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Patel MV, McNiel D, Brunson C, Kuo PH, Hennemeyer CT, Woodhead G, McGregor H. Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:752-757. [PMID: 36344658 DOI: 10.1007/s00261-022-03718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre-90Y radioembolization 99mTc-MAA scintigraphy for hepatocellular carcinoma (HCC). METHODS 99mTc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. RESULTS Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p = 0.001). Larger tumor size trended toward lower T:N (p = 0.052). CONCLUSION Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.
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Affiliation(s)
- Mikin V Patel
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA.
| | - David McNiel
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Christopher Brunson
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Charles T Hennemeyer
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Gregory Woodhead
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Hugh McGregor
- Department of Radiology, University of Washington Medicine, Seattle, WA, USA
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2
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Puleo L, Agate L, Bargellini I, Boni G, Piaggi P, Traino C, Depalo T, Lorenzoni G, Bianchi F, Volterrani D, Brogioni S, Bottici V, Brunetto MR, Coco B, Molinaro E, Elisei R. Yttrium-90 transarterial radioembolization for liver metastases from medullary thyroid cancer. Eur Thyroid J 2022; 11:e220130. [PMID: 36126186 PMCID: PMC9641787 DOI: 10.1530/etj-22-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Liver metastases occur in 45% of patients with advanced metastatic medullary thyroid cancer (MTC). Transarterial radioembolization (TARE) has been proposed to treat liver metastases (LM), especially in neuroendocrine tumors. The aim of this study was to investigate the biochemical (calcitonin and carcino-embryonic antigen) and objective response of liver metastases from MTC to TARE. Methods TARE is an internal radiotherapy in which microspheres loaded with β-emitting yttrium-90 (90Y) are delivered into the hepatic arteries that supply blood to LM. Eight patients with progressive multiple LM underwent TARE and were followed prospectively. They were clinically, biochemically and radiologically evaluated at 1, 4, 12 and 18 months after TARE. Results Two patients were excluded from the analysis due to severe liver injury and death due to extrahepatic disease progression, respectively. One month after TARE, a statistically significant (P = 0.02) reduction of calcitonin was observed in all patients and remained clinically relevant during follow-up; reduction of CEA, although not significant, was found in all patients. Significant reduction of liver tumor mass was observed 1, 4 and 12 months after TARE (P = 0.007, P = 0.004, P = 0.002, respectively). After 1 month, three of six patients showed partial response (PR) and three of six stable disease (SD) according to RECIST 1.1, while five of six patients had a PR and one of six a SD according to mRECIST. The clinical response remained relevant 18 months after TARE. Excluding one patient, all others showed only a slight and transient increase in liver enzymes. Conclusions TARE is effective in LM treatment of MTC. The absence of severe complications and the good tolerability make TARE a valid therapeutic strategy when liver LM are multiple and progressive.
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Affiliation(s)
- Luciana Puleo
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | - Laura Agate
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | | | - Paolo Piaggi
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | | | | | | | | | - Sandra Brogioni
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | - Valeria Bottici
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | - Barbara Coco
- Hepatology Unit, University of Pisa, Pisa, Italy
| | | | - Rossella Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine
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3
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Liu R, Li H, Qiu Y, Liu H, Cheng Z. Recent Advances in Hepatocellular Carcinoma Treatment with Radionuclides. Pharmaceuticals (Basel) 2022; 15:1339. [PMID: 36355512 PMCID: PMC9694760 DOI: 10.3390/ph15111339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/20/2024] Open
Abstract
As the third leading cause of cancer death worldwide, hepatocellular carcinoma (HCC) is characterized by late detection, difficult diagnosis and treatment, rapid progression, and poor prognosis. Current treatments for liver cancer include surgical resection, radiofrequency ablation, liver transplantation, chemotherapy, external radiation therapy, and internal radionuclide therapy. Radionuclide therapy is the use of high-energy radiation emitted by radionuclides to eradicate tumor cells, thus achieving the therapeutic effect. Recently, with the continuous development of biomedical technology, the application of radionuclides in treatment of HCC has progressed steadily. This review focuses on three types of radionuclide-based treatment regimens, including transarterial radioembolization (TARE), radioactive seed implantation, and radioimmunotherapy. Their research progress and clinical applications are summarized. The advantages, limitations, and clinical potential of radionuclide treatment of HCC are discussed.
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Affiliation(s)
- Ruiqi Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hong Li
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Yihua Qiu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hongguang Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai 264117, China
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4
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Liu DM, Leung TW, Chow PK, Ng DC, Lee RC, Kim YH, Mao Y, Cheng YF, Teng GJ, Lau WY. Clinical consensus statement: Selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia. Int J Surg 2022; 102:106094. [PMID: 35662438 DOI: 10.1016/j.ijsu.2021.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is subject to different management approaches and guidelines according to Eastern and Western therapeutic algorithms. Use of selective internal radiation therapy (SIRT) with resin yttrium 90 microspheres for HCC has increased in Asia in recent years, without clearly defined indications for its optimal application. The objective of this systematic review and expert consensus statement is to provide guidance and perspectives on the use of SIRT among patients with HCC in Asia. MATERIALS AND METHODS A systematic literature review identified current publications on HCC management and SIRT recommendations. A group of 10 experts, representing stakeholder specialties and countries, convened between August 2020 and March 2021 and implemented a modified Delphi consensus approach to develop guidelines and indications for use of SIRT for HCC in Asia. Final recommendations were organized and adjudicated based on the level of evidence and strength of recommendation, per approaches outlined by the American College of Cardiology/American Heart Association and Oxford Centre for Evidence-Based Medicine. RESULTS The experts acknowledged a general lack of evidence relating to use of SIRT in Asia and identified as an unmet need the lack of phase 3 randomized trials comparing clinical outcomes and survival following SIRT versus other therapies for HCC. Through an iterative process, the expert group explored areas of clinical relevance and generated 31 guidance statements and a patient management algorithm that achieved consensus. CONCLUSION These recommendations aim to support clinicians in their decision-making and to help them identify and treat patients with HCC using SIRT in Asia. The recommendations also highlight areas in which further clinical trials are needed to define the role of SIRT in management of HCC among Asian populations.
