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Objective: To evaluate the safety and long-term outcomes of microwave ablation (MWA) combined with transarterial chemoembolization (TACE) in a single stage for the treatment of hepatocellular carcinoma (HCC) with a maximum diameter of 5.0-10.0 cm., Methods: From January 2013 to December 2016, 84 consecutive HCC patients with cirrhosis from two medical centers who underwent MWA-TACE as a first-line treatment for up to three HCCs with maximum diameters of 5.0-10.0 cm were included. Feasibility, safety and effectiveness were evaluated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox regression models were used to identify the prognostic factors., Results: The technique was successfully performed in all the patients. Grade 3 complications consisted of two cases of hemoperitoneum requiring blood transfusions and embolization. The cumulative incidence of local tumor progression was 25.8% at 3 years, with tumor size found to be the only significant predictive factor (p = .007). The cumulative incidence of OS was 81%, 68% and 49% at 1, 2 and 3 years, respectively. According to the Cox proportional hazards model analysis, serum AFP level, Child-Pugh class and tumor number were significant prognostic factors for OS., Conclusion: MWA-TACE is a safe, feasible and effective therapy for the treatment of 5.0- to 10.0-cm HCC lesions in patients with cirrhosis.

Purpose: To evaluate the safety and efficacy of iodine-125 ( 125 I) seed strand implantation in combination with transarterial chemoembolization for the treatment of hepatitis B-related unresectable hepatocellular carcinoma (HCC) with portal vein invasion., Materials and Methods: From January 2013 to June 2016, 76 HCC patients with type II tumor thrombus were included in this single-center retrospective study. Twenty patients underwent 125 I seed strand implantation combined with transarterial chemoembolization (group A; n = 20), while 56 patients underwent transarterial chemoembolization alone (group B; n = 56). The procedure-related and radiation complications were assessed. Overall survivals were compared by propensity-score analysis., Results: The technique was successfully performed in all patients. The mean intended dose (r = 10 mm; z = 0; 240 days) was 62.6 ± 1.8 Gy. No grade 3 or 4 adverse events related to the procedure occurred in either group. After propensity-score-matching analysis, 19 patients were selected into each group, respectively. In the propensity-matching cohort, the median overall survival time was significantly longer in group A than in the group B (19 pairs; 28.0 ± 2.4 vs 8.7 ± 0.4 mo; P = .001). Treatment strategy, arterioportal shunt, and number of transarterial chemoembolization sessions were significant predictors of favorable overall survival time., Conclusions: 125 I seed strand implantation combined with transarterial chemoembolization is a safe and effective treatment for HCC patients with portal vein invasion., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the safety and efficacy of radiofrequency ablation combined with transarterial chemoembolization in patients with specially located small hepatocellular carcinoma., Materials and Methods: Between March 2014 and March 2017, a total of 26 patients with 26 lesions (10 perivascular, 6 subdiaphragmatic, 5 subcapsular, 5 perivascular, and subdiaphragmatic location; mean diameter 2.12 (0.62) cm), who received radiofrequency ablation-transarterial chemoembolization treatment, were retrospectively analyzed. Local tumor response was assessed by computed tomography/magnetic resonance imaging 1 month after the procedure. Tumor-free survival was also assessed according to the modified Response Evaluation Criteria in Solid Tumors. Complications were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (version 4.0)., Results: Complete response was achieved in all patients 1 month after the procedure. During a median follow-up duration of 16.76 months (95% confidence interval: 7.78-25.73 months), local tumor recurrence occurred in 2 patients and new intrahepatic lesions developed in 7 patients. The 1-, 2-, and 3-year cumulative local tumor progression rates were 3.84%, 7.69%, and 7.69%, respectively. The median tumor-free survival duration was 21.96 months (95% confidence interval: 17.58-26.34 months). The 1-, 2-, and 3-year tumor-free survival rates were 67.4%, 46.1%, and 39.3%, respectively., Conclusion: The radiofrequency ablation-transarterial chemoembolization combination therapy appears to be safe and effective and might be a treatment option for specially located small hepatocellular carcinoma lesions that have a risk of incomplete ablation or major complications.

