• Drug-eluting microsphere
• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Transarterial chemoembolization

• Humans
• Portal Vein
• Retrospective Studies
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Liver Neoplasms/complications
• Liver Neoplasms/therapy
• Treatment Outcome
• Thrombosis

• 2018A030313700 Science and Technology Planning Project of Guangdong Province
• 2018A030313511 Science and Technology Planning Project of Guangdong Province
• 82072035 National Natural Science Foundation of China

AIM: To evaluate the survival benefits of different treatment strategies for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to determine the prognosis factors.

METHODS: Between 2007 and 2009, 338 HCC patients treated for PVTT were retrospectively studied. The patients were divided into 4 groups that underwent different treatments: the conservative treatment group (n = 75), the transarterial chemoembolization (TACE) group (n = 86), the hepatic resection group (n = 90), and the hepatic resection associated with postoperative TACE group (n = 87). Survival rates were determined using the Kaplan-Meier method and differences between the groups were identified through log-rank analysis. Cox’s proportional hazard model was used to identify the risk factors for survival.

RESULTS: The mean survival periods for patients in the conservative treatment, TACE, hepatic resection and hepatic resection associated with postoperative TACE groups were 3.8, 7, 8.2 and 15.1 mo, respectively. Significant differences were observed in the survival rates. For the surgical resection associated with postoperative TACE group, the survival rates after 1, 2 and 3 years were 49%, 37% and 19%, respectively. These results were significantly higher than those of the other groups (P < 0.05). Meanwhile, the 1, 2 and 3 year survival rates for the surgical resection group were 28%, 20% and 15%, whereas those for the TACE group were 17.5%, 0% and 0%, respectively. These values significantly increased after hepatic resection compared with those after TACE (P < 0.05).

CONCLUSION: Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and results in high hepatic functional reserve. For patients who can tolerate the procedure, postoperative TACE is necessary to prevent recurrence and prolong the survival period.

• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Conservative treatment
• Transarterial chemoembolization
• Surgical resection
• Postoperative transarterial chemoembolization

• Adult
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Chemoembolization, Therapeutic/mortality
• Chemotherapy, Adjuvant
• Chi-Square Distribution
• Female
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Recurrence, Local
• Portal Vein/surgery
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Survival Rate
• Time Factors
• Treatment Outcome
• Venous Thrombosis/mortality
• Venous Thrombosis/pathology
• Venous Thrombosis/therapy

AIM: To investigate the safety and effectiveness of combined ¹³¹I-metuximab and transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

METHODS: One hundred and eighty-five patients (159 men and 26 women) with advanced HCC were enrolled in this study from February 2009 to July 2011. There were 95 patients in the combined metuximab and TACE group, and 90 patients in the TACE only group. The patients were followed for 12 mo. Clinical symptoms, blood cell counts, Karnofsky Performance Score (KPS) evaluation and therapeutic effects according to the Response Evaluation Criteria in Solid Tumors were recorded and evaluated.

RESULTS: The 1-mo effective rates (complete response + partial response + stable disease) of the test group and control group were 71.23% and 38.89%, respectively (P < 0.001). The 6-, 9- and 12-mo survival rates were 86.42%, 74.07% and 60.49% for the test group and 60.0%, 42.22% and 34.44% for the control group (P < 0.001). The incidence of adverse events (gastrointestinal symptoms, fever and pain) and blood cell toxicity were significantly higher for the test group than for the control group (P < 0.001). No severe ¹³¹I-metuximab-related complications were identified. With respect to efficacy, patients in the test group had greater improvement in tumor-related pain (P = 0.014) and increase in KPS (P < 0.001) than those in the control group.

CONCLUSION: Combination of ¹³¹I-metuximab and TACE prolonged the survival time in patients with HCC compared with TACE alone. The combination treatment was safe and effective.

