第5章 肝動脈化学塞栓療法 TACE - jsh.or.jp

1 5 TACE 137 transcatheter arterial embolization TAE 1990 transcatheter arterial chemoembolization TACE 1990 TACE/TAE RFA TACE/TAE 2000 2 RCT TACE/TAE Lip-TACE/TAE TACE/TAE 5 1 TAI Lip-TAI chemoembolization TACE 2 TAE 3 TACE drug-eluting beads DEB Lip-TACE 5 TACE 138 CQ 37 TACE/TAE TACE/TAE A B Child A B TACE/TAE TACE/TAE TACE/TAE LF066871 Level 4 LF104512 TACE/TAE TACE/TAE RCT 1990

2 TACE/TAE RCT 5 LF023133 Level 1b LF023324 Level 1b LF027455 Level 1b LF029596 Level 1b LF037347 Level 1b AFP Child C Okuda III TACE/TAE LF019208 Level 1a 2000 RCT 2 TACE/TAE LF018999 Level 1b LF0628310 Level 1b 2005 LJ1000111 2002 BCLC group Staging LF104512 TACE/TAE LF1068612 Level 6 A B 3cm 2 3 4 TACE/TAE BCLC group TACE Stage B intermediate stage 4 Child A B Okuda I II performance status 0 2 Stage C 5 TACE 139 advanced stage performance status 1 2 N1 M1 2008 SHARP L3F0050613 Level 1b BCLC group AASLD TACE/TAE 4 Child A B performance status 0 2 Stage B intermediate stage L3H0001814 A B Child A B TACE/TAE TAE LF0678315 Level 4 TACE/TAE LF066871 Level 4 LF104512 Level 6 1990 RCT LF023133 Level 1b LF023324 Level 1b LF027455 Level 1b LF029596 Level 1b LF037347 Level 1b 2000 TACE/TAE RCT 2 LF018999 Level 1b LF0628310 Level 1b Okuda III Child C 1990 RCT 2000

3 RCT TACE/TAE Camma 18 2 TACE/TAE 95 p TACE TAE LF019208 Level 1a RCT TACE/TAE 2005 TACE/TAE RCT Okuda III Child C TACE/TAE BCLC group Staging LF104512 Stage B intermediate stage 4 Child A B Okuda II performance status 0 2 Stage C advanced stage performance status 1 2 N1 M1 2005 A B Child 3 cm 2 3 4 5 TACE 140 LF104512 LF1068612 2008 SHARP L3F0050613 Level 1b Interventional Radiology SIR BCLC group AASLD TACE/TAE 4 Child A B performance status 0 2 Stage B intermediate stage L3H0001814 LF104512 Level 6 10 cm TACE TAE LF1026216 Level 2a TACE/TAE RCT 1 Lip-TACE 40 9 39 12 Stage C advanced stage TACE/TAE TACE/TAE RCT TACE/TAE performance status 3 75 80 LF023133 Level 1b LF023324 Level 1b L3F0010117 Level 6

4 Lip-TACE Takayasu 2 LF1046218 Level 2a L3H0002119 Level 2a 1994 2001 8,510 5 25 i ii Stage iii AFP 401 ng/ml or 2000 2005 4,966 5 34 Stage AFP des- -carboxy prothrombin DCP PIVKA-II 2005 TACE TACE TACE TACE TACE/TAE BCLC 5 TACE 141 staging Stage C advanced stage TACE/TAE drug eluting beads DEB DEB DEB-TACE Lip-TACE II PRECISION V L3F0006420 Level 2a DEB-TACE DEB-TACE II Lip-TACE 1 LF06687 Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, et al.

5 Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993; 188(1): 79-83. 2 LF10451 Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004; 127(5 Suppl 1): S179-88. 3 LF02313 Bruix J, Llovet JM, Castells A, Montana X, Bru C, Ayuso MC, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 1998; 27(6): 1578-83. 4 LF02332 Pelletier G, Ducreux M, Gay F, Luboinski M, Hag ge H, Dao T, et al. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC. J Hepatol 1998; 29(1): 129-34. 5 LF02745 Madden MV, Krige JE, Bailey S, Beningfield SJ, Geddes C, Werner ID, et al.

6 Randomised trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment for hepatoma. Gut 1993; 34(11): 1598-600. 6 LF02959 Pelletier G, Roche A, Ink O, Anciaux ML, Derhy S, Rougier P, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 1990; 11(2): 181-4. 7 LF03734 Anonymous. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. N Engl J Med 1995; 332(19): 1256-61. 8 LF01920 Camma C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: 5 TACE 142 meta-analysis of randomized controlled trials.

7 Radiology 2002; 224(1): 47-54. 9 LF01899 Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35(5): 1164-71. 10 LF06283 Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359(9319): 1734-9. 11 LJ10001 .. 2005. 12 LF10686 Llovet JM. Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 2005; 40(3): 225-35. 13 L3F00506 Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359(4): 378-90.

8 14 L3H00018 Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53(3): 1020-2. 15 LF06783 Okazaki M, Higashihara H, Koganemaru F, Nakamura T, Kitsuki H, Hoashi T, et al. Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization. Radiology 1991; 180(3): 647-51. 16 LF10262 Jang JW, Bae SH, Choi JY, Oh HJ, Kim MS, Lee SY, et al. A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management. Cancer Chemother Pharmacol 2007; 59(1): 9-15. 17 L3F00101 Raoul JL, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization.

9 Cancer Treat Rev 2011; 37(3): 212-20. 18 LF10462 Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006; 131(2): 461-9. 19 L3H00021 Takayasu K, Arii S, Kudo M, Ichida T, Matsui O, Izumi N, et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol 2012; 56(4): 886-92. 5 TACE 143 20 L3F00064 Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010; 33(1): 41-52.

10 5 TACE 144 CQ 38 TACE/TAE TACE/TAE TACE Lip-TACE 1mm 2mm LF066871 Level 4 LF068812 Level 2a 17 2002 2004 4,774 TACE 90 TACE L3F002373 Level 6 TACE C LF026514 Level 4 LF036535 Level 1b LF037566 Level 2a LF040417 Level 4 LF062998 Level 4 LF068819 Level 2a CDDP L3F0018810 Level 4 L3F0017811 Level 4 CDDP TACE L3F0026512 Level 2a CDDP TACE TACE CDDP L3F0018613 Level 2b L3F0026714 Level 2b L3F0023515 Level 1b L3F0022316 Level 3 L3F0017717 Level 4