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Affiliation(s)
- David M Liu
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Wt Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Pierce Kh Chow
- National Cancer Centre Singapore, Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - David Ce Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Duke-NUS Medical School, Singapore
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun Hwan Kim
- Department of Radiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Yilei Mao
- Department of Liver Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Gao-Jun Teng
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Wan Yee Lau
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.
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5
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Qian Y, Liu Q, Li P, Han Y, Zhang J, Xu J, Sun J, Wu A, Song S, Lu W. Highly Tumor-Specific and Long-Acting Iodine-131 Microbeads for Enhanced Treatment of Hepatocellular Carcinoma with Low-Dose Radio-Chemoembolization. ACS NANO 2021; 15:2933-2946. [PMID: 33529007 DOI: 10.1021/acsnano.0c09122] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transarterial radioembolization (TARE) is considered the standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Iodine-131 (131I)-labeled lipiodol TARE is an effective treatment for HCC but has been withdrawn due to its poor retention in tumor lesions and significant distribution in normal tissues with severe side effects. In this work, a highly tumor-specific 131I-TARE agent with long-time retention is developed by simply introducing tyrosine to poly(vinyl alcohol) (PVA) drug-eluting microbeads (Tyr-PVA-DEBs). The labeling efficiency of 131I-labeled microbeads remains above 85% in 50% serum for 31 days. Micro-single-photon emission computed tomography/computed tomography (μSPECT/CT) evidences that the 131I-labeled microbeads accumulate in the orthotopic N1S1 hepatoma of rats for 31 days following intra-arterial injection. The cumulative radiation dose per cubic centimeter of the tumor is at least 13 678-fold higher than that of normal tissues. The highly tumor-selective radiation of the 131I-labeled microbeads allows localized delivery of 345.04 ± 139.16 Gy to the tumor following a single injection dose as low as 0.2 mCi of 131I. Moreover, the 131I-labeled microbeads are loaded with doxorubicin hydrochloride (DOX) through the carboxy groups on tyrosine of the polymer. The 131I-DOX-loaded microbeads present a synergetic antitumor effect without recurrence in comparison with the microbeads labeled with 131I or loading DOX alone, attributed to the sensitization of DOX to 131I-induced ionizing radiation damage to DNA under the embolization-induced hypoxia. Our results demonstrate a high tumor retention of 131I-labeled embolic agent for low-dose transarterial radio-chemoembolization (TARCE) with a synergetic therapeutic effect on treating HCC, showing potential for clinical application.
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Affiliation(s)
- Yuyi Qian
- Minhang Hospital & School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 201199, China
| | - Qiufang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Panli Li
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Yaobao Han
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, China
| | - Jianping Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Jiaojiao Xu
- Minhang Hospital & School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 201199, China
| | - Jingwen Sun
- Minhang Hospital & School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 201199, China
| | - Aihua Wu
- Minhang Hospital & School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 201199, China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Wei Lu
- Minhang Hospital & School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, & State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 201199, China
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Xue C, Shao S, Yan Y, Yang S, Bai S, Wu Y, Zhang J, Liu R, Ma H, Chai L, Zhang X, Ren J. Association between G-protein coupled receptor 4 expression and microvessel density, clinicopathological characteristics and survival in hepatocellular carcinoma. Oncol Lett 2020; 19:2609-2620. [PMID: 32218811 PMCID: PMC7068660 DOI: 10.3892/ol.2020.11366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/14/2019] [Indexed: 12/27/2022] Open
Abstract
G-protein coupled receptor 4 (GPR4) acts as a proton-sensing receptor and plays a role in regulating angiogenesis. Endoglin/CD105 is a marker of cell proliferation in vascular endothelial cells, particularly in tumor vasculature cells. Although there have been several studies investigating angiogenesis in hepatocellular carcinoma (HCC), none have investigated the association between GPR4 and microvessel density (MVD)-CD105 in this type of cancer. In the present study, CD105 and GPR4 were found to be expressed in benign and malignant liver tissues by immunofluorescence staining and laser confocal microscopy. Compared with levels in benign tissues, CD105 and GPR4 were highly expressed in neoplastic tissues. Furthermore, the average fluorescence intensity of GPR4 and MVD-CD105 was positively correlated. GPR4 and CD105 were found to be co-localized in the vascular endothelium in tumor tissues. Furthermore, the expression of GPR4 was higher in the marginal region of tumor tissues compared with the central region. These findings suggest that the expression of GPR4 in tumor microvessels in HCC may be implicated in tumor angiogenesis and development. Furthermore, the association between the expression of GPR4 and the clinicopathological features of patients with HCC further suggests a role for GPR4 in tumor angiogenesis and growth. Overall, these results suggest the potential of GPR4 as a prognostic factor and as an antiangiogenic target in patients with HCC.
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Affiliation(s)
- Chaofan Xue
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shuai Shao
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yanli Yan
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Si Yang
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shuheng Bai
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yinying Wu
- Department of Chemotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiangzhou Zhang
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Rui Liu
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Hailin Ma
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Linyan Chai
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaozhi Zhang
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Juan Ren
- Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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7
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Lau WY, Lai EC. Loco-regional intervention for hepatocellular carcinoma. J Interv Med 2019; 2:43-46. [PMID: 34805870 PMCID: PMC8562167 DOI: 10.1016/j.jimed.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Anatomic location/size and number of lesions, inadequate volume of future liver remnant, or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma (HCC). Liver transplantation can cure some patients with poor liver function, but few patients are eligible because of scarcity of donors. Without specific anti-cancer treatment, the prognosis of HCC is poor. Various locoregional therapies are used to treat patients who are not candidates for surgery, and have emerged as tools for palliation, tumor down-staging, and bridging therapy prior to liver transplantation. Currently, local ablative therapy even competes with partial hepatectomy and liver transplantation as a primary treatment for small HCC. HCC is well suited to treatment with loco-regional therapy because it has a tendency to stay within the liver, with distant metastasis generally occurring late in the course of disease. This suggests that an effective local-regional therapy can have a great impact on HCC patients who are not candidates for surgical treatment. Loco-regional therapy can further be justified because patients with HCC usually die of liver failure consequent to intrahepatic growth resulting in liver tissue destruction, rather than extrahepatic metastases.
