Efficacy of Transarterial Chemoembolization on Lesion Reduction in Colorectal Liver Metastases

  • Hossein Ghanaati Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of medical Sciences, Tehran, Iran.
  • Vahid Mohammadzadeh Medical Student, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Mohammadzadeh Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical sciences, Tehran, Iran.
  • Kavous Firouznia Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of medical Sciences, Tehran, Iran.
  • Maryam Mohammadzadeh Mail Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Marzieh Marzieh Motevali Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical sciences, Tehran, Iran.
  • Sakineh Kadivar Department of Ophthalmology, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Mohammad Ali Mohammadzadeh Department of Vascular Surgery, Poursina Hospital,Guilan University of Medical Sciences, Rasht, Iran.
  • Abbas Dargahi Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of medical Sciences, Tehran, Iran.
  • Amir Hossein Jalali Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of medical Sciences, Tehran, Iran.
  • Madjid Shakiba Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of medical Sciences, Tehran, Iran.
  • Payam Azadeh Department of Radiotherapy and Oncology, Jorjini Cancer Center, Imam Hossien Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords:
Colorectal carcinoma, Liver metastases, Transarterial chemoembolization, Chemotherapy

Abstract

Following failure of systemic chemotherapy, transarterial chemoembolization (TACE) is an available method to control unresectable liver metastases from colorectal carcinoma (CRC). The aim of present study was to evaluate the efficacy of chemoembolization for inoperable metastatic liver lesions from CRC. Forty-five CRC patients with liver metastases resistant to systemic chemotherapy were enrolled in our study. For each patient, three session of TACE were conducted with 45 days interval. A combination of mitomycin, doxorubicin, and lipiodol were used for TACE. A tri-phasic computed tomography scan and biochemical laboratory tests were performed for all patients at baseline and 30 days after each TACE. Image analysis included measurement of lesion diameters as well as contrast enhancement. Eleven patients deceased before completing three session and the final analyses were performed on the remaining 34 patients. Evaluation of a total 93 lesions in all patients after chemoembolization sessions revealed a 25.88% reduction in anteroposterior (AP) diameter, 33.92% transverse (T) diameter, and 42.22% in product of APxT diameter of lesions (P<0.001 for all instances). CT scan showed a total disappearance of 33% of lesions and evident reduction in contrast enhancement in 16% of them. There were no changes in contrast enhancement in 51% of lesions. Evaluation of single largest lesion in each patient revealed 57.32% reduction in AP diameter, 59.66% in T diameter, and 62.17% in product of APxT diameters (P<0.001 for all diameters). TACE offers a viable option for CRC patients with unresectable liver metastases by significantly reducing lesion size and contrast enhancement.

References

Vogl TJ, Zangos S, Eichler K, Yakoub D, Nabil M. Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update. Eur Radiol 2007;17(4):1025-34.

Cohen AD, Kemeny NE. An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist 2003;8(6):553-66.

Bentrem DJ, Dematteo RP, Blumgart LH. Surgical therapy for metastatic disease to the liver. Annu Rev Med 2005;56:139-56.

Ji SH, Park YS, Lee J, Lim DH, Park BB, Park KW, Kang JH, Lee SH, Park JO, Kim K, Kim WS, Jung CW, Im YH, Kang WK, Park K. Phase II study of irinotecan, 5- fluorouracil and leucovorin as first-line therapy foradvanced colorectal cancer. Jpn J Clin Oncol 2005;35(4):214-7.

Kuehr T, Ruff P, Rapoport BL, Falk S, Daniel F, Jacobs C,Davidson N, Thaler J, Boussard B, Carmichael J. Phase I/II study of first-line irinotecan combined with 5-fluorouraciland folinic acid Mayo Clinic schedule in patients with advanced colorectal cancer. BMC Cancer 2004;4:36.

Kemeny N, Garay CA, Gurtler J, Hochster H, Kennedy P, Benson A, Brandt DS, Polikoff J, Wertheim M, Shumaker G, Hallman D, Burger B, Gupta S. Randomized multicenter phase II trial of bolus plus infusional fluorouracil/leucovorin compared with fluorouracil/leucovorin plus oxaliplatin as third-line treatment of patients with advanced colorectal cancer. J Clin Oncol 2004;22(23):4753-61.

Germer CT, Buhr HJ, Isbert C. Nonoperative ablation for liver metastases. Possibilities and limitations as a curative treatment. Chirurg 2005;76(6):552-4, 556-63.