• Hepatocellular carcinoma
• ¹³¹I-metuximab
• Transcatheter arterial chemoembolization
• Radioimmunotherapy

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal/administration & dosage
• Antibodies, Monoclonal/adverse effects
• Carcinoma, Hepatocellular/blood supply
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Child
• Female
• Femoral Artery
• Humans
• Injections, Intra-Arterial
• Iodine Radioisotopes/administration & dosage
• Iodine Radioisotopes/adverse effects
• Kaplan-Meier Estimate
• Karnofsky Performance Status
• Liver Neoplasms/blood supply
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Radioimmunotherapy/adverse effects
• Radiopharmaceuticals/administration & dosage
• Radiopharmaceuticals/adverse effects
• Survival Rate
• Time Factors
• Treatment Outcome
• Young Adult

AIM: To evaluate the pain relief effect of psychological intervention and pharmacological analgesia during hepatic arterial chemoem-bolization procedure.

METHODS: Two hundred and sixty-two patients underwent hepatic arterial chemoembolization for unresectable hepatic carcinoma were randomized into pharmacological analgesia group (n = 46) and combined therapy group (n = 216, psychological intervention and medication were performed in turn). The baseline characteristics, psychological status and NRS-10 scores before pain control showed no statistical difference between two groups. All patients were measured with Symptom Checklist-90 (SCL-90) before embolization and pain Numeric Rating Scale-10 (NRS-10) score were recorded before psychological intervention/medication, after psychological intervention (only in combined therapy group) and following medication during therapeutic process.

RESULTS: Postembolization pain was significantly relieved after medication, psychological intervention or combined therapy (t' = 4.47, 5.79, 20.24, P < 0.01). There were obvious differences among the curative effect scores (pre-therapy NRS-10 score-post-therapy NRS-10 score) of the above three therapeutic methods (F = 21.98, P < 0.01). According to the curative effect scores, medication and combined therapy were more satisfactory than psychological intervention (2.71 ± 4.05, 3.40 ± 3.82 vs 1.24 ± 2.76; both P < 0.01). Combined therapy was the best method for pain relief, but its curative effect score indicated no statistical difference from that of medication.

CONCLUSION: Pharmacological analgesia combined with psychological intervention is able to relieve pain efficiently during hepatic arterial chemoembolization procedure.

• Liver neoplasm
• Radiology
• Intervention
• Pain

AIM: To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on proliferation of hepatocellular carcinoma (HCC) cells.

METHODS: A total of 136 patients with HCC underwent liver resection. Of 136 patients, 79 patients received 1 to 5 courses of TACE prior to liver resection (TACE group), who were further subdivided into four groups: Group A (n = 11) who received 1 to 4 courses of chemotherapy alone; Group B (n = 33) who received 1 to 5 courses of chemotherapy combined with iodized oil; Group C (n = 23) who received 1 to 3 courses of chemotherapy combined with iodized oil and gelatin sponge; and Group D (n = 12) who received 1 to 3 courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge. The other 57 patients only received liver resection (non-TACE group). The expressions of Ki-67 and proliferating cell nuclear antigen (PCNA) protein were detected in the liver cancer tissues by immunohistochemical method.

RESULTS: The Ki-67 protein expression was significantly lower in Groups C and D as compared with non-TACE group (31.35% ± 10.85% vs 44.43% ± 20.70%, 30.93% ± 18.10% vs 44.43% ± 20.70%, respectively, P < 0.05). The PCNA protein expression was significantly lower in Groups C and D as compared with non-TACE group (49.61% ± 15.11% vs 62.92% ± 17.21%, 41.16% ± 11.83% vs 62.92% ± 17.21%, respectively, P < 0.05). The Ki-67 protein expression was significantly higher in Group A as compared with non-TACE group (55.44% ± 13.72% vs 44.43% ± 20.70%, P < 0.05). The PCNA protein expression was significantly higher in Groups A and B as compared with non-TACE group (72.22% ± 8.71% vs 62.92% ± 17.21%, 69.91% ± 13.38% vs 62.92% ± 17.21%, respectively, P < 0.05).

