Tatsuo Ueda

Interventional treatment for unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

Endovascular embolization strategy for renal arteriovenous malformations.

Background Renal arteriovenous malformations (AVMs) are rare vascular malformations that cause hematuria. Treatment for renal AVMs has evolved from open nephrectomy to transcatheter arterial embolization (TAE). Purpose To retrospectively evaluate efficacy and adverse events of TAE for renal AVMs. Material and Methods We examined 12 patients (three men, nine women; mean age, 56 years) with renal AVM with gross hematuria, who underwent 14 sessions of treatment, using various embolization materials (liquid embolization agents, gelatin sponge, and coils). Among the 12 patients, 10 had cirsoid AVMs, eight of which were high-flow lesions. The remaining two patients had aneurismal AVMs. We assessed technical and clinical success, and also complications. All patients were followed for 7–92 months (mean, 48 months). Results Technical success was obtained in all patients. Primary clinical success was obtained in all patients; however, recurrence was observed in two patients who were treated with coils alone. A second session of TAE led to the sustained relief of symptoms. Clinical success rate was significant better (P = 0.045) when coils combined with other agents or liquid agents were used, than when only coils were used. No major complications occurred in any of patients; post-embolization syndrome and deterioration of renal function were not observed. Conclusion TAE treatment was safe, effective, and provided a good outcome, except when only coils were used as the embolization agent.

Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation) can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE), and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process.

Background Although the morbidity of bowel ischemic events after glue embolization has been suggested, a causal relationship between glue and ischemia has not been clearly established. Purpose To evaluate the efficiency and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA–TAE) for upper gastrointestinal hemorrhage (GIH). Material and Methods Between October 2006 and October 2012, 21 patients with upper GIH underwent NBCA–TAE, and endoscopic data were obtained within 30 days of follow-up. Shock index prior to and immediately after NBCA–TAE were compared to determine changes in hemodynamics. Days to Forrest type III, as assessed by follow-up endoscopy, was used as an indicator of the healing process. Other clinical outcomes included days for starting ingestion and for hospital discharge. Results Sixteen gastric and five duodenal ulcers, classified into Forrest type I, were treated. Immediate hemostasis was achieved in all the patients, and no re-bleeding occurred within the follow-up period. Shock index significantly (P < 0.001) improved from before (0.99 ± 0.076) to immediately after NBCA–TAE (0.67 ± 0.038). Sequential mucosal healing processes were observed in all the patients, and the number of days to Forrest type III was 9.6 ± 7.1. The number of days for starting ingestion and hospital discharge was 9.0 ± 4.5 and 15 ± 7.7 days, respectively. Conclusion NBCA–TAE is an effective and safe method for the control of nonvariceal upper GIH, in terms of contribution to hemodynamics and healing process of the gastroduodenal mucosa.

Contribution of extrahepatic collaterals to liver parenchymal circulation after proper hepatic artery embolization.

To retrospectively evaluate proper hepatic artery embolization, with respect to the development of extrahepatic collaterals.

Comparison of Epirubicin-Iodized Oil Suspension and Emulsion for Transcatheter Arterial Chemoembolization in VX2 Tumor

To compare the antitumor efficacy and safety of transcatheter arterial chemoembolization (TACE) by epirubicin suspension (epirubicin suspension: epirubicin-iodized oil mixture without solution) to that by epirubicin emulsion (epirubicin emulsion: epirubicin-iodized oil mixture with solution), the efficacy of treatment by administration of either an epirubicin suspension or emulsion was examined in an animal model. Changes in plasma epirubicin concentration were compared over 24 h immediately after treatment, and enhanced ultrasonographic and histopathological analysis subsequently conducted 7 days after treatment to determine the growth ratio and proportion of viable tumor cells. The growth ratio and proportion of viable tumor cells were found to be significantly lower in the suspension group than in the emulsion group while the plasma epirubicin concentration was found to be significantly higher in the suspension group than in the emulsion group. These results indicate that administration of an epirubicin suspension is a superior form of TACE compared to that of administration of an epirubicin emulsion.

Comparison of the antitumor efficacy of transcatheter arterial chemoembolization with a miriplatin-iodized oil suspension and a cisplatin-iodized oil suspension for hepatocellular carcinoma.

To retrospectively compare the short‐term antitumor efficacy and safety of transcatheter arterial chemoembolization (TACE) with a cisplatin‐iodized oil suspension (C‐IS) and a miriplatin‐iodized oil suspension (M‐IS) for hepatocellular carcinoma (HCC).

Glue embolization for endoscopically unmanageable gastrointestinal haemorrhage.

BACKGROUND/AIMS To evaluate the clinical feasibility of embolization with n-butyl cyanoacrylate (NBCA) for endoscopically unmanageable non-variceal gastrointestinal hemorrhage (GIH). METHODOLOGY Between June 2004 and May 2009, 61 patients with confirmed acute upper and/or lower GIH underwent emergency embolization for haemorrhage control; NBCA was used in 28 of these patients, all of whom were in shock despite receiving blood transfusions. The results were studied retrospectively. Clinical parameters and embolization data were assessed for technical success, clinical success and outcome. RESULTS Technical success was achieved in all patients. Clinical success was achieved in 19 (68%) of the 28 patients. The mortality rate was 25% (7 patients). The cause of death was disseminated intravascular coagulation (DIC) in 6 patients and heart failure in 1. The presence of coagulopathy or DIC significantly decreased the degree of clinical success (p=0.015, p=0.001, respectively) and increased the mortality rate (p=0.013, p<0.001, respectively). Unfortunately, 86% patients who had DIC before embolization, died. CONCLUSIONS NBCA embolization is technically feasible and is effective for the control of haemorrhage in endoscopically unmanageable GIH. However, the presence of coagulopathy or DIC significantly decreases the clinical success and increases the mortality rate.

Diabetic mastopathy mimicking breast cancer

Diabetic mastopathy is a source of diagnostic confusion with breast carcinoma. The association between mastopathy and Type I and II diabetes of long duration has been reported, but this clinical condition is poorly recognized since the clinical, mammographic, and sonographic findings simulate breast cancer. We report a case of diabetic fibrous mastopathy with suspicious clinical and imaging findings in order to draw the attention of physicians to this possibility when encountering similar lesions in the breast of diabetic patients.

Comparative study of cisplatin-iodized oil suspension and emulsion for transcatheter arterial chemoembolization of rabbit VX2 liver tumors

Aim:  To evaluate the antitumor effects and hepatotoxicity of transcatheter arterial chemoembolization (TACE) with cisplatin‐iodized oil suspension and emulsion in a rabbit tumor model.