This study sought to develop an effective and reliable nomogram for predictions of recurrence for postoperative adjuvant transarterial chemoembolization (PA-TACE) in patients with hepatitis B virus-related (HBV) hepatocellular carcinoma (HCC).The nomogram was established based on data obtained from a retrospective study on 235 consecutive patients with HBV HCC who received PA-TACE as an initial therapy from 2006 to 2010 in our center. Eighty-four patients who were collected at another institution between 01/2008 and 12/2010 served as an external validation set. Recurrence-free survival (RFS) was collected. The nomogram for tumor recurrence was developed based on the data obtained before the PA-TACE procedure. Predictive accuracy and discriminative ability of the nomogram were assessed by concordance index (C-index), calibration curves, and validation set.The 1, 2, 3-year RFS rates were 55.5%, 27.0%, and 14.1%, respectively, in the patients from the derivation set and 60.7%, 33.2%, and 23.8% in those from the validation set. Four risk factors (HBV-DNA level, vascular invasion, change of Child-Pugh score, and tumor diameter) in the multivariate analysis were significantly associated with RFS. The statistical nomogram incorporated these 4 factors achieved good calibration and discriminatory abilities with the c-index of 0.74 (95% CI 0.66-0.82). The findings were supported by the independent external validation set (c-index, 0.70; 95% CI 0.58-0.83). The area under the receiver operating characteristic curve in our model was greater than those of conventional staging systems in the validation patients (corresponding c-indices, 0.56-0.64).The novel nomogram may achieve an optimal prediction for recurrence outcome in HBV-related HCC with PA-TACE.

Hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus have a median survival time of only about 4 months. We therefore compared the safety and efficacy of endovascular brachytherapy (EVBT) and sequential three-dimensional conformal radiotherapy (3-DCRT). From a cohort of 176 patients, we treated 123 with EVBT using iodine-125 seed strands (group A) and the remaining 53 with sequential 3-DCRT (group B). Overall survival, progression free survival and stent patency characteristics were compared between the two groups. Our analysis demonstrated a median survival of 11.7 ± 1.2 months in group A versus 9.5 ± 1.8 months in group B (p = 0.002). The median progression free survival was 5.3 ± 0.7 months in groupA versus 4.4 ± 0.4 months in group B (p = 0.010). The median stent patency period was 10.3 ± 1.1 months in group A versus 8.7 ± 0.7 months in group B (p = 0.003). Therefore, as compared to sequential 3-DCRT, EVBT combined with portal vein stenting and TACE improved overall survival of HCC patients with main portal vein tumor thrombus.

This study sought to develop a reliable and easy-to-use scoring model to guide the decision to perform postsurgical adjuvant transarterial chemoembolization (PA-TACE) in patients with hepatitis B-related hepatocellular carcinoma (HCC).The study included 235 consecutive patients with hepatitis B-related HCC undergoing PA-TACE at our medical center. Patients were assigned to 2 sets according to the PA-TACE date: initial (2005-2007; n = 130) and internal validation (2008-2009; n = 105) sets. With the aid of a Cox regression model, we developed a risk-scoring model from the independent predictive factors of our initial set designed as a guide for PA-TACE, and the performance of the model was validated with an internal set. External validation was also performed with an independent dataset (n = 84) to assess the discriminatory power of the scoring model.In the multivariate analysis, 4 risk factors (an increase in Child-Pugh score of at least 1 point, hepatitis B virus deoxyribonucleic acid [HBV-DNA] level >10 IU/mL, tumor diameter ≥5 cm, and the presence of vascular invasion) were significantly associated with prognosis. These factors were incorporated into a novel clinicopathological scoring model (assessment for PA-TACE [APT] risk-scoring model) ranging from 0 to 8 that was correlated with prognosis. Different survival outcomes were identified in three groups (0-2 points, 3-6 points, and 7-8 points). The risk-scoring model was further confirmed with 2 independent sets.The novel APT risk-scoring model, merging 4 prognostic factors, may achieve an optimal postsurgical prediction of PA-TACE in HBV-related HCC. The risk for an individual patient with an APT score of ≥7.0 prior to the PA-TACE, who may not profit from further PA-TACE, can be determined, and this may lead to a more appropriate choice of treatment., Competing Interests: The authors have no funding and conflicts of interest to disclose.

