Skip to main content

Advertisement

SpringerLink
Log in

Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the efficacy of transarterial chemoembolization (TACE) using different drug combinations in the treatment of breast cancer liver metastases in terms of local tumor control and survival rate. A total of 208 patients (mean age 56.4 years, range 29–81) with unresectable hepatic metastases of breast cancer were repeatedly treated with TACE at 4-week intervals. In total, 1,068 chemoembolizations were performed (mean 5.1 sessions/patient, range 3–25). The chemotherapy protocol consisted of mitomycin-C only (8 mg/m2; n = 76), mitomycin-C with gemcitabine (n = 111), and gemcitabine only (1,000 mg/m2; n = 21). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated by MRI according to RECIST criteria. Survival rates were calculated using Kaplan-Meier method. For all protocols, local tumor control was partial response 13% (27/208), stable disease 50.5% (105/208), and progressive disease 36.5% (76/208). The 1-, 2-, and 3-year survival rates after TACE were 69, 40, and 33%. Median and mean survival times from the start of TACE were 18.5 and 30.7 months. Treatment with mitomycin-C only showed median and mean survival times of 13.3 and 24 months, with gemcitabine only they were 11 and 22.3 months, and with a combination of mitomycin-C and gemcitabine 24.8 and 35.5 months. TACE is an optional therapy for treatment of liver metastases in breast cancer patients with better results from the combined chemotherapy protocol.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1a–j
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Pickren JW, Tsukada Y, Lane WW (1982) Liver metastases: analysis of autopsy data. In: Weiss L, Gilbert HA (eds) Liver metastases. GK Hall Medical, Boston, pp 2–18

    Google Scholar 

  2. Hoe AL, Royle GT, Taylor I (1991) Breast liver metastases-incidence, diagnosis and outcome. J R Soc Med 84(12):714–716

    CAS  PubMed  Google Scholar 

  3. Fenster LF, Klatskin G (1961) Manifestations of metastatic tumors of the liver. A study of eighty-one patients subjected to needle biopsy. Am J Med 31:238–248

    Article  CAS  PubMed  Google Scholar 

  4. Kasper HU, Drebber U, Dries V, Dienes HP (2005) Liver metastases: incidence and histogenesis. Z Gastroenterol 43(10):1149–1157

    Article  PubMed  Google Scholar 

  5. Bathe OF, Kaklamanos IG, Moffat FL, Boggs J, Franceschi D, Livingstone AS (1999) Metastatectomy as a cytoreductive strategy for treatment of isolated pulmonary and hepatic metastases from breast cancer. Surg Oncol 8(1):35–42

    Article  CAS  PubMed  Google Scholar 

  6. Zinser JW, Hortobagyi GN, Buzdar AU, Smith TL, Fraschini G (1987) Clinical course of breast cancer patients with liver metastases. J Clin Oncol 5(5):773–782

    CAS  PubMed  Google Scholar 

  7. Vogl TJ, Mack MG, Straub R, Engelmann K, Zangos S, Roggan A (1999) Interventional laser-induced thermotherapy of hepatic metastases from breast cancer. Method and clinical outcome. Gynäkologe 32:666–674

    Google Scholar 

  8. Livraghi T, Goldberg SN, Solbiati L, Meloni F, Ierace T, Gazelle GS (2001) Percutaneous radio-freqiency ablation of liver metastases from breast cancer: initial experience in 24 patients. Radiology 220(1):145–149

    CAS  PubMed  Google Scholar 

  9. Mack MG, Straub R, Eichler K, Söllner O, Lehnert T, Vogl TJ (2004) Breast cancer metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology 233(2):400–409

    Article  PubMed  Google Scholar 

  10. Brown DB, Geschwind J-FH, Soulen MC, Millward SF, Sacks D (2006) Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol 17:217–223

    PubMed  Google Scholar 

  11. Germer CT, Buhr HJ, Isbert C (2005) Nonoperative ablation for liver metastases. Possibilities and limitations as a curative treatment. Chirurg 76(6):552–554 556–563

