Tag Archives: chemoembolization

Chemoembolization and Radioembolization for Difficult Liver Tumors; Choice May Depend on Blood Flow

Two-thirds of primary liver cancer patients and 90 percent of secondary liver cancer patients have inoperable tumors that are unresponsive to systemic chemotherapy and may benefit from transarterial chemoembolization or radioembolization with yttrium-90 (Y-90), both minimally-invasive, palliative procedures. Although research shows transarterial chemoembolization and Y-90 are usually equivalent treatments for most intermediate-stage hepatocellular carcinomas (HCCs)1, Heart and Vascular Institute considers tumor blood supply when deciding which therapy would be most beneficial for a specific patient.

Image on the left: Pre-chemoembolization axial, contrast-enhanced CT scan at the level of the liver. Image on the right: Post-chemoembolization axial, contrast-enhanced CT scan at the same level as the previous image.

Image on the left: Pre-chemoembolization axial, contrast-enhanced CT scan at the level of the liver. White arrow shows a hypervascular lesion (33.8 mm x 31.6 mm) in segment 7 of the liver consistent with hepatocellular carcinoma.
Image on the right: Post-chemoembolization axial, contrast-enhanced CT scan at the same level as the previous image. White arrows show the treated lesion (22.4 mm x 24.0 mm) in segment 7. The lesion is no longer enhancing and has decreased in size.

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Case Study: Chemoembolization for Transplant-Eligible Patient with HCC

A 41-year-old African male with a history of hepatitis B whose disease has progressed to Childs A cirrhosis, making him at increased risk for HCC. In April 2014, ultrasound describes two masses in the liver as worrisome for hepatocellular carcinoma. Additional imaging is recommended for further evaluation of the masses. The patient’s Alpha-fetoprotein (AFP) was 13.9 at this time. CT imaging demonstrated a hypervascular mass without washout in segment 7 of the liver. The other mass seen on ultrasound was not visualized on CT. The worrisome lesion was designated LIRADs 4B because of hypervascularity, lack of washout and size greater than 2.0 cm. The percutaneous biopsy performed for further evaluation was negative for malignancy. Subsequent imaging demonstrates continued lesion growth. That, combined with the elevated AFP, suggests that the lesion is HCC despite the biopsy results. The patient was evaluated for liver transplant and subsequently placed on the transplant list. In order to maintain the patient’s eligibility for transplantation, the decision was made to have the patient undergo chemoembolization. The patient underwent a single drug eluting bead chemoembolization approximately 20 months after the initial diagnosis of the mass lesion by US. The patient’s AFP decreased from a peak of 69.9 to 5.1 (normal is less than 7.5) post treatment. He will undergo routine follow-up until transplantation. If recurrent or new lesions are found, repeat chemoembolization can be considered.

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