Purpose: To evaluate the safety and efficacy of microwave (MW) ablation combined with transarterial chemoembolization in a single stage for the treatment of large (≥ 5 cm) hepatocellular carcinoma (HCC)., Materials and Methods: From March 2013 to January 2015, 66 patients (54 men and 12 women; mean age, 54 y; range, 29-83 y) with 72 large HCC lesions were included in this study. Eighteen (27.3%) had Barcelona Clinic Liver Cancer class B disease, and 48 (72.7%) had class C disease. Seventy-nine percent of patients (n = 52) had hepatitis B virus infection. The average tumor size was 9.0 cm ± 3.9, ranging from 5 to 19 cm. MW ablation was performed under ultrasound guidance, immediately followed by chemoembolization. Local tumor response, progression-free survival (PFS), and overall survival (OS) were assessed., Results: The technique was successfully performed in all patients. Complete response (CR) was achieved in 28 cases (42.4%), and partial response (PR) was achieved in 34 cases (51.5%) at 1 month after the procedure. The objective response rate (ie, CR plus PR) was 93.9%. Median PFS and OS times were 9 months and 21 months, respectively. The 6-, 12-, and 18-month OS rates were 93.9%, 85.3%, and 66.6%, respectively. Hemorrhage was detected in three patients and arteriovenous fistula in two patients after MW ablation; all were promptly treated with embolization. There were no liver abscesses, bile-duct injuries, or other major procedure-related complications., Conclusions: MW ablation immediately followed by chemoembolization is safe and effective in the treatment of large HCC lesions., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: This study sought to establish an effective and reliable prognostic nomogram to guide the decision for post-surgical adjuvant transarterial chemoembolization (PA-TACE) in patients with hepatitis B virus-related (HBV) hepatocellular carcinoma (HCC)., Results: The 1, 3, 5-year overall survival rates were, respectively, 87.7%, 52.1% and 28.3% in the patients from the derivation set and 91.7%, 57.1% and 34.1% in those from the validation set. Five risk factors (HBV-DNA level, platelet count, vascular invasion, change of Child-Pugh score, and tumor diameter) in the multivariate analysis were significantly associated with prognosis. The statistical nomogram incorporated these five factors achieved good calibration and discriminatory abilities with c-index of 0.75 (95% CI 0.67 to 0.83). The findings were supported by the independent external validation set (c-index, 0.69; 95% CI 0.56 to 0.83). Patients who had a nomogram score of less than 180 was considered to have higher survival benefit from PA-TACE., Methods: The nomogram was established based on data obtained from a retrospective study on 235 consecutive patients with HBV HCC who received PA-TACE as an initial therapy from 2006 to 2010 in our center. 84 patients who were collected at another institution between 01/2008 and 12/2010 served as an external validation set. The prognostic nomogram was developed based on the data obtained before the PA-TACE procedure. Predictive accuracy and discriminative ability of the nomogram were assessed by concordance index (C-index), calibration curves, and validation set., Conclusions: The novel nomogram may achieve an optimal prognostic prediction for PA-TACE in HBV-related HCC., Competing Interests: The authors report no declarations of interest.

Purpose: This study was designed to evaluate the safety and efficacy of transarterial chemoembolization (TACE) combined with intra-IVC implantation of an irradiation stent for the treatment of hepatocellular carcinoma (HCC) complicated by inferior vena cava tumor thrombosis (IVCTT)., Methods: Sixty-one consecutive patients with HCC complicated by IVCTT treated by TACE combined with IVC stenting were retrospectively analysed. IVC stenting was performed using a stent loaded with (125)I seeds strands (the irradiation stent) in 33 patients (Group A) and 28 patients with a bare stent (Group B). Propensity score matching eliminated the baseline differences. Overall survival, oedema related to IVC obstruction remission rate and procedure-related adverse events were compared between the two groups., Results: The adverse effect rate was similar for both Group A and Group B patients, and complications were adequately handled by medical treatment. TACE combined with implantation of an irradiation stent showed a significant median survival benefit over TACE combined with a bare stent, with a median survival time of 203.0 ± 28.135 days versus 93.0 ± 24.341 days (p = 0.006). The propensity score-matched (24 pairs) cohort analyses (200 ± 31.231 days vs. 66 ± 23.270 days, p = 0.019). The oedema remission rate was 97.0 % in group A patients and 96.4 % in group B, respectively. TACE-irradiation stent and object tumor response were the independent prognostic factors of favorable survival., Conclusions: TACE combined with irradiation stent implantation is a safe and effective treatment modality for patients with HCC complicated by IVCTT and may extend their survival time.

Propose: To evaluate the safety and efficacy of endovascular brachytherapy (EVBT) with iodine-125 ((125)I) seed strand implantation combined with stent placement and transarterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT)., Methods: Data of 276 consecutive HCC patients with MPVTT treated by stent placement and TACE were analyzed retrospectively. (125)I seed strands were implanted in 182 patients (group A). The remaining 94 patients, who did not receive EVBT, served as control (group B). The overall survival, free of disease progression survival, stent patency period and procedure-related complications were compared between the two groups., Results: During a mean 9.9 ± 9.7 month (range 1.3-62.2 months) follow-up, the median survival time was 9.3 ± 0.9 months (95 % CI 7.6-11.0 months) in group A compared to 4.9 ± 0.5 months (95 % CI 4.0-5.8 months) in group B (p < 0.001). Median free of disease progression survival time in group A and B was 1.8 ± 0.1 months (95 % CI 1.6-2.0 months) and 1.5 ± 0.1 months (95 % CI 1.3-1.7 months), respectively (p < 0.001). Median stent patency period was 9.2 ± 1.1 months (95 % CI 7.0-11.4 months) in group A and 4.8 ± 0.5 months (95 % CI 3.9-5.7 months) in group B, respectively (p < 0.001)., Conclusion: These findings suggested that EVBT combined with stent placement and TACE might be a safe and effective palliative treatment option for HCC with main portal vein tumor thrombus.

