) The hepatic arterial administration of iodized oil and pharmorubicin (TACE-ip), (3) The hepatic arterial administration of iodized and cis-DDP (TACE-ic), (4) The hepatic arterial administration of iodized and sorafenib (TACE-is). The growth rate and intrahepatic metastasis of implanted VX-2 tumor in each rabbit were measured. Microvessel density (MVD) in the adjacent tissues of implanted VX-2 tumor were estimated by detecting the expression of CD34 and VEGF level in tumor adjacent tissues were also examined by Immunohistochemistry. RESULTS: Compared with other groups, TACE-is treatment group presented a better effect on inhibiting tumor growth rate and intrahepatic metastasis in rabbit VX-2 HCC model. The angiogenesis (assessed by MVD) in the adjacent tissues were suppressed more dramatically in TACE-is treated group. Moreover, TACE-is treatment did not significantly increase the levels of alanine transaminase and creatinine compared to the group with TACE-i treatment. CONCLUSION: The hepatic arterial administration of sorafenib and iodized oil (TACE-is) effectively attenuates tumor growth and intrahepatic metastasis in rabbit VX-2 HCC model without obvious hepatic and renal toxicity. One of the related mechanisms may be due to the inhibition of angiogenesis in the adjacent tissues. Our data indicated that TACE-is may be a secure and effective treatment for HCC.

[Extrahepatic collateral arteries are involved in the blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization].

OBJECTIVE: To evaluate the incidence of extrahepatic collateral arteries involved in the blood supply to hepatocellular carcinoma (HCC) and to assess the technical success rates and complications of transcatheter arterial chemoembolization (TACE) through the collaterals. METHODS: 1356 TACE procedures were performed in 874 consecutive patients through extrahepatic collateral pathways to HCC between August 2006 and August 2010 in our department. The extrahepatic collateral pathways to HCC revealed on angiography were retrospectively evaluated. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the feeding branch to avoid nontarget embolization. RESULTS: Incidences of collateral source to HCC were 76.3% from the right inferior phrenic artery (RIPA), 2.4% from the left inferior phrenic artery (LIPA), 6.9% from the right and 0.4% from the left internal mammary arteries (RIMA, LIMA), 2.9% from the right intercostal artery (RICA), 2.0% from the omental artery, 0.8% from the right or middle colic artery, 2.3% from the cystic artery, 1.3% from the left and 1.1% from the right gastric arteries (LGA, RGA), 3.5% from the right renal capsular artery (RRCA), right middle adrenal artery (RMAA) and right inferior adrenal artery (IAA). Technical success rates of TACE were 95.9% in the RIPA, 93.8% in the LIPA, 100.0% in the RIMA and LIMA, 55.0% in the RICA, 77.8% in the omental artery, 63.6% in the colic artery, 67.7% in the cystic artery, 76.5% in the LGA, 73.3% in the RGA and 95.8% in the RRCA, RMAA, and RIAA. Complications included skin erythema and necrosis after TACE through the RIMA, skin erythema after TACE through the RICA, cholecystitis after TACE through the cystic artery (n = 1), and pleural effusion, basal atelectasis and hiccup after TACE through the IPA. CONCLUSION: TACE through extrahepatic collaterals is safe and feasible, and with a high success rate in the treatment of hepatocellular carcinoma.

Hepatocellular carcinoma associated with Budd-Chiari syndrome: imaging features and transcatheter arterial chemoembolization.

BACKGROUND: Budd-Chiari syndrome (BCS) often leads to hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) has been increasingly used to treat BCS patients with HCC. The purposes of this study were to illustrate imaging features in BCS patients with HCC, and to analyze the effects of TACE on BCS patients with HCC. METHODS: 246 consecutive patients with primary BCS were retrospectively studied. 14 BCS patients with HCC were included in this study. BCS were treated with angioplasty and/or stenting, and HCC were managed with TACE. Imaging features on ultrasonography, CT, MRI, and angiography and the serum AFP level were analyzed. RESULTS: Inferior vena cava block and stricture of hepatic venous outflow tract more frequently occurred. Portal vein invasion was found in only 2 patients (14.2%). Imaging studies showed that most nodules of HCC were near the edge of liver, irregular, more than 3 cm in diameter, heterogeneous mass and solitary (≤3 nodules). HCC in patients associated with BCS was isointense or hypointense in nonenhanced CT images, and exhibited heterogeneous enhancement during the arterial phase and washout during the portal venous phase on enhanced CT and MRI. The serum AFP level significantly declined after TACE treatment. CONCLUSIONS: BCS patients with inferior vena cava block and stricture of hepatic venous outflow tract seems to be associated with HCC. A single, large, irregular nodule with a peripheral location appears to be HCC. TACE can effectively treat HCC in BCS patients.

