Liver Neoplasms
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Publication
Journal: Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology
October/9/2019
Publication
Journal: Radiation oncology (London, England)
November/26/2018
Abstract
BACKGROUND
Radiotherapy of liver metastases is commonly being performed with photon-beam based stereotactic body radiation therapy (SBRT). The high risk for radiation-induced liver disease (RILD) is a limiting factor in these treatments. The use of proton-beam based SBRT could potentially improve the sparing of the healthy part of the liver. The aim of this study was to use estimations of normal tissue complication probability (NTCP) to identify liver-metastases patients that could benefit from being treated with intensity-modulated proton therapy (IMPT), based on the reduction of the risk for RILD.
METHODS
Ten liver metastases patients, previously treated with photon-beam based SBRT, were retrospectively planned with IMPT. A CTV-based robust optimisation (accounting for setup and range uncertainties), combined with a PTV-based conventional optimisation, was performed. A robustness criterion was defined for the CTV (V95% > 98% for at least 10 of the 12 simulated scenarios). The NTCP was estimated for different endpoints using the Lyman-Kutcher-Burman model. The ΔNTCP (NTCPIMPT - NTCPSBRT) for RILD was registered for each patient. The patients for which the NTCP (RILD) < 5% were also identified. A generic relative biological effectiveness of 1.1 was assumed for the proton beams.
RESULTS
For all patients, the objectives set for the PTV and the robustness criterion set for the CTV were fulfilled with the IMPT plans. An improved sparing of the healthy part of the liver, right kidney, lungs, spinal cord and the skin was achieved with the IMPT plans, compared to the SBRT plans. Mean liver doses larger than the threshold value of 32 Gy led to NTCP values for RILD exceeding 5% (7 patients with SBRT and 3 patients with the IMPT plans). ΔNTCP values (RILD) ranging between - 98% and - 17% (7 patients) and between 0 and 2% (3 patients), were calculated.
CONCLUSIONS
In this study, liver metastases patients that could benefit from being treated with IMPT, based on the NTCP reductions, were identified. The clinical implementation of such a model-based approach to select liver metastases patients to proton therapy needs to be made with caution while considering the uncertainties involved in the NTCP estimations.
Publication
Journal: Advances in experimental medicine and biology
November/12/2018
Abstract
According to data from the American Cancer Society, cancer is one of the deadliest health problems globally. Annually, renal cell carcinoma (RCC) and liver cancer cause more than 100,000 and 800,000 deaths worldwide, respectively [1–4], creating an urgent need to develop effective therapeutic treatments to increase patient survival outcomes. New therapeutic treatments are expected to address a major factor contributing to cancer’s resistance to standard therapies: oncogenic heterogeneity. Because gene expression can vary tremendously among different types of cancers, different patients of the same tumor type, and even within individual tumors, various metabolic phenotypes can emerge, making single-therapy approaches insufficient. This heterogeneity translates into changes in the landscape of metabolic enzymes and biomolecules within both the cancer cell and tumor microenvironment. Novel strategies targeting the diverse metabolism of cancers aim to overcome this obstacle, and though some have yielded positive results, it remains a challenge to uncover all of the distinct metabolic profiles of RCC and liver cancer. Nonetheless, the metabolic-oriented research focusing on these cancers has offered different, fresh new perspectives, which are expected to contribute heavily to the development of new therapeutic treatments.
Publication
Journal: AJR. American journal of roentgenology
November/7/2018
Abstract
OBJECTIVE
This study assessed radiation dose after CT-guided percutaneous radiofrequency ablations (RFAs) of hepatic and renal tumors and the effect of weight-based CT protocol modification for lowering overall dose in these procedures.
METHODS
CT-guided RFA for renal and hepatic ablations performed from January 1, 2009, through December 31, 2009, were retrospectively reviewed (90 men and 48 women; age, 42-81 years). The radiation dose was recorded during each of the following steps: planning, performing, and postprocedure. Weight-based protocol modification changes in tube voltage and tube current were then applied to renal and hepatic ablations performed subsequently (18 men and 11 women; age, 48-82 years). Image quality, needle localization, lesion detection, ability to detect complications, and overall operator satisfaction were noted for each case (score, 1-5). Dose reduction after modification was then calculated.
