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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