Sadick Maliha, Haas Stephan, Loehr Matthias, Elshwi Mohammad, Singer Manfred V, Brade Joachim, Schoenberg Stefan O, Diehl Steffen J
Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Mannheim, Germany.
Onkologie. 2010;33(1-2):31-7. doi: 10.1159/000264620. Epub 2010 Jan 22.
Application of a drug delivery device for transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment.
24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alcohol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, considering the sum of diameters of all lesions treated, was 3.83 cm (+/-2.4). Liver function and hematological parameters were documented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response.
24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treatment did not affect the patients' clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter approach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a reliable predictor of treatment response. A decrease of tumor size after TACE from 3.83 (+/-2.40) to 3.01 cm (+/-2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive.
TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.
将一种用于经动脉化疗栓塞术（TACE）的给药装置应用于肝细胞癌（HCC）患者。进行临床和影像学治疗评估。
24例肝硬化合并单灶或多灶HCC患者接受了使用阿霉素微球（DC微球）的TACE治疗。肝硬化的潜在病因是肝炎（甲型：n = 7；乙型：n = 10）或饮酒（n = 7）。患者的Child-Pugh分级为A期（n = 15）和B期（n = 9）。考虑所有治疗病灶直径总和，肝内肿瘤平均大小为3.83厘米（±2.4）。在每次TACE前后记录肝功能和血液学参数。在TACE前和TACE后4周进行磁共振成像（MRI）检查。应用T1加权三维容积内插屏气检查（VIBE）序列评估治疗反应。
24例患者共接受了69次使用DC微球的TACE治疗（平均剂量160毫克）。治疗后肝功能参数升高并未影响患者的临床状况。T1加权VIBE序列在评估肝内肿瘤扩散方面被证明非常有价值。增强后图像能够勾勒出存活的HCC病灶，从而便于进行选择性经导管治疗。19/24例患者可检测肿瘤标志物甲胎蛋白（AFP），其值从347.5降至299.5纳克/毫升，但并非治疗反应的可靠预测指标。在T1加权VIBE序列上，TACE后肿瘤大小明显从3.83（±2.40）降至3.01厘米（±2.67；p < 0.0001）。平均随访期为30个月。在数据分析时，14例患者中有10例（42%）存活。
HCC患者使用DC微球进行TACE治疗安全有效，可在短时间内使肿瘤产生反应。
