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37 protocols using lipiodol ultra fluide

1

Hepatic arterial treatment regimens

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Animals were randomized into 4 hepatic intra-arterial treatment regimens and received an infusion of either: (a) normal saline (5 mL of 0.9% NaCl) (control group; n=7); (b) evofosfamide (Evo group; n=7); (c) an emulsion of doxorubicin (Sigma-Aldrich) and Lipiodol (Lipiodol Ultra-Fluide, Laboratoire Guerbet, Aulnay-sous-Bois, France) followed by embolization with 100-300 μm bland beads (Embospheres, Merit Medical Systems, South Jordan, UT) (conventional TACE - [cTACE] - group; n=7); (d) a combination of doxorubicin/Lipiodol emulsion and evofosfamide followed by embolization with 100-300 μm bland beads (cTACE+Evo group; n=7). Animals underwent multidetector computed tomography (MDCT) 24 hours pre-treatment and then at 7 and 14 days after the interventional treatment. Comprehensive blood work (complete liver, hematologic and renal panels) was obtained at baseline, 1, 2, 7 and 14 days after treatment. Daily clinical monitoring was performed. Three animals in each group were randomly sacrificed 2 days after treatment for histopathological and immunohistochemical analysis. The rest of the animals were sacrificed on day 14 after the last imaging assessment.
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2

Transarterial Chemoembolization for Liver

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PA-TACE is recommended per the personal experience and judgment of the physician. Initial PA-TACE was performed within 1–2 months after resection. A 5-F catheter or microcatheter was inserted into an appropriate hepatic artery using the Seldinger technique. Hepatic angiography was performed to ascertain the distribution of the arteries. Chemotherapeutic agents, including cisplatin (10–30 mg), doxorubicin hydrochloride (10 mg), and pharmorubicin (20–40 mg) were slowly injected, followed by an emulsion of lipiodol (5–10 mL) (Lipiodol Ultrafluide, Guerbet, AulnaySousBois, France). Individualized dosages of chemotherapeutic agents and lipiodol were determined on the basis of the remaining liver volume and body surface.
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3

Transcatheter Arterial Chemoembolization for Tumors

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Angiographies of celiac, hepatic, superior mesenteric, left gastric, and inferior phrenic arteries were performed to identify all of the feeding arteries of the tumor. The chemotherapeutic drug and lipiodol (Lipiodol UltraFluide; Guerbet Laboratories) were mixed into a suspension and injected through the segmental or subsegmental target artery. The chemotherapeutic drugs used generally comprised of at least one of the following four types: platinum (25‐50 mg lobaplatin [Hainan Changan International Pharmaceutical Co. Ltd.], 100‐300 mg carboplatin [Bristol‐Myers Squibb], 50‐150 mg oxaliplatin [Sanof Synthelabo France]), anthracycline (30‐60 mg pirarubicin [Wan Le Pharmaceutical; Shen Zhen Co. Ltd.]), antibiotics (30‐60 mg epirubicin [Pfizer], 4‐10 mg mitomycin C [Zhejiang Hisun Pharmaceutical Co. Ltd.]), or fluorouracil (30‐60 mg Floxuridine [Nantong Jinghua Pharmaceutical Co. Ltd.], 100‐500 mg 5‐fluorouracil [Shanghai Xudong Haipu Pharmaceutical Co. Ltd.]). Similar drugs were not repetitively applied. Absorbable gelatin sponge (AGS) (H32024096; Gelfoam; Hanzhou alc Ltd) 350‐560 µm in diameter or polyvinyl alcohol (PVA) (Cook) 300 µm in diameter was injected in place of lipiodol if necessary. The mixture was infused at a rate of 0.5‐1 mL/min until flow stasis was achieved in the tumor vasculature.
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4

Transarterial Chemoembolization for Hepatocellular Carcinoma

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TACE was performed by two interventional radiologists having > 15 years of clinical experience (JW, 19 years of experience; CY, 21 years of experience). All target regions were investigated under the guidance of a diagnostic digital subtraction angiography (GE Innova 3100) using the Seldinger technique. In general, a radiologist placed a sheath introducer in the right common femoral artery, advanced a 5 French (F) angiographic catheter into the common hepatic artery, and advanced a 2.2–2.4 F microcatheter (Asahi Intecc Co. Ltd., Japan) into the feeding hepatic artery. The patients were treated with combined chemotherapy, and the average doses of epirubicin, hydroxycamptothecin, oxaliplatin, and recombinant human interleukin-2 were 50 mg, 20 mg, 50 mg, and 2 million IU, respectively. Furthermore, 350–560-μm gelatin sponge particles (Hangzhou Alicon Pharmaceutical Technology Co.Ltd. Hangzhou, China) and/or average doses of an epirubicin (10 mg) + lipiodol (6 ml; Lipiodol Ultra-Fluide; Guerbet, France) mixture were also used. The total volume of the lipiodol emulsion was determined based on the tumor size and the achievement of stagnant flow in the tumor-feeding artery, as observed in procedural fluoroscopy.
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5