Bavisotto LM, Patel NH, Althaus SJ, Coldwell DM, Nghiem HV, Thompson T, Storer B, Thomas CR Jr. Hepatic transcatheter arterial chemoembolization alternating with systemic protracted continuous infusion 5- fluorouracil for gastrointestinal malignancies metastatic toliver: a phase II trial of the Puget Sound Oncology Consortium (PSOC 1104). Clin Cancer Res 1999;5(1):95-109.

Dudeck O, Ricke J. Advances in regional chemotherapy ofthe liver. Expert Opin Drug Deliv 2011;8(8):1057-69.

Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954;30(5):969-977.

Wallace S, Carrasco CH, Charnsangavej C, Richli WR, Wright K, Gianturco C. Hepatic artery infusion and chemoembolization in the management of liver metastases. Cardiovasc Intervent Radiol 1990;13(3):153-60.

Vogl TJ, Mack MG, Balzer JO, Engelmann K, Straub R, Eichler K, Woitaschek D, Zangos S. Liver metastases:neoadjuvant downsizing with transarterial chemoembolization before laser-induced thermotherapy. Radiology 2003;229(2):457-64.

Bläker H, Hofmann WJ, Theuer D, Otto HF. Pathohistological findings in liver metastases. Radiologe 2001;41(1):1-7.

You YT, Changchien CR, Huang JS, Ng KK. Combining systemic chemotherapy with chemoembolization in the treatment of unresectable hepatic metastases from colorectal cancer. Int J Colorectal Dis 2006;21(1):33-7.

Lewis AL, Gonzalez MV, Lloyd AW, Hall B, Tang Y, Willis SL, Leppard SW, Wolfenden LC, Palmer RR, Stratford PW. DC bead: in vitro characterization of a drugdelivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006;17(2 Pt 1):335-42.

Aliberti C, Tilli M, Benea G, Fiorentini G. Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res 2006;26(5B):3793-5.

Fiorentini G, Aliberti C, Turrisi G, Del Conte A, Rossi S, Benea G, Giovanis P. Intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase II clinical study. In Vivo 2007;21(6):1085-91.

Martin RC, Joshi J, Robbins K, Tomalty D, O'Hara R, Tatum C. Transarterial Chemoembolization of Metastatic Colorectal Carcinoma with Drug-Eluting Beads, Irinotecan (DEBIRI): Multi-Institutional Registry. J Oncol 2009;2009:539795.

Martin RC, Robbins K, Tomalty D, O'Hara R, Bosnjakovic P, Padr R, Rocek M, Slauf F, Scupchenko A, Tatum C. Transarterial chemoembolisation (TACE) using irinotecanloaded beads for the treatment of unresectable metastases to the liver in patients with colorectal cancer: an interimreport. World J Surg Oncol 2009;7:80.

Sacco R, Bertini M, Petruzzi P, Bertoni M, Bargellini I, Bresci G, Federici G, Gambardella L, Metrangolo S, ParisiG, Romano A, Scaramuzzino A, Tumino E, Silvestri A, Altomare E, et al. Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma: a cohortstudy. World J Gastroenterol 2009;15(15):1843-8.

Vogl TJ, Gruber T, Balzer JO, Eichler K, Hammerstingl R,Zangos S. Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 2009;250(1):281-9.

Müller H, Nakchbandi V, Chatzisavvidis I, von Voigt C.Repetitive chemoembolization with melphalan plus intraarterial immuno-chemotherapy within 5-fluorouracil and granulocyte-macrophage colony-stimulating factor (GMCSF) as effective first- and second-line treatment ofdisseminated colorectal liver metastases.Hepatogastroenterology 2003;50(54):1919-26.

Voigt W, Behrmann C, Schlueter A, Kegel T, Grothey A, Schmoll HJ. A new chemoembolization protocol in refractory liver metastasis of colorectal cancer: a feasibility study. Onkologie 2002;25(2):158-64.

How to Cite
1.
Ghanaati H, Mohammadzadeh V, Mohammadzadeh A, Firouznia K, Mohammadzadeh M, Marzieh Motevali M, Kadivar S, Mohammadzadeh MA, Dargahi A, Jalali AH, Shakiba M, Azadeh P. Efficacy of Transarterial Chemoembolization on Lesion Reduction in Colorectal Liver Metastases. Acta Med Iran. 50(8):535-540.
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