Local ablative technique

The combination of TACE with local ablative techniques reduces the blood flow during the abla-... 

The combination of TACE with local ablative techniques is more effective than TACE or ablation alone. This multimodal therapy is a promising treatment option for patients with large unresectable HCCs. While an increased survival could be documented for the patients who were treated with combined protocols, the issue of the effectiveness of TACE in treating huge unresectable liver tumors remains unanswered. To establish an optimal therapy schedule, controlled randomized studies comparing the different methods and defining the value of the combined treatments are necessary. 

Fan et al. ascertained that TACE treatment can provide a chance for tumor resection in those patients with initially judged unresectable HCCs. Liver resection should be performed when the tumor has shrunk to a resectable situation after TACE, even when the alpha-fetoprotein (AFP) level has returned to normal (Fan et al. 1998). This principle can also be used by the combination of TACE with local ablative treatments. This technique seems to be promising for large liver tumors and the first results showed that sequential ablation of a large liver tumor after effective TACE treatment can result in a possible local curative outcome (Fan et al. 1998 Vogl et al. 2003). 

Enzymes. Enzymes too are useful labels and several have been employed, with peroxidase and alkaline phosphatase being the most popular to date. One important feature of this technique is for the enzyme to be able to convert a soluble substrate into an insoluble product in order to localize the antigen properly. Several suitable substrates are available with 3 3 -diaminobenzidine (DAB) and 3-amino-9-ethylcarbazole (AEC) being used with peroxidase and 5-bromo-4-chloro-3-indoylphosphate/nitroblue tetrazolium (BCIP/NBT) with alkaline phosphatase. 

---