Features of blood supply and results of transarterial infusion and embolization in spinal metastases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the features of blood supply and results of transarterial infusion and embolization in spinal metastases.</p><p><b>METHODS</b>Forty-one patients with spinal metastasis received transarterial infusion and embolization between March 2001 and June 2008. The inclusion criteria were: The metastatic lesion caused back pain; The metastatic lesion involved vertebra at or below T3 level. There were 29 males and 12 females with a mean age of 56.0 (33 - 71) years. Epirubicin was used as the chemotherapeutic agent. Lipoid Ultra-Fluid, Contour SE or gelfoam particles were used as embolitic material.</p><p><b>RESULTS</b>The technical success of therapy was achieved in 52 vertebrae (100%) including 14 thoracic, 35 lumbar and 3 sacral vertebrae. 105 arteries were used for infusion and embolization (16 intercostal arteries, 78 lumbar arteries, 4 iliolumbar arteries, 4 branches of iliac arteries, and 3 median sacral arteries). Lipoid Ultra-Fluid (2 - 8 ml) was used in 15, Contour SE (300 approximately 500 microm, 20 - 100 mg) in 20, and gelfoam particles in 33 arteries. Three days after treatment, complete pain relief (CR) was achieved in 17 patients, partial pain relief (PR) in 20, and moderate pain relief (MR) in 4, with an effective rate of 90.2%. Two weeks after treatment, CR was achieved in 17 patients, PR in 21, and MR in 3, with an effective rate of 92.7%. No adverse nervous system effect occurred. 16 patients developed swelling and pain of normal tissues which were alleviated after symptomatic treatment.</p><p><b>CONCLUSION</b>Transarterial infusion and embolization is an effective therapy in relieving pain resulting from spinal metastases.</p>

The preliminary study of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma patients with portal vein tumor thrombus / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus.</p><p><b>METHODS</b>22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Comparison of stent patency rate curves and survival curves was analyzed by Log rank test.</p><p><b>RESULTS</b>The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying degrees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. I-II degree gastrointestinal tract reactions occurred in 3 cases, I-II degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25% , 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 12 months was 100%, 80% , 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05).</p><p><b>CONCLUSION</b>Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.</p>

The interventional management for early hepatic arterial thrombosis after liver transplantation / 介入放射学杂志

Objective To summarize the interventional management for early hepatic arterial thrombosis(HAT)after liver transplantation.Methods 32 patients suspected of HAT or HAS after liver transplantation in 502 cases from April 2001 to September 2006 were done hepatic arterial angiography.Among them,20 patients were confirmed as HAT immediately through hepatic arterial angiography,and were further treated by transarterial thrombolysis,pereutaneous transluminal angioplasty(PTA)and stent-graft placement. Results HAT was identified in 20 patients(3.98%),occurring in the median 4.5 days(2～19 days)after liver transplantation.The sites of all the thrombosis were found at the anastomotic point of the hepatic artery.5 cases were treated by PTA and 3 cases by stent placement during the transarterial thrombolysis.Coil and stent-graft were used in 2 cases with hepatic arterial anastomostic hemorrhage.Hepatic arterial recanalization was obtained in 20 cases.The period of thrombolysis was 2.5 clays(2-11 days).Conclusions Continuous infusion of urokinase through hepatic artery with catheter,PTA and stent placement are effective modalities for hepatic arterial thrombosis after liver transplantation.(J Intervent Radiol,2007,16:799-802)

Epirubicin in the treatment of malignant obstructive jaundice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ).</p><p><b>METHODS</b>Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up.</p><p><b>RESULTS</b>Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months).</p><p><b>CONCLUSION</b>Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.</p>

Clinical analysis of 56 cases of primary liver cancer of over 5 years survival after comprehensive interventional therapy / 介入放射学杂志

Objective To analyze the key factors on long-term effect for comprehensive interventional therapy of primary liver cancer.Methods The clinical data,therapeutic protocols and follow-up of 56 patients with primary liver cancer survived for more than 5 years after comprehensive interventional therapy were analyzed retrospectively.Results Before TACE,20 patients were in clinical stageⅠ,35 were in stageⅡand one was in stageⅢ,including hepatic function of grade A(36 cases),grade B(20 cases),and grade C (0 case).The tumor patterns were consisted of mononodular type(32 cases),multinodular type(24 cases),and diffuse type(0 cases).The diameter of tumor demonstrated less than 3 cm(10 cases),3-5 cm(20 cases), 5-10 cm(19 cases)and more than 10 cm(7 cases).Thirty-three cases(58.9%)were treated by only TACE for the original lesions,while 23 cases(41.1%)were treated by TACE combined other treatment including TACE combined PEt(11 cases),TACE combined RFA(4 eases),TACE combined radiotherapy(one case),and TACE combinedⅡ-staged resection(7 cases).During follow-up,24 patients with hepatic recurrence and 17 cases of distal metastasis were treated by TACE and other anti-tumor treatment.Complications after interventional therapy in 20 cases were also treated.All cases survived for more than 5 years after interventional therapy including 3 more than 10 years.Conclusions Tumor factors,liver function, standardized TACE,combination of TACE with other anti-tumor therapy,treatment of hepatic recurrence and distal metastasis and complications are the key points to improve the long-term survival rate for primary liver cancer treated by comprehensive interventional therapy.

