Page 155 - Read Online

Stambo et al. LC Bead embolization of hepatic neoplasms

However, the use of irinotecan for colon metastasis and design, literature research, clinical studies, and
was chosen based on the oncologic data at that time. manuscript preparation: G.S. Stambo
The literature described irinotecan as very effective Statistical analysis: D. Cragun
to colon metastasis when given intravenously. Experimental studies/data analysis, and manuscript
Therefore, the investigators used this drug initially on editing: G.S. Stambo, D. Cragun
all colorectal metastasis patients. Unfortunately, during
the early part of the study, this drug was found to be Financial support and sponsorship
ineffective on the first 12 colon metastasis patients None.
with a poor response given intra-arterially. From that
point on, doxorubicin was used exclusively during the Conflicts of interest
remaining part of the study. The reason to switch from There are no conflicts of interest.
irinotecan to doxorubicin was based solely on its poor
response in the first 12 patients. Once switched, there Patient consent
were statistically improved results using doxorubicin
compared to irinotecan on colon metastasis patients. Each patient was informed of the study and gave their
Secondly, the authors used FDG PET-CT for their consent.
follow up imaging. MRI with dedicated liver agents
have become readily available and considered Ethics approval
sufficiently sensitive for routine use for detection of This was a retrospective study and did not require
HCC which may not have been identified on follow- Institutional Review Board approval.
up FDG PET-CT. Lastly, this study consisted of a very
small sample size at a single institution and may not be REFERENCES
reflective of a larger population. However, these results
were compelling and suggest the need for additional 1. Serrablo A, Tejedor L, Ramia JM. Liver Metastases - Surgical
systematic or randomized studies that compare these Treatment. In: Reeves H, editor. Liver Tumors - Epidemiology,
different treatment options. Diagnosis, Prevention and Treatment. Rijeka, Croatia: InTech; 2013.
2. Sasson AR, Sigurdson ER. Surgical treatment of liver metastases.
Semin Ocol 2002;29:107-18.
This retrospective study evaluated and compared 3. Singletary SE, Walsh G, Vauthey JN, Curley S, Sawaya R, Weber KL,
how HCC and colorectal metastasis responded to Meric F, Hortobágyi GN. A role for curative surgery in the treatment
doxorubicin and irinotecan. It demonstrated that of selected patients with metastatic breast cancer. Oncologist
doxorubicin eluted bead embolization resulted in longer 2003;8:241-51.
patient survival as compared to conventional therapies 4. Brown DB, Geschwind JFH, Soulen MC, Millward SF, Sacks
previously reported in the literature. [6-9] Although the D. Society of Interventional Radiology position statement on
chemoembolization of hepatic malignancies. J Vasc Interv Radiol
patient sample size was small, 81.8% of the HCC 2006;17:217-23.
patients and 77% of the colon metastasis patients had 5. Lencioni R, Crocetti L, De Simone P, Filipponi F. Loco-regional
either complete or partial response. interventional treatment of hepatocellular carcinoma: techniques,
outcomes, and future prospects. Transpl Int 2010;23:698-703.
Patients receiving irinotecan had a statistically 6. Stambo GW, Guiney MJ. Hepatic angiosarcoma presenting as
significant poor response as compared to doxorubicin. an acute intraabdominal hemorrhage treated with transarterial
Furthermore, those patients with colorectal metastases 7. chemoembolization. Sarcoma 2007;2007:90169.
Aliberti C, Benea G, Tilli M, Fiorentini G. Chemomembolization
who did not respond to irinotecan initially could be (TACE) of unresectable intrahepatic cholangiocarcinoma with slow-
candidates for repeat embolization with doxorubicin release doxorubicin-eluting beads: preliminary results. Cardiovasc
and could hopefully improve following repeat Intervent Radiol 2008;31:883-8.
treatment outside of this study. Overall, HCC and colon 8. Steward MJ, Warbey VS, Malhotra A, Caplin ME, Buscombe JR,
metastasis patients demonstrated the effectiveness of Yu D. Neuroendocrine tumors: role of interventional radiology in
DEB with 91% of the HCC patients alive 24 months therapy. Radiographics 2008;28:1131-45.
after treatment. Prospective randomized trials would 9. Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M, Ayuso
C, Castells L, Montañá X, Llovet JM, Bruix J. Chemoembolization
be helpful for further evaluation in a large subset of of hepatocellular carcinoma with drug eluting beads: efficacy and
patients. Endovascular specialists should be aware doxorubicin pharmacokinetics. J Hepatol 2007;46:474-81.
of the benefits LC Bead embolization can bring to the 10. Liapi E, Lee KH, Georgiades CC, Hong K, Geschwind JF. Drug-
oncology community as malignant neoplasms of the eluting particles for interventional radiology. Tech Vasc Interv Radiol
liver continue to increase in the future. 2007;10:261-9.
11. Aliberti C, Tilli M, Benea G, Fiorentini G. Trans-arterial
Authors’ contributions chemoembolization (TACE) of liver metastases from colorectal
cancer using irinotecan-eluting beads: preliminary results. Anticancer
Guarantor of integrity of the entire study, study concepts Res 2006;26:3793-5.
Hepatoma Research ¦ Volume 3 ¦ July 12, 2017 147