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5 - Principles of tumor embolotherapy and chemoembolization

from Section II - Principles of image-guided therapies

Published online by Cambridge University Press:  05 September 2016

By
Hwan Jun Jae ,
Jae Hyung Park  and
Jin Wook Chung
Edited by
Jean-Francois H. Geschwind  and
Michael C. Soulen
Hwan Jun Jae
Affiliation:
Seoul National University Hospital
Jae Hyung Park
Affiliation:
Gachon University Gil Medical Center
Jin Wook Chung
Affiliation:
Seoul National University Hospital
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
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Summary

Tumor embolotherapy

General indications

The percutaneous angiographic technique was originally introduced by Seldinger, and modern embolotherapy was first attempted by Rösch et al. to control duodenal bleeding in 1972. The term embolization refers to the induction of vascular occlusion by introducing an embolic agent into a vessel through a selectively placed catheter for therapeutic purposes.

There are various indications of embolization, including bleeding control, tumor devascularization, arteriovenous fistulas and malformations, aneurysms, organ or tissue ablation, varicoceles, blood flow redistribution, and perigraft leakage. Tumors that are indicated for devascularization by embolotherapy include renal cell carcinoma, angiomyolipoma, hepatic tumors, bone and soft-tissue tumors, and uterine fibroids. Transcatheter arterial embolization (TAE) of liver tumors was first reported by Doyon et al., while chemoembolization using Gelfoam and anticancer drugs was originally reported by Yamada et al.

Recently, catheters with hydrophilic coatings and coaxial microcatheter systems have been developed, making possible the precise and safe delivery of embolic materials to any location in the body through blood vessels. The embolization process involves the precise localization of a target lesion, the selection of ideal embolic materials, the complete embolization of the target lesion, and the preservation of non-targeted regions. For effective embolization, the selective and superselective techniques are important in inducing complete embolization and preserving normal parenchyma and target organ function.

Embolic materials

Various embolic materials are now commercially available. Embolic materials must be chosen with the following characteristics in mind: embolization level (proximal or distal), regular size and shape (constant or changing), duration of occlusion (permanent or temporary), ease of injection through a catheter (solid, elastic, or liquid) and potential risk of complication. Many embolic materials have been introduced for TAE, such as gelatin sponge particles, microspheres, autologous blood clots, polyvinyl alcohol (PVA) particles, n-butyl cyanoacrylate (NBCA, glue), and absolute ethanol.

Gelfoam

Gelatin sponge (Gelfoam) is a porous, pliable product that is prepared from purified pork skin and applied to bleeding surfaces as a hemostatic. Gelfoam is the most frequently used embolic material for the devascularization of tumors, and for vascular occlusion for bleeding control. Gelatin sponge particles of 500–1,000 μm do not cause serious hepatic damage in experimental animals or humans with good hepatic functional reserve.

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
 , pp. 35 - 43
Publisher: Cambridge University Press
Print publication year: 2016

