Kriterij i mogućnosti endovaskularnog liječenja hepatocelularnog karcinoma

master's thesis

• Title (english): Criteria and possibilities of endovascular treatment of hepatocellular carcinoma
• Author: Tomislav Brajković
• Mentor: Vinko Vidjak (mentor)
• Committee member: Tajana Filipec Kanižaj (predsjednik povjerenstva)
• Committee member: Gordana Ivanac (član povjerenstva)
• Committee member: Vinko Vidjak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Radiology); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology

Abstract

Hepatocelularni karcinom predstavlja najčešći primarni maligni tumor jetre, čija incidencija raste u cijelome svijetu. Endovaskularno liječenje obuhvaća različite metode ciljane terapije putem krvnih žila koje opskrbljuju tumorsko tkivo. Glavne metode endovaskularnog liječenja su: konvencionalna transarterijska kemoembolizacija (cTACE), transarterijska radioembolizacija (TARE), transarterijska embolizacija pomoću čestica koje otpuštaju lijek (DEB-TACE), balon okluzivna embolizacija (B-TACE) te BLAND embolizacija. cTACE je metoda koja kombinira dostavu kemoterapijskih lijekova direktno u žilu koja opskrbljuje tumor i ciljanu embolizaciju. TARE metoda uključuje endovaskularnu dostavu radioaktivnih čestica, najčešće itrij-90, u arteriju koja opsrkrbljuje tumor s ciljem njegove nekroze. U DEB TACE kombiniraju se mikrosfere koje kontinuirano otpuštaju lijek sa embolizacijom krvnih žila tumora, a cilj je osigurati opstrukciju tumorskih krvnih žila te omogućiti kontinuirano otpuštanje kemoterapijskog agensa u tumorsku tkivo, uz minimalnu sistemsku izloženost kemoterapeutiku. Kod B-TACE upotrebom balonskog mikrokatetera neposredno prije izvođenja kemoembolizacije smanjuje se lokalni krvni tlak i povećava izloženost citostatiku. BLAND embolizacija podrazumijeva ciljanu embolizaciju krvnih žila koje hrane tumor bez upotrebe kemoterapijskih lijekova. Pravilan izbor pacijenata koji su kandidati za endovaskularno liječenje je ključan za optimalne rezultate i zasniva se na nekoliko kriterija. Pacijenti sa ranim do srednje uznapredovalim stadijem HCC-a (Barcelona Clinic Liver Cancer (BCLC) stadij A i B) , očuvane funkcije jetre i očuvanih životnih sposobnosti, bez vaskularne invazije i bez ekstrahepatalne proširenosti tumora su najčešći kandidati za endovaskularno liječenje. Endovaskularno liječenje omogućuje sniženje stadija tumora do razine ispunjavanja kriterija koji otvaraju mogućnost transplantacije jetre. Kao metoda premoštenja endovaskularne metode koriste kod pacijenata koji se već nalaze unutar kriterija za transplantaciju jetre, s ciljem sprječavanja progresije tumora tijekom boravka na listi čekanja.

Abstract (english)

Hepatocellular carcinoma is the most common primary malignant liver tumor, with an increasing incidence worldwide. Endovascular treatment includes various methods of targeted therapy through the blood vessels supplying the tumor tissue. The main methods of endovascular treatment include conventional transarterial chemoembolization (cTACE), transarterial radioembolization (TARE), drug eluting beads transarterial embolization (DEB- TACE), balloon-occluded transarterial chemoembolization (B-TACE) and BLAND embolization. cTACE is a method that uses a combination of delivering chemotherapeutic drugs directly into the vessel feeding the tumor and embolization. TARE involves endovascular delivery of radioactive particles (most commonly yttrium-90 ) into the artery supplying the tumor, with the aim of inducing necrosis. DEB-TACE combines microspheres that continuously release the drug with embolization of the tumor blood vessels, aiming to ensure obstruction of the tumor blood vessels and continuous release of the chemotherapeutic agent into the tumor tissue. In B-TACE, the use of a balloon microcatheter immediately before performing chemoembolization reduces local blood pressure and increases the exposure to the cytostatic agent. BLAND embolization involes targeted embolisation of the blood vessels feeding the tumor without using chemotherapeutic agents. The proper selection of patients who are candidate for endovascular treatment is crucial and is based on several criteria. Patients with early to intermediate stage hepatocellular carcinoma (Barcelona Clinic Liver Cancer (BCLC) stages A and B), preserved liver function, good performance status, without vascular invasion and without extrahepatic spread of the tumor, are the most common candidates for endovascular treatment. Endovascular treatment allows for the downstaging of the tumor to a level that meets criteria for liver transplantation. Endovascular treatment is also used as a bridging therapy for patients already within criteria for liver transplantation, aiming to prevent tumor progression while on waiting list.

• Keywords: endovaskularno liječenje; hepatocelularni karcinom; kemoembolizacija; radioembolizacija
• Keywords (english): endovascular treatment; hepatocellular carcinoma; chemoembolisation; radioembolisation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:128951
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-08 12:03:15