title: Chemoembolization-induced arterial damage: Evaluation of three different chemotherapeutic protocols using epirubicin and miriplatin.
abstract: OBJECTIVE
  We aimed to evaluate hepatic vascular changes following lipiodol-based transarterial chemoembolization of hepatocellular carcinoma using epirubicin (EPI), miriplatin (MPT) and miriplatin plus low-dose epirubicin (MPT+EPI).
  
  
  METHODS
  A total of 185 arteries in 118 patients who underwent chemoembolization using EPI (67 arteries in 48 patients), MPT (64 arteries in 37 patients) and MPT+EPI (54 arteries in 33 patients) were retrospectively examined. The maximum dose limit of MPT was 140 mg and that of EPI was 50 and 20 mg for the EPI and MPT+EPI groups, respectively. Vascular changes and local recurrence were evaluated by subsequent angiography. Factors affecting arterial damage were analyzed using multivariate logistic regression analysis.
  
  
  RESULTS
  More severe arterial damage was observed in the EPI group (88.1%) than in the MPT+EPI (72.2%) and the MPT (18.7%) groups (P = 0.044 and P < 0.001, respectively). EPI usage (hazard ratio [HR] = 12.8, P < 0.001), selective chemoembolization (HR = 5.4, P < 0.001) and MPT usage (HR = 0.28, P = 0.020) were significant predictors for arterial damage induction. The local recurrence rate was lower for the lesions exhibiting arterial occlusion after chemoembolization (39.4%) than for the lesions exhibiting no vascular attenuation (73.9%) or wall irregularity (75.8%) (P = 0.001 and P = 0.005, respectively).
  
  
  CONCLUSIONS
  High-dose EPI, MPT, and low-dose EPI plus MPT usage in chemoembolization for hepatocellular carcinoma induced the greatest, the least, and intermediate vascular damages, respectively. Therapeutic occlusion of tumor feeder vessels is associated with lower local recurrence.
authors.affiliation: Department of Radiology, Nissay Hospital, Osaka.
authors.forename: Jin
authors.initials: J
authors.lastname: Iwazawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ohue
authors.forename: Osamu
authors.initials: O
authors.lastname: Muramoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Mitani
keywords: arterioportal shunt; embolization; epirubicin; hepatocellular carcinoma; miriplatin; vascular damage