Chemo-embolisation of Multifocal Hepatoma
Professor Michael C. Soulen, MD
Professor of Radiology and Surgery University of Pennsylvania Philadelphia, USA
Patient History
- 52-year-old male with cirrhosis attributed to past alcohol abuse presented with bleeding varices that were banded.
- MRI demonstrated two hypervascular masses measuring 5-6cm, one in left lateral segment and the other in left medial segment, surrounded by multiple small satellites.
- Biopsy revealed moderated differentiated hepatoma.
Left hepatic arteriogram: early phase
Left hepatic arteriogram: late phase
Left hepatic arteriogram: during embolisation
Procedure
- Cobra catheter was advanced into the left hepatic artery and beyond the right gastric artery.
- A solution of 100mg cisplatin, 50mg doxorubicin, 10mg mitomycin-C dissolved in 10ml of radiographic contrast was emulsified with 10ml of ethiodol.
- 10-15ml of the resulting emulsion was infused slowly into the left hepatic artery.
- One syringe of 300-500μm Bead Block™ microspheres was added to the remaining emulsion after expressing the excess saline from the syringe.
- Careful infusion was continued until near-stasis was achieved.
Outcome
- Angiography of left and common hepatic arteries showed no residual tumour blush.
- Follow-up visit one month later showed complete necrosis of both masses with no viable tumour identified.
- Complete radiographic response of multifocal hepatoma to chemo-embolisation.
Arterial phase: gadolinium enhanced MRI
Arterial phase: one month after chemoembolisation
Post-embolisation: left hepatic arteriogram
Post-embolisation: common hepatic arteriogram