    Article  PubMed  Google Scholar 

  12. Liapi E, Geschwind JF (2007) Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 25(8):978–986

    Google Scholar 

  13. Brown DB, Cardella JF, Sacks D, Goldberg SN, Gervais DA, Rajan D, Vedantham S, Miller DL, Brountzos EN, Grassi CJ, Towbin RB (2006) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Inter Radiol 17:225–232

    Article  Google Scholar 

  14. Vogl TJ, Mack MG, Balzer JO, Engelmann K, Straub R, Eichler K, Woitaschek D, Zangos S (2003) Liver metastases: neoadjuvant downsizing with transarterial chemoembolization befor laser-induced thermotherapy. Radiology 229(2):457–464

    Article  PubMed  Google Scholar 

  15. Seldinger SI (1953) Catheter replacement of needle in percutaneous arteriography: a new technique. Acta Radiol 39:368–372

    Article  CAS  PubMed  Google Scholar 

  16. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92(3):205–216

    Article  CAS  PubMed  Google Scholar 

  17. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  18. Giroux MF, Baum RA, Soulen MC (2004) Chemoembolization of liver metastases from breast carcinoma. J Vasc Interv Radiol 15(3):289–291

    PubMed  Google Scholar 

  19. Schuetz F, Diel IJ, Pueschel M, von Holst T, Solomayer EF, Lange S, Sinn P, Bastert G, Sohn C (2007) Reduced incidence of distant metastases and lower mortality in 1072 patients with breast cancer with a history of hormone replacement therapy. Am J Obstet Gynecol 196(4):342 e1–9

    Article  PubMed  CAS  Google Scholar 

  20. Eichbaum MH, Kaltwasser M, Bruckner T, da Rossi TM, Schneeweiss A, Sohn C (2006) Prognostic factors for patients with liver metastases from breast cancer. Breast Cancer Res Treat 96(1):53–62

    Article  PubMed  Google Scholar 

  21. Vogl TJ, Müller PK, Mack MG, Straub R, Engelmann K, Neuhaus P (1999) Liver metastases: interventional therapeutic techniques and results, state of the art. Eur Radiol 9(4):675–684

    Article  CAS  PubMed  Google Scholar 

  22. Maksan SM, Lehnert T, Bastert G, Herfarth C (2000) Curative liver resection for metastatic breast cancer. Eur J Surg Oncol 26(3):209–212

    Article  CAS  PubMed  Google Scholar 

  23. Pocard M, Pouillart P, Asselain B, Salmon R (2000) Hepatic resection in metastatic breast cancer: results and prognostic factors. Eur J Surg Oncol 26:155–159

    Article  CAS  PubMed  Google Scholar 

  24. Raab R, Nussbaum KT, Behrend M, Weimann A (1998) Liver metastases of breast cancer: results of liver resection. Anticancer Res 18(3c):2231–2233

    CAS  PubMed  Google Scholar 

  25. Yoshimoto M, Tada T, Saito M, Takahashi K, Uchida Y, Kasumi F (2000) Surgical treatment of hepatic metastases from breast cancer. Breast Cancer Res Treat 59(2):177–184

    Article  CAS  PubMed  Google Scholar 

  26. Elias D, Cavalcanti de Albuquerque A, Eggenspieler P, Plaud B, Ducreux M, Spielmann M, Theodore C, Bonvalot S, Lasser P (1998) Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 187:487–493

    Article  CAS  PubMed  Google Scholar 

  27. Bismuth H, Castaing D, Traynor O (1988) Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg 12(1):39–47

    Article  CAS  PubMed  Google Scholar 

  28. Nakeeb A, Tran KQ, Black MJ, Erickson BA, Ritch PS, Quebbeman EJ, Wilson SD, Demeure MJ, Rilling WS, Dua KS, Pitt HA (2002) Improved survival in resected biliary malignancies. Surgery 132(4):555–564

    Article  PubMed  Google Scholar 

  29. Elias D, Lasser PH, Montrucolli D, Bonvallot S, Spielmann M (1995) Hepatectomy for liver metastases from breast cancer. Eur Surg Oncol 21(5):510–3

