{"id":1875,"date":"2009-10-01T01:00:00","date_gmt":"2009-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/experience-monocentrique-du-traitement-du-carcinome-hepatocellulaire-chc-par-embolisation-avec-microspheres-chargees-de-doxorubicine-dc-beads\/"},"modified":"2018-10-20T18:39:51","modified_gmt":"2018-10-20T16:39:51","slug":"experience-monocentrique-du-traitement-du-carcinome-hepatocellulaire-chc-par-embolisation-avec-microspheres-chargees-de-doxorubicine-dc-beads","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/experience-monocentrique-du-traitement-du-carcinome-hepatocellulaire-chc-par-embolisation-avec-microspheres-chargees-de-doxorubicine-dc-beads\/","title":{"rendered":"Exp\u00e9rience monocentrique du traitement du carcinome h\u00e9patocellulaire (CHC) par embolisation avec microsph\u00e8res charg\u00e9es de DOXORUBICINE (DC Beads)"},"content":{"rendered":"

2009<\/strong><\/p>\n

J.DENIS 1 , T.KONE2, N.CANEPA2, M. FOKOU2, V.KUOCH2
\n(1)Service d\u2019 h\u00e9patogastroent\u00e9rologie, (2) Service de radiologie, Centre Hospitalier Sud-Francilien, 91000-Evry<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02009-07-07 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction :
\nBien que son efficacit\u00e9 ne soit pas rigoureusement d\u00e9montr\u00e9e, la chimioembolisation est une des m\u00e9thodes les plus fr\u00e9quemment utilis\u00e9es dans le traitement des carcinomes h\u00e9patocellulaires et a sa place dans l\u2019organigramme des traitements recommand\u00e9s par l\u2019EASL. En dehors des essais contr\u00f4l\u00e9s les r\u00e9sultats de la technique sont difficiles \u00e0 appr\u00e9hender du fait de la grande disparit\u00e9 des indications, des populations trait\u00e9es et des modalit\u00e9s d\u2019application (techniques, agents utilis\u00e9s et rythme d\u2019administration diff\u00e9rents) en fonction des \u00e9quipes. Depuis janvier 2007, notre centre recourt exclusivement \u00e0 une technique standardis\u00e9e utilisant des microsph\u00e8res d\u2019hydrogel calibr\u00e9es charg\u00e9es de DOXORUBINE (DC Beads). Nous rapportons les r\u00e9sultats chez les 16 patients atteints de CHC trait\u00e9s selon cette m\u00e9thode en 2007 et 2008.<\/p>\n

Patients :
\nLes 16 patients \u00e9taient tous des hommes atteints de cirrhose, d\u2019origine alcoolique exclusive ou pr\u00e9dominante dans 14 cas, due au VHC (n=1) ou au VHB (n=1). L\u2019\u00e2ge moyen \u00e9tait de 66,2 ans (49-78 ans). Le statut OMS \u00e9tait 0 dans 10 cas, 1 (n=4) ou 2 (n=2). 4 patients avaient une ascite mod\u00e9r\u00e9e, 1 un h\u00e9mop\u00e9ritoine (CHC rompu) ; 2 avaient une enc\u00e9phalopathie mod\u00e9r\u00e9e ; 10 \u00e9taient porteurs de VO (grade I = 1, II = 3, III = 3, 3 avaient eu des LVO), 10 patients \u00e9taient class\u00e9s Child A (8 A5, 2 A6) et 6 Child B (3 B7, 2 B8, 1 B?). Biologie : Bilirubine 17 \u00b5mol\/l (6 \u2013 42), albumine 30,6 g\/l (23,8 \u2013 40,5), TP 76 % (58 \u2013 100), ALAT 35 UI\/ml pour N inf. \u00e0 41(13 – 88), ASAT 50 UI\/ml pour N inf. \u00e0 37 (20 – 168), GGT 118 UI\/ml pour N inf. \u00e0 85 (37 \u2013 333), PAL 97 pour N inf. \u00e0 122 (29 \u2013 192), Hb 11,4 g\/l (8 \u2013 14,4), GB 6 000\/mm3 (2 300 \u2013 18 700), plaquettes 129 000 G\/l (51 000 \u2013 236 000), cr\u00e9atinine 94 mmol\/l (62 \u2013 127) ; dans 10 cas l\u2019aphafoetoprot\u00e9ine \u00e9tait inf\u00e9rieure \u00e0 20 ng\/ml, dans 1 cas \u00e0 526 ng\/ml et dans 4 cas tr\u00e8s \u00e9lev\u00e9e entre 5 226 et 7 962 ng\/ml.<\/p>\n

