Ethanol: TACE - Transarteriële chemo-embolisatie bij inoperabele levertumoren gevolgd door bestraling en-of injecties met ethanol geven significant langere ziektevrije periode tussen behandelingen en gemiddeld significant langere overlevingsduur

13 juni 2011:

Veel mensen vergeten dat TACE - Trans Arteriele Chemo Embolisatie een behandeling is die wel levensverlenging geeft maar zelden overall overleving. Toch kunnen andere middelen die levensduur significant verlengen. Zie o.a. onderstaande studie naar effect van lokale bestraling en/of ethanol als aanvulling op een behandeling met TACE.

10 februari 2005: Bron: Pubmed: Ai Zheng. 2005 Jan;24(1):82-6. en Rofo. 2004 Dec;176(12):1794-802

Enkele recent gepubliceerde studies bewijzen dat wanneer TACE = Transarteriële chemo-embolisatie - gevolgd wordt door lokale bestraling of injecties met ethanol (PEI) met de overlevingstijd en ziektevrije tijd tussen de behandelingen van kankerpatiënten met inoperabele levertumoren significant verbetert in vergelijking met mono TACE. In de eerste studie uitgevoerd bij 108 patiënten met primaire levertumor en gerandomiseerd: 1 groep die alleen TACE kreeg en 1 groep die TACE gevolgd door externe bestraling kreeg als behandeling. De resultaten op de 1, 2 en 3 jaars overleving was resp.: 66.5% vs. 53.9%, 48.4% vs. 37.2%, and 37.4% vs. 17.8%, P<0.05, allemaal dus betere resultaten voor groep TACE pus bestraling.

In de tweede studie uitgevoerd in universiteitsziekenhuis Heidelberg in Duitsland bij patiënten met inoperabele levertumoren werden 22 patiënten met alleen TACE behandeld en 28 patiënten met TACE plus PEI. De resultaten: De 6-,12-, 24- en 36-maanden overlevingscijfers waren 61 %, 21 %, 4 %, and 4 % voor TACE monotherapie and 77 %, 55 %, 39 % en 22 % voor de combinatiebehandeling TACE en PEI (Kaplan-Meier method). De combinatiebehandeling verhoogde significant de gemiddelde overlevingstijd (p = 0.002 log-rank test).

Naast LITT als combinatie met TACE en gezonde voeding en extra suppletie kan deze behandeling TACE = Transarteriële chemo-embolisatie - dus voor jaren langere overleving zorgen voor mensen met inoperabele levertumoren. En wie weet wat een combinatie behandeling met achteraf dendritische celtherapie nog op kan leveren. Hier de abstracten van de twee studies.

[External radiation and combined transcatheter arterial chemoembolization for unresectable primary liver cancer.]

Liu MZ, Wang XS, Cai L, Gu MF, Liu H, Li Q, Cui NJ, Zhang YQ, Li GH, Li JQ.
Department of Radiotherapy, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China. bedgoody@pub.guangzhou.gd.cn.

BACKGROUND & OBJECTIVE: Transcatheter arterial chemoembolization (TACE) is the routine treatment for unresectable primary liver cancer, but 3-year survival rate of patients received TACE alone is only about 20%. This research was to evaluate efficacy of external radiotherapy (RT) combined with TACE on unresectable primary live cancer.

METHODS: From Jun. 1994 to Apr. 2002, 114 patients with unresectable primary liver cancer were non-randomized to receive TACE plus RT (54 patients), or TACE alone (60 patients) as control. For TACE, after skiagram confirmed catheterization, suspension of 300 mg of carboplatin, 50-60 mg of epirubicin, 14-20 mg of mitomycin, and 10-30 ml of iodized oil was perfused into hepatic arteries, 1-2 mm of Gelfoam particles was given to embolize hepatic arteries according to blood supply conditions of tumors, this process was repeated every 4-8 weeks. Either group was treated with 1-4 sessions of TACE. In TACE+RT group, patients received radiation on tumor and generous margin 21-28 days after TACE. The radiation dose was 46-60 Gy in daily 2 Gy fractions.

RESULTS: In TACE+RT group, response rate (AFP titer decrease of >50%) was 61.1%, and 1-, 2-, 3-year survival rates of TACE+RT group were significantly higher than those of TACE group (66.5% vs. 53.9%, 48.4% vs. 37.2%, and 37.4% vs. 17.8%, P<0.05). Three-year survival rate correlated with tumor size, liver function grade, and portal vein embolus.

CONCLUSION: TACE combined with RT may prolong survival time of patients with unresectable primary liver cancer.

PMID: 15642207 [PubMed - in process]

Rofo. 2004 Dec;176(12):1794-802.

[Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy]

[Article in German]

Lubienski A, Bitsch RG, Schemmer P, Grenacher L, Dux M, Kauffmann GW. Radiologische Universitatsklinik Heidelberg, Abteilung Radiodiagnostik, Heidelberg. andreas_lubienski@med.uni-heidelberg.de

PURPOSE: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC).

METHODS AND MATERIALS: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared.

RESULTS: The 6-,12-, 24- and 36-month survival rates were 61 %, 21 %, 4 %, and 4 % for TACE monotherapy and 77 %, 55 %, 39 % and 22 % for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p = 0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group.

CONCLUSION: The combination of TACE and PEI is an effective and safe method in the palliative treatment of large HCC that has the potential of improving long term survival compared to TACE monotherapy.

PMID: 15573291 [PubMed - indexed for MEDLINE]