A 20-year-old otherwise healthy white man presented with a 5-week history of abdominal pain and diarrhea. Investigations for acute viral hepatitis were negative. Over the next month, he developed abdominal distention. Intravenous iodinated contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed multiple bulky soft tissue intraperitoneal masses and paraesophageal lymphadenopathy. A diagnostic CT-guided biopsy of a lesion in the left upper abdomen was performed. Immunohistochemistry of the specimen was positive for desmin, cytokeratin, FLI1, and BAF47; focally positive for epithelial membrane antigen; and negative for synaptophysin neuron-specific enolase, CD45, CD30, α-fetoprotein, human chorionic gonadotropin, and CD56. The tumor was also found to be positive for the EWSR1-WT1 primary fusion transcript, pathognomonic for desmoplastic small round cell tumor (DSRCT).
Under the auspices of the American Hepato-Pancreato-Biliary Association, an expert consensus conference was convened in January 2010 on the multidisciplinary management of hepatocellular carcinoma. The goals of the conference were to address knowledge gaps in the optimal preparation of patients with HCC for operative therapy, best methods to control HCC while awaiting liver transplantation, and developing a multidisciplinary approach to these patients with implementation of novel systemic therapies.
RATIONALE: Radioembolization is a field of interventional oncology that continues to evolve. The number of institutions adopting this approach is increasing; this trend is paralleled by a greater number of research investigations reported in the peer-reviewed literature. Therefore, developing standardization and reporting criteria therefore becomes of paramount importance in order to facilitate clear communications between investigators. The vehicle of a standards document provides the framework for reporting various aspects of the technique, including classification of methodology, descriptors of toxicities and complications, imaging guidance, and appropriate terminology that require specific attention when reporting clinical studies. It is the standpoint of the group that adherence to the recommendations will facilitate the main objective: improved precision and communication for reporting the various aspects of radioembolization. This approach should translate to more accurate comparison of data across centers and, ultimately, to enhanced research methodology. Journal of Vascular and Interventional Radiology Volume 22, Issue 3 , Pages 265-278, March 2011. Copiryght © SIR, 2011
Radioembolization is a field of interventional oncology that continues to evolve. The number of institutions adopting this approach is increasing; this trend is paralleled by a greater number of research investigations reported in the peer-reviewed literature. Therefore, developing standardization and reporting criteria therefore becomes of paramount importance in order to facilitate clear communications between investigators. The vehicle of a standards document provides the framework for reporting various aspects of the technique, including classification of methodology, descriptors of toxicities and complications, imaging guidance, and appropriate terminology that require specific attention when reporting clinical studies. It is the standpoint of the group that adherence to the recommendations will facilitate the main objective: improved precision and communication for reporting the various aspects of radioembolization. This approach should translate to more accurate comparison of data across centers and, ultimately, to enhanced research methodology.
Background & Aims: Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC.
Background and Aims Chemoembolization is a standard treatment for hepatocellular carcinoma (HCC). Radioembolization with 90Y microspheres is a new, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC.
OBJECTIVE. The purpose of this study was to assess the safety and efficacy of radioembolization in the management of hepatic metastasis of uveal melanoma after failure of immunoembolization or chemoembolization.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and its increasing incidence worldwide is a cause for concern. Fortunately, advances in diagnostic and therapeutic approaches have contributed to earlier detection and treatment. As cancer epidemiology studies continue to elucidate the natural history of liver diseases, greater understanding of HCC has led to improved risk stratification and earlier enrollment of high-risk patients in cancer screening and surveillance programs. Improved survival rates among HCC patients also reflect significant advances in available treatment options. Advances in surgical techniques are pushing the boundaries of resection for localized disease, and progress in the field of transplantation has led to refinements in listing criteria and improved post-transplantation outcomes. The evolving field of locoregional therapies—including percutaneous ablation and transarterial chemoembolization—continues to provide novel therapeutic options that can be used in place of, or in addition to, surgical approaches. Recent advances in systemic multikinase inhibitor therapies have also demonstrated significant benefits for advanced-stage disease, and these therapies also show promise as adjuvant treatments for earlier-stage disease. This article provides an update on the management of HCC, with a focus on revised guidelines for screening and an in-depth discussion of emerging novel therapies.
