Role of Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma.

Gopinathan, K (2006) Role of Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. Masters thesis, Madras Medical College, Chennai.


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Hepatocellular Carcinoma (HCC) Is One Of The Most Common Fatal Malignancies Worldwide. Incidence Is More Than 530,000 Patients Annually. It Is Common In Certain Geographic Areas Particularly In Japan, South East Asia, And Sub Saharan Africa. In India HCC Is More Common In Southern States With A Male Female Ratio Of 5-7:1. The Prevalence Of HCC Is Rapidly Increasing As A Result Of The Spread Of Chronic Infections With Hepatitis B&C. The Main Therapeutic Modalities Used For HCC Are Primary Hepatic Resection And Loco Regional Therapies. Whenever Liver Function Permits, Resection Should Be Considered The First Choice. But Only Less Than 30 % Of Patients Are Suitable Candidates For Surgery And Also 70% Of Patients Who Undergo Surgery Will Develop New Liver Tumors During The First 3 Years Of Follow Up. Since Most Of The Patients Present In Late Stage, Surgical Options Are Not Possible. Hence Loco Regional Therapies Are The Main Stay In Treatment. In Loco Regional Therapy, Liver Can Be Targeted Through A Vascular Approach, Injecting The Active Product Through Feeding Vessels Or By A Direct Approach To The Tumor By Delivering The Treatment Directly Inside The Mass Lesion. Loco Regional Therapy Can Be 1) Vascular 2) Direct Vascular Approach Procedures Hepatic Arterial Chemotherapy Trans Arterial Chemoembolization (TACE) Hepatic Injection Of Loaded Embols (Drug And Radiation) Intra Portal Drug Delivery Isolated Liver Perfusion Direct Approach Procedures Percutaneous Ethanol Injection(PEI) Radio Frequency Ablation(RFA) Cryo Ablation Micro Wave And Laser Ablation When The Lesions Are Small Or Less Than 3 In Number With Less Preserved Hepatic Reserve PEI / RFA Is Indicated. In Large Lesions Or More Lesions With Well Preserved Hepatic Reserve TACE Is Indicated. Chemoembolization Combines Simultaneous Infusion Of A Concentrated Dose Of Chemotherapeutic Drugs And Embolization Particles. Chemoembolization Causes Tumor Drug Concentration Manifolds Than That Achieved By Infusion. Hepatic Artery Embolization Renders The Tumor Ischemic, Depriving It Of Nutrients And Oxygen. The Dwell Time Of The Chemotherapy Agent Within The Tumor Is Markedly Prolonged, With Measurable Drug Levels Present As Long As One Month After Procedure. Because Most Of The Drug Is Retained Within The Liver, Systemic Toxicity Is Reduced.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Transarterial ; Chemoembolization ; Unresectable Hepatocellular ; Carcinoma.
Subjects: MEDICAL > Radio Diagnosis
Depositing User: Subramani R
Date Deposited: 29 Jun 2017 11:58
Last Modified: 29 Jun 2017 11:58

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