Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.95
Peer-review started: October 24, 2017
First decision: December 1, 2017
Revised: December 7, 2017
Accepted: December 28, 2017
Article in press: December 28, 2017
Published online: January 27, 2018
In transarterial chemoembolization with drug-eluting beads (DEB) (DEB-TACE) for hepatocellular carcinoma (HCC), it is particularly important to prevent inflow of DEB into normal hepatic parenchyma and to administer the beads into the tumor artery because of their effect as a permanent embolic material. However, some HCCs are difficult to visualize on digital subtraction angiography for TACE due to the complex blood supply. On the other hand, contrast-enhanced ultrasonography (CEUS) is useful for evaluation of the hemodynamics of hepatic tumors and surrounding hepatic parenchyma in real time. Transcatheter (intra-arterial) CEUS (IAUS) has recently been used in DEB-TACE for HCC, and its safety and efficacy in identifying the feeding artery have been evaluated.
Generally, the complete response (CR) rate of DEB-TACE for small HCC is reported to be low. It is thought that DEB-TACE is mainly performed for giant and multiple HCCs in many facilities. The authors wanted to know the true therapeutic effect of DEB-TACE for small HCCs less than 50 mm by considering whether feeding artery can be selected reliably and whether the timing of completion of treatment is appropriate.
IAUS has recently been used in DEB-TACE for HCCs and metastatic hepatic tumors, and its safety and efficacy in identifying the feeding artery have been evaluated. However, the therapeutic effect using IAUS as support for DEB-TACE in HCC has not been examined. In this study, the authors evaluated the usefulness of IAUS using Sonazoid® in DEB-TACE for HCC.
The authors evaluate the identification of feeding arteries and the appropriate timing of completion of DEB-TACE for HCC by IAUS using Sonazoid®.
DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC. This study includes the small number of cases and short observation period. A same study with much larger number of patients and much longer observation period are awaited.
IAUS is very useful to obtain CR in HCC treatment with DEB-TACE. IAUS is very useful to obtain CR in HCC treatment with DEB-TACE. In all cases in which residual tumor enhancement was judged to have disappeared on Digital subtraction angiography (DSA), IAUS showed a residual enhancement in the tumor. Disappearance of contrast medium within 5-6 heartbeats in fluoroscopy is generally used to indicate completion of DEB-TACE, but this criterion may be insufficient. The appropriate treatment using IAUS is possible to obtain CR in DEB-TACE for relatively small HCC. There is a possibility of obtaining CR by appropriate treatment in DEB-TACE for HCC. The appropriate treatment using IAUS is possible to obtain CR in DEB-TACE for HCC. The authors treated HCCs with IAUS using Sonazoid®. In DSA, disappearance of contrast medium within 5-6 heartbeats in fluoroscopy is generally used to indicate completion of DEB-TACE, but this criterion may be insufficient. The appropriate treatment using IAUS is possible to obtain CR in DEB-TACE for HCC. The therapeutic effect of DEB-TACE for HCC may improve.
In DSA, disappearance of contrast medium within 5-6 heartbeats in fluoroscopy is generally used to indicate completion of DEB-TACE, but this criterion may be insufficient. IAUS is very useful for obtaining CR in DEB- TACE for HCC. The authors are planning to perform a long-term study of the effect of IAUS on the therapeutic efficacy of DEB-TACE in a larger number of patients with HCC. The authors prospectively compare therapeutic efficacy of DEB-TACE with/without IAUS.