CONCLUSION: Preoperative multi-material TACE suppresses the proliferation of HCC cells, while a single material embolization and chemotherapy alone enhance the proliferation of HCC cells.

• Hepatocellular carcinoma
• Transcatheter arterial chemoembolization
• Proliferating cell nuclear antigen
• Ki-67

• Adult
• Aged
• Antineoplastic Agents/pharmacology
• Antineoplastic Agents/therapeutic use
• Biomarkers, Tumor/metabolism
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Cell Proliferation/drug effects
• Chemoembolization, Therapeutic
• Ethanol/metabolism
• Female
• Gelatin Sponge, Absorbable
• Hepatectomy
• Humans
• Infusions, Intra-Arterial
• Ki-67 Antigen/metabolism
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Preoperative Care
• Proliferating Cell Nuclear Antigen/metabolism
• Retrospective Studies
• Treatment Outcome

AIM: To evaluate the efficacy of different treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and investigate factors influencing prognosis.

METHODS: One hundred and seventy-nine HCC patients with macroscopic PVTT were enrolled in this study. They were divided into four groups and underwent different treatments: conservative treatment group (n = 18), chemotherapy group (n = 53), surgical resection group (n = 24) and surgical resection with postoperative chemotherapy group (n = 84). Survival rates of the patients were analyzed by the Kaplan-Meier method. A log-rank analysis was performed to identify group differences. Cox’s proportional hazards model was used to analyze variables associated with survival.

RESULTS: The mean survival periods of the patients in four groups were 3.6, 7.3, 10.1, and 15.1 mo respectively. There were significant differences in the survival rates among the groups. The survival rates at 0.5-, 1-, 2-, and 3-year in surgical resection with postoperative chemotherapy group were 55.8%, 39.3%, 30.4%, and 15.6% respectively, which were significantly higher than those of other groups (P<0.001). Multivariate analysis revealed that the strategy of treatment (P<0.001) and the number of chemotherapy cycles (P = 0.012) were independent survival predictors for patients with HCC and PVTT.

CONCLUSION: Surgical resection of HCC and PVTT combined with postoperative chemotherapy or chemoembolization is the most effective therapeutic strategy for the patients who can tolerate operation. Multiple chemotherapeutic courses should be given postoperatively to the patients with good hepatic function reserve.

• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Surgical resection
• Chemotherapy
• Chemoembolization

• Adult
• Aged
• Antineoplastic Agents/therapeutic use
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/drug therapy
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• Chemoembolization, Therapeutic
• Combined Modality Therapy
• Female
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/drug therapy
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Portal Vein
• Prognosis
• Proportional Hazards Models
• Thrombosis/etiology
• Thrombosis/mortality

AIM: To evaluate long-term effect of ethanol embolization for the treatment of hepatocellular carcinoma (HCC) with severe hepatic arterioportal shunt (APS), compared with Gelfoam embolization.

METHODS: Sixty-four patients (ethanol group) and 33 patients (Gelfoam group) with HCC and APS were respectively treated with ethanol and Gelfoam for APS before the routine interventional treatment for the tumor. Frequency of recanalization of shunt, complete occlusion of the shunt, side effects, complications, and survival rates were analyzed between the two groups.

RESULTS: The occlusion rate of APS after initial treatment in ethanol group was 70.3%(45/64), and recanalization rate of 1 month after embolization was 17.8%(8/45), and complete occlusion rate was 82.8%(53/64). Those in Gelfoam group were 63.6%(21/33), 85.7%(18/21), and 18.2%(6/33). There were significant differences in recanalization rate and complete occlusion rate between the two groups (P < 0.05). The survival rates in ethanol group were 78% at 6 months, 49% at 12 months, 25% at 24 months, whereas those in Gelfoam group were 58% at 6 months, 23% at 12 months, 15% at 24 months. The ethanol group showed significantly better survival than Gelfoam group (P < 0.05). In the ethanol group, there was a significant prolongation of survival in patients with monofocal HCC (P < 0.05) and Child class A (P < 0.05). There were no significant differences in survival rate in the Gelfoam group with regard to the number of tumor and Child class (P > 0.05). The incidence rate of abdominal pain during procedure in ethanol group was 82.8%. There was no significant difference in postembolization syndromes between two groups. Procedure-related hepatic failure did not occur in ethanol group.