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Affiliation(s)
- Wan Yee Lau
- Corresponding author. Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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8
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Manceau V, Palard X, Rolland Y, Pracht M, Le Sourd S, Laffont S, Boudjema K, Lievre A, Mesbah H, Haumont LA, Lenoir L, Brun V, Uguen T, Edeline J, Garin E. A MAA-based dosimetric study in patients with intrahepatic cholangiocarcinoma treated with a combination of chemotherapy and 90Y-loaded glass microsphere selective internal radiation therapy. Eur J Nucl Med Mol Imaging 2018; 45:1731-1741. [PMID: 29560519 DOI: 10.1007/s00259-018-3990-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/01/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Selective internal radiation therapy (SIRT) appears to be an interesting treatment possibility for locally-advanced intrahepatic cholangiocarcinoma (ICC), yet the appropriate dosimetry has never been evaluated in this context. METHODS We retrospectively studied data from 40 patients treated at our institution with 90Y-loaded glass microsphere SIRT combined with chemotherapy for inoperable ICC as first-line treatment. Macroaggregated albumin (MAA)-based single-photon emission computed tomography (SPECT)/computed tomography (CT) quantitative analysis was used to calculate the tumor dose (TD), healthy-injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 months using the European Association for the Study of the Liver criteria. Factors associated with response and toxicity were analyzed using univariate analysis. RESULTS We assessed a total of 35 patients (five excluded) receiving 55 injections. Mean TD was 322 ± 165Gy and mean HILD was 74 ± 24Gy for a mean ILD of 128 ± 28Gy. All but two lesions responded, with a minimal TD for responding lesions of 158Gy. Six Grade 3-4 permanent liver toxicities were observed. Mean HILD was not associated with liver toxicity (73.2 ± 25.8Gy for patients with liver toxicity and 77.8 ± 16.9Gy for patients without, ns). Only underlying Child-Pugh status (p = 0.0014) and underlying cirrhosis (p = 0.0021) were associated with liver toxicity. Median progression-free survival was 12.7 months and median overall survival (OS) was 28.6 months. Median OS was 52.7 months for patients with Child-Pugh A5 status. CONCLUSIONS When combined with chemotherapy, SIRT is highly effective, with a TD > 158Gy. Tolerance was good except for the few patients with cirrhosis or Child-Pugh status ≥A6, who exhibited some liver toxicity. Prospective studies are warranted to confirm.
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Affiliation(s)
- Vincent Manceau
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Xavier Palard
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France.,Université de Rennes 1, F-35033, Rennes, France
| | - Yan Rolland
- Department of Medical Imaging, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerqu, CS 44229e, F-35042, Rennes cedex, France.,U 1099, INSERM, Rennes, France.,LTSI, Université de Rennes 1, Rennes, France
| | - March Pracht
- Department of Medical Oncology, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Samuel Le Sourd
- Department of Medical Oncology, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Sophie Laffont
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Karim Boudjema
- Department of Hepatobiliary Surgery, CHU Pontchaillou, 2 rue Henri le Guilloux, F-35033, Rennes cedex, France
| | - Astride Lievre
- Department of Hepatology, CHU Pontchaillou, F-35033, Rennes cedex, France
| | - Habiba Mesbah
- Department of Medical Information, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Laure-Anne Haumont
- Department of Medical Information, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Laurence Lenoir
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France
| | - Vanessa Brun
- Department of Medical Imaging, CHU Pontchaillou, F-35033, Rennes cedex, France
| | - Thomas Uguen
- Department of Hepatobiliary Surgery, CHU Pontchaillou, 2 rue Henri le Guilloux, F-35033, Rennes cedex, France
| | - Julien Edeline
- Université de Rennes 1, F-35033, Rennes, France.,Department of Medical Oncology, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France.,INSERM, INRA, Université de Rennes 1, Université de Bretagne Loire, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France. .,Université de Rennes 1, F-35033, Rennes, France. .,INSERM, INRA, Université de Rennes 1, Université de Bretagne Loire, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, France.
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9
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Shen JD, Fu SZ, Ju LL, Wang YF, Dai F, Liu ZX, Ji HZ, Shao JG, Bian ZL. High expression of ubiquitin-conjugating enzyme E2A predicts poor prognosis in hepatocellular carcinoma. Oncol Lett 2018; 15:7362-7368. [PMID: 29725449 DOI: 10.3892/ol.2018.8189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022] Open
Abstract
The present study aimed to illustrate the association of the expression of ubiquitin-conjugating enzyme E2A (UBE2A) with the clinicopathological parameters and prognosis in hepatocellular carcinoma (HCC). The expression levels of UBE2A mRNA and protein in a total of 276 HCC tissues and six liver cell lines was detected by fluorescent quantitative polymerase chain reaction, western blotting and immunohistochemistry. Statistical analysis was also performed to assess the association of the expression of UBE2A with the clinicopathological parameters and prognosis by the GraphPad Prism and SPSS version 21.0 software. UBE2A mRNA and protein were highly expressed in HCC tissues compared with those in the adjacent normal tissue. Immunohistochemical analysis revealed that UBE2A protein was more strongly stained in the 276 paraffin-embedded HCC tissues as compared with the 63 adjacent normal tissue. Statistical analysis also demonstrated that UBE2A expression was significantly associated with histological differentiation, TNM stage and vascular invasion of HCC (P<0.05). Notably, HCC patients with a high expression of UBE2A had a shorter survival time as compared with those with a low expression of UBE2A. There results suggested that UBE2A may be involved in the pathogenesis of HCC and may serve as an important prognostic marker. Further exploration of the involvement of UBE2A in HCC development may provide novel therapeutic targets.
