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MONOGRAFÍAS


Quimioembolización arterial transcatéter

01 diciembre 2013

RADIOLOGY. Comparison of Combined Transcatheter Arterial Chemoembolization and Radiofrequency Ablation with Surgical Resection by Using Propensity Score Matching in Patients with Hepatocellular Carcinoma within Milan Criteria

Yoshitaka Takuma, MD, Hiroyuki Takabatake, MD, Youichi Morimoto, MD, Nobuyuki Toshikuni, MD, Takahisa Kayahara, MD, Yasuhiro Makino, MD, Hiroshi Yamamoto, MD

Purpose: To retrospectively compare the outcome of combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) (hereafter, TACE-RFA) with that of surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within the Milan criteria.

21 noviembre 2013

WORLD JOURNAL OF GASTROENTEROLOGY. Extravascular use of drug-eluting beads: A promising approach in compartment-based tumor therapy

Simon Binder, Andrew L Lewis, J-Matthias Löhr and Michael Keese.

Intraperitoneal carcinomatosis (PC) may occur with several tumor entities. The prognosis of patients suffering from PC is usually poor. Present treatment depends on the cancer entity and includes systemic chemotherapy, radiation therapy, hormonal therapy and surgical resection. Only few patients may also benefit from hyperthermic intraperitoneal chemotherapy with a complete tumor remission. These therapies are often accompanied by severe systemic side-effects. One approach to reduce side effects is to target chemotherapeutic agents to the tumor with carrier devices. Promising experimental results have been achieved using drug-eluting beads (DEBs). A series of in vitro and in vitro experiments has been conducted to determine the suitability of their extravascular use. These encapsulation devices were able to harbor CYP2B1 producing cells and to shield them from the hosts immune system when injected intratumorally. In this way ifosfamide - which is transformed into its active metabolites by CYP2B1 - could be successfully targeted into pancreatic tumor growths. Furthermore DEBs can be used to target chemotherapeutics into the abdominal cavity for treatment of PC. If CYP2B1 producing cells are proven to be save for usage in man and if local toxic effects of chemotherapeutics can be controlled, DEBs will become promising tools in compartment-based anticancer treatment.

14 noviembre 2013

WORLD JOURNAL OF GASTROENTEROLOGY. Multimodal treatment of hepatocellular carcinoma on cirrhosis: An update

Marco Vivarelli, Roberto Montalti and Andrea Risaliti.

Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, and overall, it is one of the most frequent cancers. The association of HCC with chronic liver disease, and cirrhosis in particular, is well known, making treatment complex and challenging. The treatment of HCC must take into account the presence and stage of chronic liver disease, with the aim of preserving hepatic function that is often already impaired, the stage of HCC and the clinical condition of the patient. The different treatment options include surgical resection, transplantation, local ablation, chemoembolization, radioembolization and molecular targeted therapies; these treatments can be combined in various ways to achieve different goals. Ideally, liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it; however, the application of this powerful tool is limited by the scarcity of donors. Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation. Several professionals, including gastroenterologists, radiologists and surgeons, are involved in the choice of the most appropriate treatment for a single case, and a multidisciplinary approach is necessary to optimize the outcome. The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages, disadvantages and rationale for their use.

01 noviembre 2013

RADIOLOGY. Sorafenib Alone versus Sorafenib Combined with Transarterial Chemoembolization for Advanced-Stage Hepatocellular Carcinoma: Results of Propensity Score Analyses

Gwang Hyeon Choi, MD, Ju Hyun Shim, MD , Min-Joo Kim, MS, Min-Hee Ryu, MD, Baek-Yeol Ryoo, MD, Yoon-Koo Kang, MD, Yong Moon Shin, MD, Kang Mo Kim, MD, Young-Suk Lim, MD, Han Chu Lee, MD

Purpose: To compare the time to progression (TTP) and overall survival (OS) in patients with advanced-stage hepatocellular carcinoma (HCC) who are undergoing sorafenib treatment combined with transarterial chemoembolization (TACE) versus sorafenib monotherapy.

01 noviembre 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Intratumoral Gas in Hepatocellular Carcinoma following Transarterial Chemoembolization: Associated Factors and Clinical Impact

Damien Bisseret, MD , Maxime Ronot, MD , Mohamed Abdel-Rehim, MD , Annie Sibert, MD , Mohamed Bouattour, MD , Laurent Castera, MD, PhD , Jacques Belghiti, MD , Valérie Vilgrain, MD, PhD

Purpose: To determine the frequency and factors associated with the presence of intratumoral gas-containing areas in hepatocellular carcinoma (HCC) on computed tomography (CT) scans obtained 4–6 weeks after transarterial chemoembolization.

