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Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor： clinical presentation and chest imaging findings

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Chinese Medical Journal 2014年第4期127卷 675-679页

作者： Xu Haifeng Yang Renjie Wang Xiaodong Zhu Xu Chen Hui Department of Interventional Therapy Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education)Peking University Cancer Hospital &amp Institute Beijing 100142China

Background Pulmonary lipiodol embolism after transarterial chemoembolization （TACE） was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven （2.3%） of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was （13.6＆#177;2.0） cm.All were hyper-vascular.The mean volume of lipiodol was （21.8＆#177;8.2） ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.

关键词： lipiodol pulmonary embolism hepatic tumor complications transarterial chemoembolization

Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

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World Journal of Gastroenterology 2010年第3期16卷 398-402页

作者： Wu, Lu Yang, Ye-Fa Liang, Jun Shen, Shu-Qun Ge, Nai-Jian Wu, Meng-Chao Second Mil Med Univ Dept Intervent Radiol 1 Eastern Hepatobiliary Surg Hosp Shanghai 200438 Peoples R China

Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

关键词： Intracranial embolism lipiodol Chemotherapeutic embolization Hepatocellular carcinoma

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

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World Journal of Gastroenterology 2021年第42期27卷 7387-7401页

作者： Kim Hay Be Richard Khor Daryl Lim Joon Ben Starvaggi Michael Chao Sweet Ping Ng Michael Ng Leonardo Zorron Cheng Tao Pu Marios Efthymiou Rhys Vaughan Sujievvan Chandran Department of Gastroenterology and Hepatology Austin HealthHeidelberg 3084VictoriaAustralia Department of Radiation Oncology Austin HealthHeidelberg 3084VictoriaAustralia School of Cancer Medicine La Trobe UniversityMelbourne 3086VictoriaAustralia Medicine Dentistry and Health SciencesUniversity of MelbourneParkville 3010VictoriaAustralia Genesis Care East Melbourne 3002VictoriaAustralia

BACKGROUND Image-guided radiotherapy(IGRT)has significantly improved the precision in which radiotherapy is delivered in cancer treatment.Typically,IGRT uses bony landmarks and key anatomical structures to locate the tumor.Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue.The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied.However,placement requires expertise and specialized endoscopic ultrasound equipment.This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT.AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients.METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne,Australia was conducted.Up to four liquid fiducials were inserted per patient,each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil(lipiodol;Aspen Pharmacare)and n-butyl 2-cyanoacrylate(Histoacryl®;B.Braun).A 23-gauge injector(Cook Medical)was used for the injection.All procedures were performed by or under the supervision of a gastroenterologist.Liquid fiducial-based IGRT(LF-IGRT)consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy.Patients received standard-IGRT(S-IGRT)if fiducial visibility was insufficient,consisting of bone match as a surrogate for tumor position.Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments.RESULTS 52 patients were referred for liquid fiducial placement within the study period.A total of 51 patients underwent liquid fiducial implantation.Of these a total of 31 pati

关键词： Image-guided radiotherapy lipiodol Gastroscopy Gastric cancer Oesophageal cancer Fiducial

Research Progress on the Prediction of TACE Efficacy by lipiodol Deposition

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Journal of Biosciences and Medicines 2023年第11期11卷 258-268页

作者： Yi Qing Yong Li Zhuhai Intervention Medical Center Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital) Zhuhai China

Primary hepatocellular carcinoma is one of the most common and deadliest malignant tumors in the world, and most patients are diagnosed after missing the optimal treatment period. TACE (Transcatheter arterial chemoembolization) is currently the preferred treatment for advanced HCC (Hepatocellular Carcinoma), as it can induce local ischemic necrosis of the tumor while reducing the systemic side effects of drugs by embolizing the tumor-feeding arteries. lipiodol, with its unique comprehensive properties of imaging, drug loading, and embolization, has become a key component in the process of TACE. Therefore, analyzing the deposition of lipiodol in hepatic tumor tissues after TACE can effectively evaluate the treatment efficacy. This article summarizes and analyzes the metabolism of lipiodol in tumors and the clinical application of lipiodol deposition status in predicting patient prognosis, aiming to provide clearer diagnostic and treatment strategies for clinical doctors.

关键词： Hepatocellular Carcinoma Transcatheter Arterial Chemoembolization lipiodol Interventional Treatment

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lipiodol

实用放射学杂志 1985年第3期 164-165页

作者： Ansell G. 毛松寿

For many years following the inception of bronchography, iodized oilremained the standard contrast medium. It is now rarely, if ever,used forthis purpose but analogous preparations are still used in lymphography,sinog... 详细信息

关键词： lipiodol

The clinical efficacy of percutaneous ethanol-lipiodol injection(PEI)combined with high-intensity focused ultrasound(HIFU)for small hepatocellularcarcinoma in special or high-risk locations

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Oncology and Translational Medicine 2021年第4期7卷 172-176页

作者： Xiaoli Zou Changzhi Zhao Tao Wang Li Jia Zhongyi Feng Xiaoguang Wang Lei Wei Xiaobei Liu Department of Ultrasound Imaging The Affiliated Dalian Municipal Friendship Hospital of Dalian Medical UniversityDalian 116001China Department of Hepatobiliary Surgery The Affiliated Dalian Municipal Friendship Hospital of Dalian Medical UniversityDalian 116001China

Objective The objective of this study was to explore the short-term effects and postoperative complications of ultrasound-guided percutaneous ethanol-lipiodol injection(PEI)combined with high-intensity focused ultrasound(HIFU)for the treatment of small hepatocellular carcinoma in a special or high-risk location.Methods Forty patients with small liver cancer in a special or high-risk location were randomly divided into two groups:20 patients were treated with PEI combined with HIFU(P+H group),and 20 patients were treated with HIFU alone(H group).There were no significant differences in average age,liver function,tumor location,tumor number,or tumor size between the two groups(P>0.05).Results Significant differences were observed in ablation parameters between the two groups(P<0.05).Under the same power,ablation rates of the P+H group were significantly higher than those in the H group,and postoperative complications in the P+H group were significantly lower than those in the H group(P<0.05).Conclusion The combination of PEI and HIFU has better clinical value than HIFU alone for small-cell liver cancer in special or high-risk locations.