CONCLUSION: Ethanol embolization for patients with HCC and severe APS is efficacious and safe, and may contribute to prolongation of the life span versus Gelfoam embolization.

• Arteriovenous Fistula/etiology
• Arteriovenous Fistula/therapy
• Carcinoma, Hepatocellular/complications
• Ethanol/administration & dosage
• Gelatin Sponge, Absorbable/administration & dosage
• Hemostatics/administration & dosage
• Hepatic Artery
• Humans
• Injections, Intra-Arterial
• Liver Neoplasms/complications
• Portal Vein

AIM: To evaluate the effects of p53 on apoptosis and proliferation of hepatocellular carcinoma (HCC) cells treated with transcatheter arterial chemoembolization (TACE).

METHODS: A total of 136 patients with HCC received TACE and other management before surgery were divided into TACE group and non-TACE group. TACE group included 79 patients who had 1-5 courses of TACE before surgery, of them, 11 patients had 1-4 courses of chemotherapy (group A), 33 patients had 1-5 courses of chemotherapy combined with iodized oil (group B), 23 patients had 1-3 courses of chemotherapy, iodized oil and gelatin sponge (group C), 12 patients had 1-3 courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge (group D). Non-TACE group included the remaining 57 patients who had surgery only. The extent of apoptosis was analyzed by transferase mediated dUTP nick end labeling (TUNEL) staining. The expressions of p53, Bcl-2, Bax, Ki-67 and PCNA protein were detected by immunohistochemical method.

RESULTS: p53 protein expressions in trabecular and clear cells in HCC specimens were significantly lower than that in pseudoglandar, solid, poorly differentiated or undifferentiated and sclerosis HCC (P < 0.05). Expression of p53 protein in HCC cells increased with the increase of pathological grades (P < 0.05), and correlated positively with expressions of Ki-67 and PCNA protein, and negatively with Bcl-2 to Bax protein expression rate and AI (P < 0.05). Expression of p53 protein was significantly higher in group A than in groups B, C, D and the non-TACE group, and was higher in group B than in groups C and D, and lower in group D than in the non-TACE group (P < 0.05).

CONCLUSION: Expression of p53 protein can enhance proliferation of HCC cells and suppress apoptosis of HCC cells after TACE.

• Adult
• Aged
• Apoptosis/physiology
• Carcinoma, Hepatocellular/metabolism
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Cell Division/physiology
• Chemoembolization, Therapeutic
• Female
• Humans
• Immunohistochemistry
• In Situ Nick-End Labeling
• Ki-67 Antigen/metabolism
• Liver Neoplasms/metabolism
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Proliferating Cell Nuclear Antigen/metabolism
• Proto-Oncogene Proteins/metabolism
• Proto-Oncogene Proteins c-bcl-2/metabolism
• Tumor Suppressor Protein p53/metabolism
• bcl-2-Associated X Protein

AIM: After transarterial chemoembolization (TACE), the residual cancer cells are under extensive hypoxic or even anoxic environment. Hypoxia can lead to adaptive responses. For example, angiogenesis will help these cells survive. In this study, we examined the effect of TACE on angiogenesis and expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) and to assess their relevance to Walker-256 transplanted hepatoma.

