Liver Metastases: PEI, HAI, Embolization written and compiled by doctordee | Search LMS site |

Percutaneous Ethanol Injection [PEI] Hepatic Arterial Infusion [HAI] Arterial Embolization and Chemoembolization
Percutaneous Ethanol Injection [PEI]
Percutaneous Ethanol Injection [PEI] & Liver Metastases Percutaneous interstitial [through the skin and into the tissue] systems to induce liver tumor necrosis [tissue death] can be classified into two major groups: those using chemical agents (ethanol and acetic acid) and those adopting thermal effects (hot saline, radiofrequency, laser and microwave). Percutaneous Ethanol Injection [PEI] is the injection of ethyl alcohol in high concentration, through the skin, directly into liver tumors. This is done under ultrasound or Xray visualization. Injecting into the tissue or into the blood vessel feeding the tissue leads to cell death by destroying the cell membrane, cooking the cell enzymes, and blocking the blood vessels. [Percutaneous infiltration or intravascular injection of ethanol leads to cell death by causing cell membrane lysis, protein denaturation, and vascular occlusion.] Percutaneously injected ethanol is now used in the ablation of hepatic cysts and solid tumors. As a treatment agent, ethanol combines the benefits of being widely available, inexpensive, efficacious, and relatively easy to administer. Optimal results require that the radiologist have considerable experience in scanning techniques and facility with percutaneous needle insertion under real-time visualization. Percutaneous ethanol injection therapy has a low complication rate. Percutaneous ethanol injection therapy does not always completely ablate tumors, but can be used to debulk or downsize tumors, or to devascularize them prior to surgery. For the latest updates, Search Pubmed for Percutaneous Ethanol Injection and Liver Metastases For discussion of results of treatment and of complications, see the abstracts below. Percutaneous Ethanol Injection [PEI] in the Treatment of Liver Metastases Selected Annotated Medical Journal References [For the full abstract, use the links provided, or search on Pubmed. Ed.] Radiol Med (Torino) 1998 Sep;96(3):238-42 [Ultrasonography-guided percutaneous ethanol injection in large an/or multiple liver metastasis]. [Article in Italian] Giorgio A, Tarantino L, Mariniello N, De Stefano G, Perrotta A, Aloisio V, Del Viscovo L, Alaia A. Servizio di Ecografia ed Ecointerventistica, Ospedale D. Cotugno, Napoli. assanui@tin.it INTRODUCTION: Percutaneous ethanol injection (PEI) under sonographic guidance is an effective therapy for hepatocellular carcinoma on cirrhosis, while less favorable results have been reported for liver metastases. Surgery and/or other new treatments (i.e., interstitial thermotherapy) are indicated only for small metastases (< 3 cm) and surgeons no longer perform the palliative debulking of neoplastic masses. ...thirty-three patients with 62 large (> 3.5 cm) and/or multiple liver metastases, who were not eligible for surgery nor thermotherapy, were treated with one-shot PEI under general anesthesia. The diameter of the nodules ranged 35-92 mm (mean: 39); the lesions were single in 15 patients and localized in both the right and the left lobe in 19 patients. 25-110 ml ethanol were injected per session. Post-treatment results were assessed with dynamic or dual-phase spiral CT; therapeutic success was defined as the absence of hyperdense lesion areas. ... Complete necrosis of the metastases was shown in 10 patients (30.3%). Necrosis rate ranged 70-90% in 21 patients (64%) and was 50% in 2 patients (5.7%). Survival rates were 94%, 80%, 80% and 44% at 12, 24, 36 and 44 months, respectively. No major complications were observed. Seeding of neoplastic cells along the needle tract has been never observed to date. ... Metastasis diameter and number impact on long-term survival. PEI under general anesthesia allows to treat also the patients who are not eligible for other treatments and to inject large amounts of ethanol per session in different tumor areas because metastases usually set on in an otherwise healthy liver. ... One-shot PEI can cause major, even complete, tumor necrosis in large and multiple liver metastases. The absence of any important complications and the survival rates in our series seem to indicate that one-shot PEI is effective for tumor debulking in patients not eligible for surgery and other alternative treatments. Publication Types: Clinical trial Fetch PMID: 9850718 Br J Radiol 2000 Aug;73(872):833-9 Percutaneous ethanol injection of the supplying artery to hepatocellular carcinoma that is not amenable to conventional treatment. Lin ZY, Wang JH, Hsieh MY, Yu ML, Chen SC, Chuang WL, Wang LY, Tsai JF, Chang WY. Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, Republic of China. The purpose of this study was to evaluate the clinical usefulness of ultrasound-guided percutaneous ethanol injection of the supplying artery (PEISA) to the tumour in the palliative management of hepatocellular carcinoma (HCC) that is not amenable to conventional treatments. A total of 23 cases of HCC, measuring from 3.1 cm to larger than 15 cm (median 5.4 cm) in 17 cirrhotic patients, were treated by PEISA. PEISA was used to control rapid growth of the tumour in seven patients and to reduce abdominal discomfort caused by rapid expansion of the tumour in 10 patients. .... Following treatment, one tumour disappeared, 13 tumours shrank and nine tumours were unchanged in size. All patients with abdominal discomfort had relief after treatment. The common complications of PEISA were local pain and fever. In conclusion, PEISA is effective at treating painful HCC unsuitable for conventional treatment. Fetch PMID: 11026857 J Neurosurg. 1998 May;88(5):923-4. Comment in: J Neurosurg. 1999 Sep;91(3):521-3. Tumor devascularization by intratumoral ethanol injection during surgery. Technical note. Lonser RR, Heiss JD, Oldfield EH. Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA. Preoperative reduction in tumor vascularity has been accomplished previously by selective catheterization of tumor vessels and delivery of occlusive materials. The results of percutaneous infusion of vertebral hemangiomas and other vascular lesions led the authors to speculate that rapid devascularization of tumors by direct injection of ethanol (ETOH) could be used to reduce bleeding and facilitate resection during surgery. Thus, the use of intratumoral injection of ETOH and its effects on tumor hemostasis and resectability were examined. Four patients received direct injection of ETOH into either a spinal epidural (two renal cell carcinomas and one rhabdomyosarcoma) or a large cerebellar neoplasm (hemangioblastoma). Intraoperative perfusion of the tumors with ETOH produced immediate blanching and devascularization and enhanced visualization and resection. Incremental tumor devascularization is achieved by careful injection of small amounts of ETOH directly into the lesion, producing immediate and complete regional tumor devascularization. Use of this technique reduces intratumoral bleeding and enhances the ease and effectiveness of resection. Fetch PMID: 9576266 Eur J Surg Oncol 2000 Feb;26(1):67-72 Multimodality treatment for patients with hepatocellular carcinoma: a single institution retrospective series. Takano S, Watanabe Y, Ohishi H, Kono S, Nakamura M, Kubota N, Iwai S. Third Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. ... The main therapeutic options for hepatocellular carcinoma (HCC) are hepatic resection, transcatheter arterial embolization (TAE), percutaneous ethanol injection therapy (PEIT) and regional chemotherapy (RC). ... This study retrospectively examined the results of primary treatment of 600 patients with hepatocellular carcinoma .... RESULTS: The selected primary treatment was hepatic resection for 53.7% of the cases, TAE for 31.5%, PEIT for 8.2% and RC for 6.6%,. .... The cumulative 5 and 7-year survival rates after the primary treatments were 52.% and 40.1%, respectively, for hepatic resection; 46.5% and 38.7%, for TAE; 49.6% and 33.1% for PEIT; and 16.7% and 8.3% for RC. ... To improve the treatment results for HCC, early detection is essential and various modalities of treatments in combination should be used for recurrence after primary treatment. Fetch PMID: 10718183 Acta Radiol 1996 Sep;37(5):655-9 Complications following high-dose percutaneous ethanol injection into hepatic tumors. Tapani E, Soiva M, Lavonen J, Ristkari S, Vehmas T. Department of Radiology, Helsinki University Central Hospital, Finland. ... Percutaneous ethanol injection therapy (PEIT) with a 2-10 ml ethanol dose per session is widely used in the treatment of small hepatocellular carcinoma. Larger doses have been restricted for fear of complications. The aim of the present study was to make a retrospective evaluation of the complications following treatment of hepatic tumors with high doses of ethanol (up to 200 ml). ... ....: Serious complications did not occur. Pain was a common side effect, occurring in 48% of the procedures. Immediate pain during the treatment was related to the ethanol dose and increased significantly with increasing doses (p < 0.01). Other side effects were rare. ... PEIT with doses higher than previously reported seems to be safe. This should encourage further clinical studies that aim at fully working out the clinical value of such treatment. Fetch PMID: 8915270 J Ultrasound Med 1998 Aug;17(8):531-3 Comment in: J Ultrasound Med. 1999 Apr;18(4):314 Complications of percutaneous ethanol ablation. Gelczer RK, Charboneau JW, Hussain S, Brown DL Department of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. Percutaneous ethanol injection therapy performed with sonographic visualization is a steadily growing therapeutic method that can be used in the ablation of solid and cystic masses in a variety of anatomic locations.... Local infiltration or intravascular injection of ethanol leads to cell death by causing cell membrane lysis, protein denaturation, and vascular occlusion. ... percutaneously injected ethanol is now used in the ablation of hepatic cysts and solid tumors, ...As a treatment agent, ethanol combines the benefits of being widely available, inexpensive, efficacious, and relatively easy to administer. Optimal results require that the radiologist have considerable experience in ultrasonographic scanning techniques and facility with percutaneous needle insertion under real-time visualization. Alternatively, the radiologist may choose CT as a method to visualize needle placement. Percutaneous ethanol injection therapy ... has a low complication rate. We present two patients in whom hypotensive complications occurred during percutaneous ethanol injection therapy and discuss the likely causative mechanisms. Fetch PMID: 9697961 Liver Transpl Surg 1998 Jul;4(4):271-5 An appraisal of percutaneous treatment of liver metastases. Mazziotti A, Grazi GL, Gardini A, Cescon M, Pierangeli F, Ercolani G, Jovine E, Cavallari A. Policlinico S. Orsola, University of Bologna, Italy. "Percutaneous treatments, such as ethanol injection and radiofrequency, have been recently proposed for the treatment of liver metastases. The aim of this study was to evaluate the effects of these treatments in ... 8 patients who subsequently underwent liver resection." "These patients had been treated with percutaneous methods between December 1995 and May 1997.... the primary tumor was... in 1 patient, ileal leiomyosarcoma. The lesions were all initially small...The number of...[treatments]... ranged from 2 to 21. In all patients, a progression of the disease occurred... Histologic examination of all surgical specimens revealed the presence of vital neoplastic tissue; only two specimens of carcinoid tumors showed more than 50% necrosis of the nodules treated percutaneously. These results led us to express doubts as to the efficacy of percutaneous ablative treatment for liver metastases." Copyright 1998 W.B. Saunders Company. Fetch PMID: 9649639 Acad Radiol 1997 Sep;4(9):634-8 Liver tumor ablation: real-time monitoring with dynamic CT. [In rabbits. ed.] Hahn PF, Gazelle GS, Jiang DY, Compton CC, Goldberg SN, Mueller PR. Department of Radiology, Massachusetts General Hospital, Boston 02114, USA. ... To determine whether incomplete contact of ethanol with tumor limits the success of percutaneous ethanol injection therapy. ... Percutaneous ethanol injection was performed in seven normal New Zealand white rabbits and 18 rabbits with 1-3-cm liver tumors .... ... In normal animals, virtually all injected ethanol tracked to the hepatic capsule. As ethanol was injected into tumors, peripheral tracking, similar to that seen in normal livers, or extratumoral puddling was observed. Ethanol-tumor contact was incomplete in 16 of 18 animals (89%). Histopathologic analysis showed incomplete tumor necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis, the tumor failed to hold sufficient ethanol for successful ablation by means of percutaneous ethanol injection therapy. Fetch PMID: 9288191 Gan To Kagaku Ryoho. 2001 Aug;28(8):1083-9. [Less invasive medical therapy for hepatocellular carcinoma][Article in Japanese] Ikeda K. Dept. of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan. Since hepatocellular carcinoma (HCC) usually occurs in chronic liver disease, especially viral cirrhosis, it often recurs even after surgical resection. Because of the high recurrence rate of HCC, less invasive therapies have become more common recently, including percutaneous ethanol injection (PEI), percutaneous microwave coagulation therapy(PMCT), and radiofrequency ablation(RFA). A PEI needle or a coagulation electrode is usually inserted into an HCC nodule under ultrasonographic-guidance, and chemical or heat ablation is carried out with local or general anesthesia. A patient with a few numbers of small HCCs of 3 cm or less in diameter is a good candidate for these therapy modalities. Although RFA is the easiest and most effective of these therapies the best therapy for each patient is selected according to the number, size, and location of target lesions. Fetch PMID: 11525022 Langenbecks Arch Surg 1999 Aug;384(4):339-43 Percutaneous ethanol injection and radio-frequency ablation for the treatment of nonresectable colorectal liver metastases - techniques and results. Becker D, Hansler JM, Strobel D, Hahn EG. Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstr. 12, D-91054 Erlangen, Germany, dirk.becker@med1.med.uni-erlangen.de BACKGROUND: Percutaneous ethanol injection (PEI) and radio-frequency (RF) ablation are possible palliative treatment modalities for patients with non-resectable liver metastases of colorectal carcinomas. The different techniques are explained and reviewed. ... PEI did not show promising results for the treatment of liver metastases. RF results were more encouraging; some studies showed improved mean survival times for patients when a complete necrosis of the metastases could be achieved. The maximum diameter of the necrotic area possible in a single session is about 5 cm. ... PEI and RF are palliative last-line treatment strategies for patients with non-resectable liver metastases and should only be applied if chemotherapy is not sufficient or not possible. The long-term efficacy of RF ablation in this group of patients has to be evaluated. Fetch PMID: 10473853 Acta Radiol 2000 Sep;41(5):458-63 High-dose percutaneous ethanol injection therapy of liver tumors. Patient acceptance and complications. Elgindy N, Lindholm H, Gunven P. Department of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden. ... To study the safety of high-dose ethanol injections in liver tumors and their acceptability as out-patient procedures under local anesthesia. ... High-dose injections with an average volume of 39 ml gave a mean pain score of 5.1, with a weak relationship between pain and volume. Other side effects and complications were unrelated to the ethanol dose. They comprised 1 syncopation, 1 occasion of hypoventilation requiring antidote to opiates, 12 short episodes of nausea or vomiting without need for i.v. fluids, 2 instances of sepsis, and 1 abscess that was drained percutaneously. Thirty-nine of the 62 sessions were performed in day care. .... Low-dose injections resulted in a mean pain score of 4.7 with the same requirement of i.v. analgesics as high doses, fewer instances of nausea and no infectious complications. ... High-dose ethanol injections in patients with liver malignancy had no mortality and a reasonable complication rate. They could be given without general anesthesia, often in day care. Fetch PMID: 11016766 Eur J Gastroenterol Hepatol 2000 Mar;12(3):285-90 Early detection of haemobilia associated with percutaneous ethanol injection for hepatocellular carcinoma. Obi S, Shiratori Y, Shiina S, Hamamura K, Kato N, Imamura M, Teratani T, Sato S, Komatsu Y, Kawabe T, Omata M. Department of Gastroenterology, University of Tokyo, Japan. ... Haemobilia [bile in the blood] often results from iatrogenic [doctor-caused] injury [to the gall bladder] caused by therapeutic procedures. ... Early diagnosis of haemobilia based on ultrasonographic findings of the gallbladder lumen effectively reduces the severity of haemobilia-related complications due to immediate interruption of the interventional procedure. Fetch PMID: 10750648 Int J Clin Pract 1999 Jun;53(4):257-62 Percutaneous ethanol injection therapy in 47 cirrhotic patients with hepatocellular carcinoma 5 cm or less: a long-term result. Lin SM, Lin DY, Lin CJ. Liver Research Unit, Chang Gung University, Taipei, Taiwan. To elucidate the long-term results of percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC), 47 cirrhotic patients with HCC < or = 5 cm after PEI were analysed. ... 5-10 ml 95% ethanol was injected into the tumour every three to seven days until the echogenicity of the tumour changed to a hyperechoic or heterogeneous one. A booster PEI was given in 34 (56%) lesions with viable tumour, which was detected by dynamic computed tomography. The one, two, three and four-year survival rates were 85%, 75%, 61% and 39% respectively for all patients. Good liver reserve significantly improved the survival rate ... The one, two, three and four-year recurrence rates were 24%, 55%, 69% and 79% for all patients. HCC recurred more frequently in patients with multiple tumours (p < 0.02). Fetch PMID: 10563068 Eur J Gastroenterol Hepatol 1998 Nov;10(11):915-8 Comment in: Eur J Gastroenterol Hepatol. 1998 Nov;10(11):907-9 Hepatic infarction following percutaneous ethanol injection therapy for hepatocellular carcinoma. Seki T, Wakabayashi M, Nakagawa T, Imamura M, Tamai T, Nishimura A, Yamashiki N, Okamura A, Inoue K. Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan. We report on two patients who developed hepatic infarction after undergoing percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC). In both cases, liver function parameters deteriorated immediately after the ethanol injection, and enhanced computed tomography images showed a wedge-shaped avascular low-density area due to hepatic infarction. ... When PEIT is used for patients with HCC who have previously undergone TAI, especially with SMANCS, PEIT may induce hepatic infarction. Fetch PMID: 9872612 Abdom Imaging 1998 Nov-Dec;23(6):608-10 Fatal thrombosis of the portal vein following single-session percutaneous ethanol injection therapy of hepatocellular carcinoma. Lencioni R, Cioni D, Uliana M, Bartolozzi C. Department of Oncology, University of Pisa, Italy. Two weeks after percutaneous ethanol injection therapy for hepatocellular carcinoma, performed by injecting 110 mL ethanol in a single session with general anesthesia, a 69-year-old woman with well-compensated liver cirrhosis developed an extensive thrombosis of the whole portal tree that caused severe uncorrectable ascites and progressive deterioration of her general condition, resulting in death 6 weeks after the procedure. Fetch PMID: 9922194 Acta Gastroenterol Belg 1999 Jan-Mar;62(1):49-51 Acute renal failure requiring haemodialysis after high doses percutaneous acetic acid injection for hepatocellular carcinoma. Van Hoof M, Joris JP, Horsmans Y, Geubel A. Department of Gastroenterology, Saint Luc University Hospital, Bruxelles, Belgium. Recently, ultrasound-guided percutaneous acetic acid injection has been proposed in the treatment of hepatocellular carcinoma ...We report the case of severe renal failure requiring haemodialysis that occurred in a patient with 4 cm hepatocellular carcinoma treated adequately by high dose percutaneous acetic acid injection. The risk of such a serious side effect, likely related to a direct toxic effect of acetic acid, should be of concern when considering percutaneous treatment of hepatocellular carcinoma. Acute renal failure has been reported as a complication of acetic acid poisoning, but to our knowledge, we report here the first case of acute renal failure following high dose percutaneous acetic acid injection. Fetch PMID: 10333599 Gastroenterol Clin Biol 1998 Apr;22(4):459-61 [Massive hepatic necrosis secondary to treatment of hepatocellular carcinoma by percutaneous alcoholization].[Article in French] Boucher E, Carsin A, Raoul JL, Marchetti C, Joram F, Kerbrat P. Centre Regional de Lutte contre le Cancer, Rennes. Fatal complication ... We report a case of massive hepatic necrosis after treatment by percutaneous ethanol injection of a 4 cm diameter hepatocellular carcinoma, which resulted in the death of the patient. The mechanism of this complication was probably an intratumoral aterioportal shunt, which allowed ethanol to spread through the blood vessels. Fetch PMID: 9762276