Objective: This study evaluated the safety and objective response of combining 131I-labeled-metuximab (Licartin) with transarterial chemoembolization (TACE) in the treatment of unresectable hepatocellular carcinoma (HCC)., Materials and Methods: In a multicenter open-label clinical trial, 341 enrolled patients with stage III/IV HCC according to TNM criteria were nonrandomly assigned to a trial group (n=167) and a control group (n=174), undergoing TACE following hepatic intra-arterial injection of licartin or TACE alone from July 2007 to July 2009. Radiopharmaceutical distribution was evaluated. The primary endpoint was overall survival; secondary endpoints included time-to-progression (TTP), toxicity and adverse events (AEs)., Results: The radiobiological distribution demonstrated better localization of licartin in liver tumors than other tissues (P<0.01). The organ absorbed doses to liver and red marrow were 3.19 ± 1.01 Gy and 0.55 ± 0.22 Gy, respectively. The 1-year survival rate was significantly higher [79.47% vs. 65.59%, hazard ratio (HR), 0.598, P=0.041] and TTP significantly improved (6.82 ± 1.28 vs. 4.7 ± 1.14 months, P=0.037) compared with the control group. Patients at stage III achieved more benefit of one year survival than stage IV in the trial group (86.9% vs. 53.8%, P<0.001). There were significant different toxicities in leukocytopenia, thrombocytopenia and increased total bilirubin level [P<0.001, P=0.013, P<0.01, relative risk (RR) 1.63, 1.33, 1.43], but no differences in severe AEs of upper GI hemorrhage and severe liver dysfunction between the groups (5.39% vs. 2.3%, P=0.136)., Conclusions: Owing to excellent tumor-targeting, promised efficacy and favourable toxicity profile, the novel combination therapy of licartin and TACE could be applied in patients with unresectable HCC.

Unlabelled: Transarterial chemoembolization (TACE) is the current standard of treatment for unresectable intermediate-stage hepatocellular carcinoma (HCC). Brivanib, a selective dual inhibitor of vascular endothelial growth factor and fibroblast growth factor signaling, may improve the effectiveness of TACE when given as an adjuvant to TACE. In this multinational, randomized, double-blind, placebo-controlled, phase III study, 870 patients with TACE-eligible HCC were planned to be randomly assigned (1:1) after the first TACE to receive either brivanib 800 mg or placebo orally once-daily. The primary endpoint was overall survival (OS). Secondary endpoints included time to disease progression (TTDP; a composite endpoint based on development of extrahepatic spread or vascular invasion, deterioration of liver function or performance status, or death), time to extrahepatic spread or vascular invasion (TTES/VI), rate of TACE, and safety. Time to radiographic progression (TTP) and objective response rate were exploratory endpoints. The trial was terminated after randomization of 502 patients (brivanib, 249; placebo, 253) when two other phase III studies of brivanib in advanced HCC patients failed to meet OS objectives. At termination, median follow-up was approximately 16 months. Intention-to-treat analysis showed no improvement in OS with brivanib versus placebo (median, 26.4 [95% confidence interval {CI}: 19.1 to not reached] vs. 26.1 months [19.0-30.9]; hazard ratio [HR]: 0.90 [95% CI: 0.66-1.23]; log-rank P=0.5280). Brivanib improved TTES/VI (HR, 0.64 [95% CI: 0.45-0.90]), TTP (0.61 [0.48-0.77]), and rate of TACE (0.72 [0.61-0.86]), but not TTDP (0.94 [0.72-1.22]) versus placebo. Most frequent grade 3-4 adverse events included hyponatremia (brivanib, 18% vs. placebo, 5%) and hypertension (13% vs. 3%)., Conclusions: In this study, brivanib as adjuvant therapy to TACE did not improve OS., (© 2014 by the American Association for the Study of Liver Diseases.)

Transarterial chemoembolization represents a first-line non-curative therapy for hepatocellular carcinoma (HCC), although the biological changes in the remaining cancer after embolization are not completely understood. In the present study, we examined whether transarterial embolization (TAE) enhances the metastatic potential of residual HCC and investigated the mechanisms underlying embolization. The hepatoma cell line McA-RH7777, which is marked by green fluorescent protein (GFP), was used in the study. The invasion of cells cultured under hypoxia and normoxia was observed using the Transwell assay. Twenty male buffalo rats were implanted with GFP transfected McA-RH7777 tumors in the left lateral lobe of the liver. After laparotomy and retrograde placement of a catheter into the gastroduodenal artery (on the 14th day after implantation), TAE using lipiodol (0.2 ml/kg) was performed. Tumor volumes were measured before and after treatment using magnetic resonance imaging (MRI). Lung metastases were observed using fluorescence imaging, and the molecular changes of residual tumor cells were evaluated by western blotting or immunohistochemistry. The invasion assays indicated that the number of invading hypoxic cells was significantly higher than that of normoxic cells (30.2 ± 2.46 vs. 20.4 ± 1.89, P=0.013). Accompanying an increase in hypoxia-inducible factor-1α (HIF-1α) expression, the metastatic potential of tumor cells following hypoxia or TAE was enhanced. This enhanced metastatic potential was indicated by a significant reduction in the expression of E-cadherin and an upregulation of N-cadherin and vimentin expression. The number of lung metastases in the TAE group was 19.20 ± 1.76, whereas this number was 11.30 ± 1.54 in the control group, which represented a statistically significant difference (P=0.003). In conclusion, hypoxia in the residual tumor after TAE can increase the invasiveness and metastatic potential of HCC and may be responsible for the failure of TAE.