Treatment of symptomatic polycystic liver disease: transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil.

BACKGROUND: Surgical therapy for symptomatic polycystic liver disease (PLD) is effective but has substantial mortality and morbidity. Minimally invasive options such as laparoscopic fenestration, percutaneous cyst aspiration with or without injection of a sclerosing solution have had disappointing results. Because the hepatic cysts in autosomal dominant polycystic kidney disease (ADPKD) patients are mostly supplied from hepatic arteries but not from portal veins, therefore, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply major hepatic cysts can lead to shrinkage of the cyst and liver size. AIM: The purpose of this study was to evaluate the safety and effectiveness of TAE using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for massive PLD in ADPKD patients. METHODS: From February 2007 to March 2011, a total of 21 patients with symptomatic PLD underwent super-selective hepatic TAE with the mixture of NBCA and iodized oil. The patients consisted of 17 women and 4 men (age range 36-64 years, average age 48.8 years). All patients underwent contrast-enhanced computed tomography (CT) of the liver before TAE, and at every 3 months for the first year after TAE and at 6-monthly intervals thereafter. Laboratory data, including routine blood tests and liver enzymes, were collected before and 1, 3, 7, and 14 days, 1, 3, 6, and 12 months after TAE. RESULTS: Technical success was achieved in all cases. No serious complications were experienced. The mean follow-up period was 34 ± 20 months (range 12-60 months). At follow-up of 6-12 months, symptoms notably improved in 18 (85.7%) of 21 patients, and these patients experienced further relief of the symptoms during the follow-up period. TAE failed to benefit in 3 patients (14.3%). No patient complained of worsening of the symptoms after the procedure. At follow-up CT, the total liver volume and total intra-hepatic cyst volume decreased significantly (p < 0.001) compared with pre-TAE in 18 (85.7%) of 21 patients at 12 months after TAE. The total liver volume decreased from 8270 ± 3016 to 6120 ± 2680 cm(3) and the total intra-hepatic cyst volume decreased from 7120 ± 3070 to 4530 ± 2600 cm(3). Mild elevation of the liver enzymes was shown in patients at 1-14 days after TAE but returned to the normal range within 1 month. CONCLUSION: The mixture of NBCA and iodized oil is an acceptable embolic agent for embolization of the hepatic artery branches that supply the hepatic cysts in ADPKD patients. This technique is an option for patient with highly symptomatic PLD who are not candidates for surgical treatment.

Pharmacokinetic evaluation of pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier in an animal model.

The purpose of this study was to investigate the potential pharmacokinetic advantage of pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier for pancreatic cancer in a dog model. The 20% Intralipid, as a solvent, was used in the experimental animals with 2 ml/kg (group A) and 1 ml/kg (group B). Normal sodium as a solvent was used as a control with 2 ml/kg (group C) and 1 ml/kg (group D), respectively. Cisplatin (4 mg/kg) was infused into the proximal segment of the splenic artery. The concentrations of cisplatin were measured in plasma of the portal vein and in the liver and pancreas of groups A and C. The area under the concentration-time curve (AUC), the maximum plasma concentration (C(max)), and the elimination half-life (t(1/2)) in plasma were calculated and compared statistically. Compared with group C, the AUC and C(max) of group A were significantly lower (P<0.01 and P<0.01, respectively), the t 1/2 was longer (P<0.05), and the tissue cisplatin concentration of the pancreas was higher (P<0.05). Compared with group D, the AUC and C(max) of group B were significantly lower (P<0.01 and P<0.01, respectively) and the t(1/2) was longer (P<0.01). Pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier can increase the local concentration and prolong the retention time of a drug.