Transarterial Chemoembolization for HCC

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TACE was performed within 2–3 days after diagnosis of HCC as described. Using the Seldinger technique, an arterial catheter (5-Fr) was inserted into the femoral artery after local anesthesia. The catheter was then advanced in the hepatic artery, and digital subtraction angiography was performed. The tumor-feeding vessels were superselected using the catheter or microcatheter (2.8-Fr) to infuse a suspension containing 20–60 mg of doxorubicin hydrochloride (Adriamycin; Shenzhen Main Luck Pharmaceutical Inc., Shenzhen, China) and 2–20 ml of iodized oil (Lipiodol Ultra-Fluide; Laboratoire Guerbet, Roissy-Charlesde Gaulle, France). Gelfoam sponge embolization was performed following iodized oil embolization. The dosages of doxorubicin and iodized oil were determined by the patient’s liver function and tumor characteristics.
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6

Transarterial Embolization and Chemoembolization Protocol

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The tumor supplying artery was approached with a 4-Fr J-curve (5Fr RLG) and 2.7 Fr microcatheter (Progreat; Terumo, Japan). The TAE/TACE procedure was performed by infusion of iodized oil contrast medium (Lipiodol Ultra-Fluide; Guerbet, Aulnay-sous-Bois, France) and/or doxorubicin (Adrinamycin) followed with gelatin sponge particles. The amount of lipiodol injection ranged from 10–90 ml and some patients also received doxorubicin 40 mg. Tumor angiography was reviewed and extra-hepatic shunting was specially recorded.
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7

Transarterial Chemoembolization for Remnant Liver

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When the liver function of the patient had recovered at 4 weeks after resection, TACE procedure was performed for the remnant liver. Angiography of celiac, hepatic, superior mesenteric, left gastric, and bilateral inferior phrenic arteries was performed using a 4F/5F catheter to identify all feeding arteries of any obvious tumor stains in the remnant liver using the Seldinger technique. An emulsion of 2-10 mL of Lipiodol Ultra-Fluide (Guerbet, France) mixed with 30-50 mg of EADM (Pfizer, USA) was then infused through a microcatheter (Progreat, TERUMO, Japan). The dosages of the chemotherapy drugs and lipiodol depended on the underlying state of liver function and body surface area [14 (link)]. The criteria for liver treatment used in both institutions were similar.
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8

Multimodal Interventional Approach for Liver Cancer

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The Allura Xper FD 20 (Philips Healthcare, Best, Amsterdam, the Netherlands) digital subtraction angiography (DSA) instrument was used for the TACE procedures. A 16-slice spiral computed tomography (CT) scanner (Brilliance CT BigBore; Phillip Medical Systems, the Netherlands) was used for cryoablation puncture guidance and image acquisition. The cryoablation was performed with the Cryo-HitTM (Galilmedical, Israel) using argon gas as a cryogen. Consumables included the puncture needle, the artery catheter sheath, the angiography catheter (Terumo, Tokyo, Japan), and the micro-catheter (Terumo, Tokyo, Japan), lipiodol (Lipiodol Ultrafluide; Guerbet, Aulnay-Sous-Bois, France), gelatin sponge particles (Alicon, Hangzhou, China), and chemotherapeutics including lobaplatin (Chang’an International Pharmaceutical, Hainan, China) and epirubicin (Shenzhen Main Luck Pharmaceuticals, Shenzhen, China).
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9

Transarterial Chemoembolization for Liver

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When patients’ liver function has recovered at 4 weeks after liver surgery, we performed TACE treatment for the remaining portion of the liver. We inserted a vascular catheter through the femoral artery by using the Seldinger technique and also performed hepatic angiography. In addition, we inserted the catheter’s tip into the relevant hepatic artery selectively. We then infused an emulsion of 2–10 mL of Lipiodol Ultra-Fluide (Guerbet, France) mixed with 30–50 mg of EADM (Pfizer) through a microcatheter (Progreat, TERUMO, Japan). In addition, the dosages of the chemotherapy drugs and lipiodol were based on the liver function and body surface area.
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10

Transarterial Chemoembolization for Liver

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All TACE procedures were performed using digital subtraction angiography guidance (9). At 4 weeks after RH, when the liver function of the patient had recovered, a hepatic arterial catheter was placed into the proper hepatic artery through the femoral artery using the Seldinger technique, and TACE was performed for the entire remnant liver. Hepatic angiography and dyna-CT were performed to detect any obvious tumor stains in the remnant liver. An emulsion of pharmorubicin (20–40 mg) and lipiodol (2–10 mL) (Lipiodol Ultrafluide, Guerbet, AulnaySous-Bois, France) then was infused through the catheter.
The dosage of lipiodol and doxorubicin was determined by body surface area and underlying liver function. After 1 month of follow-up evaluation, a CT scan was performed to determine the effects of TACE.
All procedures were technically successful with no major procedural complications requiring additional hospitalization or intervention.
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