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References

1. Seldinger, SI. Catheter placement of the needle in percutaneous arteriography. Acta Radiol 1953; 39: 368–376.Google Scholar
2. Rösch, J, Dotter, CT, Brown, MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 1972; 102: 303–306.Google Scholar
3. Ellman, BA, Parkhill, BJ, Curry, TS 3rd, et al. Ablation of renal tumors with absolute ethanol: a new technique. Radiology 1981; 141: 619–626.Google Scholar
4. Soulen, MC, Faykus, MH Jr., Shalnsky-Goldberg, RD, et al. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol 1994; 5: 587–591.Google Scholar
5. Yamada, R, Sato, M, Kawabata, M, et al. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983; 148: 397–401.Google Scholar
6. Chuang, VP, Soo, CS, Wallace, S, et al. Arterial occlusion: management of giant cell tumor and aneurysmal bone cyst. AJR Am J Roentgenol 1981; 136: 1127–1130.Google Scholar
7. Goodwin, SC, Vedantham, S, McLucas, B, et al. Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 1997; 8: 517–526.Google Scholar
8. Doyon, D, Mouzon, A, Jourde, AM, et al. Hepatic arterial embolization in patients with malignant liver tumors. Ann Radiol (Paris) 1974; 17: 593–603.Google Scholar
9. Reuter, SR, Chuang, VP, Bree, RL. Selective arterial embolization for control of massive upper gastrointestinal tract bleeding. AJR Am J Roentgenol 1975; 125: 119–126.Google Scholar
10. Nishioka, Y, Kyotani, S, Okamura, M, et al. A study of embolizing materials for chemo-embolization therapy of hepatocellular carcinoma: effects of particle size and dose on chitin-containing cis-diamminedichloroplatinum (II) albumin microsphere antitumor activity in VX2 hepatic tumor model rabbits. Biol Pharm Bull 1994; 17: 1251–1255.Google Scholar
11. Gunji, T, Kawauchi, N, Akahane, M, et al. Long-term outcomes of transcatheter arterial chemoembolization with autologous blood clot for unresectable hepatocellular carcinoma. Int J Oncol 2002; 21: 427–432.Google Scholar
12. Tadavarthy, SM, Moller, JH, Amplatz, K. Polyvinyl alcohol (Ivalon) – a new embolic material. AJR Am J Roentgenol 1975; 125: 609–616.Google Scholar
13. Dotter, CT, Goldman, ML, Rösch, J. Instant selective arterial occlusion with isobutyl-2-cyanoacrylate. Radiology 1975; 114: 227–230.Google Scholar
14. Cho, KJ, Reuter, SR, Schmidt, R. Effects of experimental hepatic artery embolization on hepatic function. AJR Am J Roentgenol 1976; 127: 563–567.Google Scholar
15. Chuang, VP, Soo, CS, Wallace, S. Ivalon embolization in abdominal neoplasms. AJR Am J Roentgenol 1981; 136: 729–733.Google Scholar
16. Chuang, VP, Wallace, S. Hepatic arterial redistribution for intraarterial infusion of hepatic neoplasms. Radiology 1980; 135: 295–299.Google Scholar
17. Park, JH, Jeon, SC, Kang, HS, et al. Transcatheter renal arterial embolization with mixture of ethanol and Lipiodol. Invest Radiol 1986; 21: 577–580.Google Scholar
18. Park, JH, Kim, WS, Han, MC, et al. Renal arterial embolization with absolute ethanol. J Korean Med Sci 1987; 2: 13–18.Google Scholar
19. Matsui, O, Kadoya, M, Yoshikawa, J, et al. Small hepatocellular carcinoma: treatment with subsegmental trans-catheter arterial embolization. Radiology 1993; 188: 79–83.Google Scholar
20. Laurent, A. Microspheres and nonspherical particles for embolization. Tech Vasc Interv Radiol 2007; 10: 248–256.Google Scholar
21. Baek, JH, Chung, JW, Jae, HJ, et al. A new technique for superselective catheterization of arteries: preshaping of a micro-guide wire into a shepherd's hook form. Korean J Radiol 2007; 8: 225–230.Google Scholar
22. Kan, Z, Ivancev, K, Lunderquist, A. Peribiliary plexa – an important pathway for shunting of iodized oil and silicon rubber solution from the hepatic artery to the portal vein. An experimental study in rats. Invest Radiol 1994; 29: 671–676.Google Scholar
23. Sigurdson, ER, Ridge, JA, Kemeny, N, et al. Tumor and liver drug uptake following hepatic artery and portal vein infusion. J Clin Oncol 1987; 5: 1836–1840.Google Scholar
24. Yu, AS, Keeffe, EB. Management of hepatocellular carcinoma. Rev Gastroenterol Disord 2003; 3: 8–24.Google Scholar
25. Kruskal, JB, Hlatky, L, Hahnfeldt, P, et al. In vivo and in vitro analysis of the effectiveness of doxorubicin combined with temporary arterial occlusion in liver tumors. J Vasc Interv Radiol 1993; 4: 741–747.Google Scholar
26. Konno, T. Targeting cancer chemotherapeutic agents by use of Lipiodol contrast medium. Cancer 1990; 66: 1897–1903.Google Scholar
