title: Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion.
abstract: Transarterial chemoembolization with Lipiodol (Lipiodol TACE), also called conventional TACE, was developed in the early 1980s and widely adopted worldwide after randomized control trials and meta-analysis demonstrated superiority of Lipiodol TACE to best supportive care. Presently, there is no level one evidence that other TACE techniques are superior to Lipiodol TACE for intermediate stage hepatocellular carcinoma (HCC), which includes patients with preserved liver function and nonsurgical large or multinodular HCC without distant metastases. In addition, TACE is part of the treatment for progressive or symptomatic liver metastases from gastroenteropancreatic neuroendocrine tumors. When injected into the hepatic artery, Lipiodol has the unique property of selective uptake and retention in hyperarterialyzed liver tumors. Lipiodol/drug emulsion followed by particle embolization has been demonstrated to improve the pharmacokinetic of the drug and tumor response. Radio opacity of Lipiodol helps to monitor treatment delivery, with retention of Lipiodol serving as an imaging biomarker for tumor response. For 30 years, Lipiodol TACE has been inconsistently referenced in many publications with various levels of details for the method of preparation and administration, with reported progressive outcomes following improvements in the technique and the devices used to deliver the treatment and better patient selection. Consequently, there is no consensus on the standard method of TACE regarding the use of anticancer agents, embolic material, technical details, and the treatment schedule. In order to develop an internationally validated technical recommendation to standardize the Lipiodol TACE procedure, a worldwide panel of experts participated in a consensus meeting held on May 10, 2014 .
authors.affiliation: Department of Interventional Radiology, Gustave Roussy, 112 Rue Edouard Vailant, 94805, Villejuif, France. thierry.debaere@gustaveroussy.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: de Baere
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan. arai-y3111@mvh.biglobe.ne.jp.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Division of Diagnostic Imaging and Intervention (R.L.), Pisa University School of Medicine, Pisa, Italy. riccardo.lencioni@med.unipi.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lencioni
authors.affiliation: Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA. jfg@jhmi.edu.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Geschwind
authors.affiliation: Division of Vascular and Interventional Radiology Rm2803, Medical College of Wisconsin, Milwaukee, WI, USA. wrilling@mcw.edu.
authors.forename: William
authors.initials: W
authors.lastname: Rilling
authors.affiliation: Department of Radiology, Northwestern University, Chicago, IL, USA. r-salem@northwestern.edu.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Advanced Medical Imaging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan. matsuio@med.kanazawa-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.affiliation: Division of Interventional Radiology (MCS), University of Pennsylvania, Philadelphia, PA, USA. michael.soulen@uphs.upenn.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000628:therapy; D018579:Patient Selection; D011300:Preoperative Care
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil
keywords: Chemoembolization/chemoembolisation; Clinical practice; Hepatocellular carcinoma (HCC); Interventional oncology; Intra-arterial; Liver/hepatic; Transarterial chemoembolization/embolisation (TACE); Transcatheter therapy