Clinical efficacy of hepatic artery chemoembolization combined with systemic treatment in the treatment of recurrent hepatocellular carcinoma with abdominal lymph node metastasis / 中华消化外科杂志

In China, patients with hepatocellular carcinoma (HCC) are usually with late stage and long medical history when diagnosed, resulting in a lower 5-year survival rate. For advanced HCC, guidelines from different countries have different indications for local treatment. The applica-tion of hepatic artery chemoembolization has brought new treatment opportunities to patients with advanced HCC. Due to tumor heterogeneity, the response to immunotherapy is different in patients with intrahepatic recurrent lesions and extrahepatic metastatic lesions of primary hepatic carcinoma. Therefore, hepatic artery chemoembolization combined with systemic treatment is beneficial to prolong the survival of patients. The authors introduce the clinical experience of a patient with recurrent advanced HCC combined with abdominal lymph node metastasis who was treated with hepatic artery chemoembolization combined with atezolizumab plus bevacizumab. The results show that tumor is controlled in a short period with a good clinical effect.

Effect of Dahuang Zhechong Pills combined with TACE on VEGF, MMP-2, TGF-β1 and immune function of patients with primary liver cancer (blood stasis and collaterals blocking type) / 中国中药杂志

To investigate the effects of Dahuang Zhechong Pills combined with hepatic arterial chemoembolization(TACE) on tumor index and immune function of patients with primary liver cancer(blood stasis and collaterals blocking type), observe its application values in treatment of such patients, and provide effective treatment means for this disease. From June 2019 to December 2019, 79 patients with confirmed primary liver cancer(blood stasis and collaterals blocking type) treated in Wenzhou Hospital of Traditional Chinese Medicine were included in this study, all of which were grouped with random number table method before inclusion in this study. 40 patients in the control group were treated with TACE, while 39 patients in the observation group were treated with Dahuang Zhechong Pills combined with TACE. The efficacy was compared between two groups after 4 weeks of treatment. The immune function indexes of serum CD4~+ cells, CD4~+/CD8~+, CD3~+ cells of the observation group were higher than those in control group after treatment(P<0.05), and tumor indexes such as serum alpha-fetoprotein(AFP), carbohydrate antigen 199(CA199) and glutamic-pyruvic transaminase(ALT), total bilirubin(TBiL) levels were lower than those in the control group, with statistically significant differences(P<0.05). Plasma vascular endothelial growth factor(VEGF), transforming growth factor-β1(TGF-β1), and matrix metalloprotei-nase-2(MMP-2) levels in the observation group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). The total effective rate of the observation group was 87.18%, higher than 67.50% in the control group, and the benefit rate was 94.87% in the observation group, higher than 85.00% in the control group(P<0.05). The total incidence of adverse reactions such as bone marrow suppression, gastrointestinal reaction, fever, renal function injury and peripheral nerve injury in the observation group was 48.72%, lower than 82.50% in the control group, with statistically significant difference(P<0.05). In summary, the combination of Dahuang Zhechong Pills with TACE could improve immunity, protect liver function, and reduce the risk of metastasis and the incidence of adverse reactions from chemotherapy, so it is worth popularizing for patients with primary liver cancer(blood stasis and collaterals blocking type).

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer / 中国基层医药

Objective@#To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization(SPVCE) in the treatment of primary liver cancer.@*Methods@#A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study, and randomly divided into two groups according to the digital table, namely TACE(hepatic carcinoma arterial perfusion chemoembolization)+ SPVCE group and TACE group, with 59 cases in each group.In the TACE+ SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug-borne embolic agent, superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed, regional embolization was performed for liver cancer, and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared.@*Results@#The short-term objective(CR+ PR) efficiency of the TACE+ SPVCE group was 74.57%(44/59), which was significantly higher than that of the TACE group [54.23% (32/59)], the difference was statistically significant(χ2=5.323, P=0.021). The differences were statistically significant in the main indicators, such as the decrease of tumor lesion volume, the increase of liver volume without cancer, and the decrease of FAP(all P<0.05). The long-term objective efficiency of the TACE+ SPVCE group was 45.76%(27/59), which was also significantly higher than that of the TACE group[32.2%(19/59)], but the difference was no statistically significant(χ2=2.280, P=0.131). The TACE+ SPVCE group extended the median survival time by 3.5 months compared to the TACE group, there was statistically significant difference in median survival between the two groups(t=3.211, P=0.000). Major adverse reactions were compared between the two groups, the patients with decreased albumin in the TACE + SPVCE group was less than the TACE group, but there was no statistically significant difference(χ2=1.156, P=0.282), the patients with bone marrow inhibition in the TACE + SPVCE group decreased significantly compared with the TACE group, the difference was statistically significant(χ2=4.882, P=0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group, but there was no statistically significant difference(χ2=1.035, P=0.308).@*Conclusion@#Injection for drug carrier with lobaplatin with gelatin sponge embolism agent, percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization, is safe and effective, and can improve the curative effect of conventional TACE, and prolong survival, has important clinical value for advanced liver cancer patients that cannot be surgically removed.

