1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Gustave Roussy, Department of Interventional Radiology, Villejuif, France ; 3 Guerbet, Division of Research & Innovation, Aulnay-sous-Bois, France.
Chin J Cancer Res. 2015 Apr;27(2):96-121. doi: 10.3978/j.issn.1000-9604.2015.03.03.
Transarterial chemoembolization (TACE) is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma (HCC) patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients' life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival (OS) with TACE was similar to that with hepatic resection and radiofrequency ablation. Although being used for decades, Lipiodol(®) (Lipiodol(®) Ultra Fluid(®), Guerbet, France) remains important as a tumor-seeking and radio-opaque drug delivery vector in interventional oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead (DEB) is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem(®) (CeloNova Biosciences Inc., USA), DC-Beads(®) (BTG, UK) and HepaSphere(®) (BioSphere Medical, Inc., USA). Transarterial radioembolization (TARE) technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres(®) (Sirtex Medical Limited, Australia) and TheraSphere(®) (BTG, UK). This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical evaluation. The key clinical trials of transcatheter arterial therapy for liver cancer are summarized.
经动脉化疗栓塞术（TACE）是一种基于动脉内导管的化疗形式，它通过动脉栓塞诱导的缺血性坏死作用，将高剂量细胞毒性药物选择性地输送到肿瘤床。化疗栓塞术和放射性栓塞术是不能接受移植、切除或经皮消融等潜在治愈性治疗的肝癌患者的治疗核心。TACE 已被证明可有效控制局部肿瘤、预防肿瘤进展、延长患者生命并控制患者症状。最近的证据表明，对于无血管侵犯的 3cm 或更小的单结节 HCC 患者，TACE 的 5 年总生存率（OS）与肝切除术和射频消融术相似。尽管已经使用了几十年，但碘油（Lipiodol(®)）（Guerbet，法国）仍然是介入肿瘤学中重要的肿瘤靶向和放射不透性药物输送载体。人们一直在努力改进化疗药物向肿瘤的输送。载药微球（DEB）是一种相对较新的药物输送栓塞系统，允许固定剂量和以持续方式释放抗癌药物。目前有三种 DEB 可供使用，即 Tandem(®)（CeloNova Biosciences Inc.，美国）、DC-Beads(®)（BTG，英国）和 HepaSphere(®)（BioSphere Medical，Inc.，美国）。经动脉放射性栓塞术（TARE）技术已经得到发展，并已证明在晚期肝癌和有血管并发症的肝癌中是有效和安全的。有两种类型的放射性栓塞微球可供使用，即 SIR-Spheres(®)（Sirtex Medical Limited，澳大利亚）和 TheraSphere(®)（BTG，英国）。本文综述了 TACE 的基本操作流程、一些已上市或正在临床评估的化疗栓塞系统和放射性栓塞剂的特性和疗效。总结了肝癌经导管动脉治疗的关键临床试验。
