Arterial embolization of unresectable hepatocellular carcinoma with use of cyanoacrylate and lipiodol.
OBJECTIVE
To assess the potential of transarterial permanent embolization with use of a mixture of cyanoacrylate and lipiodol for treatment of unresectable primary hepatocellular carcinoma (HCC).


METHODS
In a retrospective study, 36 patients with histologically proven HCC were treated with transarterial embolization (TAE) of the hepatic arteries. None of these patients were candidates for surgical resection and some had advanced disease with multinodular disease or bulky tumor, thrombosis of a segmental branch of the portal vein, and/or extrahepatic spread. To induce permanent and more peripheral embolization, cyanoacrylate, an adhesive polymerizing on contact with blood, was used in TAE. From 1990 to 1998, a total of 76 embolization procedures were performed. Cumulative survival rates were calculated.


RESULTS
Most of the patients presented with a self-limited postembolization syndrome. Severe procedure-related complications were found after four treatment sessions (5.2%). The 30-day perioperative mortality rate was 2.7%. The mean follow-up period was 20.3 months (range, 1-68 mo), with a median survival of 26 months. The median survival was also estimated for different Okuda stages of disease: stage II (n = 26) versus stage III (n = 5) disease (32 vs 9 months; P <.05); patients with (n = 9) or without (n = 27) extrahepatic metastasis (10 vs 26 months; P <.05); and patients with (n = 10) or without (n = 26) thrombosis of a segmental branch of the portal vein (7 versus 34 months [P <.005]).


CONCLUSIONS
TAE with use of cyanoacrylate and lipiodol for unresectable HCC is a feasible treatment modality. This retrospective report indicates beneficial effects on survival even in patients with advanced disease.
Loewe
Christian
C
Department of Radiology, Section of Interventional Radiology, University of Vienna, Waehringer Guertel 18 - 20, A-1090 Vienna, Austria. christian.loewe@univie.ac.at
Cejna
Manfred
M
Schoder
Maria
M
Thurnher
Majda M
MM
Lammer
Johannes
J
Thurnher
Siegfried A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003487:Cyanoacrylates; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007459:Iodized Oil; D015993:Life Tables; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D003487:Cyanoacrylates; D007459:Iodized Oil