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cours chimioembolisation CHC dec 2014
Trans Arterial Chemo Embolisation (TACE) is a treatment for Hepatocellular Carcinoma (HCC) where an anticancer agent is mixed with an embolic agent and delivered via the hepatic artery. Early studies showed improved survival rates for TACE-treated HCC patients compared to controls. Patient selection is important, as TACE is best for patients with preserved liver function. More recently, techniques have improved such as using drug-eluting beads and performing highly selective TACE of tumor-feeding arteries to minimize liver damage while maximizing tumor exposure. Ongoing research continues to refine TACE as a key treatment option for HCC.
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cours chimioembolisation CHC dec 2014
- 1. Trans Arterial ChemoEmbolisation for HepatoCellulare Carcinoma EUROPEAN UNIVERSITARY DIPLOMA HEPATIC-PANCREATIC AND BILIARY CANCER 15 December 2014 Dr.Y AJAVON and Pr. M LEWIN Department of Interventionnal Radiology Dr Sameh AWAD
- 2. Principle of TACE HCC 5% Portalvein 95 % Hepatic Artery Normal Liver 75% Portal vein 25 % Hepatic Artery
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- 4. 1- T cœliaque 2-A Gastriqie Gauche 3- A Splenique 4- A Gastro-épiploique D et G 5- A Hépatique moyenne (commune) 1 2 3 56 7 8 9 10 11 6- A Gastro-duodénale 7- A Hépatique propre 8- Branche droite de l’AH 9- Sectorielle postérieure (Seg 6 et 7) 10 - Sectorielle antérieure (seg 5 et 8) 11- Branche du seg 4 12- Branche gauche de l’AH (seg 2 et 3) 13- A Gastrique droite (pyélorique) 12 Estomac 13 4
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- 6. Anti-cancer Agent - Whetheran anticancer agent is indispensable for embolization and if so which agent is the best if needed, is still controversial. - (doxorubicin (36%) cisplatin (31%) epirubicin (12%)
- 8. Doyon : Hepaticarterial embolisation for the treatement du HCC, Ann Radiol 1974 Vetter: 30 Patients: 1 year survival 59% vs 0 for controls, 3 Child C deceased. » Hepatology 1991 Bismuth: 291 patients: 2 year survival Child A 49% 3 months mortality in 37% with Child C.Am J Surg 1992 First experience of TACE in EU
- 9. Yamada et al.120 patients de multinodulaires HCC, survival at one year : - 44% for TACE , 28% for surgery Radiologie 1983. Okamura J. 13 patients before resection: complete necrosis in 8 , Gan To Kagaku Ryoho, 1983 Ohnishi K. 20 patients of whom 16 had a tumor response >50%,– 1 year survival 38% in 11 patients w.o. PVT, Radiology, 1984 First experience of TACE in ASIA
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- 23. What are thelessons
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- 25. Takayasu et al,Jpn J Clin Oncol 2012 30% of patients 50% of patients Patients selection
- 26. Patients selection Takayasu etal, Jpn J Clin Oncol 2012
- 27. CASE 1: ConventionnalTACE of whole liver for HCC right liver (male of 47 years with alcolic cirrhosis. a d c e f b
- 28. CT after onemonth
- 29. CASE 2 : -woman of 62 years with cirrhosis viral C, Child A - TIPS for recurrance UDH - Smalle HCC of 3 cm in segment 8
- 30. Hyper selective TACEof segment 8
- 31. CT after onemonth Befor TACE
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- 33. Nodule 1 du secteurlatéral droit Nodule 2 du dôme hépatique CASE 3: selective TACE with DC Beads for tow HCC (man, 77 years old with cirrhosis C Chil B. MRI befor TACE
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- 35. Be careful Bilary injurywith non selectif TACE with DC Beads (CT after one month)
- 36. Be careful Dont doportal embolization early after TACE
- 37. TACE for HCCin 2014
- 46. Japonais experience withlipiodol
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