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Affiliation(s)
- Jian-Dong Shen
- Department of Invasive Technology, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Shou-Zhong Fu
- Department of Invasive Technology, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Lin-Ling Ju
- Nantong Institute of Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Yi-Fang Wang
- Nantong Institute of Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Feng Dai
- Department of Invasive Technology, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Zhao-Xiu Liu
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226021, P.R. China
| | - Han-Zheng Ji
- Library of Nantong Third People's Hospital, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Jian-Guo Shao
- Department of Gastroenterology and Hepatology, Nantong Institute of Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
| | - Zhao-Lian Bian
- Department of Gastroenterology and Hepatology, Nantong Institute of Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu 226006, P.R. China
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10
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Woo HY, Kim DY, Heo J, Kim CW, Kim S, Yoon KT, Lim W, Hong YM, Won JY, Lee S, Han KH, Cho M. Effect of yttrium-90 radioembolization on outcomes in Asian patients with early to advanced stage hepatocellular carcinoma. Hepatol Res 2017; 47:387-397. [PMID: 27272116 DOI: 10.1111/hepr.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/07/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to investigate the effect of yttrium-90 radioembolization on the outcome of Asian patients with early to advanced stage hepatocellular carcinoma (HCC). METHODS Sixty-two patients were screened and 50 patients (80.6%) were eligible. Response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST), and overall survival was estimated using the Kaplan-Meier method. RESULTS The Barcelona Clinic Liver Cancer (BCLC) stage was A in 40% of patients, B in 24%, and C in 36%; 66% of patients had hepatitis B virus infections. According to RECIST criteria, partial responses occurred in 40% of patients, and stable disease was achieved in 46%. Tumor response was significantly associated with BCLC stage (P = 0.003). The median overall time to progression was 5.8 months (range, 0.9-46.1 months). Follow-up treatments after radioembolization were carried out in 31 patients due to remnant HCC (n = 18) or HCC progression (n = 13). The median overall survival was 40.9 months (95% confidence interval, 10.2-71.6 months). Treatment was tolerable except for one lung toxicity and two hepatic toxicities. CONCLUSION Yttrium-90 radioembolization appears to be well tolerated and effective in Asian patients with BCLC stage A-C HCC. Follow-up treatments after radioembolization can be safely provided.
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Affiliation(s)
- Hyun Young Woo
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Do Young Kim
- Departments of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jeong Heo
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Chang Won Kim
- Department of Radiology, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Suk Kim
- Department of Radiology, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Won Lim
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Young Mi Hong
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Jong Yun Won
- Department of Radiology, College of Medicine, Yonsei University, Seoul, Korea
| | - Sangheun Lee
- Departments of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Kwang Hyub Han
- Departments of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Mong Cho
- Department of Internal Medicine, College of Medicine and Medical Research Institute, Pusan National University, Pusan National University Hospital, Busan, Korea
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11
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Lau WY. Commentary on the article entitled "hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation". Hepatobiliary Surg Nutr 2017; 6:49-51. [PMID: 28261595 DOI: 10.21037/hbsn.2017.01.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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12
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de la Torre MA, Buades-Mateu J, de la Rosa PA, Lué A, Bustamante FJ, Serrano MT, Testillano M, Lorente S, Arenas JI, Gil C, Iñarrairaegui M, Sangro B. A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib. Liver Int 2016; 36:1206-12. [PMID: 26910784 DOI: 10.1111/liv.13098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR. METHODS Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses. RESULTS After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis. CONCLUSIONS In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.
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Affiliation(s)
| | | | | | - Alberto Lué
- Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | | | - María T Serrano
- Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | | | - Sara Lorente
- Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Juan I Arenas
- Gastroenterology and Hepatology, Hospital Universitario Donostia, San Sebastian, Spain
| | - Cristina Gil
- Liver Unit, Hospital Universitario Cruces, Baracaldo, Spain
| | - Mercedes Iñarrairaegui
- Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
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13
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Current Treatment Approaches to HCC with a Special Consideration to Transplantation. J Transplant 2016; 2016:7926264. [PMID: 27413539 PMCID: PMC4931061 DOI: 10.1155/2016/7926264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/19/2016] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. The mainstay of treatment of HCC has been both resectional and transplantation surgery. It is well known that, in selected, optimized patients, hepatectomy for HCC may be an option, even in patients with underlying cirrhosis. Resectable patients with early HCC and underlying liver disease are however increasingly being considered for transplantation because of potential for better disease-free survival and resolution of underlying liver disease, although this approach is limited by the availability of donor livers, especially in resectable patients. Outcomes following liver transplantation improved dramatically for patients with HCC following the implementation of the Milan criteria in the late 1990s. Ever since, the rather restrictive nature of the Milan criteria has been challenged with good outcomes. There has also been an increase in the donor pool with marginal donors including organs retrieved following cardiac death being used. Even so, patients still continue to die while waiting for a liver transplant. In order to reduce this attrition, bridging techniques and methods for downstaging disease have evolved. Additionally new techniques for organ preservation have increased the prospect of this potentially curative procedure being available for a greater number of patients.
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14
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Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience. J Transplant 2016; 2016:7895956. [PMID: 27057348 PMCID: PMC4736995 DOI: 10.1155/2016/7895956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/03/2015] [Indexed: 12/21/2022] Open
Abstract
Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ2-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp(B) = 10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp(B) = 3.645), bilateral tumor spreading (exp(B) = 14.505), tumor grading beyond G2 (exp(B) = 8.668), and vascular infiltration of small or large vessels (exp(B) = 11.612, exp(B) = 18.324, resp.). Grading beyond G2 (exp(B) = 10.498) as well as small and large vascular infiltrations (exp(B) = 13.337, exp(B) = 16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp(B) = 4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ2p = 0.006) and intrahepatic tumor spreading (χ2p = 0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process.
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15
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Microwave ablation of hepatocellular carcinoma with portal vein tumor thrombosis after transarterial chemoembolization: a prospective study. Hepatol Int 2016; 10:175-84. [DOI: 10.1007/s12072-015-9673-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
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16
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Wedd JP, Nordstrom E, Nydam T, Durham J, Zimmerman M, Johnson T, Thomas Purcell W, Biggins SW. Hepatocellular carcinoma in patients listed for liver transplantation: Current and future allocation policy and management strategies for the individual patient. Liver Transpl 2015; 21:1543-52. [PMID: 26457885 DOI: 10.1002/lt.24356] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
Abstract
Liver transplantation can provide definitive cure for patients with cirrhosis and hepatocellular carcinoma (HCC) when used appropriately. Advances in the management of HCC have allowed improved control of HCC while waiting for liver transplantation and new approaches to candidate selection particularly with regard to tumor burden and downstaging protocols. Additionally, there have been recent changes in allocation policy related to HCC in the U.S. that cap the HCC MELD exception at 34 points and implement a 6-month delay in a HCC MELD exception. This review examines the U.S. liver transplant allocation policy related to HCC, comprehensively details locoregional therapy options in HCC patients awaiting liver transplantation, and considers the impact of an increasing burden of HCC on future liver graft allocation policy.