RESULTS
Retrospective analysis found a mean (± SD) overall CT dose index (CTDI) for CT-guided RFA to be 16.5 ± 2.3 mGy. After protocol modification, the mean CTDI decreased to 6.63 ± 0.67 mGy, a 59.6% reduction overall; for hepatic ablations, the reduction was 65.96% (p < 0.0001) and the reduction for renal ablations was 38.97% (p = 0.0153). Image quality analysis showed high operator satisfaction (3-5), including adequate needle localization (4-5), lesion visibility (3-5), and high performer confidence (4-5). Higher dose reduction was noted for patients weighing more than 180 lb (82 kg) (p < 0.0001).
CONCLUSIONS
Simple weight-based CT protocol modifications can significantly reduce radiation dose during CT-guided percutaneous ablations in the liver and kidneys without significantly sacrificing image quality.
Publication
Journal: BMJ case reports
October/29/2018
Abstract
Tumour lysis syndrome (TLS) is an oncological emergency. It is caused by cellular death occurring secondary to cancer therapy or spontaneously in rapidly dividing tumours. More common in haematological malignancies, it has also been reported in solid tumours. Out of 14 cases of small cell lung cancer (SCLC) with TLS, only three cases of spontaneous TLS have been reported in literature to date. Here we report a case of SCLC presenting as a spontaneous TLS.
Publication
Journal: Technology and health care : official journal of the European Society for Engineering and Medicine
October/28/2018
Abstract
OBJECTIVE
The aim of the research is to obtain the relative influences of some critical electro-thermal parameters on the ablation temperature and lesion volume during temperature-controlled radiofrequency ablation (RFA) of liver tumor by parameter sensitivity analysis.
METHODS
The finite element method (FEM) has been used to establish the simulation model of RFA temperature field, and the sensitivity of the tissue parameters has been analyzed. The effects of six parameters have been taken into account, including the thermal specific capacity (Cp), the thermal conductivity (k), the electrical conductivity (Sigma), the density (rho), the dielectric constant (Epsilon) and the resistance (R). The simulation processes based on different parameter values have been accomplished with Comsol Multiphysics software, and the sensitivity parameters have been obtained utilizing the variance contribution rate (SS%) or the main effects.
RESULTS
It was found that the ablation temperature and lesion volume increased with increasing the values of Rand Sigma, but was a reverse situation for Cp and rho. Besides, the influence of k on ablation volume was relatively small and Epsilon had a negligible effect on ablation temperature.
CONCLUSIONS
It is concluded that these parameter sensitivity results can provide scientific and reliable reference for the specificity analysis of the RF ablation models.
Publication
Journal: Journal of vascular and interventional radiology : JVIR
October/22/2018
Abstract
To evaluate cone-beam parenchymal blood volume (PBV) before and after embolization as a predictor of radiographic response to transarterial chemoembolization in unresectable hepatocellular carcinoma (HCC).
A phase IIa prospective clinical trial was conducted in patients with HCCs > 1.5 cm undergoing chemoembolization; 52 tumors in 40 patients with Barcelona Clinic Liver Criteria stage B disease met inclusion criteria. Pre- and postembolization PBV analysis was performed with a semiquantitative best-fit methodology for index tumors, with a predefined primary endpoint of radiographic response at 3 months. Analyses were conducted with Wilcoxon signed-rank tests and one-way analysis of variance on ranks.
Mean tumoral PBV measurements before and after embolization were 170 mL/1,000 mL ± 120 and 0 mL/100 mL ± 130, respectively. Per modified Response Evaluation Criteria In Solid Tumors, 25 tumors (48%) exhibited complete response (CR), 13 (25%) partial response (PR), 3 (6%) stable disease (SD), and 11 (21%) progressive disease (PD). Statistically significant changes in median PBV (ΔPBV) were identified in the CR (P = .001) and PR (P = .003) groups, with no significant difference observed in SD (P = .30) and PD groups (P = .06). A statistically significant correlation between ΔPBV and tumor response was established by one-way analysis of variance on ranks (P = .036; CR, 200 mL/100 mL ± 99; PR, 240 mL/100 mL ± 370; SD, 64 mL/100 mL ± 99; PD, 88 mL/100 mL ± 129).