关键词： hepatocellular carcinoma special location high-intensity focused ultrasound(HIFU) percutaneous ethanol-lipiodol injection(PEI) ethanol lipiodol

Transcatheter embolization therapy in liver cancer:an update of clinical evidences

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Chinese Journal of Cancer Research 2015年第2期27卷 96-121页

作者： Yi-Xiang J.Wang Thierry De Baere Jean-Marc Idee Sebastien Ballet Department of Imaging and Interventional Radiology Faculty of MedicineThe Chinese University of Hong KongPrince of Wales Hospital Gustave Roussy Department of Interventional Radiology Guerbet Division of Research & Innovation

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. Mthough being used for decades, lipiodol~ （lipiodol~ Ultra Fluid~, Guerbet, France） remains important as a tumor-seeking and radio-opaque clrug delivery vector in intervendonal 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

关键词： Transarterial chemoembolization hepatocellular carcinoma （HCC） drug-eluting particles microspheres lipiodol radioembolization yttrium-90

Arterial chemoembolization for hepatocellular carcinoma

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World Journal of Gastroenterology 1998年第1期4卷 38-42页

作者： FAN Jian TEN Gao-Jing HE Shi-Cheng GUO Jin-He YANG Dong-Pei WENG Guo-Ying Department of General Surgery First Affil. Hosp. Nanjing Rlwy. M. Nanjing 210009 Jiangsu Province China Nanjing Railway Medical College China Department of General Surgery First Affil. Hosp. Nanjing Rlwy. M. 87 Dingjiaqiao Road Nanjing 210009 Jiangsu Province China

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ＡｒｔｅｒｉａｌｃｈｅｍｏｅｍｂｏｌｉｚａｔｉｏｎｆｏｒｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａＦＡＮＪｉａｎ，ＴＥＮＧａｏＪｉｎｇ，ＨＥＳｈｉＣｈｅｎｇ，ＧＵＯＪｉｎＨｅ，ＹＡＮＧＤｏｎｇＰｅｉａｎｄＷＥＮＧＧｕｏＹｉｎｇＳｕｂｊｅ...

关键词： Liver neoplasm/therapy lipiodol sinobufagin microsphere gelatin sponge chemoembolization,therapeutic

Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 259-266页

作者： Timm D Kirchhoff Joerg S Bleck Arne Dettmer Ajay Chavan Herbert Rosenthal Sonja Merkesdal Bernd Frericks Lars Zender Nisar P Malek Tim F Greten Stefan Kubicka Michael P Manns Michael Galanski Department of Diagnostic Radiology Hannover Medical School Germany Department of Gastroenterology Hepatology and Endocrinology Hannover Medical School Germany Department of Diagnostic and Interventional Radiology Klinikum Oldenburg Germany Division of Rheumatology Hannover Medical School Germany Department of Radiology and Nuclear Medicine Campus B.F-Charité-University Medicine Berlin Germany

BACKGROUND: In a multidisciplinary conference patients with advanced non-resectable hepatocellular carcinoma (HCC) were stratified according to their clinical status and tumor extent to different regional modalities or to best supportive care. The present study evaluated all patients who were stratified to repeated transarterial chemoembolization (TACE) from 1999 until 2003 in terms of tumor response, toxicity, and survival. A moderate embolizing approach was chosen using a combination of degradable starch microspheres (DSM) and iodized oil (lipiodol) in order to combine anti-tumoral efficiency and low toxicity. METHODS: Fourty-seven patients were followed up prospectively. TACE treatment consisted of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), 450-900 mg DSM, and 5-30 ml lipiodol. DSM and lipiodol were administered according to tumor vascularization. Patient characteristics,toxicity, and complications were outlined. In multivariate regression analyses of pre-treatment variables from a prospective database, predictors for tumor response and survival after TACE were determined. RESULTS: 112 TACE courses were performed (2.4±1.5 courses per patient). Mean maximum tumor size was 75 (± 43) mm, in 68% there was bilobar disease. Best response to TACE treatment was: progressive disease (PD) 9%, stable disease (SD) 55%, partial remission (PR) 36%, and complete remission (CR) 0%. Multivariate regression analyses identified tumor size ≤75 mm, tumor number ≤5, and tumor hypervascularization as predictors for PR. The overall 1-, 2-, and 3-year-survival rates were 75%, 59%, and 41%, respectively, and the median survival was 26 months. Low α-fetoprotein levels (30 months, R2=36%). Grade 3 toxicity occurred in 7.1% (n=8), and grade 4 toxicity in 3.6% (n=4) of all courses in terms of reversible leukopenia and thrombocytopenia. The incidence of major complications was 5.4% (n=6). All complications

关键词： carcinoma, hepatocellular transarterial chemoembolization degradable starch microspheres lipiodol tumor response survival