Bleomycin ; analogs & derivatives ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Hemangioma ; therapy ; Humans ; Infant ; Iodized Oil ; therapeutic use ; Syndrome ; Thrombocytopenia ; therapy

Despite remarkable advancement in the surveillance and treatment of hepatocellular carcinoma (HCC) and the availability of novel curative options, a great proportion of HCC patients are still not eligible for curative treatment due to an advanced tumor stage or poor hepatic functional reserve. Therefore, there is a continuing need for effective palliative treatments. Although practiced widely, it has only recently been demonstrated that the use of transarterial chemoembolization (TACE) provides a survival benefit based on randomized controlled studies. Hence, TACE has become standard treatment in selected patients. TACE combines the effect of targeted chemotherapy with the effect of ischemic necrosis induced by arterial embolization. Most of the TACE procedures have been based on iodized oil utilizing the microembolic and drug-carrying characteristic of iodized oil. Recently, there have been efforts to improve the delivery of chemotherapeutic agents to a tumor. In this review, the basic principles, technical issues and complications of TACE are reviewed and recent advancement in TACE technique and clinical applicability are briefed.
Antineoplastic Agents/therapeutic use ; Carcinoma, Hepatocellular/*therapy ; Chemoembolization, Therapeutic/*methods ; Gelatin Sponge, Absorbable/therapeutic use ; Humans ; Infusions, Intra-Arterial ; Iodized Oil/therapeutic use ; Liver Neoplasms/*therapy

OBJECTIVETo study the histopathological effect of hepatic arterial infusion of lipiodol on transplanted hepatoma in rats.

METHODSFourty-one rats bearing Walker-256 transplanted hepatoma were randomly divided into embolization group (n = 35, divided in 5 subgroups, with 7 rats in each) and control group (n = 6). Lipiodol (0.5 ml/kg)emulsified with 0.2 - 0.3 ml of 76% urografin (v:v = 1:1) was infused via gastroduodenal artery into hepatic artery in embolization group. Rats in the control group were given via the same route urografin only. Histopathological changes of the treated tumors were examined by light and transmission electron microscopy.

RESULTSIn the control rats treated with urografin alone, the average tumor size increased 2.8 fold on day 3, while that in the lipiodol treated rats increased 1.7 fold (P < 0.01). Compared with the control group, on day 3, 5, 10 after embolization treatment, tumor necrosis was more extensive (P < 0.01). In one of the treated rats, the tumor was completely necrotic on day 10. Inflammatory reaction was marked in the early post-embolic period, but it was replaced by fibrous tissue encapsulation. From day 1 on, in 17 of the 18 treated rats, apoptotic cells, identified by typical morphology under light and electronic microscopes, were observed, mainly in the tumor periphery.

CONCLUSIONIn addition to cellular necrosis, apoptosis may be another important mechanism leading to cell death in hepatoma treated with transarterial embolization.

Animals ; Apoptosis ; Carcinoma 256, Walker ; pathology ; therapy ; Chemoembolization, Therapeutic ; Iodized Oil ; therapeutic use ; Liver Neoplasms, Experimental ; pathology ; therapy ; Male ; Necrosis ; Neoplasm Transplantation ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo assess the therapeutic effect of percutaneous intratumoral injection with lipiodol emulsion of chemotherapie agents (CALE) on implanted VX2 tumor in rabbits.

METHODSTwelve New Zealand rabbits with implanted VX2 tumor (24 models) were divided into lipiodol group, chemotherapeutic agent group and CALE group with intratumoral injections of the corresponding agents. The pathological changes of all the lesions were observed and the expression of proliferating cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) were evaluated 7 days after the operation.

RESULTSCompared with the lipiodol group and chemotherapie agent group, intratumoral injection of CALE resulted in the highest tumor necrosis rate and greatest tumor necrosis (P<0.01). The labeling indices of PCNA and VEGF expressions in CALE group were markedly lower than those in the other two groups (P<0.01).

CONCLUSIONPercutaneous intratumoral injection of CALE is an effective ablation approach for treatment of malignant solid tumors.

Animals ; Emulsions ; Injections, Intralesional ; Iodized Oil ; administration & dosage ; therapeutic use ; Neoplasms, Experimental ; metabolism ; pathology ; therapy ; Proliferating Cell Nuclear Antigen ; metabolism ; Rabbits ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVE: We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts. MATERIALS AND METHODS:Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications. RESULTS: The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months. CONCLUSION: Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.
Adult ; Aged ; Enbucrilate/administration & dosage/*therapeutic use ; Female ; Follow-Up Studies ; Humans ; Iodized Oil/administration & dosage/*therapeutic use ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/*surgery ; Sclerosing Solutions/administration & dosage/*therapeutic use

OBJECTIVETo study the effect of the interventional therapy of hepatoma-bearing rat by Seed of Job's-stears (SJS) injection combining with lipiodol.

METHODSTo evaluate the effect of SJS as a medicament which can be used in interventional therapy, we repeated the hepatoma-bearing rats, and treated them by interventional therapy with SJS referring to the method which Lindel set up, comparing its effect to which of chemical medicines and lipiodol.