Intraprocedural PBV can be used as a predictor of response in index HCC tumors of > 1.5 cm.
Publication
Journal: European radiology
October/16/2018
Abstract
OBJECTIVE
To study the ratio of ablation zone volume to applied energy in computed tomography (CT)-guided radiofrequency ablation (RFA) and microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC) in a cirrhotic liver and in patients with colorectal liver metastasis (CRLM).
METHODS
In total, 90 liver tumors, 45 HCCs in a cirrhotic liver and 45 CRLMs were treated with RFA or with one of two MWA devices (MWA_A and MWA_B), resulting in 15 procedures for each tumor type, per device. Device settings were recorded and the applied energy was calculated. Ablation volumes were segmented on the contrast-enhanced CT scans obtained 1 week after the procedure. The ratio of ablation zone volume in milliliters to applied energy in kilojoules was determined for each procedure and compared between HCC (RHCC) and CRLM (RCRLM), stratified according to ablation device.
RESULTS
With RFA, RHCC and RCRLM were 0.22 mL/kJ (0.14-0.45 mL/kJ) and 0.15 mL/kJ (0.14-0.22 mL/kJ; p = 0.110), respectively. With MWA_A, RHCC was 0.81 (0.61-1.07 mL/kJ) and RCRLM was 0.43 (0.35-0.61 mL/kJ; p = 0.001). With MWA_B, RHCC was 0.67 (0.41-0.85 mL/kJ) and RCRLM was 0.43 (0.35-0.61 mL/kJ; p = 0.040).
CONCLUSIONS
With RFA, there was no significant difference in energy deposition ratio between tumor types. With both MWA devices, the ratios were higher for HCCs. Tailoring microwave ablation device protocols to tumor type might prevent incomplete ablations.
CONCLUSIONS
• HCCs and CRLMs respond differently to microwave ablation • For MWA, CRLMs required more energy to achieve a similar ablation volume • Tailoring ablation protocols to tumor type might prevent incomplete ablations.
Publication
Journal: Tropical gastroenterology : official journal of the Digestive Diseases Foundation
October/15/2018
Publication
Journal: Oncology
October/8/2018
Abstract
BACKGROUND
Due to late diagnosis and resistance to chemotherapy, most patients with cholangiocarcinoma have an unfavorable prognosis. Despite the use of immunohistochemistry (IHC) in clinical routine, differentiation between intrahepatic cholangiocarcinoma (ICC) and secondary adenocarcinomas of the liver is frequently not clear, leading to false diagnosis and treatment decisions.
METHODS
Oligonucleotide microarrays (Affymetrix Hu133A©) were used for gene expression analysis of ICC (n = 11) and secondary adenocarcinomas (colorectal metastases; n = 6). By two-dimensional cluster analysis a specific gene expression profile of these tumors was established and confirmed by real-time polymerase chain reaction and IHC.
RESULTS
A total of 338 genes were significantly dysregulated (gene expression/fc ≥2; dysregulation in ≥60%) in both tumor groups. Using two-dimensional cluster analysis a fast, clear, and reproducible differentiation between ICC and colorectal metastases was possible in all cases. As potential biomarkers for differentiation, twelve genes (ICC: KRT7, DBN1, LCTB, LIF, STK17A, PIGF; metastases: TDGF1, HOXA9, TFF3, MYB, ABP1, BCL11A) were detected and will be used for further investigations.
CONCLUSIONS
A specific gene expression profile for discrimination of primary and secondary adenocarcinoma of the liver could be established. In addition, marker genes for both cancers and their potential use as discrimination markers in clinical routine were also described partially for the first time.
Publication
Journal: Cardiovascular and interventional radiology
October/1/2018
Abstract
BACKGROUND
The practice of positioning patients' arms above the head during catheter-injected hepatic arterial phase cone beam CT (A-CBCT) imaging has been inherited from standard CT imaging due to image quality concerns, but interrupts workflow and extends procedure time. We sought to assess A-CBCT image quality and artifacts with arms extended above the head versus down by the side.
