Safety and Efficacy of Transarterial Radioembolization Combined with Chemoembolization for Bilobar Hepatocellular Carcinoma: A Single-Center Retrospective Study.

BACKGROUND: Radioembolization induced liver disease (REILD) is a possible sequela of transarterial radioembolization (TARE), particularly in cases of whole-liver treatment. To mitigate this problem, the safety and efficacy of combined transarterial chemoembolization (TACE) and TARE were evaluated for patients with bilobar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Nineteen patients (mean age 60 years; range 27-82 years) treated for HCC between June 2012 and September 2014 were included in the analysis. Each patient was treated with combined TARE and TACE for bilobar HCC, with or without portal vein thrombosis. The hepatic lobe with large HCC was treated with TARE, and the other lobe with small HCC(s) was treated with TACE. Laboratory and clinical data were investigated to determine REILD occurrence. Survival data were analyzed to compare the treatment efficacy of alternative treatment modalities, including TACE and sequential TARE. RESULTS: All patients underwent TARE for a dominant tumor in one lobe and TACE for small nodule(s) in the other lobe of the liver. The mean yttrium-90 microspheres used in TARE were 2.8 GBq (range; 1.0-3.5 GBq), and the mean doses of doxorubicin and iodized oil were 24.5 mg and 5.2 mL, respectively, for TACE. No statistical differences were noted between laboratory data measured before and after treatment, and no procedure-related major clinical complications occurred. The median time-to-progression of patients was 10.0 months, and the median overall survival was 27.3 months. CONCLUSION: Combined radioembolization and chemoembolization appears to be a safe and effective treatment modality for bilobar HCC.

Transarterial Chemoembolization Using Sorafenib in a Rabbit VX2 Liver Tumor Model: Pharmacokinetics and Antitumor Effect.

PURPOSE: To investigate feasibility, safety, and effect of transarterial chemoembolization using sorafenib on degree of tumor necrosis in a rabbit VX2 liver tumor model. MATERIALS AND METHODS: New Zealand White rabbits (n = 20) with a VX2 tumor were divided into two groups; one group was treated with hepatic arterial administration of 0.5 mL ethiodized oil alone (Lipiodol; Guerbet, Aulnay-sous-Bois, France) (transarterial embolization with Lipiodol [TAE-L] group), and one group was treated with 0.5 mL ethiodized oil plus 10 mg sorafenib (transarterial embolization with sorafenib [TAE-S] group). Liquid chromatography tandem mass spectrometry was used to measure sorafenib concentration in peripheral blood and tissue. Hepatic enzymes, vascular endothelial growth factor (VEGF), and hypoxia-inducible factor 1α (HIF-1α) were measured at 0, 24, and 72 hours after treatment. Histopathologic examination was performed to evaluate extent of tumor necrosis and normal parenchymal damage. RESULTS: Serum sorafenib concentration peaked at 2 hours after treatment. The mean tissue concentration was 406.8 times greater than the serum concentration. Aspartate aminotransferase and alanine aminotransferase levels were significantly elevated in the TAE-S group at 24 hours after treatment. Serum VEGF and HIF-1α concentrations were not significantly different between the TAE-L and TAE-S groups. Hepatic parenchymal damage was more severe in the TAE-S group. Mean fraction of tumor necrosis after treatment was significantly greater in the TAE-S group. CONCLUSIONS: Transarterial chemoembolization using sorafenib resulted in a high intrahepatic concentration of sorafenib. The degree of tumor necrosis was significantly greater in the TAE-S group compared with the TAE-L group, but more severe toxicity of normal liver tissue also occurred.

Characteristics and antioxidant effect of garlic in the fermentation of Cheonggukjang by Bacillus amyloliquefaciens MJ1-4.