Background: The long-term survival in hepatocellullar carcinoma (HCC) patients after transarterial chemoembolization (TACE) remains dismal due to local and/or regional recurrence as well as distant metastasis. The efficacy of sorafenib in advanced HCC has been demonstrated and brought great hope. Recently, the use of sorafenib in combination with TACE for BCLC stage B and C HCC patients was recommended. However, data on this dual-modality treatment is little, and its advantage over TACE alone has not been addressed. The present study sought to understand the efficacy of the combination of TACE and sorafenib in the treatment of advanced HCC., Methods: Between June 2008 and Feb 2011, 45 patients with advanced HCC were enrolled and treated with sorafenib in combination with TACE according to an institutional protocol of the Zhongshan hospital, Fudan University. The control group of 45 other HCC patients with similar characteristics treated with TACE alone in the same period of time in our institute were selected for retrospective comparison of the treatment outcomes especially overall survival time. Adverse reactions induced by sorafenib were observed and recorded., Results: The median overall survival time of the combined treatment group was 27 (95% Confidence Interval: 21.9-32.1) months, and that of TACE alone group was 17 months (95% Confidence Interval: 8.9-25.0) months (P = 0.001). Patients required significantly less frequent TACE for their symptomatic treatment after the initiation of sorafenib therapy. The most common adverse events associated with sorafenib were hand-foot skin reaction, rash and diarrhea. Of CTCAE grade IV or V toxicity was observed., Conclusion: TACE combined sorafenib significantly prolonged median overall survival time of patients with advanced HCC.

Objective: To evaluate the therapeutic effect of endovascular placement of iodine-125 seed strand and stent combined with transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPVTT)., Methods: Fifty patients with HCC complicated by MPVTT were enrolled into this study. There were 46 men and 4 women with a mean age of 53.9 years. TACE was performed after the iodine-125 seed strand and self-expandable stent placement in the obstructed segment of the main portal vein (MPV)., Results: Technical success rate was 100% for placement of iodine-125 seed strand and stent in the target segment of MPV. No serious procedure-related complications occurred. The mean follow-up duration was 208.5 d. The mean and median survival time was 370.1 d and 223.0 d, respectively. The 90-, 180-, 360-day cumulative survival rates were 97.5%, 59.3%, and 38.4%, respectively. The mean and median patent time of stent was 524.2 d and 407.4 d, respectively. The 90-, 180-, 360-day cumulative patency rates of stent were 94.9%, 75.2%, and 64.5%, respectively., Conclusion: Endovascular placement of iodine-125 seed strand and stent combined with TACE is an effective therapy for HCC with tumor thrombus in the main portal vein.

Transcatheter Arterial Chemoembolization (TACE) is the first line of treatment in inoperable hepatocellular carcinoma. Magnetic affinity beads can be used to extract peptides from un-fractionated serum samples. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) can detect the presence and the molecular mass of peptides. In this study, we used a highly optimized ClinProt-matrix-assisted laser desorption/ionization time-of flight mass spectrometer (MALDI-TOF-MS) to screen hepatocellular carcinoma markers for TACE. 40 sera from 20 patients, including before and after TACE to explore those biomarkers, might be related with therapy efficiency, and some of the patients who received another therapy were analyzed as well. The spectra were analyzed statistically using FlexAnalysis™ and Clin-Prot™ bioinformatic software. The seven most significant differential peaks (p < 0.0.5) were selected out by ClinProTool software to identify hepatocellular carcinoma markers for TACE therapy. Furthermore, the differential peptide of 3883Da was identified as plasma serine protease inhibitor precursor (Protein C inhibitor). This study provides a direct link between peptide marker profiles and TACE therapy, and the markers may have clinical utility for monitoring efficiency of therapy.

