Chemoembolization

Extensive studies have been reported with cisplatin in the field of chemoembolization (59,98). Microspheres prepared by a solvent evaporation procedure were characterized in vitro and critical processing parameters in regard to drug release kinetics were identified. 

There have been few reports on the cUnical use of albumin microspheres for the delivery of drugs. The limited clinical trials, using chemotherapeutic agents, employ a technique referred to as arterial chemoembolism in which the drug-containing microspheres... 

Carnauba 30-800 Chemoembolism TDS for intra-arterial delivery of cytostatics 5-Fluorouracil, CCNU, methotrexate... 

Patients with hepatic-predominant disease whose disease progresses with systemic therapy may be candidates for hepatic-directed therapies such as chemoembolization, cryotherapy, or radiofrequency ablation. 

Chemoembolization with microencapsulated drugs has been in clinical use since 1978 [6]. Using biodegradable starch microspheres containing anticancer drugs which occlude selected arteries, anticancer drugs can be locally released upon the degradation of starch by serum amylases [333, 334]. 

A 37-year-old woman with refractory idiopathic thrombocytopenic purpura, who had responded dramatically to danazol 600 mg/day after the failure of other forms of treatment, developed a multinodular well-differentiated trabeculovesicular hepatocellular tumor after 5 years. There were no metastases and no invasion of the lymph nodes, and after chemoembolization she received an orthoptic liver transplant. A year later she remained in good condition. 

Tumor necrosis factor a-converting enzyme also transcatheter arterial chemoembolization... 

Sumi, S., Yamashita, Y., Mitsuzaki, K., Yamamoto, H., Urata, J., Nishi-haru, T., Takahashi, M. Power Doppler Sonography assessment of tumor recurrence after chemoembolization therapy for hepatocellular carcinoma. Amer. J. Roentgenol. 1999 172 67—71... 

Farinati, F., de Maria, N., Marafin, C., Herszenyi, L., dei Prato, St., Rinaldi, M., Perini, L., Cardin, R., Naccarato, R. Unresectable hepatocellular carcinoma in cirrhosis. Survival, prognostic factors, and unexpected side effects after transcatheter arterial chemoembolization. Dig. Dis. Sci. 1996 41 2332-2339... 

Pacell C.M., Bizzari, G., Cecconi, R, Caspani, B., Magnolfi, F., BiancUni, A., Anelli, V., Pacella, S., Rossi, Z. Hepatocellular carcinoma long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization. Radiology 2001 219 669-678... 

Kovacs AF, Obitz P, Wagner M. Monocomponent chemoembolization m oral and oropharyngeal cancer usmg an aqueous crystal suspension of cisplatin. Br J Cancer 2002 86(2) 196-202. 

In an open trial, percutaneous ethanol injections into the liver improved prognosis compared with conservative treatment in 63 patients with cirrhosis and hepatocellular carcinoma who were not suitable for surgery or transcatheter arterial chemoembolization (16). Most of the patients had mild to moderate local pain during or immediately after injection and 29% developed fever. 

Kato T, Saito Y, Niwa M, Ishiguro J, Ogoshi K. Combination therapy of transcatheter chemoembolization and percutaneous ethanol injection therapy for imresectable hepatocellular carcinoma. Cancer Chemother Pharmacol 1994 33(Suppl) S115-18. 

A 70-year-old patient with a metastatic carcinoid tumor of the liver presented with a hypertensive crisis after being given pethidine 10 mg/hour by continuous intravenous infusion (4). The patient remained hypertensive with a systolic blood pressure of 210 mmHg, even after chemoembolization of the tumor. The blood pressure... 

Microspheres can be used for chemoembolization of tumors in which the vasculature is blocked while anticancer agent is released from the trapped microparticles. 

Horiguchi Y, Honda T, Fujii S, Matsushima S, and Osaki Y. A Case of Allergic Contact Dermatitis from Propylene Alycol in an Ultrasonic Gel, Sensitized at a Leakage Skin Injury Due to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Int J Dermatol Z005 44 681-683. 

Spenlehauer G, Veillard M, Benoit JP. Formation and characterization of cis-platin-loaded poly(DL-lactide) microspheres for chemoembolization. J Pharm Sci 1986 75 750-755. 

Hepatocellular carcinoma (HCC) represents one of the most common types of cancer, with more than 1 million new cases worldwide and a dramatic increase in the western world. In most cases, HCC is detected at an advanced stage and frequently liver cirrhosis as an underlying disease is present. Therefore, therapeutic options are limited. Beside resection, liver transplantation is regarded the only curative therapy [4]. However, only 10%-15% of patients are candidates for curative surgery - especially due to the shortage of liver donors. There are no effective systemic treatments [4] to date for these patients and transarterial chemoembolization or RE are therefore the only palliative therapies. 

The appropriate examination technique is critical for sensitive detection and specific characterization of focal liver lesions. A biphasic examination of the liver with a late-arterial and a portal venous phase can be regarded as standard today. For specific indications, like the follow-up of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) or for the depiction of the arterial vessels prior to angiography, an early arterial phase scan, which can be post-processed into CT angiography, is helpful (Fig. 3.2). The value of delayed scans (e.g. 5 min after contrast agent injection) is controversial in the literature mainly centers with a focus on imaging in liver cirrhosis consider the use of late phase images as necessary, whereas other authors see no added value for it [21,45]. 

Fig. 3.8. Male patient suffering from a multifocal hepatocellular carcinoma (HCC), treated with repeated sessions of transarterial chemoembolization (TACE). Dyna-CT (Siemens Medical Solutions, Erlangen, Germany) image started together with injection of 10 ml iodinated contrast agent via a super-selective catheter system placed in the right hepatic artery compared with a corresponding MDCT section in the arterial phase after i.v. injection of 120 ml iodinated contrast agent. Note the excellent, direct depiction of arterial blood supply of the HCC nodule in liver segment 5/8 (arrow). The artifacts in the left and right liver lobe are caused by spots of Lipiodol in already treated HCC nodules after earlier transarterial chemoembolization...

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