Hepatic Arterial Infusion [HAI]
Hepatic Arterial Infusion [HAI] & Liver Metastases Hepatic Arterial Infusion [HAI] has been used for many years to treat liver tumors (primary or secondary) if no extrahepatic extension exists, when no resection is feasible, and when no active systemic chemotherapy is available. It is also useful for downgrading inoperable situations to operable ones. [There is a slow pumping of chemotherapy agents into the hepatic artery. LMS liver metastases get their blood supply from the hepatic artery. So they get a higher concentration of the chemotherapy agent, than if it was given intravenously. The liver can tolerate a higher concentration of the chemotherapy agent than the rest of the body, because it detoxifies it right then and there. So the liver mets get a higher concentration of the chemotherapy agent, and the liver detoxifies the rest of the blood so that the rest of the body is shielded somewhat from the chemo agent.] Infusion of cytotoxic agents into the hepatic artery is a form of therapy for unresectable hepatic metastases. The recent development of a totally implantable pump has allowed prolonged infusion of chemotherapeutic agents with good compliance and quality of life. The use of agents with high hepatic extraction results in minimal systemic toxicity. Such regional chemotherapy can increase the likelihood of hepatic response compared with systemic treatment. For the latest updates, Search Pubmed for hepatic intraarterial infusion and sarcoma Search Pubmed for hepatic arterial infusion and sarcoma Search Pubmed for hepatic intraarterial infusion and metastases Search Pubmed for hepatic arterial infusion and metastases For further information and references for this section, see below: Hepatic Arterial Infusion [HAI] & Liver Metastases Selected Medical Journal Article Annotated Citations [For the full abstract, use the links provided, or search on Pubmed. Ed.] Oncol Res. 1999;11(11-12):529-37. A clinical-pharmacological evaluation of percutaneous isolated hepatic infusion of doxorubicin in patients with unresectable liver tumors.Hwu WJ, Salem RR, Pollak J, Rosenblatt M, D'Andrea E, Leffert JJ, Faraone S, Marsh JC, Pizzorno G. Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA. hwuw@mskcc.org A dose escalation study of hepatic arterial infusion of doxorubicin during hemodynamic isolation of the liver (the Delcath system) was conducted to: 1) study the pharmacokinetics of regional doxorubicin therapy, and 2) define therapeutic efficacy in the treatment of unresectable liver tumors. Eighteen patients with unresectable primary or metastatic tumor in the liver were treated with 57 procedures. Pharmacokinetic studies were performed on all treatments. Hepatic extraction ratio of doxorubicin remained constant at 60.3+/-12.1%. independent of the dose escalation. The calculated intrahepatic concentration of doxorubicin ranged from 30 to 88 microg/ml when the dosage of doxorubicin was escalated from 50 to 120 mg/m2. Dose-limiting systemic toxicity (grade 4 myelosuppression) was observed at 120 mg/m2. Twelve of 14 patients who received more than one treatment at 90 or 120 mg/m2 were evaluable for disease response: there were 4 partial responses, 3 minor responses, I stable disease, and 4 progressive disease. The median overall survival of responders was 23 months, and for nonresponders it was 8 months. We have demonstrated a dose-response effect of hepatic infusion of doxorubicin at 90 and 120 mg/m2 in advanced hepatic malignancies. The isolated hepatic perfusion system improves the therapeutic index of doxorubicin and provides pharmacologic justification for its use in the treatment of unresectable hepatic malignancies, especially metastatic melanoma and sarcoma. Fetch PMID: 10905565 Liver Transpl Surg. 1999 Jan;5(1):65-80. Management of hepatic metastases. Choti MA, Bulkley GB. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Although the liver is the most common site of metastatic disease from a variety of tumor types, isolated hepatic metastases most commonly occur from colorectal cancer and, less frequently, from neuroendocrine tumors, gastrointestinal sarcoma, ocular melanoma, and others. Complete evaluation of the extent of metastatic disease, both intrahepatically and extrahepatically, is important before considering treatment options. Based on a preponderance of uncontrolled studies for hepatic metastatic colorectal carcinoma, surgical resection offers the only potential for cure of selected patients with completely resected disease, with 5-year survival rates of 25% to 46%. Systemic and hepatic arterial infusion chemotherapy may be useful treatment options in patients with unresectable disease and possibly as an adjuvant treatment after liver resection. Other techniques of local tumor ablation, including cryotherapy and radiofrequency ablation, although promising, remain unproved. Management of hepatic metastases from neuroendocrine tumors and other noncolorectal primary tumors should be individualized based on the patient's clinical course, extent of disease, and symptoms. Fetch PMID: 9873095 Oncology (Huntingt) 2000 Dec;14(12 Suppl 11):48-51 Intrahepatic therapy for resected hepatic metastases from colorectal carcinoma. Alberts SR. Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA. alberts.steven@mayo.edu A significant number of patients with colorectal cancer will present with hepatic metastases as their only site of metastatic disease. Surgical resection in patients with a limited number of metastases will lead to long-term survival in up to one-third. However, following surgery, many of these patients will relapse within the liver, and many will develop extrahepatic metastases. The use of hepatic artery infusion alternating with systemic therapy has proven to reduce the risk of recurrent disease and improve survival... Publication Types: Review Review, tutorial Fetch PMID: 11204664 [PubMed - indexed for MEDLINE Recent Results Cancer Res 1998;147:3-12 Are there indications for intraarterial hepatic chemotherapy or isolated liver perfusion? The case of liver metastases from colorectal cancer. Rougier P. Service d'hepato-gastroenterologie, Hopital Ambroise Pare, Boulogne, France. Intraarterial hepatic chemotherapy (IAHC) has been used for many years to treat liver tumors (primary or secondary) if no extrahepatic extension exists, when no resection is feasible, and when no active systemic chemotherapy is available. Liver metastases from colorectal cancer represent one of the best indications, and many trials have demonstrated that IAHC is an efficient treatment. .... Liver toxicity and extrahepatic progression are the two main limiting factors that can be reduced using new protocols and combinations with systemic chemotherapy. ... Isolated liver perfusion adds to IAHC an extracorporal extraction and allows the use of higher doses of chemotherapy. Its efficacy has been suggested in small phase II trials; however, its relative complexity and the lack of clear demonstration of its efficacy compared to the most recent and effective systemic chemotherapies used alone or in combination with IAHC prevent the recommendation of its use outside clinical trials. IAHC and isolated liver perfusion are two active locoregional treatments that can be combined with surgical resection and/or systemic chemotherapy ... Fetch PMID: 9670263 Ann Ital Chir 1996 Nov-Dec;67(6):793-7 [Locoregional chemotherapy of liver metastasis from colorectal carcinoma]. [Article in Italian] Zamparelli G, Pancera G, Pessi MA, Dallavalle G, Pirovano M, Valsecchi R, Labianca R, Samori G, Luporini G. Divisione Oncologia Medica, Azienda Ospedaliera San Carlo Borromeo di Milano. Hepatic metastases are a major cause of death in patients with colorectal carcinoma. Traditional intravenous chemotherapy produces responses in 10% to 30% of patients and surgical resection is feasible in approximately 20% of patients. Infusion of cytotoxic agents into the hepatic artery is the most promising form of therapy for unresectable hepatic metastases. The recent development of a totally implantable pump has allowed prolonged infusion of chemotherapeutic agents with a good compliance and quality of life of the patients. The rationale for hepatic arterial infusion (HAI) present an anatomical and pharmacological basis with the use of agents with high hepatic extraction resulting in minimal systemic toxicity. ... Fetch PMID: 9214270 Ann Surg Oncol 2000 Aug;7(7):490-5 Surgery after downstaging of unresectable hepatic tumors with intra-arterial chemotherapy. Meric F, Patt YZ, Curley SA, Chase J, Roh MS, Vauthey JN, Ellis LM. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. ... This retrospective study was performed to assess the outcome among patients who underwent hepatic resection or tumor ablation after hepatic artery infusion (HAI) therapy down-staged previously unresectable hepatocellular carcinoma (HCC) or liver metastases from colorectal cancer (CRC). ... CONCLUSIONS: Hepatic resection or ablation after tumor downstaging with HAI therapy is a viable option for patients with unresectable HCC. However, given the high rate of recurrence of metastases from CRC, hepatic resection or ablation after downstaging with HAI should be used with caution. Fetch PMID: 10947016 Zhonghua Zhong Liu Za Zhi 1996 Sep;18(5):365-7 [The clinical efficacy of hepatic artery infusion chemotherapy and chemoembolization in the treatment of liver metastases]. [Article in Chinese] Zeng X, Wang S, Wei C. Department of Radiology, Wuhan General Hospital of Guangzhou Miliary Region. The efficacy and clinical experience of transcatheter hepatic artery infusion chemotherapy alone or chemoembolization in 118 patients with hepatic metastases were reviewed. Hepatic arterial infusion chemotherapy followed by embolization with lipiodol suspension and gelatin sponge pieces was carried out in 72 cases, infusion chemotherapy followed by embolization with lipiodol suspension in 32, and arterial infusion chemotherapy alone in 14. The results showed that the clinical efficacy of the first method was the best while that of the third method was the worst. The best effect was seen in patients with the single and hypervascular metastatic focus. The overall survival rate was 86.0%, 25.0%, 3.0% in 1 year, 3 years and 5 years, respectively. Fetch PMID: 9387277
Arterial Embolization and Chemoembolization
Embolization and Chemoembolization & Liver Metastases Despite frequent tumor recurrence, the long-term outcome after liver resection for hepatic metastases from leiomyosarcoma is superior to that after chemotherapy and chemoembolization. Reference However, embolization or chemoembolization and intra-arterial infusion chemotherapy could be use for downsizing inoperable or unablatable liver metastases. The treated mets might then be operable. [Neoadjuvant therapy] Also, this regional therapy may offer new hope for those sarcoma patients who have liver mets resistant to combination systemic chemotherapy. Embolization or Chemoembolization can be used for downgrading of tumors prior to surgical resection, or for extension of survival time, or for treatment of symptomatic metastases. Embolization or chemoembolization is not curative by itself, and additional therapy is required to eradicate residual disease. But these methods can be excellent de-bulkers. Side effects and complications might include: liver pain, liver enzyme blood level increase, liver abscess, gastrointestinal reaction [paralytic ileus] requiring a nasogastric tube, urinary electrolyte losses requiring supplements, and occasionally mild but transient low white cell or platelet count. The normal liver presents a double circulation: 75% from portal circulation and 25% from hepatic artery. In malignant primary and secondary lesions the blood support to the tumors is given by the hepatic artery. Anticancer drugs mixed with some 'embolic' particles such as polyvinyl alcohol and gelatin powder can be injected selectively in the arteries that feed tumors. This causes clotting in those arteries, and infarcts [kills cells by obstructing their blood supply] tumors. Additionally, with Chemoembolization, the anticancer drugs work on the tumor. Their work is enhanced by their not being quickly washed away by the blood circulation [which has been clotted or slowed]. Radio-opaque contrast media can also be present in the mixture, and the progress of the mixture monitored radiologically. Chemoembolization causes massive shrinkage due to ischemia, and increases the local drug intensity and drug exposure. The hepatic artery is reached by advancing a catheter from the femoral or other artery to the hepatic artery. The catheter can be advanced into the artery that feeds the tumor's blood supply, and the embolization material