METHODS
We performed an IRB approved retrospective evaluation of reformatted and 3D-volume rendered images from 91 consecutive A-CBCTs (43 arms up, 48 arms down) acquired during hepatic tumor arterial embolization procedures. Two interventional radiologists reviewed all A-CBCT imaging and assigned vessel visualization scores (VVS) from 1 to 5, ranging from non-diagnostic to optimal visualization. Streak artifacts across axial images were rated from 1 to 3 based on resulting image quality (none to significant). Presence of respiratory or cardiac motion during acquisition, body mass index and radiation dose area product (DAP) were also recorded and analyzed. Univariate and multivariate analyses were used to assess the impact of arm position on VVS and imaging artifacts.
RESULTS
VVS were not significantly associated with arm position during A-CBCT imaging. One reader reported more streak artifacts across axial images in the arms down group (p = 0.005). DAP was not statistically different between the groups (23.9 Gy cm2 [6.1-73.4] arms up, 26.1 Gy cm2 [4.2-102.6] arms down, p = 0.54).
CONCLUSIONS
A-CBCT angiography performed with the arms above the head is not superior for clinically relevant hepatic vascular visualization compared to imaging performed with the arms by the patient's side.
Publication
Journal: Radiation oncology (London, England)
September/23/2018
Abstract
BACKGROUND
To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments.
METHODS
Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor.
RESULTS
The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments.
CONCLUSIONS
The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction.
Publication
Journal: Journal of vascular and interventional radiology : JVIR
September/9/2018
Abstract
To examine differences in outcome and response of cirrhotomimetic (CMM) hepatocellular carcinoma (HCC) to a combination of bridging transcatheter arterial chemoembolization and orthotopic liver transplantation (OLT) compared with non-CMM HCC.
All patients with pathologically proven CMM HCC who underwent bridging transcatheter arterial chemoembolization before OLT between 2007 and 2013 (n = 23) were retrospectively compared with a control group of patients with pathologically proven non-CMM HCC (n = 46).
There were 29 tumors in the CMM HCC group and 64 tumors in the non-CMM group identified and treated. Objective response rate on MR imaging at 1 and 3 months after transcatheter arterial chemoembolization for CMM HCC tumors (including patients with complete and partial response) was 93.1% and 86.4% compared with 85.2% and 93.2% for non-CMM tumors without statistically significant difference (P = .54 and P = .09, respectively). Pathologic study of liver explants showed complete tumor necrosis in 62.3% of non-CMM tumors (38/61) compared with 10.3% of CMM tumors (3/29) (P < .0001). Overall 2-year survival after transcatheter arterial chemoembolization and OLT was significantly lower for patients with CMM HCC compared with patients non-CMM HCC (65.2% vs 87%, P = .03). Patients with CMM HCC with extranodular tumor extension involving > 50% of liver parenchyma had worse survival with mean 2-year survival of 402 days ± 102 vs 656 days ± 39 for the remaining patients with CMM HCC (P = .02).
Despite similar early imaging response rates, CMM HCC tumors had markedly lower rates of complete pathologic necrosis on liver explants and were associated with reduced survival after OLT compared with conventional HCCs.
Publication
Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
September/4/2018
Abstract
OBJECTIVE
To retrospectively investigate the effectiveness of triple drug combination transarterial chemoembolization (TACE) on local tumor response and survival in patients with liver metastases from pancreatic cancer. Also, this study will evaluate the variances in response regarding the number of metastases, assess the correlation between tumor response and the changes in the apparent diffusion coefficients (ADC) in diffusion weighted (DW) MRI.
METHODS
One hundred and twelve patients (58 men and 54 women; mean age 57) with malignant liver metastases from pancreatic adenocarcinoma underwent at least one session of TACE with a chemotherapeutic combination of mitomycin C, cisplatin, and gemcitabine. A size-based evaluation of tumor response (response evaluation criteria in solid tumors (RECIST)) was conducted, along with ADC values, and survival indices as related to treatment pattern.
RESULTS
Four weeks following the end of the treatment, 78.26% of patients showed stable disease and 11.59% showed partial response. The median survival time was 19 months and for the stable disease group, 26 months. Low pretreatment ADC values showed no significant correlation to poor response to treatment (r = 0.347,p = 0.146).
