Interventional radiology for liver diseases
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EDITORIAL
Interventional radiology for liver diseases Luc Defreyne 1 Received: 26 July 2020 / Accepted: 25 September 2020 # European Society of Radiology 2020
Over the past thirty years interventional radiology of the liver has evolved tremendously. Established as portal vein decompression and tumor treatment, IR technology advanced continuously. Covered ePTFE stents significantly increased TIPS patency and ascites control [1, 2]. ePTFE-covered stents were tested in percutaneous palliation of biliary malignancies to prevent tumor ingrowth and increase patency. Randomized controlled trials (RCT) endorsed covered stents in extrahepatic bile duct malignancies [3]. For intrahepatic biliary malignancies, ePTFE-covered stents worked but failed to fulfill their promise: sludge formation on the inner coating impedes longer patency times [4]. Long-term patency of stents becomes a major issue, as progress in medical treatment offers longer live expectancy for patients with, i.e., portal hypertension, Budd-Chiari disease, biliary strictures, or malignancies. Research projects on drug-eluting stents and radioactive or resorbable stents are ongoing [5, 6]. Although metallic stents have been put aside in benign biliary strictures in favor of repeat balloon dilatation, preliminary results with a biodegradable stent are promising [7, 8]. Conventional chemoembolization (cTACE) and radiofrequency ablation (RFA) were embedded in the Barcelona Classification of Liver Cancer (BCLC), remaining unchallenged as level I treatments for intermediate and early HCC for almost twenty years [9–13]. However, cTACE suffers from drug and dose variation as well as technical permutations. The drug-eluting beads (DEB-TACE, Boston Scientific) installed standardization of chemoembolization, proving efficacy but not yet superiority over cTACE [14–16]. Because of a lower post-embolization toxicity, DEB-TACE research was continued with emerging of eluting microspheres manufactured from polyvinyl alcohol (CalliSpheres, Jiangsu Hengrui), expanding trisacryl/gelatin * Luc Defreyne [email protected] 1
Department of Interventional Radiology, University Hospital of Ghent, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
(HepaSphere or QuadraSphere, Merit Medical), polyethylene glycol (LifePearl, Terumo), and hydrogel with polyzene coating (Tandem, Varian). All DEB-TACE beads are nonresorbable agents, permanently blocking tumor supply at different levels according to bead sizes (from 500 to 40 μ) [17–20]. As tumor response did not quite differ, the question remains whether the eluting chemotherapeutic or the embolic particulate dominates the anti-tumor effect. Interestingly, degradable starch microspheres combined with a chemotherapeutic are finding their way into clinical practice, even in advanced HCC [21]. Biodegradable microspheres are captivating with a range of “biogel” materials now under investigation [22]. First in queue for clinical testing are combined degradable and drug-eluting beads (BioPearl, Terumo), which might provide more insi
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