Resection of pulmonary and hepatic metastasis in the management of cancer

Inhibition of liver metastasis by all-trans retinoic acid incorporated into O/W emulsions in mice

All-trans retinoic acid (ATRA) was incorporated into lipid emulsions in an attempt to alter its distribution characteristics and improve its inhibition of liver cancer metastasis. Lipid emulsions composed of egg phosphatidylcholine, cholesterol, and soybean oil were the optimized carriers for ATRA delivery, as shown by the submicron particle size and high incorporation efficiency. The particle size and zeta potential of ATRA incorporated into emulsions were about 133 nm and -11 mV, respectively. In vitro drug release study demonstrated that the release of ATRA from emulsions was sustained in the absence and present of bovine serum albumin, suggesting that ATRA was stable when incorporated in emulsions. After intravenous administration in mice, [3H]cholesteryl hexadecyl ether incorporated into emulsion, which is the inherent distribution of emulsions, accumulated gradually mainly in the liver. The blood concentration and hepatic accumulation of [3H]ATRA incorporated into emulsion was significantly higher than that of serum dissolving [3H]ATRA, which represent the original distribution characteristic of free ATRA. In a murine liver metastasis model by colon adenocarcinoma, the liver metastasis number and liver weight were significantly reduced and the survival time of mice was prolonged following intravenous injection of ATRA incorporated into emulsions.

Hepatic artery chemoembolization or embolization for primary and metastatic liver tumors: post-treatment management and complications

This paper describes complications and patient management issues associated with hepatic arterial chemoembolization (HACE) and embolization (HAE) used to treat liver malignancies and characterizes patient survival based on histologic tumor type. We performed a retrospective review of all patients treated with HACE or HAE between January 1, 1988 and December 31, 1990. During the study period, 314 HACEs and HAEs were performed in 121 patients. Ninety-six of the patients (79%) were treated for neoplasms metastatic to the liver. The morbidity rate following HACE and HAE in this study was 5.1%. The major complications included portal vein thrombosis, hepatic abscess, and liver failure. The treatment-related mortality rate was 4.1%. Fever and ileus were the most common management problems following HACE or HAE. Median survival for patients with liver metastases varied according to histologic type, and median survival for patients with hepatocellular cancer was 306 days. Morbidity and mortality from HACE and HAE to treat liver tumors can be minimized by proper selection and careful management of patients. HACE or HAE alone was not curative in any of these 121 patients. An understanding of treatment-related side effects is necessary to aid in the management of patients following HACE or HAE.