CONCLUSIONS
The triple drug TACE technique showed improvements in median survival times in patients with hepatic metastases from pancreatic carcinoma and helped control disease progression, whereas the number of hepatic lesions was not a statistically significant factor in patients' response to TACE. The data suggest that pre-treatment ADC values in DW-MRI have no statistical correlation with tumor response.
Publication
Journal: Acta medica Okayama
August/30/2018
Abstract
Transcatheter arterial chemoembolization (TACE) is often performed before radiofrequency ablation (RFA) for the treatment of early-stage hepatocellular carcinoma (HCC). TACE prior to RFA can expand the ablated area and reduce the tumor size, facilitating complete ablation. However, the factors correlated with size reduction remain uncertain. The aim of this study was to identify the factors associated with size reduction by TACE and develop a formula to predict the reduction rate. A total of 100 HCC patients treated with TACE followed by RFA at least 20 days later were enrolled. The tumor size was measured at the time of TACE and RFA, and correlations between the reduction rate and 13 clinical factors were examined. A formula to predict the reduction rate was built using the factors obtained by the analysis. Reduction in the tumor size was observed in 69 nodules, and the median reduction rate was 16.2%. A multivariate regression analysis revealed that a large tumor size (p< 0.01) and a long interval between the therapies (p= 0.01) were factors for a high tumor reduction rate, with tumor size more strongly related to the degree of reduction. A size reduction of more than 10% can be expected by waiting 20 days after TACE when the size of the tumor at TACE is over 25 mm in diameter. The tumor size.
Publication
Journal: Internal medicine (Tokyo, Japan)
August/26/2018
Abstract
A 67-year-old man presented with a fever and general malaise. Computed tomography showed multiple nodules in the lungs and liver, associated with mediastinal and para-aortic lymphadenopathy. Bone marrow aspiration revealed diffuse large B-cell lymphoma (DLBCL). Renal and liver dysfunction and pancytopenia inhibited chemotherapy administration; the patient subsequently died of multiorgan failure. An autopsy revealed pulmonary adenocarcinoma with metastases to the lungs, liver, and adrenal glands; the DLBCL spread to the liver, spleen, and bone marrow. Adenocarcinoma and DLBCL collision was observed in the mediastinal and para-aortic lymph nodes. This was a rare case of collision metastasis occurring in the lymph node.
Publication
Journal: Hepatobiliary & pancreatic diseases international : HBPD INT
August/26/2018
Abstract
BACKGROUND
Transarterial chemoembolization (TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma (HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last decade.
METHODS
We utilized the National Inpatient Sample (2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients (age >18 years). Multivariate analyses for the outcomes of in-hospital "procedure-related complications" (PRCs) and "post-procedure complications" (PPCs) were performed. We also compared early (2002 to 2006) and late (2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and mortality.
RESULTS
Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE (P<0.001) and associated PRCs (P=0.006) were observed to be increasing. There was less mortality [adjusted Odds ratio (aOR): 0.58; 95% CI: 0.41, 0.82], reduced length of hospital stay (-1.87 days; 95% CI: -2.77, -0.97) and increased hospital charges ($19232; 95% CI: 11013, 27451) in the late era. Additionally, there was increased mortality (aOR: 4.07; 95% CI: 2.96, 5.59), PRCs (aOR: 3.21; 95% CI: 2.56, 4.02), and PPCs (aOR: 2.70; 95% CI: 2.11, 3.46) among patients with coagulopathy.
CONCLUSIONS
There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.
Publication
Journal: Journal of gastroenterology and hepatology
August/19/2018
Abstract
OBJECTIVE
Surveillance for hepatocellular carcinoma (HCC) intends to detect tumors at an early stage to improve survival. The study aims were to assess the frequency and risk factors associated with HCC surveillance failure.
METHODS
The study analyzed data from 188 consecutive patients diagnosed with HCC within a surveillance program conducted among 1,242 cirrhotic patients and based on ultrasonography and alpha-fetoprotein (AFP) testing every 3 or 6 months. Program failure was defined as the detection of HCC exceeding the Milan criteria. Variables recorded at entry into the program, during follow-up and at HCC diagnosis, were analyzed.