METHODS: Male Wistar rats were inoculated with Walker-256 tumor in the left lobe of liver. Angiography and transarterial chemoembolization were performed at d14 after transplantation. Sixty rats bearing walker-256 transplanted hepatoma were randomly divided into control group, arterial infusion group and TACE group. Each group consisted of twenty rats. Normal saline, 5-FU, 5-FU and lipiodol were infused through hepatic artery respectively. Two weeks after the infusion, staining of factor VIII, VEGF and b-FGF was performed by immunohistochemistry method in routine paraffin-embeded sections. Microvessel density (MVD) was counted in endothelial cells with positive factor VIII. Their expression levels were analyzed in conjunction with the pathologic features.

RESULTS: While a smaller tumor volume was found in TACE group (F = 37.818, P < 0.001), no statistical differences between MVD and expression of VEGF and b-FGF were found among the 3 groups. MVD of the control group, chemotherapy group and chemoemoblization group was 80.84 ± 24.24, 83.05 ± 20.29 and 85.20 ± 23.91 (F = 0.193, P = 0.873), respectively. The positive expression of VEGF and b-FGF was 75%, 75%, 85% (χ² = 0.449, P = 0.799) and 30%, 25%, 30% (χ² = 0.141, P = 0.922), respectively. Statistical analysis revealed a positive correlation between the expression of VEGF and MVD (r = 0.552, P < 0.001).

CONCLUSION: There has been little influence of lipiodol chemoembolization on the formation of tumor angiogenesis, but the development of neovascularization and expression of VEGF play important roles in establishment of collateral circulation and reconstruction of blood supply of residual cancer tissue.

• Animals
• Carcinoma 256, Walker/blood supply
• Carcinoma 256, Walker/pathology
• Carcinoma 256, Walker/physiopathology
• Carcinoma 256, Walker/therapy
• Chemoembolization, Therapeutic
• Fibroblast Growth Factor 2/metabolism
• Immunohistochemistry
• Liver Neoplasms, Experimental/blood supply
• Liver Neoplasms, Experimental/pathology
• Liver Neoplasms, Experimental/physiopathology
• Liver Neoplasms, Experimental/therapy
• Male
• Microcirculation
• Neoplasm Transplantation
• Neovascularization, Pathologic/therapy
• Rats
• Rats, Wistar
• Vascular Endothelial Growth Factor A/metabolism

To observe the therapeutic efficacy of 5-FU bletilla striata microspheres inFUsed through hepatic artery against rabbit VX2 transplanted hepatoma.

Fifty rabbits bearing VX2 transplanted hepatoma were randomly divided into five groups (n =10). Normal saline 1 mL, 5-Fu solutions 1 mL, ultr-liquor-lipiodol 0.3-0.4 mL and 5-Fu solutions 1 mL, 100 g/L Bletillaolloid 0.4 mL and 5-Fu solutions 1 mL, 5 FU-bletilla striate microspheres 10 mg/kg were infused though hepatic artery respectively. The tumor growth rates, necrosis rates and hepatic function were compared among the 5 groups.

5-FU bletilla striata microspheres had a very good vessel embolization function. In 5FU-bletilla striata microspheres group, the tumor was significantly inhibited, tumor growth rate was lower than tant in the control group (P <0.01) and the lipiodol group (P <0.05). Tumor necrosis grades were also more higher compared with to the other 4 groups. Complete necrosis was found in 2 of 10 rabbits in 5FU-bletilla striata microspheres group, which was more severe than that in the lipiodol group and bletillaolloid group. But the damage of normal liver tissues was also more serious.

5-FU bletilla striata microsphere is a safe and effective peripheral embolization agent.

• N/A

AIM: To investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiotherapy for unresectable large hepatocellular carcinoma (HCC).

METHODS: From June 1994 to June 1999, a total of 76 patients with large unresectable HCC were treated with TACE followed by external-beam irradiation. 89 patients with large HCC, who underwent TACE alone during the same period, served as the control group. Clinical features, therapeutic modalities, acute effects and survival rates were analyzed and compared between TACE plus irradiation group and TACE alone group. A multivariate analysis of nine clinical variables and one treatment variable (irradiation) was performed by the Cox proportional hazards model.

