Targeted Transarterial Oily Chemoembolization for Small Foci of Hepatocellular Carcinoma Using a Unified Helical CT and Angiography system
Analysis of Factors Affecting Local Recurrence and Survival rates
Kenichi Takayasu1,
Yoshihisa Muramatsu1,
Tetsuo Maeda1,
Ryoko Iwata1,
Hiroyoshi Furukawa1,
Yukio Muramatsu1,
Noriyuki Moriyama1,
Takuji Okusaka2,
Shuichi Okada2 and
Hideki Ueno2
1
Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1,
Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
2
Department of Internal Medicine, National Cancer Center Hospital, Tokyo
104-0045, Japan.
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Fig. 1A. —81-year-old woman with hepatocellular carcinoma between
segments II and III. CT scan during arterial portography reveals perfusion
defect (arrow). Note that in right lobe previously treated lesion
contains deposition of iodized oil.
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Fig. 1B. —81-year-old woman with hepatocellular carcinoma between
segments II and III. Left hepatic angiogram shows faint tumor staining
(short arrows) supplied from two feeder arteries, one (long
arrow) from left lateral superior branch and the other
(arrowhead) from inferior branch. Latter artery was not suspected as
feeder at this angiographic study.
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Fig. 1C. —81-year-old woman with hepatocellular carcinoma between
segments II and III. CT arteriogram of B shows targeted lesion
(arrow) and noncancerous hepatic portion to be embolized.
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Fig. 1D. —81-year-old woman with hepatocellular carcinoma between
segments II and III. Angiogram shows microcatheter being advanced to more
distal branch artery that is shown as long arrow in B.
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Fig. 1E. —81-year-old woman with hepatocellular carcinoma between
segments II and III. CT arteriogram of D shows lesion and noncancerous
area to be embolized as smaller than that seen in C. Ventral portion of
lesion is incompletely enhanced, suggesting another feeding artery.
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Fig. 1F. —81-year-old woman with hepatocellular carcinoma between
segments II and III. Superselective angiogram shows another feeding artery
derived from origin of left lateral inferior branch. Note tumor stain
(arrows).
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Fig. 1G. —81-year-old woman with hepatocellular carcinoma between
segments II and III. CT arteriogram of F shows ventral defect of tumor,
which is now enhanced. Oily chemoembolization was performed.
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Fig. 1H. —81-year-old woman with hepatocellular carcinoma between
segments II and III. Unenhanced CT scan shows good retention of iodized oil in
entire tumor and in surrounding hepatic parenchyma. CT arteriography of right
hepatic artery is simultaneously performed to evaluate effect of previous oily
chemoembolization.
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Fig. 2. —Overall local recurrence rate for 71 small hepatocellular
carcinomas ( 5 cm) with one session of oily chemoembolization with unified
helical CT angiography system. Local recurrence rate is 33.2% at 1 year and
37.8% at 2 and 3 years. TOCE = transarterial oily chemoembolization.
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Fig. 3. —Local recurrence rates in relation to tumor size. Two-year
local recurrence rate was 15%, 40%, and 61% for small ( 1 cm), medium
(1-2.5 cm) and large (2.5-5 cm) groups, respectively. TOCE = transarterial
oily chemoembolization.
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Fig. 4. —Graph shows survival rates at 1, 2, and 3 years after
treatment in 54 patients with 71 hepatocellular carcinomas. Note that 1- and
3- year survival rates were 93.3% and 77.1%, respectively. TOCE =
transarterial oily chemoembolization.
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Fig. 5A. —57-year-old man undergoing misembolization for hepatocellular
carcinoma by conventional subsegmental oily chemoembolization. Radiograph
after oily chemoembolization of anterior superior branch discloses good
accumulation of iodized oil in targeted lesion (arrows) and
accompanying portal veins.
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Fig. 5B. —57-year-old man undergoing misembolization for hepatocellular
carcinoma by conventional subsegmental oily chemoembolization. Dynamic CT
scan, obtained 1 week after A, shows dense deposition of iodized oil
not in targeted lesion but in noncancerous hepatic portion just posterior to
well-opacified hepatocellular carcinoma (arrow) with faint iodized
oil deposition. Ascites has appeared anew on liver surface.
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Copyright © 2001 by the American Roentgen Ray Society.