27. Sasaki, Y, Imaoka, S, Kasugai, H, et al. A new approach to chemoembolization therapy for hepatoma using ethiodized oil, cisplatin, and gelatin sponge. Cancer 1987; 60: 1194–1203.Google Scholar
28. Ramsey, DE, Kernagis, LY, Soulen, MC, et al. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2002; 13: S211–S221.Google Scholar
29. Marelli, L, Stigliano, R, Triantos, C, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007; 30: 6–25.Google Scholar
30. Nakamura, H, Tanaka, T, Hori, S, et al. Transcatheter embolization of hepatocellular carcinoma: assessment of efficacy in case of resection following embolization. Radiology 1983; 147: 401–405.Google Scholar
31. Nakajo, M, Kobayashi, H, Shimabukuro, K, et al. Biodistribution and in vivo kinetics of iodine-131 Lipiodol infused via the hepatic artery of patients with hepatic cancer. J Nucl Med 1988; 29: 1066–1077.Google Scholar
32. Kan, Z, Sato, M, Ivancev, K, et al. Distribution and effect of iodized poppy seed oil in the liver after hepatic artery embolization: experimental study in several animal species. Radiology 1993; 186: 861–866.Google Scholar
33. Raoul, JL, Heresbach, D, Bretagne, JF, et al. Chemoembolization of hepatocellular carcinomas: a study of the biodistribution and pharmacokinetics of doxorubicin. Cancer 1992; 70: 585–590.Google Scholar
34. Nakamura, H, Hashimoto, T, Oi, H, et al. Transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 1989; 170: 783–786.Google Scholar
35. Sakaguchi, H, Uchida, H, Nishimura, Y, et al. Pharmacokinetic study of Adriamycin in the emulsion mixed with Lipiodol – difference resulting from composition and methods of preparation, and behavior after mesenteric arterial injection in rat. Gan To Kagaku Ryoho 1991; 18: 1349–1355.Google Scholar
36. Goseki, N, Nosaka, T, Endo, M, et al. Nourishment of hepatocellular carcinoma cells through the portal blood flow with and without transcatheter arterial embolization. Cancer 1995; 76: 736–742.Google Scholar
37. Wakasa, K, Sakurai, M, Kuroda, C, et al. Effect of transcatheter arterial embolization on the boundary architecture of hepatocellular carcinoma. Cancer 1990; 65: 913–919.Google Scholar
38. Strohmeyer, T, Haugeberg, G, Lierse, W. Angioarchitecture and blood supply of micro- and macrometastases in human livers. An anatomic–pathological investigation using injection techniques. J Hepatol 1987; 4: 181–189.Google Scholar
39. Taniguchi, H, Daidoh, T, Shioaki, Y, et al. Blood supply and drug delivery to primary and secondary human liver cancers studied with in vivo bromodeoxyuridine labeling. Cancer 1993; 71: 50–55.Google Scholar
40. Miyayama, S, Matsui, O, Yamashiro, M, et al. Ultraselective transcatheter arterial chemoembolization with a 2-f tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 2007; 18: 365–376.Google Scholar
41. Morise, Z, Sugioka, A, Kato, R, et al. Transarterial chemoembolization with degradable starch microspheres, irinotecan, and mitomycin-C in patients with liver metastases. J Gastrointest Surg 2006; 10: 249–258.Google Scholar
42. Varela, M, Real, MI, Burrel, M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007; 46: 474–481.Google Scholar
43. Gonzalez, MV, Tang, Y, Phillips, GJ, et al. Doxorubicin eluting beads-2: methods for evaluating drug elution and in-vitro:in-vivo correlation. J Mater Sci Mater Med 2008; 19: 767–775.Google Scholar
44. Lewis, AL, Taylor, RR, Hall, B, et al. Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 2006; 17: 1335–1343.Google Scholar
45. Poon, RT, Tso, WK, Pang, RW, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol 2007; 5: 1100–1108.Google Scholar
46. Lencioni, R, Baere, T de, Burrel, M, et al. Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 2012; 35: 980–985.Google Scholar
47. Aliberti, C, Tilli, M, Benea, G, et al. Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res 2006; 26: 3793–3795.Google Scholar
48. Tognolini, A, Louie, J, Hwang, G, et al. C-arm computed tomography for hepatic interventions: a practical guide. J Vasc Interv Radiol 2010; 21: 1817–1823.Google Scholar
49. Wallace, MJ, Murthy, R, Kamat, PP, et al. Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol 2007; 18: 1500–1507.Google Scholar
50. Sze, DY, Razavi, MK, So, SK, et al. Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma. Am J Roentgenol 2001; 177: 1339–1345.Google Scholar

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