Objective: To study the features of blood supply and results of transarterial infusion and embolization in spinal metastases., Methods: Forty-one patients with spinal metastasis received transarterial infusion and embolization between March 2001 and June 2008. The inclusion criteria were: The metastatic lesion caused back pain; The metastatic lesion involved vertebra at or below T3 level. There were 29 males and 12 females with a mean age of 56.0 (33 - 71) years. Epirubicin was used as the chemotherapeutic agent. Lipoid Ultra-Fluid, Contour SE or gelfoam particles were used as embolitic material., Results: The technical success of therapy was achieved in 52 vertebrae (100%) including 14 thoracic, 35 lumbar and 3 sacral vertebrae. 105 arteries were used for infusion and embolization (16 intercostal arteries, 78 lumbar arteries, 4 iliolumbar arteries, 4 branches of iliac arteries, and 3 median sacral arteries). Lipoid Ultra-Fluid (2 - 8 ml) was used in 15, Contour SE (300 approximately 500 microm, 20 - 100 mg) in 20, and gelfoam particles in 33 arteries. Three days after treatment, complete pain relief (CR) was achieved in 17 patients, partial pain relief (PR) in 20, and moderate pain relief (MR) in 4, with an effective rate of 90.2%. Two weeks after treatment, CR was achieved in 17 patients, PR in 21, and MR in 3, with an effective rate of 92.7%. No adverse nervous system effect occurred. 16 patients developed swelling and pain of normal tissues which were alleviated after symptomatic treatment., Conclusion: Transarterial infusion and embolization is an effective therapy in relieving pain resulting from spinal metastases.

Background: Hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT) is often associated with poor prognosis. We retrospectively assessed the effectiveness of percutaneous transhepatic portal vein stenting and transarterial chemoembolization (PTPVS-TACE) combined with or without 3-dimensional conformal radiotherapy (3-DCRT) for HCC with MPVTT., Methods: Forty-five patients with HCC complicated by MPVTT were treated with PTPVS-TACE. Among them, 16 patients (group A) received 3-DCRT with 30-60Gy as daily 2Gy fractions. The remaining 29 patients (group B) received no radiotherapy. The tumor responses, complications, stent patency rates, and cumulative survival rates were evaluated, and the Kaplan-Meier method and log-rank test were used for survival analysis., Results: No severe complications were associated with PTPVS-TACE and 3-DCRT. The objective response rate (CR and PR) was 35.6%. The 60-, 180-, and 360-day cumulative stent patency rates were 93.3%, 62.2%, and 34.6% in group A, and 58.6%, 21.7%, and 10.8% in group B, respectively, showing significant difference between the 2 groups (P<.01). The mean patency time was 475.20+/-136.97 and 199.58+/-61.40 days, respectively. The 60-, 180-, and 360-day cumulative survival rates were 93.8%, 81.3%, and 32.5%, respectively, for group A, 86.2%, 13.8%, and 6.9%, respectively, for group B. Significant statistical differences were detected between the 2 groups (P<.01)., Conclusions: These findings suggest that sequential therapy by PTPVS-TACE-3-DCRT is possibly an effective treatment modality for HCC complicated by main portal vein tumor thrombus., (Copyright (c) 2009 American Cancer Society.)

To retrospectively analyze the therapeutic results of percutaneous transhepatic portal vein stenting (PTPVS) and transcatheter arterial chemoembolization (TACE) treatment in 58 patients with hepatocellular carcinoma (HCC) invading the main portal vein (MPV). A total of 58 procedures of PTPVS were performed, immediately after which TACE was undertaken to control HCC. The clinical effects, complications, digital subtraction angiographic appearance, stent patency rates, cumulative survival rates, and predictive factors for survival were evaluated. The Kaplan-Meyer method and the log rank test were used for survival analysis. Multivariable analysis was also conducted by the Cox proportional hazard model. No patient died during stent placement or within the first 24 h. No severe procedure-related complications were observed. After stent placement, the mean +/- standard deviation portal venous pressure levels decreased from 41.43 +/- 8.56 cmH(2)O to 37.19 +/- 7.89 cmH(2)O (p < 0.01). At the time of analysis, 9 of the 58 patients survived. The 60-, 180-, 360-, and 720-day cumulative patency rates were 98.1%, 71.0%, 52.6%, and 42.1%, respectively, with a mean patency time of 552.9 +/- 88.2 days and a median patency time of 639.00 +/- 310.00 (95% confidence interval [95% CI], 31.40-1246.60) days. The 60-, 180-, 360-, and 720-day cumulative survival rates for the total study population were 74.1%, 27.1%, 17.2%, and 13.8%, respectively, with a median survival time of 113 +/- 27.29 (95% CI, 59.51-166.49) days. In the univariate analysis, the following six variables were significantly associated with the prognosis: (1) HCC type; (2) Child-Pugh grade; (3) MPV stenosis/occlusion; (4) arteriovenous shunt; (5) iodized oil deposition; and (6) number of TACE procedure. In addition, having diffuse-type HCC and Child-Pugh grade B disease were each independent factors associated with decreased survival time in the multivariate analysis. PTPVS-TACE is feasible and may be useful to control HCC invading the MPV.

