HCC is a highly malignant tumors of liver cell origin showing poor prognosis.

Definitive surgical intervention is not feasible in most cases due to

          - extreme tumor extension,
          - multiplicity of tumor foci, &
          - associated with liver cirrhosis at the time of diagnosis., &

15-30% of patient of HCCs are eligible for resection . But post-op recurrence is common.

Because of these reasons, transcatheter approach has been aggressively tried to treat HCCs.

Hepatic Mets one of the most challenging problems in clinical oncology.

The most common is colorectal cancer with a extremely poor prognosis, carrying a median survival time of 6 months with low (20%) response rate to 5-FU containing chemotherapy regiemens.

Other tumors frequently developing hepatic metastases include:-

          - Uveal melanoma
          - Neuroendocrine tumors and
          - Gastrointestinal stomal tumors

As in colorectal cancer, hepatic dissemination of these malignancies is associated with resistance to chemotherapy and poor prognosis.

          - Concomitant hepatic artery embolization and
          - Infusion of a concentrated dose of chemotherapeutic drugs.

Embolization, allowing hepatic drug concentration to reach levels 10-25 fold higher then those achieved by simple intra-arterial infusion.

Chemoembolization also appears to increase the duration of therapy effect, with measurable drug levels being detected as long as a month post-infusion.

Embolization of presinusoidal arterioportal shunts may facilitate selective drug delivery to the tumor, as the blood supply to normal liver is derived from the portal circulation while that supplying hepatic malignant cells almost exclusively from hepatic artery.

Systemic toxicity is minimized even at high dose.

Chemoembolization produces profound tumor ischemia at the time of drug administration, tumor hypoxia, is known to potentiate the effect of cytotoxic drug such as doxorubicin by inhibiting intracellular P-glycoprotein pump and increasing tumor cell uptake of drug.

Tissue Diagnosis

Cross-sectional imaging of the liver &

Laboratory studies including CBS, PT, PTT, Creatinine, liver function test and tumor markers

80-90% of patient suffer a post embolization syndrome characterized by pain, nausea and vomiting. These are controlled by medication.

Vigorous hydration, IV antibiotics and antiemetic therapy.

Neuroendocrine tumors may undergo chemoboembolization more then two times.

poor hepatic function

serum bilirubin >2.0 mg/dl

portal perfusion<50%

thrombosed main portal vein

• Chemoembolization has become standard of care for unresectable hepatoma and effectiveness in metastatic liver disease

          - Colorectal metastases
          - Ocular melanoma
          - Neuroendocrine tumors
          - Sarcomas
          - Hepatoma

External radiotherapy of whole or part of the liver with or without systemic chemotherapy or surgery has not shown good results.

Internal radiotherapy by isotopes I-131 injection in hepatic artery has shown some improvement in survival.

Percutaneous transhepatic portal vein embolization has been an effective modality for the inducement of atrophy of embolized liver and compensatory hypertrophy of nonembolized liver, even in patient with impaired liver function.

Hypertrophy of nonembolized liver reduces the possibility of hepatic failure after extensive liver resection.