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Affiliation(s)
- Joel P Wedd
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Eric Nordstrom
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
| | - Trevor Nydam
- Department of Surgery, University of Colorado, Aurora, CO
| | - Janette Durham
- Department of Interventional Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | | | - Thor Johnson
- Department of Interventional Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - W Thomas Purcell
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | - Scott W Biggins
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
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Fahrner R, Dondorf F, Ardelt M, Dittmar Y, Settmacher U, Rauchfuß F. Liver transplantation for hepatocellular carcinoma - factors influencing outcome and disease-free survival. World J Gastroenterol 2015; 21:12071-12082. [PMID: 26576092 PMCID: PMC4641125 DOI: 10.3748/wjg.v21.i42.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.
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18
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Nel I, Baba HA, Weber F, Sitek B, Eisenacher M, Meyer HE, Schlaak JF, Hoffmann AC. IGFBP1 in epithelial circulating tumor cells as a potential response marker to selective internal radiation therapy in hepatocellular carcinoma. Biomark Med 2015; 8:687-98. [PMID: 25123037 DOI: 10.2217/bmm.14.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Local ablative techniques such as selective internal radiation therapy (SIRT) have become the mainstay of treating hepatocellular carcinoma (HCC) in the bridging-to-transplant and palliative setting. We recently demonstrated that epithelial circulating tumor cells (CTCs) correlate to an unfavorable outcome. We wanted to scrutinize whether molecular markers detected in this specific CTC subgroup may also have clinical implications. MATERIALS & METHODS Mononuclear cells and CTCs were isolated from peripheral blood samples using density gradient centrifugation followed by depletion of hematopoietic and enrichment of epithelial (EpCAM(+)) cells employing immunomagnetic beads. The mRNA expression of candidate markers was correlated with response to SIRT in 25 patients using quantitative real-time reverse-transcription PCR. RESULTS IGFBP1 mRNA expression levels were significantly correlated with time to progression in a Kaplan-Meier log rank test (p = 0.04; 0 vs 4 months) and receiver operating characteristic analysis demonstrated a potential use to predict patients with shortened time to progression (area under the curve: 0.8; 95% CI: 0.44-0.98; p = 0.03). CONCLUSION The EpCAM fraction of CTCs may be useful to detect novel molecular markers to individualize treatment decision in patients with HCC.
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Affiliation(s)
- Ivonne Nel
- Department of Medical Oncology, Molecular Oncology Risk-Profile Evaluation, West German Cancer Center, University Hospital of Essen, Essen, Germany
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19
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Bevelacqua JJ. 210Po microsphere radiological design for tumor vascular disruption. PeerJ 2015; 3:e1143. [PMID: 26290796 PMCID: PMC4540027 DOI: 10.7717/peerj.1143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/10/2015] [Indexed: 12/15/2022] Open
Abstract
The feasibility of disrupting a tumor’s vascular structure using 210Po microspheres is investigated using standard ion and photon absorbed dose methodologies. Calculated absorbed dose profiles for 210Po alpha particles are sufficient to disrupt a tumor’s arteriole structure while minimizing the dose outside the blood vessel wall. 210Po photons contribute minimal dose to healthy tissue. The requisite activity of 210Po to facilitate vascular disruption is calculated.
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20
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Slotta JE, Kollmar O, Ellenrieder V, Ghadimi BM, Homayounfar K. Hepatocellular carcinoma: Surgeon's view on latest findings and future perspectives. World J Hepatol 2015; 7:1168-1183. [PMID: 26019733 PMCID: PMC4438492 DOI: 10.4254/wjh.v7.i9.1168] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/14/2014] [Accepted: 03/20/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common liver-derived malignancy with a high fatality rate. Risk factors for the development of HCC have been identified and are clearly described. However, due to the lack of tumor-specific symptoms, HCC are diagnosed at progressed tumor stages in most patients, and thus curative therapeutic options are limited. The focus of this review is on surgical therapeutic options which can be offered to patients with HCC with special regard to recent findings, not exclusively focused on surgical therapy, but also to other treatment modalities. Further, potential promising future perspectives for the treatment of HCC are discussed.
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21
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O' Doherty J. A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy. ACTA ACUST UNITED AC 2015; 2:1-34. [PMID: 27182449 DOI: 10.17229/jdit.2015-0428-016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Yttrium-90 radioembolization (90Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as high-resolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
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22
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Yim HJ, Suh SJ, Um SH. Current management of hepatocellular carcinoma: an Eastern perspective. World J Gastroenterol 2015; 21:3826-42. [PMID: 25852267 PMCID: PMC4385529 DOI: 10.3748/wjg.v21.i13.3826] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/11/2014] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death, especially in Eastern areas. With advancements in diagnosis and treatment modalities for HCC, the survival and prognosis of HCC patients are improving. However, treatment patterns are not uniform between areas despite efforts to promote a common protocol. Although many hepatologists in Asian countries may adopt the principles of the Barcelona Clinic Liver Cancer staging system, they are also independently making an effort to expand the indications of each treatment and to combine therapies for better outcomes. Several expanded criteria for liver transplantation in HCC have been developed in Asian countries. Living donor liver transplantation is much more commonly performed in these countries than deceased donor liver transplantation, and it may be preceded by other treatments such as the down-staging of tumors. Local ablation therapies are often combined with transarterial chemoembolization (TACE) and the outcome is comparable to that of surgical resection. The indications of TACE are expanding, and there are new types of transarterial therapies. Although data on drug-eluting beads, TACE, and radioembolization in Asian countries are still relatively sparse compared with Western countries, these methods are gradually gaining popularity because of better tolerability and the possibility of improved response rates. Hepatic arterial infusion chemotherapy and radiotherapy are not included in Western guidelines, but are currently being used actively in several Asian countries. For more advanced HCCs, appropriate combinations of TACE, radiotherapy, and sorafenib can be considered, and emerging data indicate improved outcomes of combination therapies compared with single therapies. To include these paradigm shifts into newer treatment guidelines, more studies may be needed, but they are certainly in progress.
