| Background and PurposeHepatocellular carcinoma (HCC) is still a substantial health challenge worldwide. Curative surgical therapy remains the primary choice of treatment, but typically only10%-15%of patients are suitable candidates for surgical resection due to coexistent cirrhosis or multiple lesions. Among the noncurative HCC treatments, transcatheter arterial chemoembolization (TACE) has been accepted as a mainstay for patients who are at middle and late stages. Lipiodol is the most popular basic material for TACE and widely used in clinical practice. Although it can induce significant necrosis, complete tumor necrosis is rarely achieved because of arterial washout. The residual surviving tumor cells then play an important role in local recurrence and metastasis, thereby diminishing the long-term efficacy of TACE.Transcatheter arterial embolization(TAE) with a mixture of Lipiodol and ethanol has been shown to be an effective treatment for intrahepatic lesions of HCC, although it is not widely recognized or used. Results from reported studies suggest that lipiodol prolongs and enhances the embolic effect of the ethanol by producing a more homogeneous distribution of the agent and increasing its contact time with the tissues.Experimentally little is known about the treatment effectiveness and angiogenesis changes in liver tumor after TAE with different ratio of lipiodol-ehtanol mixture(LEM). Thus, in the present study, we established a rabbit model with hepatic VX2carcinoma to investigate the tumor response and angiogenesis difference after embolization with varying ratio of LEM.Materials and MethodsTwenty male New Zealand white rabbits were randomly selected in this study. After successful VX2tumor implantation into the left hepatic lobe, the tumor volume of each rabbit was measured using conventional and enhanced CT scanning after14days. These rabbits were then embolized transarterially with a mixture of ethanol and lipiodol in a ratio of0:1(group A),1:3(group B),1:1(group C) and3:1(group D). Blood tests for liver function were performed for all rabbits by means of biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Follow-up CT scaning was performed at7days after TACE. The volume of the tumor was measured again and the growth ratio was calculated by comparing the tumor volumes obtained before and at7days after treatment. The mean values of ALT and AST from each group were analyzed with repeated measurement data. Tumor volume and tumor growth rate (TGR) were analyzed by using one-way analysis of variance(ANOVA).ResultsCT scaning confirmed that VX2liver tumors were successfully established in all20rabbits. Two animal models died in the process of laparo-implanting of VX2tumor model related with mal-anesthesia, one rabbit model dies in the process of CT scanning also related with mal-anesthesia, three rabbits were failed to establish including of one of negtive hepatic tumor and two of metastasis to peritoneum nearby envelop of liver according to CT scanning.These twenty rabbits successfully established with VX2hepatic tumor and divided into four groups of five rabbits each. The tumor volume at the14th day after VX2tumor implantation in group A, B, C and D was (3066.7±1865.9) mm3,(3173.8±2758.0) mm3,(1999.7±1284.4) mm3'(1730.8±1136.8) mm3, respectively. There were no statistically significant differences among the four groups in the tumor volume (P>0.05).Transcatheter arterial embolization were successfully performed in all groups. Both ALT and AST mean values in every group at each time point before and after embolization were significantly different (ALT F=53.222,69.964,148.183,959.968; AST F=51.743,69.976,102.128,469.177, respectively)(P<0.05). ALT in group A, B, C,Dwas (105.2±16.0) U/L.(97.1±13.6) U/L、(119.8±6.8) U/L、(172.7±7.3) U/L,and AST in group A,B,C,D was (107.4±17.3) U/L、(98.5±12.4) U/L、(121.2±8.3)U/L、(180.9±10.7)U/L at4days after embolization, respectively. The mean values of ALT and AST were significantly elevated4days after embolization in all four groups compared with that before embolization (P<0.05). At the4th day after embolization, there were significant differences in the mean values of ALT and AST in group A, C and D, compared with group B, while there was no significant difference between group A and group B. On the other hand, the growth rate of the tumors differed significantly among the four groups (F=4.964, P=0.013). The group C (0.883±0.123)%showed significantly lower tumor growth rate than group A (1.416±0.328)%(P=0.004) and group D (1.397±0.336)%(P=0.005), but no significantly difference compared with group B (1.171±0.116)%(P=0.087).ConclusionsTransarterial embolization using Lipiodol-Ethanol Mixture with the ethanol ratio at25%to50%is more feasible and safe in rabbit VX2liver tumor model. |
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