is injected, followed by the chemotherapy regimen previously decided upon, until the feeder artery no longer transports liquid. Side Effects and Complications are obvious ones: liver trauma, liver failure, artery rupture, infection, abscess, reaction to the injected materials, the side effects due to the injected materials, fever, pain, misdirected drainage of the injected material resulting in damage to other structures. Some of these "side effects" can be fatal. Risk factors for liver failure after embolization include poor hepatic functional reserve, high-dose infusion of chemotherapeutic agents, and a history of multiple embolization procedures. For the latest updates, Search Pubmed for LMS & liver embolization Search Pubmed for Sarcoma & liver embolization Search Pubmed for LMS & liver chemoembolization Search Pubmed for Sarcoma & liver chemoembolization Search Pubmed for Chemoembolization and liver metastases References for this section are below. Arterial Embolization and Chemoembolization & Liver Metastases Selected Medical Journal Article Annotated Citations [For the full abstract, use the links provided, or search on Pubmed. Ed.] Ann Surg 2000 Apr;231(4):500-5 Hepatic metastases from leiomyosarcoma: A single-center experience with 34 liver resections during a 15-year period. Lang H, Nussbaum KT, Kaudel P, Fruhauf N, Flemming P, Raab R. Klinik fur Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany. hauke.lang@uni-essen.de ... To describe a large single-center experience with hepatic resection for metastatic leiomyosarcoma. ... the role of liver resection for hepatic metastases from leiomyosarcoma has not been defined. ...The records of 26 patients who between 1982 and 1996 underwent a total of 34 liver resections for hepatic metastases from leiomyosarcoma were reviewed. There were 23 first, 9 second, and 2 third liver resections. The records were analyzed with regard to survival and predictive factors. ...In the 23 first liver resections, there were 15 R0, 3 R1, and 5 R2 resections. Median survival was 32 months after R0 resection and 20.5 months after R1/2 resection. The 5-year survival rate was 13% for all patients and 20% after R0 resection. ...In 10 patients with extrahepatic tumor at the time of the first liver resection, 6 R0 and 4 R2 resections were achieved. After R0 resection, the median survival was 40 months (range 5-84 months), with a 5-year survival rate of 33%. ...After repeat liver resection, the median survival was 31 months (range 5-51 months); after R0 resection, median survival was 31 months and after R1/2 resection it was 28 months. There was no 5-year survivor in the overall group after repeat liver resection. ... Despite frequent tumor recurrence, the long-term outcome after liver resection for hepatic metastases from leiomyosarcoma is superior to that after chemotherapy and chemoembolization. Although survival after tumor debulking also seems to be more favorable than after nonoperative therapy, these data indicate that only an R0 resection offers the chance of long-term survival. The presence of extrahepatic tumor should not be considered a contraindication to liver resection if complete removal of all tumorous masses appears possible. In selected cases of intrahepatic tumor recurrence, even repeated liver resection might be worthwhile. In view of the poor results of chemoembolization and chemotherapy in hepatic metastases from leiomyosarcoma, liver resection should be attempted whenever possible. Fetch PMID: 10749609 Gan To Kagaku Ryoho 1997 Sep;24(12):1878-81 [A case of liver metastasis of gastric leiomyosarcoma successfully treated by transarterial hepatic chemo-embolization and intra hepato-arterial chemotherapy repeated with infusion-a-port]. [Article in Japanese] Miya A, Yasuda S, Morimoto O, Tsuji Y, Shiozaki K, Baba M, Ishida H, Masutani S, Tatsuta M, Kawasaki T, Satomi T. Dept. of Surgery, Sakai Municipal Hospital. The patient was a 68-year-old male, who underwent total gastrectomy for giant leiomyosarcoma of the stomach and then had multiple hepatic metastases one year and six months later. Thus, transarterial hepatic chemo-embolization therapy with Lipiodol, adriamycin and gelfoam was given. Moreover, using a reservoir catheter and infusion arterial port, intermittent arterial infusion therapy with adriamycin, cyclophosphamide, and vincristine was attempted. In the metastasis lesion where there were rich blood vessels, Lipiodol was accumulated and the tumor was reduced on abdominal CT. The result indicated the efficacy of this treatment. Fetch PMID: 9382556 Gan To Kagaku Ryoho 1997 Sep;24(12):1741-4 [A case of liver metastases from leiomyosarcoma in the chest wall which was made resectable by chemoembolization]. [Article in Japanese] Mori K, Yamada S, Kosaka A, Watabiki Y, Ohara M, Yamazaki M, Shikata A, Hoshiya Y. Dept. of Surgery, Shimizu Municipal Hospital. We here report a recently experienced case in which TAE and intra-arterial infusion chemotherapy for treatment of liver metastases of leiomyosarcoma in the chest wall caused a shrinking of the metastasized focus, thus facilitating liver resection. ... A 38-year-old man ... Resection of leiomyosarcoma in his chest wall was done in May 1994. However, a local recurrence was noted in September 1995, and the tumor was removed. Then, he received systemic chemotherapy with CDDP (100 mg) and ADM (45 mg). Abdominal CT and ultrasonic examinations made in February 1996 revealed liver metastases at S2, 5,8. Angiography detected densely stained images of tumors at a number of sites along with S2, 5,8. Since these were thought unresectable, TAE therapy with EPIR (30 mg) and lipiodol (4 ml) was attempted 3 times. Then, a reservoir for intra-hepatic arterial infusion was implanted in April, 1996 and EPIR at a dose of 30 mg (150 mg in total) was given through arterial infusion, resulting in tumor disappearance at S5, 8 but further growth of the tumor metastasizes at S2. Therefore, a resection of the left lateral segment of liver was done August 23. Though he was discharged in October, metastasis was found in the thoracic spine in December. Thus, he underwent resection of the vertebral arch including the tumor. Fetch PMID: 9382521 Cancer 1995 Apr 15;75(8):2083-8 Gastrointestinal leiomyosarcoma metastatic to the liver. Durable tumor regression by hepatic chemoembolization infusion with cisplatin and vinblastine. Mavligit GM, Zukwiski AA, Ellis LM, Chuang VP, Wallace S. Department of Clinical Immunology and Biological Therapy, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. ... Gastrointestinal leiomyosarcoma metastatic to the liver is considered most resistant to any combination of systemic chemotherapy containing doxorubicin and/or ifosphamide. ... Fourteen patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated with hepatic chemoembolization infusion consisting of polyvinyl alcohol sponge particles mixed