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23
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Gramenzi A, Golfieri R, Mosconi C, Cappelli A, Granito A, Cucchetti A, Marinelli S, Pettinato C, Erroi V, Fiumana S, Bolondi L, Bernardi M, Trevisani F. Yttrium-90 radioembolization vs sorafenib for intermediate-locally advanced hepatocellular carcinoma: a cohort study with propensity score analysis. Liver Int 2015; 35:1036-47. [PMID: 24750853 DOI: 10.1111/liv.12574] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Sorafenib and transarterial (90) Y-radioembolization (TARE) are possible treatments for Barcelona Clinic Liver Cancer (BCLC) intermediate-advanced stage hepatocellular carcinoma (HCC). No study directly comparing sorafenib and TARE is currently available. This single-centre retrospective study compares the outcomes achieved with sorafenib and TARE in HCC patients potentially amenable to either therapy. METHODS Seventy-four sorafenib (71 ± 10 years, male 87%, BCLC B/C 53%/47%) and 63 TARE HCC patients (66 ± 9 years, male 79%, BCLC B/C 41%/59%) were included based on the following criteria: Child-Pugh class A/B, performance status ≤1, HCC unfit for other effective therapies, no metastases and no previous systemic chemotherapy. RESULTS Median overall survivals of the two groups were comparable, being 14.4 months (95% CI: 4.3-24.5) in sorafenib and 13.2 months (95% CI: 6.1-20.2) in TARE patients, with 1-, 2- and 3-year survival rates of 52.1%, 29.3% and 14.7% vs 51.8%, 27.8% and 21.6% respectively. Two TARE patients underwent liver transplantation after successful down-staging. To minimize the impact of confounding factors on survival analysis, propensity model matched 32 patients of each group for median age, tumour gross pathology and the independent prognostic factors (portal vein thrombosis, performance status, Model for End Liver Disease). Even after matching, the median survival did not differ between sorafenib (13.1 months; 95% CI: 1.2-25.9) and TARE patients (11.2 months; 95% CI: 6.7-15.7), with comparable 1-, 2- and 3-year survival rates. CONCLUSIONS In cirrhotic patients with intermediate-advanced or not-otherwise-treatable HCC, sorafenib and TARE provide similar survivals. Down-staging allowing liver transplantation only occurred after TARE.
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Affiliation(s)
- Annagiulia Gramenzi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Attarwala AA, Molina-Duran F, Büsing KA, Schönberg SO, Bailey DL, Willowson K, Glatting G. Quantitative and qualitative assessment of Yttrium-90 PET/CT imaging. PLoS One 2014; 9:e110401. [PMID: 25369020 PMCID: PMC4219690 DOI: 10.1371/journal.pone.0110401] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/22/2014] [Indexed: 11/24/2022] Open
Abstract
Yttrium-90 is known to have a low positron emission decay of 32 ppm that may allow for personalized dosimetry of liver cancer therapy with 90Y labeled microspheres. The aim of this work was to image and quantify 90Y so that accurate predictions of the absorbed dose can be made. The measurements were performed within the QUEST study (University of Sydney, and Sirtex Medical, Australia). A NEMA IEC body phantom containing 6 fillable spheres (10–37 mm ∅) was used to measure the 90Y distribution with a Biograph mCT PET/CT (Siemens, Erlangen, Germany) with time-of-flight (TOF) acquisition. A sphere to background ratio of 8∶1, with a total 90Y activity of 3 GBq was used. Measurements were performed for one week (0, 3, 5 and 7 d). he acquisition protocol consisted of 30 min-2 bed positions and 120 min-single bed position. mages were reconstructed with 3D ordered subset expectation maximization (OSEM) and point spread function (PSF) for iteration numbers of 1–12 with 21 (TOF) and 24 (non-TOF) subsets and CT based attenuation and scatter correction. Convergence of algorithms and activity recovery was assessed based on regions-of-interest (ROI) analysis of the background (100 voxels), spheres (4 voxels) and the central low density insert (25 voxels). For the largest sphere, the recovery coefficient (RC) values for the 30 min –2-bed position, 30 min-single bed and 120 min-single bed were 1.12±0.20, 1.14±0.13, 0.97±0.07 respectively. For the smaller diameter spheres, the PSF algorithm with TOF and single bed acquisition provided a comparatively better activity recovery. Quantification of Y-90 using Biograph mCT PET/CT is possible with a reasonable accuracy, the limitations being the size of the lesion and the activity concentration present. At this stage, based on our study, it seems advantageous to use different protocols depending on the size of the lesion.
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Affiliation(s)
- Ali Asgar Attarwala
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Flavia Molina-Duran
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Karen-Anett Büsing
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O. Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dale L. Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Kathy Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Gerhard Glatting
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- * E-mail:
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Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E. Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres. Clin Mol Hepatol 2014; 20:300-5. [PMID: 25320734 PMCID: PMC4197179 DOI: 10.3350/cmh.2014.20.3.300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 12/31/2022] Open
Abstract
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.
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Affiliation(s)
- Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Dong Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea
| | - Jin Yong Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Ha Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ho Sang Ryu
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yun Hwan Kim
- Department of Radiology, Korea University College of Medicine, Seoul, Korea
| | - Chong Suk Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Eun Shin
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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Khor AYK, Toh Y, Allen JC, Ng DCE, Kao YH, Zhu G, Choo SP, Lo RHG, Tay KH, Teo JY, Goh BKP, Burgmans MC, Irani FG, Goh ASW, Chow PKH. Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma. Hepatol Int 2014. [PMID: 26202641 DOI: 10.1007/s12072-014-9533-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Intra-arterial yttrium-90 ((90)Y) microsphere radioembolization (RE) is an emerging treatment option with good outcomes reported predominantly in hepatitis C Western populations with hepatocellular carcinoma (HCC). We report outcomes in predominantly hepatitis B Asian patients treated with (90)Y-RE focusing on overall survival (OS), time to progression (TTP), tumor response, pattern of tumor recurrence and adverse events. Prognostic factors for survival were also identified. METHODS A retrospective cohort study was conducted in a single tertiary institution. All non-trial patients treated with (90)Y-RE at our institution from 1 January 2008 to 30 June 2012 were included. RESULTS Data from 103 consecutive patients were analyzed. The majority of patients were Child-Pugh class A (59.2 %) and Barcelona Clinic Liver Cancer (BCLC) stage C (68.9 %). Median OS was 14.4 months (95 % CI 11.0-22.2), which varied by disease stage: Child-Pugh A, 21.7 months; Child-Pugh B, 7.1 months; BCLC B, 23.8 months; BCLC C, 11.8 months. Response and disease control rates by RECIST 1.1 were 21.2 and 59.6 %, respectively, while disease control for index lesions treated with (90)Y-RE was 100 %. Development of new intrahepatic lesions was the main reason for eventual disease progression. Median overall TTP was 5.3 months (95 % CI 4.1-10.0). Pretreatment vascular invasion, low serum albumin and elevated total bilirubin levels predicted poorer survival. CONCLUSIONS Survival outcomes in hepatitis B Asian patients treated with (90)Y-RE for HCC are comparable to hepatitis C Western populations. While disease control for lesions treated with (90)Y-RE is excellent, the development of new lesions suggests a role for concomitant systemic therapy.
