Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis

Kengo YoshimitsuDepartment of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, JapanAbstract: Transarterial chemoembolization (TACE) using iodized oil (Lipiodol®) (Lp-TACE) as a carrier of chemotherapeutic agents has been routinely performed to control hepatocellular carcinomas...

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Autor principal:	Yoshimitsu K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/ff6e027278344515af4b0a123ed6df52
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spelling	oai:doaj.org-article:ff6e027278344515af4b0a123ed6df522021-12-02T08:57:51ZTransarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis1179-1535https://doaj.org/article/ff6e027278344515af4b0a123ed6df522014-07-01T00:00:00Zhttp://www.dovepress.com/transarterial-chemoembolization-using-iodized-oil-for-unresectable-hep-a17459https://doaj.org/toc/1179-1535 Kengo YoshimitsuDepartment of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, JapanAbstract: Transarterial chemoembolization (TACE) using iodized oil (Lipiodol®) (Lp-TACE) as a carrier of chemotherapeutic agents has been routinely performed to control hepatocellular carcinomas (HCC) in Japan, and its use has yielded fairly beneficial therapeutic results. Lipiodol is thought to pass through the tumor sinusoids of HCC and reach the outflow drainage areas, namely, the portal venous side of the tumor. By doing this, Lipiodol blocks not only the tumor's arterial inflow but also its portal venous outflow, providing sufficient ischemic effects. It is known that the inflow blood system, tumor sinusoids, and outflow blood system change drastically during the process of multistep hepatocarcinogenesis; thus, it is reasonable to postulate that the distribution of Lipiodol and the subsequent therapeutic effect of Lp-TACE may also change during that process. Arterial inflow to HCC is highest for moderately differentiated HCC (mHCC) and is relatively low in well or poorly differentiated HCC (wHCC and pHCC, respectively). It has been suggested that the metabolic state of wHCC and mHCC is aerobic, while that of pHCC is anaerobic. The tumor sinusoids in wHCC and mHCC are small in size and large in number, while those in pHCC are large in size and small in number. This finding results in a greater chance of tumor cell exposure to chemotherapeutic agents in the former and a lesser chance in the latter. The outflow tract, namely, the drainage system via the residual portal venous branches within the pseudocapsule, is more complete in mHCC and pHCC and less so in wHCC. Considering all of these components of HCC of different histological grades, Lp-TACE should have the greatest effect on mHCC and a relatively low effect on wHCC and pHCC. To achieve consistently high therapeutic results, it is important to consider these components, which affect the sensitivity of HCC to Lp-TACE, to maximize both the chemotherapeutic and ischemic effects of this therapy.Keywords: liver cancer, multistep carcinogenesis, embolotherapy Lipiodol, histological gradeYoshimitsu KDove Medical PressarticleDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol 2014, Iss default, Pp 89-94 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Yoshimitsu K Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
description	Kengo YoshimitsuDepartment of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, JapanAbstract: Transarterial chemoembolization (TACE) using iodized oil (Lipiodol®) (Lp-TACE) as a carrier of chemotherapeutic agents has been routinely performed to control hepatocellular carcinomas (HCC) in Japan, and its use has yielded fairly beneficial therapeutic results. Lipiodol is thought to pass through the tumor sinusoids of HCC and reach the outflow drainage areas, namely, the portal venous side of the tumor. By doing this, Lipiodol blocks not only the tumor's arterial inflow but also its portal venous outflow, providing sufficient ischemic effects. It is known that the inflow blood system, tumor sinusoids, and outflow blood system change drastically during the process of multistep hepatocarcinogenesis; thus, it is reasonable to postulate that the distribution of Lipiodol and the subsequent therapeutic effect of Lp-TACE may also change during that process. Arterial inflow to HCC is highest for moderately differentiated HCC (mHCC) and is relatively low in well or poorly differentiated HCC (wHCC and pHCC, respectively). It has been suggested that the metabolic state of wHCC and mHCC is aerobic, while that of pHCC is anaerobic. The tumor sinusoids in wHCC and mHCC are small in size and large in number, while those in pHCC are large in size and small in number. This finding results in a greater chance of tumor cell exposure to chemotherapeutic agents in the former and a lesser chance in the latter. The outflow tract, namely, the drainage system via the residual portal venous branches within the pseudocapsule, is more complete in mHCC and pHCC and less so in wHCC. Considering all of these components of HCC of different histological grades, Lp-TACE should have the greatest effect on mHCC and a relatively low effect on wHCC and pHCC. To achieve consistently high therapeutic results, it is important to consider these components, which affect the sensitivity of HCC to Lp-TACE, to maximize both the chemotherapeutic and ischemic effects of this therapy.Keywords: liver cancer, multistep carcinogenesis, embolotherapy Lipiodol, histological grade
format	article
author	Yoshimitsu K
author_facet	Yoshimitsu K
author_sort	Yoshimitsu K
title	Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
title_short	Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
title_full	Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
title_fullStr	Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
title_full_unstemmed	Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
title_sort	transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/ff6e027278344515af4b0a123ed6df52
work_keys_str_mv	AT yoshimitsuk transarterialchemoembolizationusingiodizedoilforunresectablehepatocellularcarcinomaperspectivefrommultistephepatocarcinogenesis
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Transarterial chemoembolization using iodized oil for unresectable hepatocellular carcinoma: perspective from multistep hepatocarcinogenesis

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