Transarterial (Chemo-) embolization (TAE/TACE) Transarterial (Chemo-) embolization (TAE/TACE) as therapy (n = 17) was chosen in patients with BCLC stage B (advanced tumor without evidence of distant metastases or vessel invasion). Furthermore, patients with BCLC stage A were treated with transarterial embolization (TAE) or transarterial chemoembolization (TACE) in case of contraindications for orthotopic liver transplantation (OLT), liver resection or percutaneous local therapy.
TAE was performed according to a standardized technique. The femoral artery was cannulated under local anesthesia, and diagnostic angiography of the celiac trunk and superior mesenteric artery was performed. After identification of the vascular anatomy, a superselective catheter was pushed forward into the hepatic arteries by use of a guide #check details randurls[1|1|,|CHEM1|]# wire. Afterwards, different mixtures of substances for embolization were used during the time period we analyzed in this retrospective study. First, there was a mixture of N-butyl-2-cyanoacrylate (Histoacryl blue; B. Braun, Melsungen, Germany) and ethiodized oil (Lipiodol
Ultrafluide; Guerbet, Villepinte, France) as an embolic agent. Secondly in case of TACE a mixture of doxorubicin and ethiodized oil (Lipiodol Ultrafluide; Guerbet, Villepinte, France) as an embolic agent was used. TAE/TACE was performed superselectively by occluding only the tumor-feeding segmental arteries or selectively PARP inhibitor by occluding the right or left hepatic artery. In general, a superselective embolization was aimed. However, in patients with a large tumour mass or more than one nodule in the same lobe, selective embolization of the entire lobe was performed. In patients with tumor disease in both the right and the left liver lobe, only one lobe was embolized during one treatment aminophylline session to avoid a prolonged postembolization syndrome or postinterventional liver failure. A completion arteriogram was obtained to confirm occlusion of the embolized vessels. After TAE/TACE, the patients
were carefully observed and side-effects of embolization were treated symptomatically. Follow-up was done with contrast-enhanced CT of the liver to assess the effect of embolization on the tumor. Depending on success of the already performed interventions embolization sessions were repeated in intervals from 1 to 3 months. Multimodal therapy Multimodal therapy (n = 17) included a combination of local ablative therapies such as percutaneous ethanol instillation (PEI), radiofrequency ablation therapy or cryotherapy on the one hand and transarterial embolization therapy as described above on the other hand. Usually percutaneous ablative therapies were given first, after signs of tumour progression were seen treatment was continued with TAE/TACE. Palliative care 39 patients received only symptomatic therapy but no active treatment for hepatocellular carcinoma.