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Affiliation(s)
- Andrew Yu-Keat Khor
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore
| | - Ying Toh
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - David Chee-Eng Ng
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
| | - Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
| | - Guili Zhu
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore
| | - Su-Pin Choo
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Richard Hoau-Gong Lo
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Kiang-Hiong Tay
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Jin-Yao Teo
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Brian Kim-Poh Goh
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Farah Gillian Irani
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Anthony Soon-Whatt Goh
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
| | - Pierce Kah-Hoe Chow
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore. .,Department of General Surgery, Singapore General Hospital, Singapore, Singapore. .,Department of Surgical Oncology, National Cancer Centre, Singapore, Singapore.
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Bevelacqua JJ. Tumor vascular disruption using various radiation types. PeerJ 2014; 2:e320. [PMID: 24749005 PMCID: PMC3976121 DOI: 10.7717/peerj.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/04/2014] [Indexed: 01/24/2023] Open
Abstract
The feasibility of disrupting a tumor's vascular structure with various radiation types and radionuclides is investigated. Calculated absorbed dose profiles for photons and (4)He ions suggest that low-energy beta-gamma and alpha emitting radionuclides can deposit sufficient absorbed dose to disrupt a tumor's vascular structure while minimizing the dose outside the blood vessel. Candidate radionuclides uniformly distributed in microspheres are theoretically investigated with respect to their vascular disruption potential and to offer an alternative to (90)Y microsphere therapy. Requisite activities of candidate low-energy beta-gamma and alpha emitting radionuclides to facilitate vascular disruption are calculated.
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Zheng JS, Long J, Sun B, Lu NN, Fang D, Zhao LY, Du N. Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: extending the indication for ablation? Clin Radiol 2014; 69:e253-63. [PMID: 24581962 DOI: 10.1016/j.crad.2014.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 12/02/2013] [Accepted: 01/14/2014] [Indexed: 12/13/2022]
Abstract
AIM To retrospectively assess long-term survival benefit and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombosis (PVTT), and to evaluate factors that significantly affect outcomes of these patients. MATERIALS AND METHODS One hundred and thirty-four HCC patients (118 men and 16 women; mean age 54.8 years, range 26-79 years) with PVTT were retrospectively assessed. Patients were treated with TACE combined with RFA. Data analysed included patient demographics, liver volume, Child-Pugh score, and Cancer of the Liver Italian Programme (CLIP) score and imaging findings. Survival time (from occurrence of PVTT to last follow-up) was calculated using the Kaplan-Meier method, predictive factors and its correlation with survival was assessed using the multivariate Cox proportional hazards regression method. RESULTS The median overall survival (OS) time was 29.5 months (range 16.6-42.4 months), the 1, 3, and 5 year OS were 63%, 40%, and 23%. Cox hazards regression analysis revealed that functional remnant liver volume (FRLV), remnant liver volume (RLV)/total liver volume (TLV), radiation, tumour number, vascular endothelial growth factor (VEGF) distribution, and gross type were the only independent predictive factors of outcome (p = 0.039, 0.010, 0.009, 0.034, 0.031, and 0.000, respectively). CONCLUSION TACE combined with RFA was found to be an effective therapy, FRLV and RLV/TLV have close correlation with survival for HCC patients with PVTT type I, II, or partial III and Child-Pugh A or B.
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Affiliation(s)
- J-S Zheng
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
| | - J Long
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - B Sun
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - N-N Lu
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - D Fang
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - L-Y Zhao
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - N Du
- Department of Oncology Minimally Invasive Interventional Radiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
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Cilurzo F, Staltari O, Patanè M, Ammendola M, Garaffo C, Di Paola ED. Nexavar(®)-related adverse reactions: Calabrian (Italy) experience for sorafenib exposition in 2012. J Pharmacol Pharmacother 2013; 4:S86-9. [PMID: 24347990 PMCID: PMC3853677 DOI: 10.4103/0976-500x.120971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) remains a major global health problem and Calabria in the south of Italy is not an exception. Sorafenib is the first and only Food and Drug Administration approved drug for the treatment of advanced HCC and it is currently under intensive monitoring by the Health Authorities in Italy Agenzia Italiana del Farmaco. This general report has been developed with the aim of briefly reviewing the data found in the reports of adverse reactions (ADRs) collected in Calabria in 2012 for sorafenib treated patients. Extrapolated data have highlighted some differences between the adverse drug reactions reported in patients younger or older than 70 years and other important differences with the current approved leaflet. Several limitations might be present in data analysis form spontaneous reporting, however, the relevance of reporting ADRs (dermatitis, asthenia, vomiting, etc.) for the early identification of drug related signals has to be underlined.