Traitement :
\nDans tous les cas le CHC \u00e9tait multi nodulaire. Dans 2 cas le CHC avait \u00e9t\u00e9 r\u00e9v\u00e9l\u00e9 par une rupture avec h\u00e9mop\u00e9ritoine (traitement initial par embolisation vasculaire compl\u00e9t\u00e9 3 mois apr\u00e8s par DC Beads) ; dans 8 cas il s\u2019agissait d\u2019un 1er traitement, fait dans les 3 mois suivants le diagnostic ; dans les 6 autres cas le CHC \u00e9tait connu en moyen depuis 35,8 mois (6 \u2013 120) et avait d\u00e9j\u00e0 \u00e9t\u00e9 pr\u00e9alablement trait\u00e9 par radiofr\u00e9quence seule, un patient avait \u00e9galement eu une r\u00e9section et 2 autres une r\u00e9section et des cures de chimioembolisation lipiodol\u00e9e. Le traitement a consist\u00e9 en une administration hypers\u00e9lective de DC Beads 300 \u2013 500 \u00b5m, en une ou deux fois (n=2) jusqu\u2019au contr\u00f4le des l\u00e9sions trait\u00e9es, 4 patients ont eu une (n=3) ou deux (n=2) cure(s) suppl\u00e9mentaire(s) pour r\u00e9cidive. Il n\u2019y a eu aucun effet ind\u00e9sirable s\u00e9rieux. Dans le suivi, 4 p ont \u00e9t\u00e9 rapidement perdus de vue, 6 p sont d\u00e9c\u00e9d\u00e9s en moyenne 7,2 (2 \u00e0 18) mois apr\u00e8s le 1er geste, de syndrome h\u00e9pator\u00e9nal (n=2, \u00e0 M3 et M7), 1 d\u2019insuffisance cardiaque (M2), 1 de m\u00e9tastases multiples (M2), 1 de complications apr\u00e8s transplantation et retransplantation (M18) et 1 d\u2019h\u00e9mop\u00e9ritoine post RET (M11) ; 6 p sont en encore en vie 17,6 mois apr\u00e8s le traitement (11 \u2013 22 mois). En compl\u00e9ment de l\u2019embolisation par DC Beads, 3 p ont eu dans le suivi ult\u00e9rieur une transplantation h\u00e9patique (N=1) un traitement par RET (N=1) ou NEXAVAR (N=2).<\/p>\n

Conclusion :
\nLa sup\u00e9riorit\u00e9 th\u00e9rapeutique de la chimioembolisation par DC Beads par rapport \u00e0 la chimioembolisation lipiodol\u00e9e classique n\u2019est pas encore d\u00e9montr\u00e9e n\u00e9anmoins c\u2019est une m\u00e9thode standardis\u00e9e qui devrait, au moins dans les essais contr\u00f4l\u00e9s, remplacer la technique classique. Elle semble entrainer une meilleure n\u00e9crose tumorale et l\u2019appr\u00e9ciation de l\u2019efficacit\u00e9 ou de la r\u00e9cidive in situ est plus facile. Dans notre exp\u00e9rience la tol\u00e9rance est bonne mais sans doute plus du fait de la technique hypers\u00e9lective que nous utilisons que du produit lui-m\u00eame.<\/p>\n","protected":false},"excerpt":{"rendered":"

2009 J.DENIS 1 , T.KONE2, N.CANEPA2, M. FOKOU2, V.KUOCH2 (1)Service d\u2019 h\u00e9patogastroent\u00e9rologie, (2) Service de radiologie, Centre Hospitalier Sud-Francilien, 91000-Evry H\u00e9patologie – \u00a02009-07-07 –\u00a0CO – ________________________________ Introduction : Bien que son efficacit\u00e9 ne soit pas rigoureusement d\u00e9montr\u00e9e, la chimioembolisation est une des m\u00e9thodes les plus fr\u00e9quemment utilis\u00e9es dans le traitement des carcinomes h\u00e9patocellulaires et a […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[20],"class_list":["post-1875","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-20"],"yoast_head":"\nExp\u00e9rience monocentrique du traitement du carcinome h\u00e9patocellulaire (CHC) par embolisation avec microsph\u00e8res charg\u00e9es de DOXORUBICINE (DC Beads) - 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