Embolization chemoembolization therapy

Choi BI, Kim HC, Han JK, Park JH, Kim Yl, Kim ST, Lee HS, Kim CY, Han MC (1992) Therapeutic effect of transcatheter oily chemoembolization therapy for encapsulated nodular hepatocellular carcinoma CT and pathologic findings. Radiology 182 709-713 Chung JW, Park JH, Im JG, Han JK, Han MC (1993) Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 187 689-693... 

Salman HS, Cynamon J, Jagust M, Bakal C, Rozenblit A, Kaleya R, Negassa A, Wadler S (2002) Randomized phase II trial of embolization therapy versus chemoembolization therapy in previously treated patients with colorectal carcinoma metastatic to the liver. Clin Colorectal Cancer 2 173-179... 

Hepatic arterial bland and chemo-embolization have also been utilized. This therapy is based on the anatomic vascular distribution of the blood supply for hepatic tumors. The hepatic artery serves tumors in the liver almost exclusively while the portal vein serves normal hepatic parenchyma. There is some crossover but it is only approximately 10%. Bland embolization uses particles placed in the hepatic artery only while chemoembolization mixes these particles with a variety of chemotherapeutic agents and lipiodol, an iodinated poppy seed oil, which has been shown to increase the uptake into the cell via a pump in the cell wall. This therapy has been utilized for the last 20 years but eventual re-growth and recurrence have also uniformly occurred. Repeated embolizations are necessary to keep the disease in check and to palliate the patient s symptoms. The mean response to embolization is approximately 12-18 months with eventual occlusion of the hepatic arterial supply to the tumor after multiple embolizations. Response to embolotherapy has been dramatic for palliation of symptoms, with 63% of patients reporting a reduction in symptoms and an objective response seen on CT to be 76% either partial or minimal response, with an additional 16% reporting stable disease [4]. The embolotherapy will rid the patient of much of their tumor burden but isolated islets of viable tumor will remain after the procedure, accounting for the resurgence of disease. 

Radioembolization with yttrium-90 ( Y) microspheres represents an innovative approach that has gained increasing awareness and clinical use over the past 5-10 years. The minimal toxicity of radioembolization and the ability to discharge the patient on an outpatient basis make the therapy an attractive alternative in the treatment of primary and metastatic liver malignancies. Patients are able to resume normal activities shortly following treatment, with minimal side effects, in contrast to the post-embolization syndrome often associated with current chemoembolic techniques. 

Biologic Response However, monitoring the size of the tumor is often impractical for several types of minimally invasive regional therapy such as embolization, intraarterial infusion, chemoembolization, or tumor... 

Chemoembolization Moertel et al. (1994) have chronicled their 10 year experience in 111 patients with neuroendocrine hepatic metastases, usually hypervascular, receiving vascular occlusion therapy by a variety of methods. A total of 71 patients also received subsequent alternating chemotherapy regimens (dacarbazine + doxorubicin and streptozotocin + 5-fluorouracil). Objective regression rates of 60% with vascular occlusion alone and 80% with sequential therapy of vascular occlusion and chemotherapy were observed. A median survival time of 37 months was experienced in patients with islet cell carcinoma and 49 months with carcinoid hepatic metastases. Repeated embolizations were preferred. 

Tellez and colleges showed that chemoembolization is a feasible treatment modality in patients with liver metastasis from CRC who have experienced failure with other systemic treatments. It results in high response rates with transient mild-to-moder-ate toxicity. Patients who are able to undergo repetitive chemoembolization procedures may receive the most clinical benefit (Tellez et al. 1998). Salman et al. (2002) resumed that embolization of the liver as second-line therapy in patients with liver-predominant metastases is safe and effective. Median survivals are comparable to those following other second-line therapies. 

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