RESULTS: The clinical features and therapeutic modalities except irradiation between the two groups were comparable (P > 0.05). The objective response rate (RR) in TACE plus irradiation group was higher than that in TACE alone group (47.4% vs 28.1%, P < 0.05). The overall survival rates in TACE plus irradiation group (64.0%, 28.6%, and 19.3% at 1, 3, 5 years, respectively) were significantly higher than those in TACE alone group (39.9%, 9.5%, and 7.2%, respectively, P = 0.0001). Cox proportional hazards model analysis showed that tumor extension and Child grade were significant and were independent negative predictors of survival, while irradiation was an independent positive predictor of survival.

CONCLUSION: TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.

• Carcinoma, Hepatocellular/physiopathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic
• Combined Modality Therapy
• Female
• Humans
• Liver Neoplasms/physiopathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Proportional Hazards Models
• Radiotherapy
• Survival Analysis

AIM: To establish an ideal implantable rat liver tumor model for interventional therapy study and examine its angiographic signs and MRI, CT features before and after embolization.

METHODS: Forty male Wistar rats were implanted with Walker-256 tumor in the left lateral lobe of liver. Digital subtraction angiography (DSA) and transarterial chemoembolization were performed on day 14 after implantation. Native computer tomography (CT, n = 8) and native magnetic resonance (MR, n = 40) were performed between the day 8 and day 21 after implantation. The radiological morphological characteristics were correlated with histological findings.

RESULTS: Successful implantation was achieved in all forty rats, which was confirmed by CT and MRI. MR allowed tumor visualization from day 8 while CT from day 11 after implantation. The tumors were hypodensity on CT, hypointense on MR T1-weighted and hyperintense on T2-weighted. The model closely resembled human hepatocarcinoma in growth pattern and the lesions were rich in vasculature on angiography and got its filling mainly from the hepatic artery. Before therapy, tumor size was 211.9 ± 48.7 mm³. No ascites, satellite liver nodules or lung metastasis were found. One week after therapy, tumor size was 963.6 ± 214.8 mm³ in the control group and 356.5 ± 78.4 mm³ in TACE group. Ascites (4/40), satellite liver nodules (7/40) or lung metastasis (3/40) could be seen on day 21.

CONCLUSION: Walker-256 tumor rat model is suitable for the interventional experiment. CT and MRI are helpful in animal optioning and evaluating experimental results.

• Animals
• Carcinoma 256, Walker/pathology
• Carcinoma 256, Walker/therapy
• Chemoembolization, Therapeutic
• Disease Models, Animal
• Hepatic Artery
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Magnetic Resonance Imaging
• Male
• Neoplasm Transplantation
• Rats
• Rats, Wistar
• Tumor Cells, Cultured

AIM: To investigate the influence of hepatic arterial blockage on blood perfusion of transplanted cancer in rat liver and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-1 (MMP-1), and to explore the mechanisms involved in transarterial embolization (TAE)-induced metastasis of liver cancer preliminarily.

METHODS: Walker 256 carcinosarcoma was transplanted into rat liver to establish the liver cancer model. Hepatic arterial ligation (HAL) was used to block the hepatic arterial blood supply and simulate TAE. Blood perfusion of tumor in control, laparotomy control, and HAL group was analyzed by Hoechst 33342 labeling assay, the serum VEGF level was assayed by ELISA, the expression of VEGF and MMP-1 mRNA was detected by in situ hybridization.

RESULTS: Two days after HAL, the number of Hoechst 33342 labeled cells which represent the blood perfusion of tumor directly and hypoxia of tumor indirectly in HAL group decreased significantly compared with that in control group (329 ± 29 vs 384 ± 19, P < 0.01). The serum VEGF level in the HAL group increased significantly as against that of the control group (93 ng·L^-1± 44 ng·L^-1vs 55 ng·L^-1± 19 ng·L^-1, P < 0.05). The expression of VEGF and MMP-1 mRNA in the tumor tissue of the HAL group increased significantly compared with that of the control and the laparotomy control groups (P < 0.05). The blood perfusion data of the tumor, represented by the number of Hoechst 33342 labeled cells, showed a good linear inverse correlation with the serum VEGF level (r = -0.606, P < 0.05) and the expression of VEGF mRNA in the tumor tissue (r = -0.338, P < 0.01).

