SIR: Chemoembolization Unlikely to Injure Hepatic Artery

SEATTLE, March 5 -- Chemoembolization for liver cancer may damage the hepatic artery but rarely enough to affect subsequent treatment, researchers said here.

Among 49 patients who underwent the procedure, 1.1% had severe 'pruning' of the hepatic vessels that prevented further treatment while 10.1% had milder injury, said Ryan O'Hara, M.D., of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues, at the Society of Interventional Radiology meeting.

The percentage of the planned chemoembolic dose actually delivered was similar between the first and second treatments (average 87.6% versus 82.3%), reflecting that any hepatic injury had little impact on future ability to treat, they reported.

Surgical resection remains the gold standard treatment for liver cancer treatment, but only about 10% of patients are eligible for it, Dr. O'Hara said.

Chemoembolization may be used as an adjunctive treatment or for palliation. Because it often requires multiple treatments, anecdotal evidence of hepatic artery damage has been a worrisome question, he said.

"If you take out the bridge by damaging the artery, you aren't going to be able to go back in and treat," he said.

However, "in our study the answer was fiction," he said.

The study included patients treated with at least two standard transarterial chemoembolization (TACE) treatments for hepatocellular carcinoma. The protocol included cisplatin (Platinol), doxorubicin, mitomycin-c (Mutamycin), Ethiodol contrast medium, and polyvinyl alcohol particles.

Arteriogram imaging done immediately after embolization and prior to subsequent treatments were evaluated by two radiologists. Results were categorized as normal (grade I), peripheral pruning (the target for treatment, grade II), more severe pruning of most or all third order arterial branches (grade III), or occlusion (grade IV).

Overall, there were 122 treatments, 81 to the right hepatic and 41 to the left hepatic artery, recorded for the 49 patients who all had normal (grade I) hepatic arteries at baseline.

Among the findings, the researchers reported:

• On the follow-up arteriograms overall, 1.6% were grade I, 61.1% were grade II, 15.6% were grade III and 1.1% were grade IV,
• On arteriograms done before the second treatment, the rates were 3.7%, 81.7%, 12.2%, and 2.4%, respectively, and
• On follow-up arteriograms performed at a month or more after the procedure, the rates were 12.4% for grade I, 76.4% for grade II, 10.1% for grade III, and 1.1% for grade IV.

Dr. O'Hara said that further study would be needed to see whetheer the effect accumulates with additional treatments.