Ionic versus nonionic contrast media solvents used with an epirubicin-based agent for transarterial chemoembolization of hepatocellular carcinoma.
OBJECTIVE
To compare the stability of epirubicin-iodized oil emulsions prepared with ionic or nonionic contrast medium and to compare the efficacy of these emulsions in a prospective, randomized, controlled trial of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).


METHODS
Epirubicin-iodized oil emulsions prepared with ionic and nonionic contrast media was evaluated for stability with light microscopy and magnetic resonance imaging. One hundred ninety-seven patients with inoperable HCC were randomized to receive TACE with epirubicin, prepared either with ionic (control group, n = 99) or nonionic (experimental group, n = 98) contrast medium. Tumor response was graded according to iodized oil retention (grade 1 = >90% retention, grade 2 = 50%-90% retention, and grade 3 = <50% retention), as characterized with computed tomography. Survival probabilities were calculated with the Kaplan-Meier method.


RESULTS
The epirubicin-iodized oil emulsions prepared with ionic contrast medium were less stable, exhibiting rapid separation of the oil and aqueous phases, compared with emulsions prepared with nonionic medium. Ninety-one patients in the control group and 87 in the experimental group underwent follow-up CT. Thirty-seven of the 91 patients in the control group (41%) had grade 1 tumors, 41 (45%) had grade 2 tumors, and 13 (14%) had grade 3 tumors. Forty-eight of the 87 patients in the experimental group (55%) had grade 1 tumors, 22 (25%) had grade 2 tumors, and 17 (20%) had grade 3 tumors. The number of patients with grade 1 tumors was significantly higher in the experimental group than in the control group (P = .02); however, there was no difference in patient survival (P = .94).


CONCLUSIONS
Epirubicin-iodized oil emulsions prepared with nonionic contrast medium are more stable and are associated with lower tumor grade in patients with inoperable HCC. The choice of solvent, however, does not appear to have an effect on patient survival.
Tzeng
Wen-Sheng
WS
Department of Radiology, Chi-Mei Medical Center, Yung Kang City, Tainan County, Taiwan, Republic of China. tzengg@ms31.hinet.net
Wu
Reng-Hong
RH
Chang
Shih-Chin
SC
Chou
Chung-Kuao
CK
Lin
Ching-Yih
CY
Chen
Jyh-Jou
JJ
Yang
Shun-Chun
SC
Lin
Chi-Hung
CH
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000295:instrumentation*; D003287:Contrast Media; D004655:Emulsions; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D052578:Ionic Liquids; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012997:Solvents; D014057:Tomography, X-Ray Computed
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D004655:Emulsions; D052578:Ionic Liquids; D012997:Solvents; D015251:Epirubicin; D007459:Iodized Oil