Hepatic Artery Injection of 131I-Metuximab Combined with Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Prospective Nonrandomized, Multicenter Clinical Trial.

This prospective nonrandomized, multicenter clinical trial was performed to investigate the efficacy and safety of 131I-labeled metuximab in adjuvant treatment of unresectable hepatocellular carcinoma. Methods: Patients were assigned to treatment with transcatheter arterial chemoembolization (TACE) combined with 131I-metuximab or TACE alone. The primary outcome was overall tumor recurrence. The secondary outcomes were safety and overall survival. Results: The median time to tumor recurrence was 6 mo in the TACE + 131I-metuximab group (n = 160) and 3 mo in the TACE group (n = 160) (hazard ratio, 0.55; 95% CI, 0.43-0.70; P < 0.001). The median overall survival was 28 mo in the TACE + 131I-metuximab group and 19 mo in the TACE group (hazard ratio, 0.62; 95% CI, 0.47-0.82; P = 0.001). Conclusion: TACE + 131I-metuximab showed a greater antirecurrence benefit, significantly improved the 5-y survival of patients with advanced hepatocellular carcinoma, and was well tolerated by patients.

[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.

Targeted hyperthermia after selective embolization with ferromagnetic nanoparticles in a VX2 rabbit liver tumor model.

BACKGROUND: The purpose of this study was to observe the effect and feasibility of hyperthermia and the influence of heat on surrounding organs in a VX2 rabbit liver model exposed to an alternating magnetic field after embolization with ferromagnetic nanoparticles. METHODS: Forty rabbits containing implanted hepatic VX2 carcinomas were divided into four groups, each containing ten rabbits. Fourteen days after tumor transplantation, we opened the abdomen to observe the size and shape of the tumor. A transfemoral retrograde approach was then used for hepatic arterial catheterization in groups B, C, and D to perform angiography and embolization. The next day, three rabbits in group B and all rabbits in group D were exposed to an alternating magnetic field, and the temperature was recorded simultaneously in the center of the tumor, at the edge of the tumor, and in the normal liver parenchyma. On day 28, all animals was euthanized to observe changes in the implanted liver tumor and the condition of the abdomen. A pathologic examination was also done. RESULTS: Before surgery, there was no significant difference in tumor volume between the four groups. Three different temperature points (cen ter of the tumor, edge of the tumor, and in the normal liver parenchyma) of group B under an alternating magnetic field were 37.2°C ± 1.1°C, 36.8°C ± 1.2°C, and 36.9°C ± 2.1°C, none of which were significantly different from pretreatment values. Three points basal temperature in group D showed no significant difference (F = 1.038, P = 0.413). Seven to 26 minutes after hyperthermia, the temperature at the center of the tumor and at the edge of the tumor in group D was significantly different from the corresponding points in group B and from normal liver tissue in group D (F(B-D center) = 5.431, P(B-D center) = 0.041, F(B-D edge) = 9.744, P(B-D edge) = 0.011; F(D) = 8.379, P(D) = 0.002). The highest temperature recorded at the rim of the tumor was 46°C in group D. Fourteen days later, the tumor volume in the four groups was group A 31.4 ± 20.6 cm(3), group B 26.7 ± 18.2 cm(3), group C 28.7 ± 9.1 cm(3), and group D 25.8 ± 13.9 cm(3), with no significant difference found between the groups (F = 0.218, P = 0.883). The increase in tumor volume was greatest in group A and least in group D, while that in groups B and D was similar. CONCLUSION: It is feasible to treat a VX2 tumor in an alternating magnetic field after embolization with magnetic nanoparticles without a significant effect on the surrounding normal liver parenchyma.

[Interventional therapy of hepatic artery-portal vein fistula with gelatin sponge and lipiodol].

OBJECTIVE: To observe and compare the revasculation rate after embolization of hepatic artery-portal vein fistula (APVF) by gelatin sponge versus gelatin sponge with lipiodol. METHODS: The clinical data of 51 patients were retrospectively analyzed. They were divided into Groups A and B. APVF was embolized by gelatin sponge alone in Group A and gelatin sponge with lipiodol in Group B. Then the investigators observed and compared the revasculation rate of hepatic artery-portal vein fistula at Days 30 - 40 and 60 - 70 post-embolization respectively. RESULTS: There was no statistical difference in age, gender, pathological types and hepatic functions before intervention between Groups A and B. One of 28 APVF sites was embolized unsuccessfully in Group A while all APVF cases were embolized successfully in Group B. The revasculation rate of hepatic APVF were 70.37% and 46.15% at Days 30 - 40 post-embolization in Groups A and B respectively (χ(2) = 4.25, P = 0.039, chi-square test); the revasculation rates of APVF were 92.59% and 88.46% respectively at Days 60 - 70 post-embolization (P = 0.67). CONCLUSION: Interventional therapy of hepatic APVF by gelatin sponge and lipiodol is a safe method of reducing the short-term revasculation rate. It may be employed in clinical practices to save precious time for controlling hepatic malignant tumors.

[Isolated hepatic perfusion for treatment of unresectable malignant tumor].

Isolated hepatic perfusion (IHP) is the best regional chemotherapy modality for treatment of unresectable liver primary cancer and liver metastases. The main principle of isolated hepatic chemotherapy is to achieve higher regional drug concentrations and thus higher exposure of tumor tissue to the agents, resulting in increased response rates, while shielding the organism from the systemic toxicity because of the much lower concentrations in the systemic circulation. At present the methods of IHP include surgical methods and methods with balloon catheter technique, which promise to provide a micro invasive procedure, but are not fully mature. The key point of successful IHP is low leakage or leakage free. The more beneficial aspect of IHP is that it can simultaneously apply hyperthermy and biologic agent TNF to improve sensitivity of chemotherapy, which is not possible in other regional chemotherapy. From previous literatures this overview is to describe the principle, procedure techniques, leakage monitor methods, hyperthermy application, administration agents, therapeutic reaction, complications and perspective of IHP.