第6 章 肝動脈 化学 塞栓療法 TA(C)E CQ37

1 6 ( ) TA(C)E 140 CQ37 TACE/TAE 4 Child A B performance status 0 2 BCLC Stage B intermediate stage PVTT BCLC Stage C advanced stage CQ 3 CQ37 CQ 2012 1 1 2016 6 30 254 TACE/TAE 37 2 6 21 12 18 TACE/TAE RFA 1 TACE/TAE staging system TACE/TAE TACE/TAE 1-3 2000 RCT 2 TACE/TAE

2 4,5) BCLC TACE/TAE 4 Child A B PS 0 2 Stage B intermediate stage 6 TACE/TAE 1,2 2000 TACE/TAE 6 ( ) TA(C)E 141 RCT 2 4,5 Okuda III Child C RCT TACE/TAE Camm 18 7) 2 TACE/TAE 95 p Camm RCT TACE/TAE 7) 2005 TACE/TAE RCT Okuda III Child C TACE/TAE 2008 SHARP 8 Interventional Radiology SIR BCLC group AASLD TACE/TAE 4 Child A B PS 0 2 Stage B intermediate stage 6 2013 A B Child 3 cm 2 3 4 2 BCLC stage B intermediate stage TACE/TAE subgroup 10,11) 2 10 cm TACE/TAE 9 TACE/TAE 12-14)

3 Stage C advanced stage TACE/TAE TACE/TAE Takayasu Lip-TACE 2 15,16 1994 2001 8,510 5 25 i ii Stage iii AFP 401 ng/ml or 2000 6 ( ) TA(C)E 142 2005 4,966 5 34 Stage AFP PIVKA-II 2005 TACE TACE TACE TACE TACE TAE BCLC staging Stage B subgroup Stage C advanced stage TACE TAE 1 Matsui O, Kadoya M, Yoshikawa J, et al.

4 Small hepatocellular carcinoma treatment with subsegmental transcatheter arterial embolization. Radiology 1993 188 1 79-83. PMID: 8390073. 2 Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004 127 5 Suppl 1 S179-88. PMID: 15508083. 3) Brown DB, Cardella JF, et al. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 2006 17 2 Pt 1 225-32. PMID: 16517768. 4 Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002 35 1164-71. PMID: 11981766. 5 Llovet JM, Real MI, Monta a X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma a randomised controlled trial.

5 Lancet 2002 359 9319 1734-9. PMID: 12049862. 6 Bruix J, Sherman M American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma an update. Hepatology 2011 53 1020-2. PMID: 21374666. 7 Camm C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma meta-analysis of randomized controlled trials. Radiology 2002 224 47-54. PMID: 12091661. 8 Llovet JM, Ricci S, Mazzaferro V, et al SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008 359 378-90. PMID: 18650514. 9) Jang JW, Bae SH, Choi JY, et al. A combination therapy with transarterial 6 ( ) TA(C)E 143 chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management.

6 Cancer Chemother Pharmacol 2007 59 9-15. PMID: 16614848. 10) Bolondi L, Burroughs A, Dufour JF, et al. Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis. 2012 ;32:348-59. PMID: 23397536. 11 Yamakado K, Miyayama S, Hirota S, et al. Subgrouping of intermediate-stage (BCLC stage B) hepatocellular carcinoma based on tumor number and size and Child-Pugh grade correlated with prognosis after transarterial chemoembolization. Jpn J Radiol. 2014 ;32:260-5. PMID: 24615165. 12 Pinter M, Hucke F, Graziadei I, et al. Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology. 2012 ;263:590-9. PMID: 22438359. 13) Xue TC, Xie XY, Zhang L, Yin X, Zhang BH, Ren ZG.

7 Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol. 2013: 8;13:60. PMID: 23566041. 14) Leng JJ, Xu YZ, Dong JH. Efficacy of transarterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis: a meta-analysis. ANZ J Surg. 2016;86:816-820. PMID: 25088384. 15) Takayasu K, Arii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006 131 461-9. PMID: 16890600. 16) Takayasu K, Arii S, Kudo M, et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol 2012 56 886-92.

8 PMID: 22173160. 6 ( ) TA(C)E 144 CQ38 TACE/TAE TACE/TAE conventional TACE cTACE TACE DEB-TACE TACE/TAE CQ 3 CQ38 CQ 3 2012 1 1 2016 6 30 143 15 30 11 3 38 49 1.

9 2 drug-eluting beads: DEB 2008 TACE 90 TACE 3 drug-eluting beads: DEB TACE DEB-TACE TAE Bland TAE DEB-TACE Bland TACE 6 ( ) TA(C)E 145 4) bland TAE DEB-TACE 5 TACE DEB-TACE cTACE DEB-TACE 6-9) cTACE 10) cTACE 7,8) 11) DEB-TACE 100-300 m 300-500 m 100-300 m 12) 75-150 m 100-300 m 13) cTACE 50-100 m 30-60 m 10)

10 CTACE C 2,14-19 2 vs. RCT 20 p Low dose 31 50 p 21 CDDP 22,23) CDDP TACE 24 CDDP TACE TACE CDDP 25,26) 27) 28,29) cTACE cTACE 30 31 6 ( ) TA(C)