Using Epirubicin-loaded DC Beads® for Superselective Embolisation of Liver Tumours – Initial Experiences
Using Epirubicin-loaded DC Beads® for Superselective Embolisation of Liver Tumours – Initial Experiences
Case Study Two
A 53-year-old male patient suffering from hepatitis-C-induced liver cirrhosis presented with a well circumscribed, hypervascular HCC nodule in the right liver lobe in liver MR (see Figure 2a). Intra-arterial angiography using a 4F C2 Cobra catheter (see Figure 2b) confirmed the presence of a hypervascular lesion in the right liver lobe. After applying 2ml DC Beads loaded with epirubincin 50mg to the tumour and the surrounding tissue using a 2.7F microcatheter system (Progreat, Terumo, Japan), the tumour did not opacify any more (see Figure 2c). A control CT scan obtained one day after TACE confirmed the embolisation of the tumour. As in Case One, air bubbles within the tumour are regular findings following embolisation with DC Beads at our institution because the particles are suspended for a second time prior to embolisation. They do not represent an infectious complication (see Figure 2d).
Case Study Three
A 58-year-old male patient presented suffering from a diffusely growing HCC predominantly in the right liver lobe (see Figure 3a). After three cycles of DC Bead embolisation (each with 2ml of 300–500µ DC Beads enriched with epirubicin 50mg), the patient developed a biliary abscess close to the gall bladder (see Figures 3b and 3c). The abscess was drained percutaneously, and the patient was fine.
Figure 3a: CE T1w Flash FS Status Prior to Transarterial Chemoembolisation
Note the irregular nodules close to the gallbladder.
Note the irregular nodules close to the gallbladder.
Figure 3b: T2w TSE FS Status After Three Interventions
Close to the gallbladder there is an area of increased signal intensity in the T2-weighted sequence.
Close to the gallbladder there is an area of increased signal intensity in the T2-weighted sequence.
Figure 3c: CE T1w Flash FS Status After Three Interventions
Close to the gallbladder there is an area of low signal intensity comparable to the signal of the gallbladder lumen. Puncture of this area revealed a biliary abscess. CE T1w Flash FS describes the sequence used for magnetic resonance imaging: CE = contrast-enhanced; T1w = T1-weighted; Flash = the gradient echo (GRE) sequence from Siemens; FS = fat suppression.
Close to the gallbladder there is an area of low signal intensity comparable to the signal of the gallbladder lumen. Puncture of this area revealed a biliary abscess. CE T1w Flash FS describes the sequence used for magnetic resonance imaging: CE = contrast-enhanced; T1w = T1-weighted; Flash = the gradient echo (GRE) sequence from Siemens; FS = fat suppression.
References:
- Livraghi T, Radiofrequency ablation, PEIT, and TACE for hepatocellular carcinoma, J Hepatobiliary Pancreat Surg, 2003;10:67–76.
- Vogl TJ, Mack MG, Straub R, et al., Interventionelle MR-gesteuerte laserinduzierte Thermotherapie bei onkologischen Fragestellunge, Radiologe, 1999;39:764–71.
- Llovet JM, Real MI, Montaña X, et al., Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial, Lancet, 2002;359:1734–9.
- Lo CM, Ngan H, TSO WK, et al., Randomised controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma, Hepatology, 2002;35:1164–71.
- Camma C, Schepis F, Orlando A, et al., Transarterial CHemoembolization for Unresectable Hepatocellular CArcinoma: Meta-Analysis of Randomized Controlled Trials, Radiology, 2002;224:47–54.
- Clark HP, Carson WF, Kavanagh PV, et al., Staging and Current Treatment of Hepatocellular Carcinoma, Radiographics, 2005;25:S3–23.
- Konno T, Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium, Cancer, 1990;66:1897–1903.
- Egawa H, Maki A, Mori K, et al., Effects of intra-arterial chemotherapy with a new lipophilic anticancer agent, estradiol-chlorambucil, dissolved in lipiodol on experimental liver tumor in rats, J Surg Oncol, 1990;44:109–14.
- Nakamura H, Hashimoto T, Oi H, Sawada S, Transcatheter oily chemoembolization of hepatocellular carcinoma, Radiology, 1989;170:783–6.
- Sasaki Y, Imaoka S, Fujita M, et al., Regional Therapy in the Management of Intrahepatic Recurrence after Surgery for Hepatoma, Ann Surg, 1987;206:41–7.
- Lewis AL, Gonzalez MV, Lloyd AW, et al., DC bead: in vitro characterization of a drug-delivery decive for transarterial chemoembolization, J Vasc Interv Radiol, 2006;17:335–42.
- Fiorentini G, Aliberti C, Turrisi G, et al., Intra-arterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads : results of a phase II clinical study, In Vivo, 2007;21:1085–91.
- Varela M, Real MI, Burrel M, et al., Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics, J Hepatol, 2007;46:474–81.
- Malagari K, Alexopoulou E, Chatzimichail K, et al., Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: mid-term results of doxorubicin-loaded DC bead, Abdom Imaging, 2007; Epub ahead of print.
- Poon RTP, Tso WK, Pang RWC, et al., A Phase I/II Trial of Chemoembolization for Hepatocellular Carcinoma Using a Novel Intra-arterial Drug-Eluting Bead, Clin Gastroenterol Hepatol, 2007;5:1100–1108.
