Unresectable hepatocellular carcinoma: Survival and prognostic factors after lipiodol chemoembolisation in 89 patients
Jérôme DumortierFrançois ChapuisO. BorsonB DAVRILJ.Y. ScoazecGilles PoncetLuc HenryOlivier BoillotFrançois MionF Berger
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Lipiodol
Objective To investigate the intrahepatic distribution of Lipiodol in chemoembolization therapy for primary hepatic cellular carcinoma (HCC).Materials and Methods Thirtysix patients with HCC, proved by imaging and/or biopsy, were randomly divided into three groups and were treated with common Lipiodol (n=11), Ultra Fluide Lipiodol (n=13), or a mixture of the above two preparations with a ratio of 1∶1 (n=12), respectively. The distribution of Lipiodol in the liver demonstrated on plain films and CT scans was observed in 15～20 days after chemoembolization. The distribution was graded as follows. (1) Excellent: all Lipiodol was deposited in the lesions; (2) Good: most Lipiodol was deposited in the lesions, while small amount of Lipiodol stayed in normal hepatic parenchyma; (3) Poor: Lipiodol was deposited in both lesions and normal hepatic parenchyma about equally.Results The occurrences of Lipiodol deposit seen only inside the lesions in the common group, Ultra Fluide group and mixture group were 91% (10/11), 7.7% (1/13) and 33% (4/12), respectively. Followup CT scans showed that Ultra Fluide Lipiodol easily escaped from the lesions.Conclusion In chemoembolization therapy with Lipiodol for HCC, the common Lipiodol can almost always deposit in the lesions rather than in the normal parenchyma as seen in the case of using Ultra Fluide Lipiodol.
Lipiodol
Parenchyma
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Objective To study the therapeutic effect of transcatheter arterial chemoembolization(TACE) combined with iodine 131 Lipiodol( 131 I Lipiodol) for primary hepatocellular carcinoma(PHC).Methods 68 patients with PHC were divided into two groups.In group A,34 patients were treated by TACE,and in group B,34 patients treated by TACE combined with 131 I Lipiodol.Results In group A, second stage surgical resection rate was 8.8%,histologic examination of cancer specimens obtained from hepatectomy showed that TACE could not cause complete necrosis.The 1 ,2 ,and 3 year survival rate of the treated cases was 64.3%, 39.3% and 21.4%,respectively.In contrast,in group B,the second stage surgical resection rate was 29.4%,combination therapy resulted in complete histologic necrosis in 76.9% of patients.The 1 ,2 ,and 3 year survival rate was 96.4%,82.1% and 60.7%,respectively.Conclusion The therapeutic effect of TACE combined with 131 I Lipiodol is much better than that of TACE alone.
Lipiodol
Transcatheter arterial chemoembolization
Therapeutic effect
Arterial Embolization
Liver Cancer
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The purpose of this study was to elucidate the availability of cis-platinum powder suspended in lipiodol as a means for the treatment of liver cancer. The effects of cis-platinum powder (1.0 mg), suspended in lipiodol or saline (0.1 ml), as well as that of lipiodol (0.1 ml, 0.3 ml) alone, on the liver, was investigated by intra-arterially administration to 72 normal Wistar rats. It was found that injection of Cis-platinum powder suspended in Lipiodol, is compared to the suspension in saline, resulted in higher concentrations of platinum in the liver Severe histological degenerative and necrotic changes were also found. The liver cells were only moderately affected by lipiodol alone, but large amounts of lipiodol multiple anemic infarctions in the peripheral area 24 hours later. These results suggest that cis-platinum itself affects liver cells only slightly and therefore can be used for the treatment of liver cancer.
Lipiodol
Liver Cancer
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Lipiodol
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Objective :This study was conducted to clarify the characteristics of selective accumulation,per-sistent deposition and gradual disappearance of lipiodol in hepatocellular carcinoma ( HCC ) and the histopathologic morphology of tumors following transcatheter hepatic arterial chemoembolization(TAE )。 Methods :The findings of hepatic arteriography and those of CT obtained 4 to l5 d following lipiodol-TAE were compared and analyzed in 58 cases. The deposition and disappearance of lipiodol in 28 cases were ob-served by CT dynamically, in l2 of whom, CT or soft x-ray radiograms and the findings of histological exam-ination were compared.Results :Lipiodol accumulated selectively in hypervascular tumor and the amount of lipiodol accumulation correlated with the vascularity of the tumors. There was little or no lipiodol accumula-tion in hypovascular tumors。 In the necrotic tumors areas induced by chemoembolization ,lipiodol accumulat-ed selectively and deposited persistently for 2 to 6 months and sometimes even longer , with remarkable shrinkage of tumors,whereas in the tumor survival areas,selectively accumulated as lipiodol did,it disap-peared gradually in 1 to 2 months,without remarkable shrinkage of the tumors.Lipiodol in tumor-free areas disappeared much earlier,generally 2 weeks after embolization,Conclusions : Lipiodol accumulated selective-ly in hypervascular tumor tissues and deposited persistently in necrotic tumor areas induced by embolization。Therefore, CT follow-up to observe the deposition and disappearance of lipiodol in tumors is of clinical im-portance in assessing the anti-tumor effect and in deciding the time for further treatment.
