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Hiraki T.,Okayama University | Koizumi J.,Tokai University | Arai Y.,National Cancer Center Hospital | Sakurai Y.,Teine Keijinkai Hospital | And 3 more authors.
Japanese Journal of Radiology

Purpose: To evaluate the feasibility and safety of transcatheter arterial embolization (TAE) with the use of HepaSphere microspheres for hypervascular tumors. Materials and methods: This was a prospective multicenter open label clinical trial involving six institutions in Japan. TAE was performed with the HepaSphere microspheres for hypervascular tumors in various locations. The endpoint of the study was the feasibility and safety of the procedure. The feasibility and safety were evaluated according to technical success and adverse events, respectively. Adverse events that were related to TAE were evaluated by using the Common Terminology Criteria for Adverse Events, version 4.0. Results: Twenty-four patients were enrolled. The technical success rate was 100 % (24/24). Twenty-two (92 %) patients developed a total of 50 symptomatic adverse events, including 30 grade 1 events, 17 grade 2 events, and 3 grade 3 events. The most frequent adverse event was fever with an incidence of 63 %, followed by abdominal pain (25 %). Conclusion: TAE for hypervascular tumors with the HepaSphere microspheres was feasible and rarely caused major adverse events. Trial registration: This trial was registered in JAPIC Clinical Trials Information (JapicCTI-111534). © 2015, Japan Radiological Society. Source

Osuga K.,Osaka University | Maeda N.,Osaka University | Higashihara H.,Osaka University | Hori S.,Gate Tower Institute for Image Guided Therapy | And 6 more authors.
International Journal of Clinical Oncology

Gelatin sponge and polyvinyl alcohol particles have been the most popular particulate embolic agents for transarterial chemoembolization (TACE) of liver tumors. Over the last decade, calibrated microspheres have been introduced and increasingly used in liver tumor embolization in Western countries. In addition, drug-eluting beads (DEB) have been introduced for sustained local drug release. Such long-awaited spherical embolic agents will be introduced in Japan in the near future. The advantages of these microspheres are that particles are uniform in size and shape, and easy to inject through a microcatheter. They can travel distally to vessels corresponding to the particle size; in other words, the occlusion level can be predicted according to the particle size chosen. Thus, new bland microspheres and DEB may bring a significant advancement to embolization for primary liver tumors as well as hepatic metastases from various cancers. However, at this point, the published data suggests that both conventional TACE and DEB-TACE are equally effective for treatment of unresectable hepatocellular carcinoma, when patients are carefully selected. Therefore, indication, patient selection, and embolization techniques will be essential in order to individually adapt newer embolic agents based on oncological, anatomical and technical considerations. © Japan Society of Clinical Oncology 2012. Source

Seki A.,Suita Tokushukai Hospital | Hori S.,Gate Tower Institute for Image Guided Therapy | Shimono C.,Suita Tokushukai Hospital
Japanese Journal of Radiology

Purpose: Contrast material pooling on angiography within a tumor bed during embolization for hepatocellular carcinoma (HCC) presents as the vascular lake (VL) phenomenon. This retrospective study aimed to evaluate the frequency and management of VLs during chemoembolization with drug-eluting beads (DEBs) and the relationship between the VL and local response. Materials and methods: A total of 123 HCC patients without vascular invasion or intrahepatic metastases who underwent chemoembolization with DEBs (50–100 µm superabsorbent polymer microspheres loaded with epirubicin) were enrolled. Gelatin sponge particles (GS) were injected for additional embolization in limited patients with steadily increasing size of VLs during DEB injection. Overall, 338 nodules were divided into three groups: lesions without a VL (non-VL; n = 250); lesions with a VL but without additional GS embolization [VL–GS (−), n = 58]; and lesions with both VL and additional GS embolization [VL–GS (+); n = 30]. The local responses were statistically compared by Fisher’s exact test with the Bonferroni correction. Results: The frequency of VLs was 26.0 % (88/338). The response rate in the non-VL group (54.0 %) was significantly lower than those in the VL–GS (−) (91.4 %; P < 0.0001) and VL–GS (+) (96.7 %; P < 0.0001) groups. Conclusions: VL is a common angiographic finding and might be associated with the local response. © 2015, Japan Radiological Society. Source

Kennoki N.,Gate Tower Institute for Image Guided Therapy | Hori S.,Gate Tower Institute for Image Guided Therapy | Yuki T.,Gate Tower Institute for Image Guided Therapy | Sueyoshi S.,Nara Prefecture General Medical Center | Hori A.,Rinku Dejima Clinic
Japanese Journal of Cancer and Chemotherapy

A 57-year-old woman presented with lung adenocarcinoma and carcinomatous pleurisy in January 2013. The primary lesion had been treated with 60-Gy radiation therapy. She, however, showed a recurrence of the tumor in her pulmonary cavity. She received systemic chemotherapy for 1 year but did not show any improvement. She visited our clinic in March 2014. Her performance level was 3. Her hemoglobin level was 8.5 g/dL. The CT scan showed that the size of the cystic tumor was 200×144×143 mm. The tumor severely compressed her heart. We performed TACE using a spherical embolic agent. The microcatheter was guided through the left bronchial artery; left intercostal artery 9, 10, and 11; and the left inferior phrenic artery. The anticancer drugs selected were CDDP and 5-FU. The embolic material used was SAP-MS. After 3 therapy sessions, the CT scan showed shrinkage of the target lesion to 100×93×54 mm. Her hemoglobin level increased to 13.8 g/dL; furthermore, the severity of dyspnea decreased, and she showed a performance status of 0. TACE with SAP-MS was successfully performed for the large cystic tumor in the pulmonary cavity that metastasized from the lung cancer and was refractory to standard treatments. After the treatment, the tumor size decreased and the patient's symptoms alleviated. Source

Seki A.,Gate Tower Institute for Image Guided Therapy | Hori S.,Gate Tower Institute for Image Guided Therapy
CardioVascular and Interventional Radiology

Purpose There is no consensus on switching anticancer agents loaded onto drug carriers in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study aimed to evaluate the safety and clinical outcomes of TACE with cisplatin-loaded microspheres (CLM-TACE) in HCC patients refractory to TACE with epirubicin-loaded microspheres (ELM-TACE). Methods Between February 2008 and June 2010, 85 patients with unresectable HCC refractory to ELM-TACE were enrolled to undergo CLM-TACE. The number of ELM-TACE sessions until judgment of resistance ranged from 1 to 4 (median, 2.1). CLM-TACE was performed using 50-100-lm superabsorbent polymer microspheres loaded with 1 mg cisplatin/1 mg microspheres together with hepatic arterial infusion of 25 mg cisplatin and 500 mg 5-fluorouracil per patient. Tumor responses were evaluated by computed tomography according to the European Association for the Study of the Liver criteria. Results The median number of CLM-TACE treatment sessions was 1.8 (range, 1-5), and the mean total dose of cisplatin per session was 42.8 mg (range, 30.0-59.0). After 6 months, 3 (3.5%) patients achieved complete response, 31 (36.5%) had partial response, 15 (17.6%) had stable disease, and 36 (42.4%) had progressive disease. The median overall survival and time to treatment failure after initial CLM-TACE were 13.3 and 7.2 months, respectively. Overall, 9.4% of patients experienced grade 3/4 adverse events. Conclusion Switching the loaded agent from epirubicin to cisplatin is a safe, well-tolerated, and efficacious treatment strategy for salvage TACE with drug-eluting microspheres in HCC patients refractory to ELM-TACE. © Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011. Source

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