with cisplatin powder (150 mg) followed by an intrahepatic arterial infusion of vinblastine (10 mg/m2). ... Ten major (> 50% regression) tumor responses were observed (70%) in patients lasting from 8 to 31+ months (median, 12 months) after an average of two hepatic chemoembolization procedures, usually 4 weeks apart. Transient side effects included right upper quadrant pain requiring narcotics, significant hepatic enzyme elevation, particularly of lactic dehydrogenase with a minimal increase in bilirubin, paralytic ileus requiring nasogastric suction up to 72 hours, urinary electrolyte losses (potassium+, magnesium++, sodium+) requiring supplements, and occasionally mild but transient leukopenia and thrombocytopenia. ... Hepatic chemoembolization infusion appears to induce a high rate of durable tumor response in patients with notoriously chemoresistant gastrointestinal leiomyosarcoma metastatic to the liver. [This is probably a GIST. Ed.] Fetch PMID: 7697597 Gan To Kagaku Ryoho 1994 Sep;21(13):2233-6 [Analysis of cases with liver abscess following transcatheter arterial chemoembolization (TAE) for malignant hepatic tumors]. [Article in Japanese] Ishikawa H, Kanai T, Ono T, Shimoyama Y, Aizawa K, Ishida H, Saitoh Y, Hata H, Aoki A, Okuda S, et al. Dept. of Surgery and Radiology, Hiratsuka City Hospital. ... These results suggest the major factor leading to abscess formation is biliary infection. Therefore, a previous bilio-enteric anastomosis should be regarded as a risk factor for liver abscess following TAE. Fetch PMID: 7944448 Gan To Kagaku Ryoho 1993 Jan;20(1):141-3 [Hepatic metastases from jejunal leiomyosarcoma treated effectively by repeated transarterial embolization with carboplatin]. [Article in Japanese] Kokufu I, Kurokawa E, Akashi H, Mizumoto S, Kishibuchi M, Aoki Y, Inoue Y. Dept. of Surgery, Minoh City Hospital. A 67-year-old man ... was diagnosed as having jejunal leiomyosarcoma and multiple liver metastases after examination. The jejunal leiomyosarcoma was resected by operation. Unresectable liver metastases were repeatedly treated by transarterial embolization with carboplatin and Lipiodol, and a significant reduction was achieved. ... He has remained well presently for 1 year 10 months after operation. Fetch PMID: 8380684 Cancer 1991 Jul 15;68(2):321-3 Regression of hepatic metastases from gastrointestinal leiomyosarcoma after hepatic arterial chemoembolization. Mavligit GM, Zukiwski AA, Salem PA, Lamki L, Wallace S. Department of Clinical Immunology, University of Texas M.D. Anderson Cancer Center, Houston 77030. Two patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated by hepatic chemoembolization with cisplatin and polyvinyl sponge followed by hepatic arterial infusion of vinblastine. Effective palliation in terms of durable tumor regression was achieved in both patients after two chemoembolization-infusion procedures. These results suggest that regional therapy may offer new hope for the subset of sarcoma patients who have liver metastases resistant to combination systemic chemotherapy. Fetch PMID: 2070331 Zhonghua Yi Xue Za Zhi (Taipei) 2000 Nov;63(11):838-43 Abdominal wall necrosis following transcatheter arterial chemoembolization for hepatocellular carcinoma. Liu HJ, Chen TS, Lee RC, Ho DM, Lin JT, Chu LS, Chang FY. Division of Gastroenterology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan 112, ROC. We advise that embolization of the IMA [inferior mesenteric artery] in patients who have received radiotherapy should be avoided, if possible. Fetch PMID: 11155762 Acta Radiol 2000 Mar;41(2):156-60 Ischemic complications of transcatheter arterial chemoembolization in liver malignancies. Tarazov PG, Polysalov VN, Prozorovskij KV, Grishchenkova IV, Rozengauz EV. Division of Angio/Interventional Radiology, St. Petersburg Research Institute of Roentgenology and Radiation Therapy, Russia. ... To determine the frequency, character, methods of treatment, and outcome of ischemic complications after transcatheter hepatic artery chemoembolization (TACE). .. Ischemic complications appeared in 13 (4.6%) and included the following: hepatic (n=6) and splenic abscess (n= 1), cholecystitis (n=3), and bile duct necrosis (n=3). The treatment was US-guided drainage in 12 cases and systemic antibacterial therapy in 1. No negative influence of these complications on survival of patients was detected. ... Serious ischemic complications of TACE occur in about 5% of patients and can be successfully managed without open surgery. These complications do not worsen the survival of patients. Fetch PMID: 10741789 Bull Soc Sci Med Grand Duche Luxemb 1999;(2):29-36 Complications and hospitalisation--duration after chemoembolisation for liver metastases. Rauh S, Duhem C, Ries F, Dicato M. Dpt. of Hemato-Oncology, Centre Hospitalier, Luxembourg. In a retrospective study, all patients of the hemato-oncology department of the Centre Hospitalier who were treated from 1988 to 1997 by chemoembolisation for liver metastases were analysed for treatment-related hospitalisation duration, side effects and complications, in order to assess the treatment burden. Major side-effects were: pain in 17 of 29 patients, nausea in 8, vomiting in 7, persistent hiccup in 3, fever in 12, a temporary confusional state in 4 patients. 1 patient experienced syncope, 2 patients developed homolateral pleural effusions, 1 patient suffered transient supraventricular arrhythmias. Major complications included 1 hemoperitoneum (under anticoagulant therapy), 1 hemorrhagic gastritis, 1 acute cholecystitis due to inflammatory tumoral choledochal obstruction and one iatrogenous acute pancreatic ischemic necrosis. Two patients died of post-embolic acute hepatic insufficiency, one 10 days, one 41 days after the last treatment session). In summary, chemo-embolisation of liver metastases is a complication-burdened treatment in a strictly palliative setting with inestimable efficacy. The treatment modalities have to be discussed with the patient beforehand and preferably in controlled study setting. Large randomised trials may indicate patients' subgroups for benefit. Fetch PMID: 11100173 Cardiovasc Intervent Radiol 1999 Jul-Aug;22(4):293-7 Hepatic chemoembolization: effect of intraarterial lidocaine on pain and postprocedure recovery. Hartnell GG, Gates J, Stuart K, Underhill J, Brophy DP. Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, USA. . .. Intraarterial lidocaine during chemoembolization reduces the severity and duration of pain after chemoembolization resulting in faster recovery thus reducing the length of hospitalization. Fetch PMID: 10415218 Zhonghua Zhong Liu Za Zhi 1996 Sep;18(5):365-7 [The clinical efficacy of hepatic artery infusion chemotherapy and chemoembolization in the treatment of liver metastases]. [Article in Chinese] Zeng X, Wang S, Wei C. Department of Radiology, Wuhan General Hospital of Guangzhou Miliary Region. The efficacy and clinical experience of transcatheter hepatic artery infusion chemotherapy alone or chemoembolization in 118 patients with hepatic metastases were reviewed. Hepatic arterial infusion chemotherapy followed by embolization with lipiodol suspension and gelatin sponge pieces was carried out in 72 cases, infusion chemotherapy followed by embolization with lipiodol suspension in 32, and arterial infusion chemotherapy alone in 14. The results showed that the clinical efficacy of the first method was the best while that of the third method was the worst. The best effect was seen in patients with the single and hypervascular metastatic focus. The overall survival rate was 86.0%, 25.0%, 3.0% in 1 year, 3 years and 5 years, respectively. Fetch PMID: 9387277 Eur Radiol 1997;7(3):323-6 Arteritis following intra-arterial chemotherapy for liver tumors. Belli L, Magistretti G, Puricelli GP, Damiani G, Colombo E, Cornalba GP. Department of Radiology, Ospedale Multizonale, Viale Borri 57, I-21100 Varese, Italy. ... with transcatheter chemoembolization (TACE) during selective arterial catheterization... Arteritis is a possible referred side effect which can lead to tortuosity of the arteries, stenosis and occlusion of vessels. In our hospitals 117 consecutive patients were treated with TACE from January 1990 to December 1992.... Selective angiography performed 30-62 days after the first chemoembolization showed artery stenosis in 7 patients and thrombosis in 2 cases related to toxic arteritis due to chemoembolization. Reports about arteritis during TACE treatments are discussed. Fetch PMID: 9087350 Cancer 1996 Nov 15;78(10):2216-22 Comment in: Cancer. 1996 Nov 15;78(10):2039-42 Positron emission tomography with F-18-fluorodeoxyglucose to evaluate the results of hepatic chemoembolization. Vitola JV, Delbeke D, Meranze SG, Mazer MJ, Pinson CW. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675, USA. ... Positron emission tomography (PET) using F-18-flurodeoxyglucose (18FDG) is an imaging modality allowing direct evaluation of cellular glucose metabolism. The purpose of this study was to examine the role of 18FDG-PET in monitoring chemoembolization therapy of patients with liver metastases from adenocarcinoma. ... patients were evaluated with 18FDG-PET before and 2-3 months after interventional therapy. All patients underwent transcatheter arterial chemoembolization. A total of nine PET studies were performed. ... Twenty-five of 34 lesions had decreased 18FDG uptake ...as expected in successful tumor chemoembolization. These findings were associated with a significant decrease in serum tumor marker levels ... after treatment. However, there were 3 new lesions, and 6 of the 34 lesions demonstrated persistent or increased 18FDG uptake after treatment ... consistent with the presence of residual viable tumor. These findings led to further interventional therapy in all patients. ... 18FDG-PET allows monitoring of response to treatment with hepatic chemoembolization in patients with liver metastases from adenocarcinoma. PET is a useful diagnostic tool and has the potential to be used to guide further interventional therapy. Fetch PMID: 8918417 Acta Chir Belg 1996 Feb;96(1):37-40 Initial experience with the use of preoperative transarterial chemoembolization in the treatment of liver metastasis. Ceelen W, Praet M, Villeirs G, Defreyne L, Pattijn P, Hesse U, de Hemptinne B. Department of Surgery, Gent University Hospital, Belgium. We retrospectively evaluated the influence of preoperative Transarterial Chemoembolization (TAE) on technique and complications, tumour histology, and disease-free survival after surgery for hepatic metastasis. In a 2-year period, a total of 23 patients were treated. In a first group of 14 patients, preoperative TAE was performed; in a second group of 9 patients only surgical resection was done. Extensive tumour necrosis was seen in the majority of patients treated with TAE; in tumours with an important fibrotic component, embolization was less effective. No significant effect was seen on operating time, transfusion requirement or perioperative complication rate. In the group of patients who underwent TAE, survival rate was 93% after a mean follow-up period of 15.5 months (SD: 12.5); recurrence was seen in only 8% of the survivors. In the second group, however, mortality was 33% after a median follow-up of 17.5 months (SD: 10), and recurrence was present in 66.7% of the survivors. These results indicate that preoperative TAE reduces the recurrence rate in the first postoperative year. Thereby survival may be improved in patients with resectable metastatic liver cancer. Publication Types: Clinical trial Randomized controlled trial Fetch PMID: 8629387 J Surg Oncol 1995 Oct;60(2):116-21 Hepatic artery chemoembolization or embolization for primary and metastatic liver tumors: post-treatment management and complications. Berger DH, Carrasco CH, Hohn DC, Curley SA. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. ...The morbidity rate following HACE and HAE in this study was 5.1%. The major complications included portal vein thrombosis, hepatic abscess, and liver failure. The treatment-related mortality rate was 4.1%. Fever and ileus were the most common management problems ... Median survival for patients with liver metastases varied according to histologic type, .... Morbidity and mortality ... can be minimized by proper selection and careful management of patients. HACE or HAE alone was not curative in any of these 121 patients. An understanding of treatment-related side effects is necessary to aid in the management of patients .... Fetch PMID: 7564377 Radiology 1994 Dec;193(3):743-6 Multiple intrahepatic aneurysms following transcatheter arterial embolization. Work in progress. Aso N, Matsunaga N, Fukuda T, Sakamoto I, Ashizawa K, Aikawa H, Isomoto I, Hayashi K, Fukushima T, Morikawa M. Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan. ... To discuss the mechanism of multiple intrahepatic aneurysm formation after transcatheter arterial embolization (TAE) performed in five patients with hepatocellular carcinoma. ... TAE was performed with gelatin sponge particles and iodized oil as embolic materials. Mitomycin C was also used in four cases. ... Three to 14 aneurysms 1-6 mm in diameter were found in third-to sixth-order branches of the hepatic arteries at repeat angiography performed 25-45 days after TAE. Follow-up angiograms in three cases revealed that most aneurysms were no longer apparent except in one patient in whom two aneurysms remained and were larger than before. In none of the five cases were any signs of aneurysm rupture noted. ... Radiologists should be aware of this complication of TAE. It is speculated that the main cause of aneurysm formation in these patients was the embolic agents used. Fetch PMID: 7972817

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