Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2018; 10(1): 95-104
Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.95
Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma
Kazue Shiozawa, Manabu Watanabe, Takashi Ikehara, Shuhei Yamamoto, Takashi Matsui, Yoshinori Saigusa, Yoshinori Igarashi, Iruru Maetani
Kazue Shiozawa, Manabu Watanabe, Shuhei Yamamoto, Takashi Matsui, Yoshinori Saigusa, Iruru Maetani, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Ohashi Hospital, Tokyo 153-8515, Japan
Kazue Shiozawa, Takashi Ikehara, Yoshinori Igarashi, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, Tokyo 143-8541, Japan
Author contributions: Shiozawa K, Watanabe M and Igarashi Y designed the study; Yamamoto S, Matsui T, Saigusa Y, Shiozawa K, Ikehara T and Watanabe M performed transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma; Watanabe M performed intra-arterial contrast-enhanced ultrasonography with Sonazoid®; Shiozawa K and Watanabe M analyzed the data and wrote the manuscript; Maetani I supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: The study was approved by the Ethical Review Board of Toho University Medical Center, Omori Hospital.
Informed consent statement: Informed consent was obtained from all patients for being included in the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manabu Watanabe, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Ohashi Hospital, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan. manabu62@med.toho-u.ac.jp
Telephone: +81-3-34681251 Fax: +81-3-34681269
Received: October 14, 2017
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
Processing time: 94 Days and 22.9 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

The authors evaluate the identification of feeding arteries and the appropriate timing of completion of DEB-TACE for HCC by IAUS using Sonazoid®.

Research results

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.

Research conclusions

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.

Research perspectives

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.