01 noviembre 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Modified Cisplatin-based Transcatheter Arterial Chemoembolization for Large Hepatocellular Carcinoma: Multivariate Analysis of Predictive Factors for Tumor Response and Survival in a 163-Patient Cohort

Hee Mang Yoon, MD , Jin Hyoung Kim, MD , Eun-Joung Kim, RN , Dong Il Gwon, MD , Gi-Young Ko, MD , Heung Kyu Ko, MD

Purpose: To evaluate the safety and efficacy of modified cisplatin-based transcatheter arterial chemoembolization for inoperable hepatocellular carcinomas (HCCs) larger than 5 cm in diameter, and the factors associated with tumor response and survival.

01 noviembre 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Downstaging Disease in Patients with Hepatocellular Carcinoma Outside of Milan Criteria: Strategies Using Drug-eluting Bead Chemoembolization

Tyler J. Green, MD , Paul J. Rochon, MD , Samuel Chang, MD , Charles E. Ray Jr, MD, PhD , Helena Winston, MSc , Robert Ruef, MD , Sarah M. Kreidler, DPT, MS , Deborah H. Glueck, PhD , Benjamin C. Shulman, BA , Anthony C. Brown, MD , Janette Durham, MD

Purpose: To assess downstaging rates in patients with United Network for Organ Sharing stage T3N0M0 hepatocellular carcinoma (HCC) treated with doxorubicin-eluting bead transarterial chemoembolization to meet Milan criteria for transplantation.

07 octubre 2013

WORLD JOURNAL OF GASTROENTEROLOGY. Strategy for improving survival and reducing recurrence of HCV-related hepatocellular carcinoma

Toru Ishikawa

Abstract: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related death in the world. With advances in imaging diagnostics, accompanied by better understanding of high-risk patients, HCC is now frequently detected at an early stage; however, the prognosis remains poor. The recurrence rate after treatment of HCC is higher than that associated with cancers of other organs. This may be because of the high incidence of intrahepatic distant recurrence and multicentric recurrence, especially with hepatitis C virus (HCV)-related hepatocellular carcinoma. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for the clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, transcatheter arterial chemoembolization, percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy and percutaneous radiofrequency ablation) can improve survival in HCC patients diagnosed at an early stage and offer a potential long-term cure. However, treatment strategies for recurrent disease are not mentioned in the BCLC classsification. The strategy for recurrence may differ according to the recurrence pattern, i.e., intrahepatic distant recurrence vs multicentric recurrence. In this article, we review recurrent HCC and the therapeutic strategies for reducing recurrent HCC, especially HCV-related HCC.

01 julio 2013

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. Lipiodol Trans-arterial Chemoembolization of Hepatocellular Carcinoma with Idarubicin: First Experience

Sylvain Favelier, Mathieu Boulin, Samia Hamza, Jean-Pierre Cercueil, Violaine Cherblanc, Côme Lepage, Patrick Hillon, Bruno Chauffert, Denis Krausé, Boris Guiu

Background: There is still no consensus about the best chemotherapeutic agent for transarterial chemoembolization (TACE). A recent in vitro study demonstrated that idarubicin, an anthracycline, was by far the most cytotoxic drug on human hepatocellular carcinoma (HCC) cell lines. Idarubicin is much more lipophilic than doxorubicin, leading to higher cell penetration through lipidic membranes and greater accumulation of the drug in the lipiodol. Furthermore, idarubicin has the ability to overcome multidrug resistance. Therefore, we designed this pilot human study to evaluate the safety and efficacy of lipiodol TACE using idarubicin.

01 julio 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Survival Outcomes and Prognostic Factors of Transcatheter Arterial Chemoembolization for Hepatic Neuroendocrine Metastases

Saebeom Hur, MD, MS , Jin Wook Chung, MD, PhD , Hyo-Cheol Kim, MD, PhD , Do-Youn Oh, MD, PhD , Se-Hoon Lee, MD, PhD , Yung-Jue Bang, MD, PhD , Woo Ho Kim, MD, PhD

Purpose: To report survival outcomes in patients with neuroendocrine tumor (NET) with hepatic metastasis who were treated by transcatheter arterial chemoembolization and determine prognostic factors that affect clinical outcome.

01 julio 2013

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. Warming Effect on Miriplatin–Lipiodol Suspension as a Chemotherapeutic Agent for Transarterial Chemoembolization for Hepatocellular Carcinoma: Preliminary Clinical Experience

Shinn-ichi Kora, Hiroshi Urakawa, Toshimichi Mitsufuji, Akinobu Osame, Hideyuki Higashihara, Kengo Yoshimitsu

Purpose: To retrospectively elucidate the preliminary clinical impact of warmed miriplatin–lipiodol suspension (MPT-LPD) when used as a chemotherapeutic agent for transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

14 junio 2013

WORLD JOURNAL OF GASTROENTEROLOGY. Transarterial embolization of metastatic mediastinal hepatocellular carcinoma

Chia-Chang Chen, Hong-Zen Yeh, Chi-Sen Chang, Chung-Wang Ko, Han-Chung Lien, Chun-Ying Wu and Siu-Wan Hung.

This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.

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