Chemoembolization for nonresectable liver tumors

Chemoembolization for nonresectable liver tumors

A novel veterinary treatment offers hope for these often hopeless cases.
May 01, 2012

Currently, no effective treatments exist for veterinary patients with nonresectable liver cancer. Because of poor responses or complications with systemic chemotherapy and radiation therapy, veterinary oncologists typically treat these patients with supportive care.

Similar treatment difficulties in people with nonresectable hepatocellular carcinomas have led to investigation into regional, or liver-directed, therapies including intra-arterial chemotherapy delivery, transarterial embolization (TAE), transarterial chemoembolization (TACE) and ablation therapies (typically chemical or thermal).

TACE involves placing a small catheter in the femoral artery. Under fluoroscopic guidance, the catheter is advanced up the aorta and into the hepatic artery feeding the tumor, and a full dose of systemic chemotherapy and embolic particles or microspheres is injected to obstruct blood flow to the tumor. More recently, the development of drug-eluting beads has enabled 100 to 400 times the concentration of chemotherapy to be achieved within the tumor compared with the same dose given intravenously (systemically). See how this experimental therapy helped this terrier.

Initial findings

  • Signalment: 7-year-old male spayed American Staffordshire terrier mix (13 kg)
  • Presenting complaint: Slight lethargy, decreased appetite
  • Pertinent history: No significant previous medical history until three weeks prior to presentation when abdominal exploratory surgery was performed for evaluation of a liver mass—biopsy results were consistent with a nonresectable, massive, low-grade hepatocellular carcinoma
  • Medications: Milk thistle, s-adenosylmethionine
  • Physical examination findings: Bright, alert and responsive; body condition score 4/9; distended abdomen with no fluid wave but palpable firm mass in cranial abdomen

Diagnostic evaluation

Figure 1: CT angiograms taken before chemoembolization: 1A) Sagittal reconstruction of the abdomen with the dashed black line outlining the massive hepatocellular carcinoma compressing the caudal vena cava. 1B) Coronal reconstruction of the abdomen with the dashed black line outlining the massive hepatocellular carcinoma compressing the portal vein. (Images courtesy of Allyson Berent and Chick Weisse)
  • Complete blood count: White blood cells = 16,600; neutrophils = 13,200; platelets = 410,000
  • Serum chemistry profile: Alanine transaminase = 1,134; aspartate aminotransferase = 596; alkaline phosphatase = 980
  • Bile acids: Resting = 15; Postprandial = 26
  • Coagulation screen: Normal
  • Thoracic radiography: Thorax normal, hepatomegaly
  • Abdominal ultrasonography: Large, cavitated right-sided hepatic mass abutting diaphragm and caudal vena cava
  • Computed tomography (CT) angiography: Heterogeneous right-sided massive liver tumor with portal vein and caudal vena cava compression (Figure 1)