Chemoembolism research continues | yosoyrosa's Blog

What a surprising night!  3 days ago my honey was in a 3hr procedure for chemotherapy, and last night he was pain free without medication.  This morning he had a bit of a headache, and the hematoma is purple and sore, so a pain pill will start the day.  As a liver disease patient, we have to watch any pain medication that has acetaminophen (including Norco) up to, but not more than, 2 grams a day safely for pain.

The whole chemo process has me intrigued, and as the recommendation goes to be the informed patient (or wife), I'm back at the research again.  Everything I read talks about the application of chemotherapy agents, yet I do not find what is actually used.  Well there is good reason for that, as there is some controversy within the interventional radiology community on which one works best.  

The most complete information I found is located on Medscape at http://www.medscape.com/viewarticle/474054_3.  It appears that poppyseed oil is the reigning suspension medium, and a drug cocktail is most likely used to treat the tumor, instead of selecting just one type of chemical. Continuing to read various articles, the benefits of localized chemo show that concentrations of the drugs direct to the cancer are 100 times more powerful with direct exposure than traditional drug therapy by mouth or IV that are diluted by blood and impact the entire body. 

In reading an informational TACE article in cancer news from the University of Florida (http://www.ufscc.ufl.edu/Patient/cancernews.aspx?section=cancernews&id=17939), they explain "Following intra-arterial chemotherapy administration, a small gelatin sponge is placed into the hepatic artery to block blood flow to the cancer. This reduces the volume of blood in the cancer, which allows the chemotherapy agent to spread throughout the cancer and remain there in sufficient concentrations."  Checking again, the article posted in Google's Knol says that gelfoam is used in cutting off the blood supply to the tumor, and the Medscape article agrees, and goes on to say recanalization occurring in approximately 2 weeks  which means that its not a permanent sponge left behind as I'd read elsewhere.  That is a relief!

Another question we have had bugging us is that all the studies and the transplant boards talk about 1 year survival rates.  What then?  It turns out there was a study earlier this year performed on patients outside the traditional liver cancer transplant (T2) criteria that followed patients for 4 years.  I quickly associated our case as we were originally told 5, possibly 6 lesions, and even the last read by the university called out 4 lesions one of which is 3.2cm, which still is outside T2 (one < 5cm or up to 3 < 3cm).

2008: Yao Francis Y; Kerlan Robert K; Hirose Ryutaro; Davern Timothy J; Bass Nathan M; Feng Sandy; Peters Marion; Terrault Norah; Freise Chris E; Ascher ancy L; Roberts John P
Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis.
Hepatology (Baltimore, Md.) 2008;48(3):819-27.

We previously reported encouraging results of down-staging of hepatocellular carcinoma (HCC) to meet conventional T2 criteria (one lesion 2-5 cm or two to three lesions <3 cm) for orthotopic liver transplantation (OLT) in 30 patients as a test of concept. In this ongoing prospective study, we analyzed longer-term outcome data on HCC down-staging in a larger cohort of 61 patients with tumor stage exceeding T2 criteria who were enrolled between June 2002 and January 2007. Eligibility criteria for down-staging included: (1) one lesion >5 cm and up to 8 cm; (2) two to three lesions with at least one lesion >3 cm and not exceeding 5 cm, with total tumor diameter up to 8 cm; or (3) four to five lesions with none >3 cm, with total tumor diameter up to 8 cm. A minimum observation period of 3 months after down-staging was required before OLT. Tumor down-staging was successful in 43 patients (70.5%). Thirty-five patients (57.4%) had received OLT, including two who had undergone live-donor liver transplantation. Treatment failure was observed in 18 patients (29.5%), primarily due to tumor progression. In the explant of 35 patients who underwent OLT, 13 had complete tumor necrosis, 17 met T2 criteria, and five exceeded T2 criteria. The Kaplan-Meier intention-to-treat survival at 1 and 4 years after down-staging were 87.5% and 69.3%, respectively. The 1-year and 4-year posttransplantation survival rates were 96.2% and 92.1%, respectively. No patient had HCC recurrence after a median posttransplantation follow-up of 25 months. The only factor predicting treatment failure was pretreatment alpha-fetoprotein >1,000 ng/mL. CONCLUSION: Successful down-staging of HCC can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome.  

One by one, we are knocking down our questions, and after filing the medical records from this last visit I'm signing off to get some work done around the house.