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer / 中国基层医药

Objective To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization ( SPVCE) in the treatment of primary liver cancer.Methods A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study,and randomly divided into two groups according to the digital table ,namely TACE(hepatic carcinoma arterial perfusion chemoembo－lization)+SPVCE group and TACE group , with 59 cases in each group.In the TACE +SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug －borne embolic agent , superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed ,regional embolization was performed for liver cancer , and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared.Results The short－term objective(CR+PR) efficiency of the TACE+SPVCE group was 74.57%(44／59),which was significantly higher than that of the TACE group [54.23%(32／59)],the difference was statistically significant (χ2 ＝5.323,P＝0.021).The differences were statistically significant in the main indicators , such as the decrease of tumor lesion volume ,the increase of liver volume without cancer ,and the decrease of FAP(all P＜0.05).The long－term objective efficiency of the TACE +SPVCE group was 45.76%(27／59),which was also significantly higher than that of the TACE group [32.2%(19／59)],but the difference was no statistically significant (χ2 ＝2.280,P＝0.131).The TACE+SPVCE group extended the median survival time by 3.5 months compared to the TACE group,there was statistically significant difference in median survival between the two groups ( t＝3.211, P＝0.000).Major adverse reactions were compared between the two groups ,the patients with decreased albumin in the TACE +SPVCE group was less than the TACE group ,but there was no statistically significant difference (χ2 ＝1.156,P＝0.282),the patients with bone marrow inhibition in the TACE +SPVCE group decreased significantly compared with the TACE group ,the difference was statistically significant ( χ2 ＝4.882,P ＝0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group , but there was no statistically significant difference(χ2 ＝1.035,P＝0.308).Conclusion Injection for drug carrier with lobaplatin with gelatin sponge embolism agent , percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization,is safe and effective,and can improve the curative effect of conventional TACE ,and prolong survival ,has important clinical value for advanced liver cancer patients that cannot be surgically removed .

Clinical research of trans-arterial chemo-embolization in combination with radio-frequency ablation for the treatment of massive primary hepatocellular carcinoma / 中国医学装备

Objective:To investigate clinical curative effect of trans-arterial chemo-embolization (TACE) in combination with radio-frequency ablation (RFA) for the treatment of massive primary hepatocellular carcinoma so as to provide theoretical basis for clinical practice.Methods: 60 patients with massive primary hepatocellular carcinoma were divided into control group (30 cases) and observation group (30 cases) according to the different treatment methods. The patients of control group received the treatment of TACE while the patients of observation group received the combined treatment of TACE and RFA, at the same time, all of the patients of two groups received the supportive treatment for protecting liver. After the operation, the necrosis situations of patients in the two groups were evaluated by using enhanced CT, and their complication and survival time were recorded. Besides, the changes of series of indexes including blood routine, hepatic and renal function and immunologic function were monitored. Based above data, the curative effect and safety of the two therapeutic methods were compared and analyzed. Results: After treatment, the 6 months, 1 year, 2 years, 3 years survival rate of observation group were significantly higher than that of control group (x2=5.787,x2=6.814,x2=4.802,x2=4.622,P<0.05). And the TBIL, ALT and AFP of observation group were significantly lower than that of control group (t=5.775,t=3.332,t=10.231,P<0.05). Besides, the CD3+, CD4+/CD8+, NK cells and TNF-α of observation group were significantly higher than that of control group (t=6.434,t=5.125,t=6.017,t=4.669,P<0.05).Conclusion: The curative effect of TACE combined with RFA is significantly better than that of single TACE, and it is worthy in clinical popularization and application.

