Transarterial embolization ablation of hepatocellular carcinoma with a lipiodol-ethanol mixture

Abstract

Aim: To determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol-ethanol mixture.

Methods: Between January 1 and December 31, 2009, 15 patients with HCC (13 men/two women, aged 38-75 years) accepted TEA treatment and were enrolled in this study, including five newly diagnosed patients and 10 with refractory disease. Two months after TEA, angiography and contrast computed tomography (CT) were performed, and responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). The follow-up period was to June 30, 2010.

Results: Every new case was treated once. Angiography was performed immediately after TEA, and showed that the tumor-feeding vessels were completely embolized and that lipiodol was densely deposited inside tumors. Two months after treatment, contrast CT showed no enhanced lesions. Alpha fetoprotein levels returned to normal in four patients and markedly decreased in another. mean ± SD survival after treatment was 10.8 ± 4.5 mo. All five patients survived during the follow-up period. Ten patients with refractory disease were treated a total of 14 times. Angiography immediately after TEA showed that blood flow to the tumors was obviously decreased in all cases, and contrast CT showed obvious depositions of lipiodol. Two months after treatment, the tumors had shrunk (6/10) or were stable (3/10). One had progressed after 2 mo and died of tumor rupture 3 mo after TEA. mean ± SD survival after treatment was 8.6 ± 4.3 mo; two patients survived during the follow-up period. Adverse effects included reversible hepatic decompensation, upper abdominal pain, and fever.

Conclusion: TEA is an effective therapy for patients with HCC and might be more effective than transcather arterial chemoembolization for treating refractory disease.

Figures

Figure 1

A newly diagnosed patient with single-nodule treated by transarterial embolization ablation. A: An enhanced computed tomography (CT) scan of hepatocellular carcinoma tumor before treatment. The tumor measured 3.5 cm × 3.3 cm (arrows); B: Hepatic artery angiography showed the thick blood vessels of the tumor (arrowheads) and the abnormal vascular group (arrows) before treatment; C: Superselective angiography clearly showed tumor staining (arrows); D: After transarterial embolization ablation with an lipiodol-ethanol mixture, lipiodol accumulated in the tumor (arrows); E: An enhanced CT scan 2 mo after treatment showed dense deposition of lipiodol in the tumor without enhancement (arrows); F: Hepatic artery angiography showed the absence of tumor blood vessels and tumor staining at 2 mo after treatment (arrows).

Figure 2

A patient with refractory tumors treated by transarterial embolization ablation. A: Limited lipiodol accumulation in a patient with a diffuse hepatocellular carcinoma tumor after transcatheter arterial chemoembolization (TACE) (arrows); B: After a second treatment with TACE, the tumor had progressed and showed less lipiodol accumulation (arrows); C: Hepatic artery angiography showed that tumor staining was not obvious. According to computed tomography images before transarterial embolization ablation (TEA), lipiodol-ethanol mixture was injected through the left and right hepatic arteries; D: Two months after TEA, the tumor had shrunk and lipiodol accumulation had increased (arrows).