Aim: To explore the diffusion gradient b-factor that optimizes both apparent diffusion coefficient (ADC) measurement and contrast-to-noise (CNR) for assessing tumor response to transarterial chemoembolization (TACE) in a rabbit model., Methods: Twelve New Zealand white rabbits bearing VX2 tumors in the liver were treated with TACE. Diffusion-weighted imaging (DWI) with various b values was performed using the same protocol before and 3 d after treatment with TACE. ADC values and CNR of each tumor pre- and post-treatment with different b factors were analyzed. Correlation between ADC values and extent of necrosis in histological specimens was analyzed by a Pearson's correlation test., Results: The quality of diffusion-weighted images diminished as the b value increased. A substantial decrease in the mean lesion-to-liver CNR was observed on both pre- and post-treatment DW images, the largest difference in CNR pre- and post-treatment was manifested at a b value of 1000 s/mm(2) (P = 0.036 ). The effect of therapy on diffusion early after treatment was shown by a significant increase in ADCs (P = 0.007), especially with large b factors (>= 600 s/mm(2)). The mean percentage of necrotic cells present within the tumor was 76.3%-97.5%. A significant positive correlation was found between ADC values and the extent of necrosis with all b values except for b200, a higher relative coefficient between ADC values and percentage of necrosis was found on DWI with b1000 and b2000 (P = 0.002 and 0.006, respectively)., Conclusion: An increasing b value of up to 600 s/mm(2) would increase ADC contrast pre- and post-treatment, but decrease image quality. Taking into account both CNR and ADC measurement, diffusion-weighted imaging obtained with a b value of 1000 s/mm(2) is recommended for monitoring early hepatic tumor response to TACE.

Objective: To investigate the safety and efficacy of transhepatic arterial infusion of the mixture of epirubicin and microspheres as the embolization materials for treatment of patients with hepatocellular carcinoma (HCC)., Methods: The mixture was made of 10-60 mg epirubicin (Pfizer) mixed with 300-500 microm microspheres in 0.5-2 ml (Contour SE Boston Scientific), which was used for embolizating the artery supplying HCC. Changes of leucocyte counts, liver function, serum AFP level, response of tumor to TACE and complications related to embolization were analyzed before and after TACE., Results: 136 HCC patients (male/female: 91/45, mean age: 54.8 +/- 13.3 years) were studied. After TACE, the liver function was damaged and tumor size shrunken significantly (P < 0.05)., Conclusion: Transhepatic arterial chemoembolization using the mixture of epirubicin and microspheres for embolizating is safe and effective for the treatment of HCC, but the amount of embolization material should be chosen carefully in order to avoid liver function failure.

Objective: To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ)., Methods: Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up., Results: Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months)., Conclusion: Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.

Objectives: To analyze the MRI manifestations and pathological changes of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with lipiodol., Methods: 23 patients with 31 HCC lesions treated by TACE underwent MRI examination within 1 week before their surgical resections. MRI was performed with SE sequence (T1WI and FSE T2WI) and FMPSPGR sequence dynamic multi-phase contrast scans. All resected specimens were cut into 5-10mm thick slices, corresponding to the same plane as that of MRI scans. The specimens were wholly embedded in paraffin, serial sections made and stained with hematoxylin and eosin. The MRI findings were thus compared with the pathology of the specimen sections., Results: (1) MRI findings: In all 31 lesions, the signal intensity of lesions varied and was mostly heterogeneous on SE T1WI and T2WI images. Three lesions were inhomogeneous hyper-intensity and the other 28 lesions were iso- or hypo-intensity on FMPSPGR plain scannings. Twenty-two lesions were enhanced on early-phase dynamic scanning, and no enhancement was found in the other 9 lesions. Partial enhancement was also seen in 6 lesions on delay-phase dynamic scanning. (2) Pathologically, no coagulation necrosis was found in 2 specimens, but 6 lesions showed complete coagulation necrosis and 23 showed various degrees of it. The other pathological changes found included intra-tumoral hemorrhage (n=10), intra-lesional fibrotic septa formation (n=5), capsule-like fibrotic tissue proliferation around the lesions (n=12), inflammatory infiltration (n=28), focal mucoid degeneration (n=2), focal hyaline degeneration (n=2), and lipiodol retention (n=6). (3) Radiological-pathological correlation study: hyper-intense areas on T1WI corresponded to areas of coagulation necrosis with or without hemorrhage and of residual viable tumor; iso- and hypo-intense corresponded to areas of coagulation necrosis or residual viable tumor. Hyper-intense areas on T2WI corresponded to those of residual viable tumor or coagulation necrosis with hemorrhage, and iso-intense areas corresponded to those of coagulation necrosis, small residual viable tumor or intra-lesional fibrotic septa formation, and hypo-intense areas corresponded to those of coagulation necrosis or intra-lesional fibrotic septa formation. Areas of enhancement within the lesions on the early-phase dynamic-contrast images corresponded to areas of residual viable tumors, while areas of no enhancement were those of coagulation necrosis, hemorrhage, intra-lesional fibrotic septa formation or small residual viable tumors. Areas of enhancement on the delay-phase dynamic scanning were those of residual viable tumors or intra-lesional fibrotic septa formation, while no enhancement corresponded to the areas of residual viable tumors, coagulation necrosis, and hemorrhage. Areas of enhancement on the delay-phase dynamic scanning corresponded to those areas of fibrosis tissue or residual viable tumors. Inflammatory infiltration was found in areas of different signal intensity on MRI images., Conclusions: (1) Different pathological changes in HCCs after TACE are represented by various signal intensities on SE sequence images. The only area of hypo-intensity on T2WI has a specificity in representing coagulation necrosis. (2) FMPSPGR sequence dynamic MRI is superior to SE sequence in demonstrating and determining the necrosis and residual viable tumor. Enhanced areas within the lesions on the early-phase dynamic-contrast images represent residual viable tumors and the enhancement of capsule on early-phase dynamic-contrast images also represent subcapsular residual viable tumors. (3) MRI can demonstrate accurately the areas of necrosis and residual viable HCC tissues after TACE and evaluate the effect of TACE.

