Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Although various complications of TACE have been reported, cerebral lipiodol embolism after TACE is rare. We report a 67-year-old man, who had patent foramen ovale and developed cerebral lipiodol embolism after TACE via the inferior phrenic artery. At 20 months after third TACE of 3 cm sized HCC in the left hepatic lobe, computed tomography (CT) revealed about 1.6 cm newly developed HCC in the anterior superior segment of right hepatic lobe. The angiogram revealed the HCC was supplied from the right inferior phrenic artery. Toward the end of TACE, there were accumulations of the iodized oil in the pulmonary vasculature. Immediately after TACE, he complained of weakness in right upper and lower limbs and sensory decrease in right limbs and right hemitrunk. Magnetic resonance imaging revealed a cerebral lipiodol embolism. Transesophageal echocardiography revealed no visible thrombi but contrast-echocardiography using hand agitated saline revealed an intracardiac right to left shunt consistent with patent foramen ovale. Motor weakness and sensory decrease were gradually improved, and all neurological symptoms disappeared over 4 weeks.
Aged ; Carcinoma, Hepatocellular/complications/diagnosis/*therapy ; *Chemoembolization, Therapeutic ; Contrast Media/*adverse effects/diagnostic use ; Humans ; Intracranial Embolism/*diagnosis/*etiology/ultrasonography ; Iodized Oil/*adverse effects/diagnostic use ; Liver Neoplasms/complications/diagnosis/*therapy ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

Twenty four patients with hepatocellular carcinoma who refused surgery or had unresectable tumor ranging 2.5 to 8.0 cm in size were treated with intrahepatic arterial injection of iodine-131-labeled iodized oil (I-131 Lipodol) in an attempt to achieve internal radiation of tumor. 555-2,220 MBq in 3-8 ml of I-131 Lipiodol was injected into the hepatic artery or proximal to the tumor feeding vessel depending on the tumor size. Tumor size reduction was observed in 88.9% of tumor smaller than 4.0 cm in diameter, 65.5% between 4.1 to 6.0 cm, and 25.0% of larger than 6.1cm, respectively. The tumor size reduction was corresponded to the gradual drop of serum AFP levels, decreased uptake on gallium-67 scintigraphy, and devascularization on follow-up angiography. Tumors having significant A-V shunts revealed further tumor growth. Adverse reactions from the treatment include fever, mild abdominal pain, nausea and elevation of transaminases. These have been mild and well-tolerated by the patients. This method was able to provide long term local control without complications related to thyroid, lung, GI tract and bone marrow.
Adult ; Aged ; Angiography ; Carcinoma, Hepatocellular/radionuclide imaging/*therapy ; Follow-Up Studies ; Humans ; Infusions, Intra-Arterial ; Iodine Radioisotopes/therapeutic use ; Iodized Oil/adverse effects/*therapeutic use ; Liver Neoplasms/radionuclide imaging/*therapy ; Male ; Middle Aged

BACKGROUND/AIMS: Although transcatheter arterial chemoembolization (TACE) is a major treatment modality for unresectable hepatocellular carcinoma (HCC), acute hepatic failure after TACE is not rare. However, reports dealing with this important complication are not good enough and results are often variable. The purpose of this study was to evaluate the incidence and associated risk factors of acute hepatic failure after TACE. METHODS: From January 2001 to November 2004, six hundred and thirtytwo TACE sessions were performed in 377 patients (294 men and 83 women). Adriamycin mixed lipiodol solution and gelfoam were used for TACE. Various clinical and radiological factors before and after the procedure were reviewed retrospectively. Univariate and multivariate analyses were performed to evaluate the risk factors associated with the development of acute hepatic failure after TACE. RESULTS: Acute hepatic failure occurred in 76 (12.0%) of the 632 TACE sessions within 14 days. Univariate analysis revealed that Child-Pugh class, 1st TACE, total bilirubin level, number of involved segments, total size of tumor, presence of right portal vein thrombosis (PVT) or main PVT, involvement of segment 1, 5, 6, 7, modified UICC stage, and doses of chemotherapeutic agent were significantly different between the patients with or without hepatic failure after TACE. Among them, elevated total bilirubin (p=0.001, E (beta)=1.449), presence of right (p=0.035, E (beta)=2.109) or main (p=0.011, E (beta)=4.067) PVT were independently associated factors in multivariate analysis. CONCLUSIONS: The incidence of acute hepatic failure after TACE was 12.0%. Elevated bilirubin level and portal vein thrombosis could be considered as the predictive factors for acute hepatic failure after TACE in HCC patients.
Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/adverse effects/therapeutic use ; Carcinoma, Hepatocellular/complications/pathology/*therapy ; Chemoembolization, Therapeutic/*adverse effects/methods ; Doxorubicin/adverse effects/therapeutic use ; Female ; Humans ; Incidence ; Iodized Oil/adverse effects/therapeutic use ; Liver Failure, Acute/epidemiology/*etiology ; Liver Function Tests ; Liver Neoplasms/complications/pathology/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