    Article  CAS  Google Scholar 

  30. Adam R, Aloia T, Krissat J, Bralet MP, Paule B, Giacchetti S, Delvart V, Azoulay D, Bismuth H, Castaing D (2006) Is liver resection justified for patients with hepatic metastases from breast cancer? Ann Surg 244(6):897–908

    Article  PubMed  Google Scholar 

  31. Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH (1998) Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228(3):385–394

    Article  CAS  PubMed  Google Scholar 

  32. Nicolini A, Giardino R, Carpi A, Ferrari P, Anselmi L, Colosimo S, Conte M, Fini M, Giavaresi G, Berti P, Miccoli P (2006) Metastatic breast cancer: an updating. Biomed Pharmacother 60(9):548–556

    Article  CAS  PubMed  Google Scholar 

  33. Metcalfe MS, Mullin EJ, Maddern GJ (2006) Hepatectomy for metastatic noncolorectal gastrointestinal, breast and testicular tumours. ANZ J Surg 76(4):246–250

    Article  PubMed  Google Scholar 

  34. Schneebaum S, Walker MJ, Young D, Farrar WB, Minton JP (1994) The regional treatment of liver metastases from breast cancer. J Surg Oncol 55(1):26–31

    Article  CAS  PubMed  Google Scholar 

  35. Stuart K (2003) Chemoembolization in the management of liver tumors. Oncologist 8(5):425–437

    Article  PubMed  Google Scholar 

  36. Vogl TJ, Zangos S, Eichler K, Yakoub D, Nabil M (2007) Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update. Eur Radiol 17(4):1025–1034

    Article  PubMed  Google Scholar 

  37. Vogl TJ, Trapp M, Schroeder H, Mack M, Schuster A, Schmitt J, Neuhaus P, Felix R (2000) Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success—results from a liver transplantation center. Radiology 214(2):349–357

    CAS  PubMed  Google Scholar 

  38. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Solà R, Rodés J, Bruix J, Barcelona Liver Cancer Group (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319):1734–1739

    Google Scholar 

  39. Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, Matsuyama Y, Nakanuma Y, Kojiro M, Makuuchi M, Yamaoka Y (2006) Liver Cancer Study Group of Japan. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 131(2):461–469

    Article  CAS  PubMed  Google Scholar 

  40. Ho AS, Picus J, Darcy MD, Tan B, Gould JE, Pilgram TK, Brown DB (2007) Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR 188(5):1201–1207

    Article  PubMed  Google Scholar 

  41. Li X, Meng Z, Guo W, Li J (2005) Treatment for liver metastases from breast cancer: results and prognostic factors. World J Gastroenterol 11(24):3782–3787

    PubMed  Google Scholar 

  42. Pentheroudakis G, Fountzilas G, Bafaloukos D, Koutsoukou V, Pectasides D, Skarlos D, Samantas E, Kalofonos HP, Gogas H, Pavlidis N (2005) Metastatic breast cancer with liver metastases: a registry analysis of clinicopathologic, management and outcome characteristics of 500 women. Breast Cancer Res Treat 97:237–244

    Article  PubMed  Google Scholar 

  43. Caralt M, Bilbao I, Cortés J, Escartín A, Lázaro JL, Dopazo C, Olsina JJ, Balsells J, Charco R (2008) Hepatic resection for liver metastases as part of the “oncosurgical” treatment of metastatic breast cancer. Ann Surg Oncol 15(10):2804–10

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Dexter Marak for his contribution to the current work.

Author information

Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Thomas J. Vogl, Nagy N. N. Naguib , Nour-Eldin A. Nour-Eldin, Katrin Eichler, Stefan Zangos & Tatjana Gruber-Rouh

Authors
  1. Thomas J. Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nagy N. N. Naguib
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nour-Eldin A. Nour-Eldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katrin Eichler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Zangos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatjana Gruber-Rouh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas J. Vogl.

Additional information

Thomas J. Vogl and Nagy N. N. Naguib contributed equally to the current work

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vogl, T.J., Naguib , N.N.N., Nour-Eldin, NE.A. et al. Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer. Eur Radiol 20, 173–180 (2010). https://doi.org/10.1007/s00330-009-1525-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1525-0

Keywords

Search

Navigation