ABSTRACT
Chemo-embolization and Bland Embolization In last 30 years many papers have been published describing myriad techniques for performing hepatic arterial embolotherapy. Chemotherapeutic agents mixed with lipiodol and injected into the artery supplying the tumor, referred to as Trans-catheter Arterial Chemo-Embolization, or TACE, has been extensively studied and used, despite the lack of convincing pharmacokinetic data favoring this method. Studies clearly demonstrating high and prolonged concentration of chemotherapeutic agents within tumor were performed using mitomycin C, doxorubicin, and aclarubicin dissolved in hydrocarbon solvents and then in lipiodol ( 6 ), or using a lipophilic agent ( 7 ), methods which are not clinically used. When the chemotherapeutic agent is dissolved in water and then mixed with lipiodol and administered as an emulsion, concentration of drug in the tumor is immediately high, but low at 6 hours, 1 day, and 7 days ( 3 ). In a study by Raoul et al. ( 8 ) doxorubicin was given to patients intra-arterially either alone as an infusion, or emulsified with lipiodol, or with lipiodol and gelatin sponge. There was no significant difference in total amount of doxorubicin released into the circulating blood, but patients in whom gelatin sponge was used had less release within the first hour of treatment. In a prospective randomized clinical study performed to evaluate the effect of lipiodol when added to intraarterial cis -platinum and doxorubicin, there was no difference in response to treatment between the groups given only intraarterial chemotherapy compared to those who received chemotherapy emulsified with lipiodol ( 9 ). Another study evaluated intra-arterial doxorubicin versus doxorubicin with lipiodol, and found no difference in the area under the concentration-time curve, or terminal half life, and no difference in pharmacokinetic profile or systemic toxicity using the same dose schedule but administering the doxorubicin intravenously ( 10 ). Pharmacokinetic data supporting the use of intra-arterial chemotherapy, or chemotherapy plus lipiodol administered as an emulsion, as commonly used today, remains debatable.