RESULTS
At diagnosis, 50 (26.6%) HCC tumors were beyond the Milan criteria. In univariate analysis, Child-Pugh B at entry (P = 0.03), development of complications of portal hypertension before tumor diagnosis (P = 0.03), and failure to complete the prior screening round (P = 0.02), Child-Pugh B/C (P = 0.001) and AFP ≥ 100 ng/mL (P = 0.03) at diagnosis, were associated with failure. In multivariate analysis, only Child-Pugh B/C (hazard ratio, 3.18; 95% confidence interval, 1.66-6.10, P < 0.001) and AFP ≥ 100 ng/mL, both at diagnosis (hazard ratio, 2.80; 95% confidence interval, 1.37-5.71, P = 0.005), were independently associated with failure. Survival was higher among patients with tumors within the Milan criteria than those with program failure (33.9 vs 7.6 months, P < 0.001).
CONCLUSIONS
Approximately 25% of HCC cases diagnosed among patients included in a surveillance program were beyond the Milan criteria. Child-Pugh B/C and AFP ≥ 100 ng/mL at diagnosis were associated with program failure. However, Child-Pugh B at entry and development of liver-related complications during follow-up can be early predictors of failure.
Publication
Journal: The Malaysian journal of pathology
August/14/2018
Abstract
BACKGROUND
Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy so that major hepatectomy can be performed safely. This staged procedure allows for liver biopsy specimens to be taken before and after the liver begins to regenerate.
METHODS
The liver progenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatic tumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number of liver progenitor cell under high magnification examination by stain of immunomarkers. This is the first in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.
Publication
Journal: Gan to kagaku ryoho. Cancer & chemotherapy
August/2/2018
Abstract
Double cancer of intrahepatic cholangiocarcinoma and gastric cancer is rare. A 62-year-old man underwent gastrectomy for gastric cancer. The pathological findings were tub1>tub2, m, ly0, v0, n0, Stage I A. Two years and a month later, a liver tumor(diameter of 3 cm)and a pelvic mass(diameter of 2.5 cm)were observed. Metastasis from gastric cancer was suspected and chemotherapy(SOX)was administered. However, after 5 courses, CT revealed worseningof the liver tumor (diameter of 12 cm)and pelvic mass(diameter of 3 cm). Intrahepatic cholangiocarcinoma and its peritoneal metastasis were also suspected. There was a limit to treatment with chemotherapy, and it was difficult to judge whether to target gastric cancer or intrahepatic cholangiocarcinoma for chemotherapy. In addition, the lesions were localized in the right lobe of the liver and the pelvis. Therefore, we decided to perform resection. As a second-stage operation, pelvic mass extraction and portal vein embolization were performed first. The pathological result of the pelvic mass assessment was mucinous carcinoma. Subsequently, expansive right hepatectomy was performed. The pathological findings were also suggestive of mucinous carcinoma, which was finally diagnosed as intrahepatic cholangiocarcinoma and peritoneal dissemination. Six months after the surgery, several recurrent nodules were observed in the pelvis and GEM plus CDDP was initiated. Currently, 1 year after surgery, there are no restrictions in the activities of daily life of the patient and he is treated on an outpatient basis.
Publication
Journal: BMJ case reports
July/12/2018
Abstract
We present a case of carcinoma en cuirasse as a presentation of advanced lobular breast carcinoma. On further investigation, she was found to have metastasis to her liver and bone. We report this case to highlight the phenomenon of cutaneous metastasis. It is important to consider this diagnosis as an initial manifestation of breast cancer, but rarely, it can also be associated with other adenocarcinomas, for example, carcinoma of lung, kidney or gastrointestinal tract.
Publication
Journal: Indian journal of cancer
July/9/2018
Abstract
OBJECTIVE
The aim of this retrospective study is to assess the toxicity and tumor response of stereotactic body radiation therapy (SBRT) protocol for hepatocellular carcinoma (HCC) in our institution.
BACKGROUND
Hepatocellular cancer is one of the leading cancers among men in India. In recent years, SBRT has emerged as a promising tool in the treatment of HCC.
METHODS
Ten patients diagnosed as HCC with Barcelona Clinic Liver Cancer Stage B and C, treated with SBRT technique from January 2013 to December 2016, were included in this study. SBRT was delivered using 6 MV photons with volumetric modulated arc therapy. Acute and late toxicities were graded, and tumor response was assessed using response evaluation criteria in solid tumors criteria. Kaplan-Meier curves were generated for progression-free survival (PFS) and overall survival (OS).