OBJECTIVETo evaluate the efficacy and safety of high doses of thymopentin (10 mg/d) combined with transartery chemoembolization for primary liver cancer.

METHODSFifty primary liver cancer patients were randomly divided into two groups: therapeutic and control group, and all were treated with transfemoral artery chemoembolization (TACE) with oxaliplatin 150 mg, pharmorubicin 50 mg, 5-Fu 750 mg, CF 300 mg and lipiodol 20 ml. Therapeutic group (25) were added 10 mg thymopentin daily after TACE: i.v. on dl - d5, and im on D6 - D21.

RESULTSThere was a significant difference in adverse effect and toxicity such as naupathia,fever, swirl, asthenia observed between two groups (P < 0.05). No difference in either pre- or post-chemotherapy peripheral blood examination and biochemical assay was found between two groups (P > 0.05). In control group, CD4+ cell was 37.92% +/- 8.71% in pre-treatment, which decreased to 29.16% +/- 8.21% in post-treatment with a significant difference (P < 0.01), whereas there was no evident difference in CD4+ cell between pre-treatment and post-treatment in the treatment group.

CONCLUSIONTransartery chemoembolization combined with high dose of thymopentin in the treatment for primary liver cancer is effective and safe, and can significantly improve the immune function and the chemotherapy tolerance.

Adjuvants, Immunologic ; adverse effects ; therapeutic use ; Adult ; Aged ; Asthenia ; chemically induced ; CD4-Positive T-Lymphocytes ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Disease-Free Survival ; Epirubicin ; administration & dosage ; Female ; Fever ; chemically induced ; Fluorouracil ; administration & dosage ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; therapy ; Lymphocyte Count ; Male ; Middle Aged ; Nausea ; chemically induced ; Organoplatinum Compounds ; administration & dosage ; Remission Induction ; Survival Rate ; Thymopentin ; administration & dosage ; adverse effects ; therapeutic use

OBJECTIVETo analyze the biodistribution of (186)Re-lipiodol (RL) in patients with primary liver cancer (PLC) after hepatic arterial injection in attempt to assess the potential of RL as a radiopharmaceutical for the treatment of PLC.

METHODSRL was synthesized from (186)Rhenium and Lipiodol by a series of physical and chemical procedures. Doses of RL ranged from 1 110 MBq to 2 220 MBq per patient depending on the volume of tumor. Quantitative gamma camera imaging (ECT) and gamma counting of serum and urine were used to obtain data for dosimetry estimation. Serum tumor marker (AFP) level and shrinkage of tumor were used to evaluate the therapeutic efficacy of RL.

RESULTSIn the hepatic tumor, RL was selectively retained and radioactivity was very high throughout this study. The ratio of tumor concentration to the normal liver tissue concentration (T/NT ratio) was 10 - 14 at 48 hours after injection of RL. The main side effects of this therapy were transient fever and anorexia. No unacceptable toxicity was observed. In 100% of the patients, the therapy resulted in a significant decrease of AFP level and reduction of tumor volume.