The portal venous pressure change due to metallic stents implanted into portal veins in HCC patients / 介入放射学杂志

Objective To research the change of the portal venous pressure after the stents implanted into portal vein in HCC.Methods Twelve HCC patients receiving portal venous stem embolization were included in this study.The portal venous pressures were recorded before varices embolized(P1),after embolized(P2)and after stents implanted(P3),respectively.Four groups were formed according to the pressures within portal vein stem(PV),portal vein branch without tumor invasion(PVB),splenic vein(SV) and superior mesenteric vein(SMV).Results In PV group,P1 was(45:17?2.25)cm H20,and P2 was (48.33?2.20)cm H_2O,P＜0.05,P3 was(39.33?2.44)em H_2O,thus P＜0.05 in comparing with P2.for PVB group,P1 was(38.08?2.97)cm H_2O,and P2 was(38.83?2.94)cm H_2O,P＞0.05,P3 was(37.41?2.37)cm H_2O,comparing with P2,P＞0.05.In SV group,P1 was(44.67?2.13)cm H_2O,and P2 was(48.17?2.20)cm H_2O,P＜0.05,P3 was(41.67?2.20)cm H_2O,comparing with P2,P＜0.05.Finally,the SMV group,P1 was(45.25?2.21 )cm H_2O,P2 was(48.42?2.19)cm H_2O,P＜0.05,P3 was(41.25?2.24)cm H_2O, in comparison with P2,P＜0.05.Conclusions In portal vein stem embolization,portal venous pressure would be higher after varices embolized,but lower after stents placement.

Stenting in malignant obstruction of inferior vena cava caused by hepatic carcinoma / 介入放射学杂志

Objective To evaluate the effectiveness of endovascular deployment of metallic Z-type self- expandable stents in treating the patients with inferior vena eava(IVC)obstruction caused by hepatic malignant tumour.Methods One hundred and fifty six patients with IVC obstruction due to malignant compression were enrolled.Venography was performed via femoral vein before and after metallic Z-type self-expandable stent deployment across the stenotic segment of IVC.The diameter of stenotic segment,collateral vessels,venous pressures and the scores of patients IVC syndrome were compared before and after stent placement.Results One hundred and seventy nine stents were implanted in 156 patients successfully.The average obstructive length of IVC was(6.1?2.2)cm.The pressure gradient of stenotie segments of IVC declined from(2.1?0.5)kPa to (0.5?0.11)kPa.The diameters of stenotic segment of IVC increased from(0.33?0.11 )cm to(1.6?0.4) cm.After operations,the main clinical symptoms and physical signs relieved quickly.During 2～24 month follow-up,the pateney of IVC stents reached 86.7%.Conclusion Endovascular deployment of metallic Z-type self-expandable stent is an effective palliative treatment for patients with malignant obstruction of IVC.

Preliminary study on therapeutic effect of poly(N-isopropylacrylamide)adriamycin magnetic nanoparticles via transarterial embolization on liver VX2 tumor in rabbits / 介入放射学杂志

Objective To evaluate the therapeutic effects of poly(N-isopropylacrylamide)adriamycin magnetic nanoparticles(ADM-PNIPAM-Fe_3O_4)on liver VX2 tumor in rabbits via transcatheter arterial chemoembolization.Methods VX2 tumor pieces were successfully implanted into liver lobes of rabbits with liver tumors formation.All the animals were randomly divided into 4 groups of 8 each.Group A(control group)injected with 10 ml physiologic saline,Group B(ADM group)treated with free adriamycin (1 mg/kg)via arterial infusion,Group C(ADM-PNIPAM group)ADM-PNIPAM(1.5 mg/kg)was infused through arterial route,Group D(ADM-PNIPAM-Fe_3O_4+M group)ADM-PNIPAM-Fe_3O_4(2 mg/kg)was infused through arterial route;all were in individual doses,respectively;meanwhile an persistant magnet with intensity of 0.4 T was stabilized at the tumor region.Spiral CT scans were performed to measure size of liver tumors and evaluate lung metastasis at 1 day before operation and 14 days after operation.All experimental animals were sacrficed on the 15th days after operation and followed by pathologic and histologic examination of the tumor and lung specimens including changes befor and after the operation with correlative comparisons.Results There were no significant difference in volumes of tumors among 4 groups at 1 day before operation.The average tumor volume in the group A was(23.87?7.02)cm~3 at 14 days after operation;(7.70?1.53)cm3 in group B;(4.29?0.25)cm~3 in group C;(2.05?0.18)cm~3 in group D. The average tumor volumes in the group B,group C and group D were significantly smaller than that in the control group A at same time after operation and there was significant difference among the three experimental groups.According to the order of tumor sizes from small to large was as follows:group D＜group C＜group B＜group A.It showed that the average size of group D(ADM-PNIPAM-Fe_3O_4+M group) was the smallest among the 4 groups.Lung metastatic rates were 100%,66.7%,37.5% and 12.5% in group A,group B,group C and group D at 14 days after operation,respectively.Lung metastatic rates of group D was lower than that of group A,but there were no significant differences among group A,B and C.But pathological examination showed that there were lesser number of lung metastatic tumors in group B and C than that of group A .The intratumoral necrotic degrees showed as group D＞group C＞group B＞group A. Conclusions ADM-PNIPAM-Fe_3O_4 treatment for liver tumor via vascular interventional method combined with magnetic field localized in the lesion possesses significant inhibitory effect on tumor growth of liver VX2 tumor in rabbits.ADM-PNIPAM-Fe_3O_4 is thus initially confirmed as a kind of effective praeputium in interventional chemoembolization.