Purpose: To evaluate the potential role of external beam radiation therapy (EBRT) in the treatment of patients with hepatocellular carcinoma (HCC) who have portal vein (PV) and/or inferior vena cava (IVC) tumor thrombi., Methods and Materials: One hundred fifty-eight patients with HCC who had PV and/or IVC tumor thrombus were reviewed and analyzed by Kaplan-Meier and Cox regression analysis. Forty-four patients with HCC who received local limited EBRT (in addition to other treatment modalities) were classified as the EBRT group. The total radiation dose was 36-60 Gy (median, 50 Gy) and was focused on the tumor thrombi. One hundred fourteen patients with HCC who did not receive EBRT were selected from hospitalized patients with HCC who had PV and/or IVC thrombi during the same period; these were classified as the non-EBRT group, and their intrahepatic tumors were treated with transarterial chemoembolization or resection, on the basis of the patients' status. Parameters observed included survival rates and the tumor thrombus response to EBRT as seen on CT scan or MRI., Results: Of the 44 patients who received EBRT, 15 (34.1%) showed complete disappearance of tumor thrombi, 5 (11.4%) were in partial remission, 23 (52.3%) were stable in their tumor thrombi, and 1 (2.3%) showed disease progression at the end of the study period. The median survival was 8 months, and the 1-year survival rate was 34.8% in the EBRT group. In the non-EBRT group, the median survival and 1-year survival rates were 4 months and 11.4%, respectively. In stepwise multivariate analysis, EBRT showed a strongly protective value (relative risk = 0.324, p < 0.001). Survival was not related to intrahepatic tumor status in the non-EBRT patients. However, in the EBRT group, poorer prognosis was significantly related to intrahepatic multifocal or diffusion lesions, and the most common reason for death was liver failure caused by uncontrolled intrahepatic disease., Conclusion: Although EBRT is palliative in intent, it is preferred for prolonging survival in the treatment of tumor thrombi.

Purpose: This study evaluated the effect of transcatheter arterial chem-oembolization combined with external beam radiotherapy on the response rates and sur vival of patients with unresectable hepato-cellular carcinoma. Transcatheter arterial chemoembolization is frequently used for the treatment of this cancer, but complete or massive necrosis is seldom observed. Historically, radiotherapy for hepatocellular carcinoma has yielded poor long-term survival. Multimodality therapy has been initiated in an effort to improve survival statistics., Patients and Methods: We retrospectively studied 203 patients with unresectable hepa-tocellular carcinoma, who were free of tumor thrombus, lymph node involvement, or extrahepatic metastasis based on computed tomography scans of the chest and abdomen. Among the 203 patients who received transcatheter ar terial chemoembolization as initial therapy, 54 also received combination therapy with external beam radiotherapy. Tumor response rate, survival, and failure patterns were analyzed and compared between the two groups., Results: Objective responses (complete and partial responses) on computed tomography study were obser ved in 31% and 76% of patients in the non-radiotherapy and radiotherapy groups, respectively. Overall survival rates in the patients in the radiotherapy group were 71.5%, 42.3%, and 24.0% at 1, 2, and 3 years, respectively, improved over the non-radiotherapy group rates of 59.6%, 26.5%, and 11.1% at 1, 2, and 3 years, respectively. Intrahepatic failure was lower in the radiotherapy group than in the non-radiotherapy group, but the difference was not significant. Side effects from radiotherapy were common, but rarely severe., Conclusions: This retrospective study suggests that the outcome of unresectable hepatocellular carcinoma can be influenced by radiation therapy, but a prospective randomized trial would be necessary to draw definitive conclusions.