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Microvascular Perfusion Changes following Transarterial Hepatic Tumor Embolization
Carmen Gacchina Johnson1, Karun V Sharma2, Elliot B Levy1
1Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.
Journal of Vascular and Interventional Radiology : JVIR
|September 1, 2015
Summary
Tumor embolization to angiographic stasis leaves nearly half of microvascular perfusion intact. This persistent perfusion, especially at the tumor periphery, may impact treatment effectiveness in embolotherapy.
Area of Science:
- Interventional Radiology
- Oncology
- Vascular Biology
Background:
- Tumor microvascular perfusion is crucial for tumor growth and metastasis.
- Transarterial embolization is a common oncologic treatment aiming to block tumor blood supply.
- Current angiographic endpoints may not fully capture the extent of microvascular occlusion.
Purpose of the Study:
- To quantify changes in tumor microvascular perfusion after embolization.
- To compare microvascular perfusion changes relative to standard angiographic endpoints (substasis and stasis).
Main Methods:
- Rabbit Vx2 liver tumors were embolized using 100-300 micrometer particles to substasis or complete stasis.
- Microvascular perfusion was assessed using dual-fluorophore labeled perfusion markers before and after embolization.
- Tumor microvasculature was identified using CD31 staining and analyzed via fluorescence microscopy.
Main Results:
- Before embolization, 81% of tumor microvasculature was perfused.
- Embolization to substasis reduced perfusion by 37%; complete stasis reduced perfusion by 56%.
- Persistent perfusion was observed, particularly at the tumor periphery, and newly perfused vessels appeared after substasis embolization.
Conclusions:
- Significant tumor microvascular perfusion persists even after embolization to complete angiographic stasis.
- The findings suggest that current angiographic endpoints may overestimate the efficacy of embolization in eliminating tumor blood supply.
- This residual perfusion could influence tumor response to embolotherapy and warrants further investigation.