Sorafenib in combination with transarterial chemoembolization and bronchial arterial chemoinfusion in the treatment of hepatocellular carcinoma with pulmonary metastasis.

AIM: Hepatocelluar carcinoma (HCC) with pulmonary metastasis is considered incurable. This study addresses the efficacy of the combination of systemic therapy using sorafenib and local treatment using transarterial chemoembolization (TACE) for intrahepatic and bronchial transarterial chemoinfusion (TAI) for pulmonary lesions for this condition. METHODS: In all, 52 HCC patients with pulmonary metastasis were treated with sorafenib and TACE/TAI for intrahepatic and intrapulmonary lesions. Response to treatment, progression-free survival (PFS), overall survival (OS) and treatment-induced adverse effects were analyzed. RESULTS: With a median follow-up time of 11.4 months, radiologically confirmed complete response (CR), partial response (PR), stable disease and disease progression for intrahepatic disease were observed in 0, 22, 23 and seven patients, respectively; radiologically confirmed CR, PR, stable disease and disease progression observed for intrapulmonary lesions were in 1, 8, 25 and 18 patients, respectively. Median OS and PFS was 12.0 and 10.0 months, respectively. Median OS of patients who achieved response (i.e., CR + PR + stable disease) in their gross lesion(s) was 14.0 and 13.0 months, respectively, as compared to 4.0 and 3.0 months for patients who progressed (P < 0.003). Significant prognosticators for OS and PFS included performance status, Barcelona Clinic Liver Cancer stage and response to treatment. The combined treatment strategy was well tolerated. CONCLUSION: The combination of sorafenib, TACE and TAI produced median OS and PFS of 12 and 10 months, respectively, in HCC patients with lung metastasis. The outcomes of patients who achieved a response to their gross lesions were significantly better than those who had disease progression. Further investigation is warranted to test the efficacy of this treatment combination.

[Clinical observation of the treatment with combination of transcatheter arterial chemoembolization and sorafenib for hepatocellular carcinoma with lung metastasis].

OBJECTIVE: To evaluate the safety and efficacy of the combination of transcatheter arterial chemoembolization (TACE) and sorafenib in treatment of hepatocellular carcinoma (HCC) with lung metastasis. METHODS: Thirty HCC patients with lung metastasis were treated by the combination of TACE and sorafenib between Oct 2006 and May 2008, including 27 men and 3 women. The age of the patients ranged 32 to 73 years old. Sorafenib was administrated orally at 400 mg, twice daily (the less tolerant patients received 200 mg, bid.), if there was no counterindication, at 3 - 4 weeks after TACE, with every 4 weeks as a course of treatment. The efficacy was evaluated at the end of every course of treatment. RESULTS: The metastatic lesions in the lung were diminished in 6 cases and stable diseases achieved in 8 cases. The primary liver tumors were stable in 22 cases, including 10 cases achieved by TACE before sorafenib treatment. Eight cases had slightly progressed liver tumors and were treated with 1 - 3 times of TACE in combination with sorafenib. Side effects included skin lesions in 7 cases, hair loss in 6 cases, fatigue in 18 cases, diarrhea in 6 cases, anemia and bone marrow suppression in 5 cases, high blood pressure in 2 cases, and gastrointestinal bleeding in 1 case. CONCLUSION: The combination of TACE and sorafenib can be used as an effective treatment for hepatocellular carcinoma patients with lung metastasis, which may stabilize the disease in some patients.

[Investigation of bile duct injury after transcatheter arterial chemoembolization].

OBJECTIVE: To investigate the image findings of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy. METHODS: During the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients (1.4%) developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and ultra-sonography, 14 MRI and 15 digital subtract angiography (DSA). The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury. RESULTS: TACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis (8.8%), 5 of 1092 patients with hepatocellular carcinoma (HCC) (0.5%). On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in non-cirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis (P < 0.01), and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents (P < 0.01). The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions (P < 0.05). CONCLUSION: Biliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predisposing factors to the development of TACE-induced bile duct injury.