The changes in the ß-glucosidase activity, total phenolic contents, isoflavone contents, and antioxidant activities during the fermentation of cheonggukjang by Bacillus amyloliquefaciens MJ1-4 with and without garlic were investigated. The levels of total phenolic and isoflavonemalonylglycoside, -acetylglycoside, and -aglycone contents increased, whereas the 2,2-diphenyl- 1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) radical scavenging activities and ferric reducing/antioxidant power (FRAP) assay results increased, but isoflavone-glycoside levels decreased during cheonggukjang fermentation. The levels of total phenolic and total isoflavone contents and the antioxidant activities were higher in cheonggukjang fermented without garlic (CFWOG) than in cheonggukjang fermented with garlic (CFWG) after 24 h of fermentation, but they were lower in CFWOG than in CFWG after 72h of fermentation. In particular, the highest levels of total phenolic, daidzein, glycitein, and genistein were present at concentrations of 15.18 mg/g, 264.4 µg/g, 16.4 µg/g, and 31.1 µg/g after 72h of fermentation in CFWG, showing 82.89% in DPPH radical scavenging activity, 106.32% in ABTS radical scavenging activity, and 1.47 (OD593 nm) in FRAP assay, respectively. From these results, we suggest that the high antioxidant activity of CFWG might be related to the markedly higher levels of total phenolic contents, isoflavone-malonylglycosides, - acetylglycosides, and -aglycones achieved during fermentation.

Sprague-Dawley rats bearing McA-RH7777 cells for study of hepatoma and transarterial chemoembolization.

AIM: To evaluate the feasibility of the McA-RH7777 tumor model in Sprague-Dawley (SD) rats, for study of hepatoma and transarterial chemoembolization. MATERIALS AND METHODS: McA-RH7777 rat hepatoma cells (1×10(7)) were inoculated into the left hepatic lobe of SD rats (n=38). Chemoembolization with left common carotid artery access was performed using an emulsion of iodized oil and doxorubicin, and polyvinyl alcohol particles. Tumor induction rate and response to chemoembolization were assessed by magnetic resonance imaging and histology. RESULTS: Tumor induction rate of McA-RH7777 in SD rat livers was 73.3% (11/15). Hematoxylin-and-eosin staining revealed hypercellular tumor with a trabecular pattern that mimics human hepatocellular carcinoma. Chemoembolization was successfully conducted in all rats. There was a significant difference in tumor growth rates between the chemoembolization-treated and control groups (p<0.0001). CONCLUSION: A rat tumor model of McA-RH7777 cells in SD rats is feasible and has the potential to be a good model for hepatoma and chemoembolization studies.

Chemoembolization via branches from the splenic artery in patients with hepatocellular carcinoma.

PURPOSE: This study was designed to evaluate the radiologic findings and imaging response of chemoembolization via branches of the splenic artery in patients with hepatocellular carcinoma (HCC). METHODS: From January 2001 to July 2010, we observed tumor staining supplied by branches of the splenic artery in 34 (0.6%) of 5,413 patients with HCC. Computed tomography (CT) scans and digital subtraction angiograms of these patients were retrospectively reviewed in consensus by two investigators. RESULTS: A total of 39 tumor feeding-vessels in 34 patients were identified: omental branches from the left gastroepiploic artery (n = 5), branches from the short gastric artery (n = 9), and omental branches directly from the splenic artery (n = 25). Branches of the splenic artery that supplied tumors were revealed on the celiac angiogram in 29 (85%) of 34 patients and were detected on pre-procedure CT images in 27 (79%) of 34 patients. Selective chemoembolization was achieved in 38 of 39 tumor-feeding vessels. Complete or partial response of the tumor fed by branches of the splenic artery, as depicted on follow-up CT scans, was achieved in 21 (62%) patients. No patient developed severe complications directly related to chemoembolization via branches of the splenic artery. CONCLUSIONS: Omental branches directly from the splenic artery are common tumor-feeding vessels of the splenic artery in cases of advanced HCC with multiple previous chemoembolizations. Tumor-feeding vessels of the splenic artery are usually visualized on the celiac angiogram or CT scan, and chemoembolization through them can be safely performed in most patients.