The clinical application of raltitrexed in TACE for primary hepatocellular carcinoma / 介入放射学杂志

Objective To investigate the curative effect and safety of transcatheter arterial chemoembo -lization (TACE) containing raltitrexed scheme for primary hepatocellular carcinoma (PHCC).Methods From May 2013 to June 2014,a total of 90 patients with inoperable PHCC were treated with TACE containing raltitrexed scheme.The short-term effect,long-term effect and adverse reactions were analyzed.Results Of the 90 patients,complete response was obtained in 23,partial response in 36,stable disease in 24 and progressive disease in 7,the effective rate was 65.6％.The one-year survival rate was 72.2％,the median survival time was 15.9 months,and the progression free survival was 9.1 months.Single factor analysis showed that the statistically significant differences in survival rate existed among the patients with different BCLC staging,combination therapy,lipiodol deposit pattern and vascular tumor thrombus (P＜0.05).Multivariate analysis of Cox model indicated that BCLC staging (x2=9.83,P=0.002) and combined therapy (x2=6.40,P=0.011) were independent prognostic factors.The main adverse reactions were fever,pain,vomiting and bone marrow suppression.Grade Ⅲ-Ⅳ adverse reactions were rare and no treatment-related death occurred.Conclusion For the treatment of inoperable PHCC,TACE containing raltitrexed scheme is effective and safe,and this therapy can be well tolerated by patients.

Changes and clinical significance of plasma vascular endothelial growth factor of patients with primary liver cancer before and after interventional treatment / 中国综合临床

Objective To investigate the changes of plasma vascular endothelial growth factor( VEGF) of patients of advanced primary liver cancer before and after interventional treatment and its clinical Significance. Methods Forty-six patients with advanced primary liver cancer were performed the hepatic arterial chemoembolization and served as observation group. Sixty healthy people were served as control group and measured their level of serum VEGF. The level of serum VEGF of patients in observation group before treatment and intervention 1 month were measured. Results Before interventional treatment,the serum VEGF level of observation group were(510. 0 ± 310. 0)ng/L,significantly higher than that of control group((27. 0 ± 23. 0) ng/L,P﹤0. 001). After interventional treatment,he serum VEGF level decreased to(316. 4 ± 240. 7)ng/L and the difference was statistically significant( P=0. 036 ). After one month interventional treatment,4 cases were complete remission(8. 70%),34 cases were partial remission(73. 91%),6 cases were in stable(13. 04%),and 2 cases were progress( 4. 35%),and the total effective rate were 82. 61%( 38/46 ). The 38 cases who were complete remission and partial remission were been served as effective group,the other 8 cases were served as invalid group. The serum VEGF level in effective group were( 260. 6 ± 70. 5 )ng/L,lower than that in invalid group(( 346. 7 ± 61. 3 )ng/L,P = 0. 046 ). Conclusion Hepatic arterial chemoembolization treatment on primary liver cancer curative effect is a better approach. VEGF involves in the development of primary liver cancer,and the high serum VEGF level with poor prognosis can be the reference of efficacy.

Analysis of related factors of family care needs in patients with primary hepatocellular carcinoma after transcatheter hepatic arterial chemoembolization / 中国实用护理杂志

Objective To investigate the family care needs in patients with primary hepatocellular carcinoma after transcatheter hepatic arterial chemoembolization (TACE).Methods One hundred and twenty patients of hepatocellular carcinoma with non first time of TACE were selected from August 2013 to June 2014 by convenience sampling method.Using a self designed questionnaire form,investigated patients' families care after discharge needs,including psychological demand,nursing requirements and other requirements.The independent factors affecting families psychological needs were analyzed by multi-factor analysis of variance.Results Patients' families care needs in dimensions,psychological demand was the highest score for (3.12±0.81) scores.Care requirements and other requirements were (3.04±0.56),(2.18±0.36) scores,respectively.Each demand entries,understand pain processing requirements was the highest score for (3.78 ±1.02) scores,hospice and funeral support was the lowest for (1.27±0.38) scores.Education degree,and patient relationship were independent factors affecting patients' families psychological demand,P＜0.05.Conclusions TACE reduces quality of life of patients,the role of families in the care of patients is also important.Care needs of families after TACE,the psychological demand should be satisfied first,required at the same time attention to relevant nursing requirements and other requirements;while education from families and relationships with patients are independent factors affecting the psychological needs of patients' family members.

Interventional chemoembolization through hepatic artery and superior mesenteric artery for primary hepatocellular carcinoma：a control study of 21 cases / 介入放射学杂志