Purpose. We sought to evaluate our experience using yttrium-90 (90Y) resin microsphere hepatic radioembolization as salvage therapy for liver-dominant metastatic colorectal cancer (mCRC). Methods. A retrospective review of consecutive patients with unresectable mCRC who were treated with 90Y after failing first and second line systemic chemotherapy. Demographics, treatment dose, biochemical and radiographic response, toxicities, and survival were examined. Results. Fifty-one patients underwent 90Y treatments of which 69% were male. All patients had previously undergone extensive chemotherapy, 31% had undergone previous liver-directed therapy and 24% had a prior liver resection. Using RECIST criteria, either stable disease or a partial response was seen in 77% of patients. Overall median survival from the time of first 90Y treatment was 10.2 months (95% CI = 7.5–13.0). The absence of extrahepatic disease at the time of treatment with 90Y was associated with an improved survival, median survival of 17.0 months (95% CI = 6.4–27.6), compared to those with extrahepatic disease at the time of treatment with 90Y, 6.7 months (95% CI = 2.7–10.6 Conclusion: 90Y therapy is a safe locoregional therapy that provides an important therapeutic option to patients who have failed first and second line chemotherapy and have adequate liver function and performance status.
To evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization. Materials and Methods Forty-six patients had cystic artery embolization performed immediately before yttrium- 90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed. Rates of collateralization or recanalization of the cystic artery were compared, as well as the frequency of postprocedural abdominal pain and need for cholecystectomy. Cardiovasc Intervent Radiol (2011) 34:786–792. Coptright The Author(s) 2010. This article is published with open access at Springerlink.com
Hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in North America. Because the vast majority of HCCs occur in the setting of a cirrhotic liver, management of this malignancy is best performed in a multidisciplinary group that recognizes the importance of liver function, as well as patient and tumour characteristics. The Barcelona Clinic Liver Cancer (BCLC) staging system is preferred for HCC because it incorporates the tumour characteristics (ie, tumour-node-metastasis stage), the patient’s performance status and liver function according to the Child-Turcotte-Pugh classification, and then links the BCLC stage to recommended therapeutic interventions. However, the BCLC algorithm does not recognize the potential role of radiofrequency ablation for very early stage HCC, the expanding role of liver transplantation in the management of HCC, the role of transarterial chemoembolization in single large tumours, the potential role of transarterial radioembolization with 90Yttrium and the limited evidence for using sorafenib in Child-Turcotte-Pugh class B cirrhotic patients. The current review article presents an evidence-based approach to the multidisciplinary management of HCC along with a new algorithm for the management of HCC that incorporates the BCLC staging system and the authors’ local selection criteria for resection, ablative techniques, liver transplantation, transarterial chemoembolization, transarterial radioembolization and sorafenib in Alberta.
Hepatocellular carcinoma (HCC) is the most common malignant hepatobiliary disease; it is responsible for about 1 million deaths per year. Risk factors include hepatitis B and C, hepatic cirrhosis, including alcohol related hepatitis, metabolic and nutritional hepatic damage. The main modality of diffusion is intrahepatic in the natural course of the disease. There are two leading types of treatment: local and systemic. Surgical resection and liver transplantation constitute the most appropriate local treatments and are considered the only real possibility for recovery. Other local approaches include: radiofrequency ablation, percutaneous ethanol ablation, hepatic endoarterial chemoembolization and intrahepatic radiotherapy (SIRT: selective internal radiation therapy). These last treatments are used to control the disease when surgery or transplantation is not achievable; in some cases they are able to prolong survival while they constitute mainly a palliative treatment. Systemic treatments include: chemotherapy, immunological and hormonal therapies and, more recently, the introduction of new specific molecular target drugs. At the moment, in this group, the only drug that has given positive results during phase III trials (SHARP study) is Sorafenib.
Purpose: Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 (90Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of 90Y microspheres in HCC with major PVT.
Purpose Liver dissemination is a major cause of mortality among patients with advanced colorectal cancer. Hepatic intra-arterial injection of the β-emitting isotope yttrium-90 (90Y) bound to resin microspheres (radioembolization) delivers therapeutic radiation doses to liver metastases with minimal damage to adjacent tissues.
The primary purpose of this study was to demonstrate intraobserver/interobserver reproducibility for novel semiautomated measurements of hepatic volume used for Yttrium-90 dose calculations as well as whole-liver and necrotic-liver (hypodense/nonenhancing) tumor volume after radioembolization. The secondary aim was to provide initial comparisons of tumor volumetric measurements with linear measurements, as defined by Response Evaluation Criteria in Solid Tumors criteria, and survival outcomes. Methods Between 2006 and 2009, 23 consecutive radioembolization procedures were performed for 14 cases of hepatocellular carcinoma and 9 cases of hepatic metastases. Baseline and follow-up computed tomography obtained 1 month after treatment were retrospectively analyzed. Three observers measured liver, whole-tumor, and tumornecrosis volumes twice using semiautomated software. Cardiovasc Intervent Radiol (2011) 34:306–318. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
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