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Affiliation(s)
- Felisa Cilurzo
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy ; Department of Science of Health, Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Italy
| | - Orietta Staltari
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy ; Department of Science of Health, Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Italy
| | - Marinella Patanè
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy ; Department of Science of Health, Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Italy
| | - Michele Ammendola
- Department of Medical and Surgery Science, University of Catanzaro, Magna Graecia, Medical School, Catanzaro, Italy
| | | | - Eugenio Donato Di Paola
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy ; Department of Science of Health, Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Italy
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Mearini L. High intensity focused ultrasound, liver disease and bridging therapy. World J Gastroenterol 2013; 19:7494-7499. [PMID: 24282341 PMCID: PMC3837248 DOI: 10.3748/wjg.v19.i43.7494] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) is a non-invasive modality that uses an extracorporeal source of focused ultrasound energy. This technique was introduced by Lynn et al and is able to induce coagulative necrosis in selected tissues without damaging adjacent structures. Although HIFU has been studied for 50 years, recent technological developments now allow its use for tumours of the liver, prostate and other sites. In liver disease, HIFU has been used to treat unresectable, advanced stages of hepatocellular carcinoma (HCC) and liver metastases. Hepatocellular carcinoma is a serious health problem worldwide and is endemic in some areas because of its association with hepatitis B and C viruses (in 20% of cases). Liver transplantation (LT) has become one of the best treatments available because it removes both the tumour and the underlying liver disease such as cirrhosis (which is present in approximately 80% of cases). The prerequisite for long-term transplant success depends on tumour load and strict selection criteria regarding the size and number of tumour nodules. The need to obtain the optimal benefit from the limited number of organs available has prompted strict selection criteria limited to only those patients with early HCC who have a better long-term outcome after LT. The so-called “bridging therapy” has the aim of controlling disease burden for patients who are on the organ transplant waiting list. Amongst various treatment options, transarterial chemoembolisation and radiofrequency ablation are the most popular treatment choices. Recently, Cheung et al demonstrated that HIFU ablation is a safe and effective method for the treatment of HCC patients with advanced cirrhosis as a bridging therapy and that it reduced the dropout rate from the liver transplant waiting list. In this commentary, we discuss the current value of HIFU in the treatment of liver disease, including its value as a bridging therapy, and examine the potential advantages of other therapeutic strategies.
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Individual profiling of circulating tumor cell composition and therapeutic outcome in patients with hepatocellular carcinoma. Transl Oncol 2013; 6:420-8. [PMID: 23908685 DOI: 10.1593/tlo.13271] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND AIMS Circulating tumor cells (CTCs) have been proposed as a monitoring tool in patients with solid tumors. So far, automated approaches are challenged by the cellular heterogeneity of CTC, especially the epithelial-mesenchymal transition. Recently, Yu and colleagues showed that shifts in these cell populations correlated with response and progression, respectively, to chemotherapy in patients with breast cancer. In this study, we assessed which non-hematopoietic cell types were identifiable in the peripheral blood of hepatocellular carcinoma (HCC) patients and whether their distribution during treatment courses is associated with clinical characteristics. METHODS Subsequent to few enrichment steps, cell suspensions were spun onto glass slides and further characterized using multi-immunofluorescence staining. All non-hematopoietic cells were counted and individual cell profiles were analyzed per patient and treatment. RESULTS We detected a remarkable variation of cells with epithelial, mesenchymal, liver-specific, and mixed characteristics and different size ranges. The distribution of these subgroups varied significantly between different patient groups and was associated with therapeutic outcome. Kaplan-Meier log-rank test showed that a change in the ratio of epithelial to mesenchymal cells was associated with longer median time to progression (1 vs 15 months; P = .03; hazard ratio = 0.18; 95% confidence interval = 0.01-2.75). CONCLUSIONS Our data suggest that different CTC populations are identifiable in peripheral blood of HCC patients and, for the first time in HCC, that these individual cell type profiles may have distinct clinical implications. The further characterization and analysis of patients in this ongoing study seems to be warranted.
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Garin E, Lenoir L, Edeline J, Laffont S, Mesbah H, Porée P, Sulpice L, Boudjema K, Mesbah M, Guillygomarc'h A, Quehen E, Pracht M, Raoul JL, Clement B, Rolland Y, Boucher E. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept. Eur J Nucl Med Mol Imaging 2013; 40:1057-68. [PMID: 23613103 PMCID: PMC3679421 DOI: 10.1007/s00259-013-2395-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/07/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with (90)Y-loaded glass microspheres (TheraSphere®). METHODS TheraSphere® was administered to 71 patients with inoperable HCC. MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), healthy injected liver dose (HILD), and total injected liver dose. Response was evaluated at 3 months using EASL criteria. Time to progression (TTP) and overall survival (OS) were evaluated using the Kaplan-Meier method. Factors potentially associated with liver toxicity were combined to construct a liver toxicity score (LTS). RESULTS The response rate was 78.8%. Median TD were 342 Gy for responding lesions and 191 Gy for nonresponding lesions (p < 0.001). With a threshold TD of 205 Gy, MAA SPECT/CT predicted response with a sensitivity of 100% and overall accuracy of 90%. Based on TD and HILD, 17 patients underwent treatment intensification resulting in a good response rate (76.4%), without increased grade III liver toxicity. The median TTP and OS were 5.5 months (2-9.5 months) and 11.5 months (2-31 months), respectively, in patients with TD <205 Gy and 13 months (10-16 months) and 23.2 months (17.5-28.5 months), respectively, in those with TD >205 Gy (p = 0.0015 and not significant). Among patients with portal vein thrombosis (PVT) (n = 33), the median TTP and OS were 4.5 months (2-7 months) and 5 months (2-8 months), respectively, in patients with TD <205 Gy and 10 months (6-15.2 months) and 21.5 months (12-28.5 months), respectively, in those with TD >205 Gy (p = 0.039 and 0.005). The median OS was 24.5 months (18-28.5 months) in PVT patients with TD >205 Gy and good PVT targeting on MAA SPECT/CT. The LTS was able to detect severe liver toxicity (n = 6) with a sensitivity of 83% and overall accuracy of 97%. CONCLUSION Dosimetry based on MAA SPECT/CT was able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved.
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Affiliation(s)
- E Garin
- Department of Nuclear Medicine, CS 44229, Comprehensive Cancer Center, Institute Eugène Marquis, F-35042 Rennes, France.
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Kim DY. Which treatment modality should we choose for advanced hepatocellular carcinoma? THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:353-4. [PMID: 21415577 PMCID: PMC3304607 DOI: 10.3350/kjhep.2010.16.4.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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