Objective To investigate the clinical efficacy, the toxicity and side reactions of interventional chemoembolization with FOLFOX4 regimen through both hepatic artery and superior mesenteric artery, i.e. dual access technique, in treating primary hepatocellular carcinoma. Methods Between November 2010 and March 2013 at authors’ hospital, a total of 21 patients with advanced primary hepatocellular carcinoma (the study group) were treated with FOLFOX4 regimen by using dual access interventional technique. FOLFOX4 regimen included hepatic arterial infusion of 5-fluorouracil 400 mg/m2, hepatic arterial chemoembolization with iodipin and oxaliplatin 85 mg/m 2, intravenous administration of calcium folinate 200 mg/m2 IV on the first and second day, trans-superior mesenteric artery continuous infusion (lasting for 22 hours) of 5 -Fuorouracil 600 mg/m2 on the first and second day. During the same period other 21 patients with primary hepatocellular carcinoma were selected (used as the control group) to receive conventional hepatic arterial chemoembolization. In both groups, the treatment was repeated after 4-6 weeks. The therapeutic effect and the toxicity and side reactions were evaluated after the second treatment. Results The effective rate for the study group and the control group was 61.9% and 28.6% respectively, and the median survival time for the study group and the control group was 14.7 months and 9.4 months respectively. The differences in the effective rate and the median survival time between the two groups were statistically significant (P = 0.030 and P = 0.034). The occurrence of toxicity and side reactions, such as digestive tract reactions and the damage of liver function, in the study group were strikingly lower than those in the control group. Conclusion Through dual approach of hepatic artery and superior mesenteric artery catheterization, interventional chemoembolization with FOLFOX4 regimen is outstandingly effective for primary hepatocellular carcinoma, meanwhile, the side effects are very slight.

Using humanized nursing for fiver cancer patients by transcatheter hepatic artery chemobolization / 中国实用护理杂志

Objective In order to know the application effects of transcatheter hepatic artery chemoembolization for patients with liver cancer. Methods Divided 144 liver cancer patients into the experimental group and the control group randomly, there were 82 cases in each group. Routine nursing cares were used in the control group, humanized nursing were used in the experimental group in addition. Compared the curative effect, incidence rate of complication and scores of SAS and SDS between the two groups. Results The curative effect in the experimental group was significant better than in the control, the incidence rate of complications were lower in the experimental group than those of in the control group. Before out of hospital, the SAS and SDS level in the experimental group was better than in the control group. Conclusions Humanized nursing can enhance the curative effec4 avoid disputs between patients and nurses, and then promote nurses' working interesting.

LP-THAE induced tumor cell apoptosis of rabbit VX2 liver carcinoma / 介入放射学杂志

Objective To research tumor cell apoptosis induced by Lp-THAE of rabbit VX2 liver implanted tumor.Methods 27 New Zealand white rabbits implanted with VX2 tumor at left middle lobe of the liver divided into three groups:Group A(n = 9) Lp-THAE:treated through transhepatic artery catheterization;Group B(n = 9) THAI and Group C(n = 9) as control.The rabbits were executed at second to fifth day after treatment.HE dye microscopy was taken for counting the typical apoptosis cells and calculating apoptosis index(ApI).FITC-AnnexinV/PI assay was used for measuring apoptosis by flow cytometry.Results The ApI of tumor central area and marginal area were(17.769 ? 2.417)%,(4.129 ? 1.172)%,P

Brain Abscess After Hepatic Artery Chemoembolization for Hepatocellular Carcinoma: Case Report

We describe a case of brain abscess which developed in a 64-year-old man after hepatic artery chemoem-bolization(HACE) for hepatocellular carcinoma(HCC).On his first admission, percutaneous liver biopsy led to a diagnosis of type-C liver cirrhosis, he readmitted 5 years later and HCC was diagnosed. The patient underwent two HACE procedures, with a two-month interval. Three month later, he was readmitted to hospital with headache and brief loss of consciousness; brain magnetic resonance imaging(MRI) revealed a brain abscess. Stereotactic aspiration was performed and antibiotics sensitive to the klebsiella pneumonia bacteria cultured in the abscess were administrated intraveously. One month later, the abscess size became smaller and the patient was discharged. This report reviews the literature and discusses the pathogenesis of brain abscess after intra-arterial embolization.

Experimental Study of Methotrexate Microspheres'Shortterm Toxicity after Hepatic Arterial Infusion / 介入放射学杂志

The aim of the experimental study is to investigate shortterm toxicity of an initial domestic Methotrexate microspheres(MTX-ms)by hepatic arterial infusion in rats,provide some experimental bases for clinic interventional treatment of liver carcinoma with this new chemoembolization agent.Compareing with control group and MTX group, MTX-ms of largedoses could result in temporal rise of GPT and AKP,deterioration or necroses of animal's liver at different degrees,12 days later a number of microspheres could still be found in the small arteries of the necrotizing area.No pathological changes related to microsphere could be found in other main organs(heart,spleen,lung and kidney).Results suggested that chemoembolization effect of MTX-ms is relatively strong;for effectively oc- cluding blood flow of hepatic arteries on the level of small arteries.Meanwhile MTX-ms oc- clud blood supply of liver carcinoma,they may also cause damages of normal liver tissue. Clinically more attention ought to be paid to the dosage of MTX1 microspheres and thus avoid the overflow of more microspheres to the normal liver tissue causing damage.