Volume 8, Issue 3, September 2020, Page: 54-64
Evaluation of Combined Transcathter Arterial Chemo Embolization (TACE) with Percutaneous Ethanol Injection (PEI) Vs. (TACE) for Unresectable Hepatocellular Carcinoma
Heba Samier, Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt
Hazem Omar, National Liver Institute, Menoufia University, Menoufia, Egypt
Rasha Dawoud, Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt
Alsiagy Ali Salama, Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt
Abd-Elmonem Nooman, Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt
Received: Sep. 19, 2020;       Accepted: Oct. 5, 2020;       Published: Oct. 12, 2020
DOI: 10.11648/j.ijmi.20200803.14      View  71      Downloads  18
Abstract
There are many treatment options available for hepatocellular carcinoma (HCC) but the best choices for intermediate and advanced tumors are sometimes a matter of controversies. The aim of the work was to compare the combined Trans-catheter arterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) against the technique of TACE alone in patients with unresectable HCC. The study included fifty patients proved radiologically to have hepatocellular carcinoma (HCC) >5 cm in diameter and were not candidate for surgical resection. The patients were divided into two groups Group 1: Patients underwent single Trans-catheter arterial chemoembolization (TACE) followed by four times of Percutaneous ethanol injection (PEI) every other day. Group 2: Patients underwent repeated Trans-catheter arterial chemoembolization (the frequency of sessions was according to response of the patients). Complete resolution of HCC masses achieved in 60% in group 1 versus 52% in group 2. This complete resolution occurred earlier in group 1 than group 2. Group 1 had lower local recurrence rate than group 2. There was a statistically significant reduction in alpha-feto protein level at 3 months post interventional in group 1 and in both groups at 6 months. There was no significant difference between both groups in overall survival, So combined treatment could help in saving time and resources.
Keywords
Trans-catheter Arterial Chemoembolization, Percutaneous Ethanol, HCC
To cite this article
Heba Samier, Hazem Omar, Rasha Dawoud, Alsiagy Ali Salama, Abd-Elmonem Nooman, Evaluation of Combined Transcathter Arterial Chemo Embolization (TACE) with Percutaneous Ethanol Injection (PEI) Vs. (TACE) for Unresectable Hepatocellular Carcinoma, International Journal of Medical Imaging. Vol. 8, No. 3, 2020, pp. 54-64. doi: 10.11648/j.ijmi.20200803.14
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Jemal A, Bray F, Center MM, et al. (2011) Global cancer statistics. CA Cancer J Clin; 61: 69-90.
[2]
Liovet JM and Bruix (2003) J. systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Heaptology; 37: 429-42.
[3]
Kudo M. Japan’s Successful Model of Nationwide Hepatocellular Carcinoma Surveillance, Highlighting the Urgent Need for Global Surveillance. Liver Cancer, in press.
[4]
Kim DY and Han KH (2012). Epidemiology and surveillance of hepatocellular carcinoma. Liver Cancer 2012; 1: 2-14.
[5]
Bruix J and Llovet JM. (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology; 35: 519-24.
[6]
Llovet JM, Burroughs A and Bruix J. (2003) Hepatocellular carcinoma. Lancet; 362: 1907-17.
[7]
Mondazzi L, Bottelli R, Brambilla G, et al. (1994) Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology; 19: 1115-1123.
[8]
Shiina S, Teratani T, Obi S, et al. (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology; 129: 122-30.
[9]
Brunello F, Veltri A, Carucci P, et al. (2008) Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol; 43: 727-35.
[10]
Bartolozzi C, Lencioni R, Caramella D, et al. (1995) Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology; 197: 812-8.
[11]
Altekruse SF, Henley SJ, Cucinelli JE, et-al. (2014): Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol; 109: 542-53.
[12]
Iyer JK, Kalra M, Kaul A, et al. (2017): Estrogen receptor expression in chronic hepatitis C and hepatocellular carcinoma pathogenesis. World J Gastroenterol; 23: 6802-16.
[13]
Noda T, Nagano H, Tomimaru Y, Murakami M, Wada H, Kobayashi S, et al.(2011) Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liver surgery. Surgery.; 149: 371–377.
[14]
Xiangji L, Weifeng T, Bin Y, Chen L, Xiaoqing J, Baihe Z, et al. Surgery of hepatocellular carcinoma complicated with cancer thrombi in bile duct: efficacy for criteria for different therapy modalities. Langenbecks Arch Surg. 2009; 394: 1033–1039.
[15]
Satoh S, Ikai I, Honda G, et al. Clinicopathologic evaluation of hepatocellular carcinoma with bile duct thrombi. Surgery. 2000; 128: 779–783.
[16]
Shiomi M, Kamiya J, Nagino M, et al. (2011): Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery.; 129: 692–698.
[17]
Subramaniam S, Kelley RK, Venook AP. (2013): A review of hepatocellular carcinoma (HCC) staging systems. Chin ClinOncol; 2: 33 (PMID: 25841912 DOI: 10.3978/j.issn.2304-3865.2013.07.05).
[18]
Botta F, Giannini E, Romagnoli P, et al. (2003): scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut; 52: 134-139 (PMID: 12477775).
