J Korean Med Assoc.  2013 Nov;56(11):972-982. 10.5124/jkma.2013.56.11.972.

Recent advance in international management of hepatocellular carcinoma

• Chung JW

• KMID: 2193471
• DOI: http://doi.org/10.5124/jkma.2013.56.11.972

Abstract

During the most recent decade, remarkable progress has taken place in intra-arterial therapy for hepatocellular carcinoma. Advances in knowledge of hepatic vascular anatomy and tumor blood supply have contributed to the safety and efficacy of intra-arterial therapies. Technological advances in C-arm computed tomography and microcatheter systems have improved the technical success rates for superselective or ultraselective catheterization of tumor-feeding arteries. Drug-eluting bead technology has provided the option of performing chemoembolization with less systemic exposure to anticancer drugs and a more standardized delivery. Radio-embolization with yttrium-90 microspheres has emerged as a promising option offering increased quality of life. In addition, chemoembolization plays a central role in recently developed combination therapy strategies. In this era of advanced technologies and new treatment options, efforts should be made to understand the advantages and disadvantages of new technologies and treatment strategies and to apply them properly, which may lead to better local control of tumors, better quality of life, and longer patient survival.

Keyword

Hepatocellular carcinoma; Chemoembolization; Drug-eluting bead; Radioembolization

MeSH Terms

Arteries
Blood
Carcinoma, Hepatocellular*
Catheterization
Catheters
Humans
Microspheres
Quality of Life

Figure

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  Figure 1 Oily portogram sign in a 46-year-old man. Arrows indicate peripheral portal veins filled with lipiodol around the tumor.

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  Figure 2 Schematic diagram illustrating the development of extrahepatic collateral supply for hepatocelluar carcinoma located at the bare area of the liver.

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  Figure 3 Four centimeter-sized solitary nodular hepatocellular carcinoma supplied by the inferior phrenic artery at the initial presentation in a 75-year-old male. (A) Liver dynamic computed tomography (CT) scan in the arterial phase shows 4 cm-sized enhancing tumor (arrows). (B) The axial image of C-arm CT hepatic arteriography clearly shows a peripheral defect (arrows) in the hepatic arterial enhancement of the tumor suggesting the presence of extrahepatic collateral supply to the tumor. (C) Right inferior phrenic arteriography demonstrates hypervascular tumor stain at the area of defect on C-arm hepatic arteriography. (D,E) Based on C-arm CT information, it was possible to perform complete superselective chemoembolization using a 2.0F microcatheter not only at the feeder from the hepatic artery (D) but also at the feeder from the right inferior phrenic artery (E). Small black arrows indicate the appearance of peripheral portal veins filled with Lipiodol. (F) Iodized-oil CT taken two weeks later shows homogenous and compact Lipiodol accumulation in the tumor without any defect.

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  Figure 4 Volume rendered image of C-arm computed tomography hepatic arteriography obtained in 81-year-old man. It clearly depicts large hypervascular tumor and feeding arteries and provides a three-dimensional roadmap to navigate a microcatheter to the target feeding artery.

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