CONCLUSION: Blockage of hepatic arterial blood supply results in decreased blood perfusion and increased expression of metastasis-associated genes VEGF and MMP-1 of transplanted liver cancer in rats. Decreased blood perfusion and hypoxia may be the major cause of up-regulated expression of VEGF.

• Animals
• Carcinoma 256, Walker/blood supply
• Carcinoma 256, Walker/genetics
• Carcinoma 256, Walker/secondary
• Embolization, Therapeutic/adverse effects
• Endothelial Growth Factors/blood
• Endothelial Growth Factors/genetics
• Gene Expression
• Hepatic Artery
• Ligation
• Liver Neoplasms, Experimental/blood supply
• Liver Neoplasms, Experimental/genetics
• Lymphokines/blood
• Lymphokines/genetics
• Male
• Matrix Metalloproteinase 1/genetics
• RNA, Messenger/genetics
• RNA, Messenger/metabolism
• RNA, Neoplasm/genetics
• RNA, Neoplasm/metabolism
• Rats
• Rats, Wistar
• Vascular Endothelial Growth Factor A
• Vascular Endothelial Growth Factors

AIM: To conduct a randomized trial to evaluate the role of using high-dose iodized oil transcatheter arterial chemoembolization(TACE) in the treatment of large hepatocellular carcinoma (HCC).

METHODS: From January 1993 to June 1998, 473 patients with unresectable hepatocellular carcinoma were divided into two groups: 216 patients in group A received more than 20mL iodized oil during the first TACE treatment; 257 patients in group B received 5-15 mL iodized oil in the same way. The Child’s classification and ICG-R15 for evaluating the liver function of the patients were done before the treatment. During the TACE procedure the catheters was inserted into the target artery selectively and the tumor vessels were demonstrated with contrast medium in the hepatic angiography. The anticancer drug mixed with iodized oil (Lipiodol) were Epirubicin and Mitomycin. In group A, 112 cases received 20-29 mL Lipiodol in the first procedure, 85 cases 30-39 mL, 19 cases more than 40 mL. The largest dose was 53 mL and the average dose was 28.3 mL. In group B, 119 cases received 5-10 mL Lipiodol, 138 cases received 11-15 mL, and the average dose was 11.8 mL.

RESULTS: High-dose Lipiodol chemoembolization caused tolerable side effects and a little hurt to the liver function in the patients with Child grade A or ICG-R15 < 20. But the patients with child grade B or ICG-R15 > 20 had higher risk of liver failure after high-dose TACE. More type I and type II lipiodol accumulations in CT scan after 4 weeks of TACE were seen in the group A patients than those in the group B patients (P < 0.01). The resection rate and complete tumor necrosis rate in group A were higher than those of group B (P < 0.05). The 1-,2-,3-year survival rates of group A patients with Child grade A were 79.2%, 51.8% and 34.9%, respectively, better than those of group B (P < 0.001).

CONCLUSION: High-dose Lipiodol can result in more complete tumor necrosis by blocking both arteries and small portal vein of the tumor. High-dose TACE for treatment of large and hypervascular hepatocellular carcinoma is practically acceptable with the better effect than the routine dose. For the patients with large and hypervascular tumor of Child grade A liver function or ICG-R15 less than 20%, oily chemoembolization with 20-40 mL Lipiodol is recommended.

• Adult
• Aged
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic
• Contrast Media/administration & dosage
• Contrast Media/adverse effects
• Female
• Follow-Up Studies
• Humans
• Iodized Oil/administration & dosage
• Iodized Oil/adverse effects
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Survival Rate
• Tomography, X-Ray Computed
• Treatment Outcome