[19]
Miki I, Murata S, Uchiyama F, et al. (2017): Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy. World J Gastroenterol; 23(35): 6437-6447.
[20]
Hiramatsu K, Koda E, Mori M, Isobe Y. (1982): X-ray Anatomy of the Abdominal Vascular System. Tokyo: Igaku-Shoin; 63-81.
[21]
Niggemann P, Murata S, Naito Z, et al. (2004): A comparative study of the microcirculatory changes in the developing liver cirrhosis between the central and peripheral parts of the main lobe in mice. Hepatol Res.; 28: 41-48.
[22]
Tamada T, Ito K, Higaki A, et al. (2011): Gd-EOB-DTPA-enhanced MR imaging evaluation of hepatic enhancement effects in normal and cirrhotic livers. Eur J Radiol.; 80: e311-e316.
[23]
Chen LT, Liu TW, Chao Y, et al. (2005): alpha-fetoprotein response predicts survival benefits of thalidomide in advanced hepatocellular carcinoma. Aliment Pharmacol Ther.; 22: 217 226.
[24]
Memon K, Kulik L, Lewandowski RJ, et al. (2012): Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: a subgroup analysis. J Hepatol.; 56: 1112–1120.
[25]
Lee S, Kim BK, Kim SU, et al. (2015): Early alpha-fetoprotein response predicts survival in patients with advanced hepatocellular carcinoma treated with sorafenib. J Hepatocell Carcinoma.; 2: 39–47.
[26]
Kao WY, Chiou YY, Hung HH, et al. (2012): Serum alpha-fetoprotein response can predict prognosis in hepatocellular carcinoma patients undergoing radiofrequency ablation therapy. Clin Radiol.; 67: 429–436.
[27]
Shao YY, Lin ZZ, Hsu C, et al (2010): Early alpha-fetoprotein response predicts treatment efficacy of antiangiogenic systemic therapy in patients with advanced hepatocellular carcinoma. Cancer.; 116: 4590–4596.
[28]
Liu L, Zhao Y, Jia J, et al. (2016): The prognostic value of alpha-fetoprotein response for advanced-stage hepatocellular carcinoma treated with sorafenib combined with transarterial chemoembolization. Sci Rep.; 6: 19851.
[29]
Riaz A, Ryu RK, Kulik LM, et al. (2009): Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: oncologic marker of radiologic response, progression, and survival. J Clin Oncol.; 27: 5734–5742. doi: 10.1200/JCO.2009.23.1282.
[30]
Bae SI, Yeon JE, Lee JM, et al. (2012): A case of necrotizing pancreatitis subsequent to transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma. ClinMolHepatol; 18: 321–5.
[31]
Miyayama S, Yamashiro M, Okuda M, et al. (2010): Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol; 33: 1168–79.
[32]
Chu HJ, Lee CW, Yeh SJ, et al. (2015): Cerebral lipiodol embolism in hepatocellular carcinoma patients treated with transarterial embolization/chemoembolization. PLoS One; 10: e0129367.
[33]
Toro A, Bertino G, Arcerito MC, et al. (2015): A lethal complication after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. Case Rep Surg; 2015: 873601.
[34]
Pietrosi G, Miraglia R, Luca A, et al. (2009): Arterial chemoembolization/embolization and early complications after hepatocellular carcinoma treatment: a safe standardized protocol in selected patients with Child class A and B cirrhosis. J VascInterv Radiol; 20: 896–902.
[35]
Jia Z, Tian F and Jiang G. (2013): Ruptured hepatic carcinoma after transcatheter arterial chemoembolization. CurrTher Res ClinExp; 74: 41–3.
[36]
Becker G, Soezgen T, Olschewski M, e al. (2005): Combined TACE and PEI for palliative treatment of unresectable hepatocellular carcinoma. World J Gastroenterol; 11: 6104-9.
[37]
Chua TC, Liauw W, Saxena A, et al. (2009): Systematic review of neoadjuvanttransarterial chemoembolization for resectable hepatocellular carcinoma. Liver Int; 30: 166-74.
[38]
Jia-yan Ni, Shan-shan Liu, Ni JY, et al. (2013): Transarterial chemoembolization combined with percutaneous radiofrequency ablation versus TACE and PRFA monotherapy in the treatment for hepatocellular carcinoma: a meta-analysis. J Cancer Res Clin Oncol; 139: 653-659.
[39]
Yang Fu1, Xu Zhao2, Qiang Yun3, et al: Transarterial chemoembolization (TACE) plus percutaneous ethanol injection (PEI) for thetreatment of unresectable hepatocellular carcinoma: a meta-analysis of randomized controlled trials.
[40]
Germani G, Pleguezuelo M, Gurusamy, et al (2010). Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocellular: a meta-analysis. J Hepatol, 52, 380-87.
[41]
Ebied OM, Federle MP, Carr BI, et al. (2003): Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer.; 97: 1042–1050. doi: 10.1002/cncr.11111.
[42]
Golfieri R, Renzulli M, Mosconi C, et al. (2013): Hepatocellular carcinoma responding to superselective transarterial chemoembolization: an issue of nodule dimension? J Vasc Interv Radiol.; 24: 509–517. doi: 10.1016/j.jvir.2012.12.013.
Browse journals by subject