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ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer

Intra-Arterial Therapies for Hepatic Malignancies

Alexander Y. Kim, MD, and Maximilian A. Schellinger, MD
Published Online: Nov 14,2017

Alexander Y. Kim, MD
Abstract

Intra-arterial therapies (IATs) are taking on an increasingly prominent role in the treatment of patients with primary and secondary liver cancers. Although the mechanism and rationale behind these treatments are similar—catheter-based delivery from the hepatic artery to augment local treatment response and reduce systemic adverse events—IATs are heterogeneous. The underlying principle of an IAT may be to occlude the arterial blood supply to the tumor, to deliver a high local concentration of chemotherapy, and/or to deliver tumor-selective radiation. All of these treatments can be and have been used to treat various liver cancer types. The heterogeneous nature of IATs and the overlapping diseases they treat makes it challenging to understand which type of IAT to incorporate for specific cancer types. Here, we review IATs and the latest literature supporting their use, categorized by different tumor types.

Introduction

Intra-arterial therapies (IATs) are taking on an increasingly prominent role in the treatment of patients with primary and secondary liver cancers. Although the mechanism and rationale behind these treatments are similar—catheter-based delivery from the hepatic artery to augment local treatment response and reduce systemic adverse events—IATs are heterogeneous. The underlying principle of an IAT may be to occlude the arterial blood supply to the tumor, to deliver a high local concentration of chemotherapy, and/or to deliver tumor-selective radiation. All of these treatments can be and have been used to treat various liver cancer types. The heterogeneous nature of IATs and the overlapping diseases they treat makes it challenging to understand which type of IAT to incorporate for specific cancer types. Here, we review IATs and the latest literature supporting their use, categorized by different tumor types. Introduction Intra-arterial therapies (IATs) are regional therapies designed to augment local treatment effects while minimizing systemic adverse effects (AEs). Although IATs have been delivered for treatment of disease in organs beyond the liver1, the predominant targets of IAT are primary and secondary liver cancers.

The physiologic basis for liver-directed IAT relies on the dual hepatic blood supply: The normal liver parenchyma is supplied primarily by the portal circulation (75% to 80%), while the blood supply to highly vascular malignant hepatic cells is almost exclusively derived from the hepatic artery. By taking advantage of this differential blood flow between tumor and normal tissue, the goal of IAT is to maximize delivery of cytotoxic agents to the tumor while minimizing toxicity to the background liver.2

Characterized by catheter-based arterial delivery, IAT encompasses a heterogeneous set of treatments including transarterial chemoembolization (TACE), transarterial embolization (TAE), yttrium-90 radioembolization (Y-90 RE), and hepatic artery infusion (HAI).

The purpose of this article is to review the literature for use of IAT in treatment of hepatocellular carcinoma (HCC), metastatic colorectal cancer (mCRC), and other secondary liver metastases.

Types of IAT

Transarterial Embolization (TAE)

TAE, colloquially known as “bland” embolization, is a procedure wherein embolic particles, such as polyvinyl alcohol (PVA) or tris-acryl gelatin microspheres (TAGMs) are infused through a catheter into the hepatic artery. The goal of TAE is to occlude the arterial tumor supply and cause ischemic tissue death. TAE is a treatment strategy used not only for cancer care but also in symptomatic benign disease such as uterine fibroids3 or lower urinary symptoms due to benign prostate hypertrophy.4

Transarterial Chemoembolization (TACE)

Similar to the goal of TAE, the goal of TACE is to inhibit the arterial blood flow to tumors. However, in TACE, chemotherapy is also delivered through the hepatic artery to infuse a high concentration of chemotherapy locally into tumor tissue. The goal is to maximize the chemotherapeutic effects while minimizing potential systemic AEs.



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Intra-Arterial Therapies for Hepatic Malignancies
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