RESULTS
The median age was 61.5 (52-69) years. The radiation dose ranged from 35 Gy to 60 Gy. All patients obtained partial response during assessment at 3 months after completion of treatment. The median PFS is 8 months (95% confidence interval [CI] - 5.22-10.77 months). The median OS is 51 months (95% CI - 17.64-65.10 months). The OS at 1 and 2 years is 75% and 57%, respectively.
CONCLUSIONS
SBRT is well tolerated by our patients. The 1- and 2-year OS of 75% and 57% is consistent with other prospective and retrospective SBRT studies from the literature.
Publication
Journal: Indian journal of cancer
July/9/2018
Abstract
BACKGROUND
Minimal invasive surgery has proven its advantages over open surgeries in the perioperative period. Food and Drug Administration approved da Vinci robot in 2000. The latest version, da Vinci Xi system has a mobile tower-based robot with several modifications to improve the functionality, versatility, and operative ease. None of the centers have reported exclusively on hepatobiliary oncology using the da Vinci Xi system. We report our initial experience.
OBJECTIVE
To study the feasibility, advantages, and discuss the operative technique of da Vinci Xi system in hepatobiliary oncology.
METHODS
Data were analyzed retrospectively from a prospectively maintained database from June 2015 to October 2016. Twenty-five patients with suspected or proven hepatobiliary malignancies were operated. Total robotic technique using da Vinci Xi system was used. Demographic details and perioperative outcomes were noted.
RESULTS
Of the 25 surgeries, 14 patients had a suspected gallbladder malignancy, 11 patients had primary or metastatic liver tumor. Median age was 53 years. The average duration of surgery was 225 min with a median blood loss 150 ml. The median postoperative stay was 4 days. The median nodal yield for radical cholecystectomy was seven. Five patients required conversion. Two of these developed postoperative morbidity.
CONCLUSIONS
Robotic surgery for hepatobiliary oncology is feasible and can be performed safely in experienced hands. Increasing experience in this field may equal or even prove advantageous over conventional or laparoscopic approach in future. A cautious approach with judicious patient selection is the key to establishing robotic surgery as a standard surgical approach.
Publication
Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
July/8/2018
Abstract
The relative benefit of anatomic resection (AR) versus non-anatomic resection (NAR) of HCC remains poorly defined. We sought to evaluate the available evidence on oncologic outcomes, as well as the clinical efficacy and safety of AR versus NAR performed as the primary treatment for HCC patients.
A systematic review and meta-analysis was conducted using Medline, ClinicalTrials.gov and Cochrane library through April 15th, 2017. Only clinical studies comparing AR versus NAR were deemed eligible.
A total of 43 studies were considered eligible (total 12,429 patients: AR, n = 6839 (55%) versus NAR, n = 5590 (45%)). Blood loss was higher among patients undergoing AR (mean difference: +229.74 ml, 95% CI: 97.09-362.38, p = 0.0007), whereas resection margin was slightly wider following AR versus NAR (mean difference: +0.29 cm, 95% CI: 0.15-0.44, p < 0.0001). No difference was noted for perioperative complications (RR: 0.95, 95% CI: 0.81-1.11, p = 0.49) and perioperative mortality (RR: 0.91, 95% CI: 0.43-1.95, p = 0.82). AR was associated with a disease-free survival (DFS) benefit at 1- (HR: 0.79, 95% CI: 0.68-0.92, p = 0.002), 3- (HR: 0.87, 95% CI: 0.78-0.95, p = 0.004) and 5-years (HR: 0.87, 95% CI: 0.82-0.93, p < 0.0001). AR also was associated with a decreased risk of death at 5-years (HR: 0.88, 95% CI: 0.79-0.97, p = 0.01).
Despite the high heterogeneity among studies, the data demonstrated that AR had comparable perioperative morbidity and mortality versus NAR. AR seemed to offer an advantage versus NAR in terms of DFS and OS among patients undergoing resection of HCC - especially among patients without cirrhosis. Thus, AR should be considered the preferred surgical option for patients with HCC when feasible.
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