Lipiodol
Vascularity
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Objective:The aim of the study was to determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol–ethanol mixture.Background:TEA is a new treatment strategy for HCC, and some researchers have reported its effectiveness in HCC.Patients and methods:This study was a prospective cohort study conducted at the National Liver Institute and Faculty of Medicine, Menoufia University, and included 40 patients having unresectable HCCs. At 3 and 6 months after TEA, triphasic computed tomography was performed, and tumor responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumor (mRECIST).Results:Every case was treated. At 3 and 6 months after embolization, contrast computed tomography showed no enhancing lesions.a-Fetoprotein levels were significantly reduced (12.18 ± 15.67) at 6 months after treatment. The partial and complete responses of tumors were 12.5 and 87.5%, respectively, 6 months after treatment. The overall survival rate was 90%.Conclusion:TEA is an effective therapy for patients with unresectable HCC.
Lipiodol
Transarterial embolization
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Objective To evaluate the clinical effect in patients with primary liver cancer (PLC) well filled with Lipiodol after transcatheter arterial chemoembolization (TACE). Methods 144 patients with PLC well filled with lipiodol after TACE were analysed retrospectively, and the survival rates were calculated by Kaplan Meier method. Results The overall cumulative survival rates for 1,2,3,4 and 5 year were 85.0%, 63.7%, 51.7%, 33.9% and 16.9% respectively. Significant differences were found for 1,2,3 and 4 year survival rates and that of 400 patients with PLC treated by TACE reported previously by our department ( P 0.001), but the 5 year survival rate showed no difference ( P =0.88). Conclusions Well filled with lipiodol in the tumor after TACE can improve the short term therapeutic effect and the 1,2,3 and 4 year survival rate of patients with PLC. The long term therapeutic effect is poor yet. Integrative treatment is needed to make further improvement on the therapeutic effect.
Lipiodol
Therapeutic effect
Transcatheter arterial chemoembolization
Liver Cancer
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The lipid lymphographic agent, Lipiodol ultrafluid has been found to remain selectively in hepatocellular carcinoma. Using this characteristic nature of Lipiodol, a new targeting anticancer chemotherapy was devised. In order to achieve targeting anticancer chemotherapy and useful anticancer effects, anticancer drugs must be dissolved or suspended in Lipiodol and diffuse out from the Lipiodol gradually. Oily anticancer agents such as SMANCS dissolved in Lipiodol (SMANCS/Lipiodol), Mitomycin C in Lipiodol (MMC/Lipiodol), Aclarubicin in Lipiodol (ACR/Lipiodol) and a mixture of these were administered by catheterizing the celiac or hepatic artery under X-ray monitoring in 216 patients with hepatocellular carcinoma. Remarkable anticancer effects of this targeting chemotherapy were achieved, the serum AFP level and tumor size both showing a decrease in 91% of cases. The survival period of patients with unresectable hepatoma treated with the present protocol was definitely longer than the comparison group.
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Tissue tolerance to pelvic intraarterial chemoembolization with cisplatin-lipiodol suspension was studied in rabbits. Cisplatin (3 mg/kg) was used with different doses of lipiodol (0.0, 0.1, 0.2, and 0.3 ml/kg). Cisplatin-lipiodol suspension was injected into the umbilical artery through polyethylene catheter. It was found that the local tissue concentration of platinum (Pt) was increased with lipiodol, while that in the liver, heart and kidneys was reduced. Tissue retention of platinum was linearly related to the dosage of lipiodol. With a single dose of 0.2ml/kg lipiodol, only slight degeneration and sparse hemorrhage were observed without necroses. The result suggested that lipiodol, as liquid embolic agent, could give a transient embolic effect on local pelvic tissue with safety under 0.2ml/kg.
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