CONCLUSIONThe biodistribution and imaging results demonstrated RL localized selectively in tumor, and that RL may be a potential internal radiopharmaceutical agent for the treatment of primary liver cancer.

Adult ; Aged ; Carcinoma, Hepatocellular ; drug therapy ; metabolism ; Drug Carriers ; Humans ; Infusions, Intra-Arterial ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; drug therapy ; metabolism ; Male ; Middle Aged ; Radiopharmaceuticals ; adverse effects ; pharmacokinetics ; therapeutic use ; Radiotherapy Dosage ; Rhenium ; adverse effects ; pharmacokinetics ; therapeutic use ; Treatment Outcome

OBJECTIVETo investigate the cause and treatment as well as prevention measures of rarely occurring severe complications after transcatheter arterial chemoembolization (TACE) for primary hepatic carcinoma.

METHODS573 consecutive patients with primary hepatic carcinoma underwent a total of 1252 TACE procedures from January 2005 to July 2007. All the patients who developed complications after TACE received imaging and biochemical examinations. The cause, treatment and preventive measures of the complications in the 573 cases were analyzed.

RESULTSThere were upper gastrointestinal hemorrhage in 3 cases, hepatic failure in 4, pulmonary embolism in 1, cholecystitis in 4, hepatic encephalopathy in 2, gastric perforation in 1, and intrahepatic biloma in 2 cases. Two patients died of the complications: 1 of hepatic failure and 1 of gastric perforation.

CONCLUSIONThe rarely occurring severe complications after transcatheter arterial chemoembolization for primary hepatic carcinoma is correlated with poor hepatic function and portal hypertension before therapy, overdose and reflux of chemotherapeutic agents or allotopic chemoembolism, etc. It can be reduced or prevented through careful selection of proper cases before the treatment, close observation, and protection of hepatic function and gastric mucosa after treatment.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; methods ; Epirubicin ; administration & dosage ; adverse effects ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; Gastrointestinal Hemorrhage ; etiology ; Hepatic Encephalopathy ; etiology ; Humans ; Iodized Oil ; administration & dosage ; adverse effects ; Liver Failure ; etiology ; Liver Neoplasms ; therapy ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; adverse effects ; Pulmonary Embolism ; etiology ; Young Adult

OBJECTIVETo observe the protective effect of ginsenosides (GS) or low dose of glucocorticoid dexamethasone (Dex) alone or combined in managing the liver injury and renal function after transcatheter arterial chemoembolization (TACE).

METHODS120 patients with primary liver carcinoma were randomly divided into four groups (A, B, C, D) with 30 patients in each. Group A was treated with placebo; group B with Dex; group C with GS and group D with Dex plus GS. The changes in liver and renal function after TACE were observe according to the WHO criteria for side effects of anti-cancer drug.

RESULTSCompared with group A, Dex combined with GS was able to reduce the level of TB, ALT/AST, BUN and Child-grade, which significantly protected the liver and kidney (P < 0. 05). However, Dex or GS alone could also improve some parameters of liver and renal function after TACE (P < 0.05).

CONCLUSIONDex combined with GS is effective in managing the liver injury and renal function after transcatheter arterial

Adult ; Aged ; Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Bilirubin ; blood ; Blood Urea Nitrogen ; Chemoembolization, Therapeutic ; adverse effects ; methods ; Creatinine ; blood ; Dexamethasone ; pharmacology ; therapeutic use ; Drug Therapy, Combination ; Epirubicin ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Ginsenosides ; pharmacology ; therapeutic use ; Glucocorticoids ; pharmacology ; therapeutic use ; Humans ; Iodized Oil ; administration & dosage ; Kidney ; drug effects ; pathology ; physiopathology ; Liver Diseases ; etiology ; pathology ; prevention & control ; Liver Neoplasms ; blood ; therapy ; Male ; Middle Aged ; Prospective Studies ; Topotecan ; administration & dosage