Trans Arterial Chemo Embolisation for HepatoCellulare Carcinoma

EUROPEAN UNIVERSITARY DIPLOMA

HEPATIC-PANCREATIC AND BILIARY CANCER

15 December 2014

Dr.Y AJAVON and Pr. M LEWIN

Department of Interventionnal Radiology

Dr Sameh AWAD

Principle of TACE

HCC

5% Portal vein

95 % Hepatic Artery

Normal Liver

75% Portal vein

25 % Hepatic Artery

Digestive arteries

1- T cœliaque2- A Gastriqie Gauche3- A Splenique4- A Gastro-épiploique D et G5- A Hépatique moyenne

(commune)

1

2

3

56

7

8

9

10

11

6- A Gastro-duodénale7- A Hépatique propre8- Branche droite de l’AH9- Sectorielle postérieure (Seg 6

et 7)

10 - Sectorielle antérieure (seg 5 et 8)11- Branche du seg 4 12- Branche gauche de l’AH (seg 2 et 3)13- A Gastrique droite (pyélorique)

12

Estomac

13

4

Anatomical variant

Anti-cancer Agent

- Whether an anticancer agent is indispensable for

embolization and if so which agent is the best if needed, is

still controversial.

- (doxorubicin (36%) cisplatin (31%) epirubicin (12%)

Doyon : Hepatic arterial embolisation for the treatement du HCC, Ann Radiol 1974

Vetter: 30 Patients: 1 year survival 59% vs 0 for controls, 3 Child C deceased. » Hepatology 1991

Bismuth: 291 patients: 2 year survival Child A 49% 3 months mortality in 37% with Child C.Am J Surg 1992

First experience of TACE in EU

Yamada et al. 120 patients de multinodulaires HCC, survival at one year : - 44% for TACE , 28% for surgery Radiologie 1983.

Okamura J. 13 patients before resection: complete necrosis in 8 , Gan To Kagaku Ryoho, 1983

Ohnishi K. 20 patients of whom 16 had a tumor response >50%,– 1 year survival 38% in 11 patients w.o. PVT, Radiology, 1984

First experience of TACE in ASIA

The disaster

What are the lessons

 J Bruix, Hepatology 2011

Patients selection

Takayasu et al, Jpn J Clin Oncol 2012

30% of patients 50% of patients

Patients selection

Patients selection

Takayasu et al, Jpn J Clin Oncol 2012

CASE 1: Conventionnal TACE of whole liver for HCC right liver (male of 47 years with alcolic cirrhosis.

a

d

c

e f

b

CT after one month

CASE 2 : - woman of 62 years with cirrhosis viral C, Child A- TIPS for recurrance UDH- Smalle HCC of 3 cm in segment 8

Hyper selective TACE of segment 8

CT after one month

Befor TACE

DC Beads

Nodule 1 du secteur latéral droit

Nodule 2 du dôme hépatique

CASE 3: selective TACE with DC Beads for tow HCC (man, 77 years old with cirrhosis C Chil B.

MRI befor TACE

(N1)

(N2)

MRI after one month

Be careful Bilary injury with non selectif TACE with DC Beads

(CT after one month)

Be careful Dont do portal embolization early after TACE

TACE for HCC in 2014

Japonais experience with lipiodol

MERCI