Transcatheter arterial chemoembolization combined with elemene for the treatment of hepatic carcinoma

Introduction

Hepatic carcinoma is the second most frequent cause of cancer death in men and the sixth in women worldwide (1). Surgical resection or transplantation has been considered only for a small number of patients with hepatic carcinoma because of the extent of disease or liver dysfunction. Transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of patients with inoperable hepatic carcinomas (2,3). Elemene, a natural sesquiterpene extracted from the essential oils of a kind of Chinese herb—Curcuma aromatica Salisb, has been confirmed to be a broad-spectrum antitumor drug (4). In this video, the authors introduced the procedure of TACE combined with elemene for the treatment of a patient with unresectable hepatic carcinoma (Figure 1).

Figure 1 This video describes the procedure of TACE combined with elemene for the treatment of a patient with unresectable hepatic carcinoma (5). TACE, transcatheter arterial chemoembolization. Available online: http://www.asvide.com/article/view/26846

Operative techniques

A 75-year-old female patient with a liver tumor confirmed intrahepatic cholangiocarcinoma by biopsy, unresectable for her pulmonary insufficiency. Hepatic angiography was performed using 5-Fr angiographic catheters to assess the vascularity of the tumor. After super-selective catheterization of the tumor feeding artery with a microcatheter (Progreat, Terumo, Japan), elemene injection was infused into the tumor for more than 15 minutes. The infused dose of elemene injection (300 mg) was determined based on the body weight and liver function of the patient, double diluted with 5% glucose injection. Then, an emulsion of oxaliplatin (50 mg), epirubicin (30 mg) and lipiodol 5 mL (1–2 mL/cm diameter of the tumor) was injected carefully and slowly to prevent backflow. Until the feeding arterial flow stasis or the portal branches were appeared, little gelatin sponge particles were then used to embolize the tumor-feeding vessels completely. Hepatic angiography was performed again to confirm the treatment effect.

Comments

TACE has been proven to be effective to prolong the survival of the patient with inoperable hepatic carcinoma. Blood concentration in the tumor is significantly associated with the tumor response. Elemene injection can be infused into the feeding arteries of the tumor by using catheters accurately and safely. Combined with TACE, this combination therapy might support very high drug solubility locally and enhance effectiveness of the treatment for unresectable hepatic carcinoma.

Acknowledgments

Dr. Wengui Liu was awarded “Second Prize Winner” in the AME Liver Surgery/Interventional Surgical Video National Championship held in Nanjing, China on June 16, 2018.

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2018.08.20). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

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5. Wang Y, Shen X, Huang S, et al. This video describes the procedure of TACE combined with elemene for the treatment of a patient with unresectable hepatic carcinoma. Asvide 2018;5:728. Available online: http://www.asvide.com/article/view/26846