RESULTSSJS or lipiodol alone had an inhibiting effect to liver cancer. The tumor growth rates were 13.89%, 14.05%, and the tumor inhibiting rates reached 38.10%, 37.49%. The curative effect of the SJS/lipiodol group was the best, and its growth rate and inhibiting rate were 3.36% and 85.03%, respectively better than the SJS group and lipiodol group (P<0.01). There was no statistically significant difference between the effect of the SJS/lipiodol group and the mitomycin/lipiodol group. The survival period of SJS/lipiodol group was longer than the rest groups (P<0.01 or P<0.05).

CONCLUSIONSThe interventional therapy by SJS/lipiodol has obvious inhibitory effect on the growth of hepatoma-bearing rats, which is similar to that of MMC/lipiodol. This inhibiting effect is better than that of the SJS or lipiodol group. SJS/lipiodol can prolong the survival period of hepatoma-bearing rats obviously, and this effect is better than that of single lipiodol, SJS or MMC/lipiodol.

Animals ; Cell Division ; drug effects ; Coix ; chemistry ; Drug Therapy, Combination ; Iodized Oil ; therapeutic use ; Liver Neoplasms, Experimental ; drug therapy ; pathology ; Mitomycin ; therapeutic use ; Phytotherapy ; methods ; Plant Extracts ; chemistry ; therapeutic use ; Rats ; Rats, Wistar ; Seeds ; chemistry ; Survival Analysis

The interaction between Lipiodol and cells was studied by treating Lipiodol in a human hepatocellular carcinoma cell line(Hep) and mouse fibroblast cell line (L929). Irregular, sustained radioactivity was released from both cell lines shortly after incubation in the radioiodinated Lipiodol mixed media. Lipiodol droplets were found to be firmly attached to the cells following the incubation and these cells were strongly positive for fat stains. The radioiodinated Lipiodol demonstrated the same behavior of accumulation within the cell and on the cell membrane. Although the amount of Lipiodol attached was almost equal in both of the cell lines, the final amount accumulated in the cells was larger in the Hep cells. The accumulation of Lipiodol within the cell and on the cell membrane may play a significant role for its selective targeting and its prolonged retention in the solid tumor.
Carcinoma, Hepatocellular/*pathology/therapy ; Human ; Iodine Radioisotopes/diagnostic use/therapeutic use ; Iodized Oil/pharmacokinetics/*pharmacology/therapeutic use ; Liver Neoplasms/*pathology/therapy ; Support, Non-U.S. Gov't ; Tumor Cells, Cultured/drug effects

To evaluate the changes induced in tumor tissue, the feeding artery, and neovascularization upon pingyangmycin-lipiodol emulsion treatment via transcatheter arterial chemoembolization (TACE) using the rabbit VX2 liver cancer model. The VX2 liver tumor model was established in 28 rabbits, and baseline tumor volume (V1, in mm3) was measured by spiral scan computed tomography (CT). Then, the rabbits were randomly divided into four groups (n = 7 each) and administered intraarterial therapies of: ultrafluid lipoidol embolization (group A); pingyangmycin (group B); pingyangmycin-lipiodol emulsion (group C); or saline (group D). All rabbits were sacrificed seven days later, and the response to therapy was determined by measuring the tumor volume (V2, in mm3), calculating the tumor growth rate, detecting expression of the vascular endothelial growth factor (VEGF) tumor biomarker, and performing histological analysis of the microvessel density (MVD) in the liver. Prior to therapy, the average V1 of the groups was statistically similar (A: 389.8+/-167.3, B: 404.1+/-184.9, C: 355.1+/-158.3, D: 378.1+/-189.0; (F = 0.257, P more than 0.05). In contrast, after therapy the average V2 of the groups was significantly different (A: 922.6+/-32.9, B: 665.9+/-99.9, C: 349.5+/-177.8, D: 1403.5+/-411.2; F = 26.23, P less than 0.05), as was the tumor growth ratio (A: 1.4, B: 0.6, C: -0.02, D: 2.7) and the mean positive ratio of VEGF (A: 57.1%, B: 42.9%, C: 28.6%, D: 100%; F = 8.407, P less than 0.05). MVD was highest in group D and lowest in group C (all, P less than 0.05). Bivariate correlation analysis revealed a positive correlation between VEGF expression and MVD (r = 0.743, P less than 0.01). Pingyangmycin exerts anti-tumor effects in the rabbit VX2 liver cancer model, but is more effective when administered as the combination therapy of pingyangmycin-lipiodol emulsion with TACE.
Animals ; Antibiotics, Antineoplastic ; administration & dosage ; therapeutic use ; Bleomycin ; administration & dosage ; analogs & derivatives ; therapeutic use ; Chemoembolization, Therapeutic ; methods ; Emulsions ; Ethiodized Oil ; administration & dosage ; therapeutic use ; Female ; Iodized Oil ; administration & dosage ; therapeutic use ; Liver Neoplasms, Experimental ; blood supply ; drug therapy ; pathology ; Male ; Microvessels ; Neoplasm Transplantation ; Neovascularization, Pathologic ; Rabbits ; Random Allocation ; Tumor Burden ; drug effects ; Vascular Endothelial Growth Factor A ; metabolism

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

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