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Dupart J, Zhang W, Trent JC. Gastrointestinal stromal tumor and its targeted therapeutics. CHINESE JOURNAL OF CANCER 2012; 30:303-14. [PMID: 21527063 PMCID: PMC4013395 DOI: 10.5732/cjc.011.10062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past 60 years, investigators of basic science, pathology, and clinical medicine have studied gastrointestinal stromal tumor (GIST) and made minor advances in patient care. Recent discoveries have led to an understanding of the biological role of KIT and platelet-derived growth factor receptor-α in GIST and the development of the tyrosine kinase inhibitor imatinib mesylate (Gleevec, formerly STI-571), one of the most exciting examples of targeted therapy to date. The success of targeted therapy in GIST has lead to new developments in our understanding of the medical and surgical management of the disease. Intense study of GIST may lead to new paradigms in the management of cancer.
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Affiliation(s)
- Jheri Dupart
- Department of Sarcoma Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Transcatheter arterial chemoembolization (TACE) is one of the most commonly performed procedures in interventional radiology and is currently used for the palliative treatment of primary and metastatic hepatic malignancies. A new type of TACE is TACE with drug-eluting microspheres, which is currently gaining wide acceptance worldwide. In this article, we will review some technical components, patient selection, current results, and future directions of TACE and TACE with drug-eluting microspheres for primary and metastatic liver cancer.
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KASTHURI R, CHANDRAMOHAN S. Vascular interventional radiology in oncology. IMAGING 2009. [DOI: 10.1259/imaging/12960019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Artinyan A, Nelson R, Soriano P, Chung V, Retseck J, Reynolds J, Marx H, Kim J, Wagman L. Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liver. HPB (Oxford) 2008; 10:396-404. [PMID: 19088924 PMCID: PMC2597318 DOI: 10.1080/13651820802356564] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Transcatheter arterial embolization (TAE) and chemoembolization (TACE) are increasingly used to treat unresectable primary and metastatic liver tumors. The purpose of this study was to determine the objective response to TAE and TACE in unresectable hepatic malignancies and to identify clinicopathologic predictors of response. MATERIALS AND METHODS Seventy-nine consecutive patients who underwent 119 TAE/TACE procedures between 1998 and 2006 were reviewed. The change in maximal diameter of 121 evaluable lesions in 56 patients was calculated from pre and post-procedure imaging. Response rates were determined using Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The Kaplan-Meier method was used to compare survival in responders vs. non-responders and in primary vs. metastatic histologies. RESULTS TAE and TACE resulted in a mean decrease in lesion size of 10.3%+/-1.9% (p<0.001). TACE (vs. TAE) and carcinoid tumors were associated with a greater response (p<0.05). Lesion response was not predicted by pre-treatment size, vascularity, or histology. The RECIST partial response (PR) rate was 12.3% and all partial responders were in the TACE group. Neuroendocrine tumors, and specifically carcinoid lesions, had a significantly greater PR rate (p<0.05). Overall survival, however, was not associated with histology or radiologic response. DISCUSSION TAE and TACE produce a significant objective treatment response by RECIST criteria. Response is greatest in neuroendocrine tumors and is independent of vascularity and lesion size. TACE appears to be superior to TAE. Although an association of response with improved survival was not demonstrated, large cohort studies are necessary to further define this relationship.
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Affiliation(s)
- Avo Artinyan
- Department of General Oncologic Surgery, City of Hope National Medical CenterDuarte CAUSA
| | - Rebecca Nelson
- Department of Biostatistics, City of Hope National Medical Center, Division of Information SciencesDuarte CAUSA
| | - Perry Soriano
- Department of General Oncologic Surgery, City of Hope National Medical CenterDuarte CAUSA
| | - Vincent Chung
- Department of Medical Oncology, City of Hope National Medical CenterDuarte CAUSA
| | - Janet Retseck
- Department of General Oncologic Surgery, City of Hope National Medical CenterDuarte CAUSA
| | - Jonathon Reynolds
- Department of General Oncologic Surgery, City of Hope National Medical CenterDuarte CAUSA
| | - Howard Marx
- Department of General Oncologic Surgery and Radiology, City of Hope National Medical CenterDuarte CAUSA
| | - Joseph Kim
- Department of General Oncologic Surgery, City of Hope National Medical CenterDuarte CAUSA
| | - Lawrence Wagman
- Center for Cancer Prevention and Treatment, St Joseph HospitalOrange CAUSA
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Verhoef C, de Wilt JHW, ten Hagen TLM, Eggermont AMM. Isolated hepatic perfusion for the treatment of liver tumors: sunset or sunrise? Surg Oncol Clin N Am 2008; 17:877-94, xi. [PMID: 18722924 DOI: 10.1016/j.soc.2008.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Experience with isolated hepatic perfusion (IHP) is limited to a few centers in the world because of the technical difficulties, surgery-related morbidity, and unproved efficacy in randomized trials. Experimental animal IHP models have led to exploring new ways of improving efficacy, reducing technical difficulties, and minimizing regional and systemic toxicity. Future research should be directed to the identification of suitable biologic or chemotherapeutic agents, defining clinical indications, and development of technical modifications to make it more generally applicable and even repeatable.
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Affiliation(s)
- Cornelis Verhoef
- Department of Surgical Oncology, Erasmus University Medical Centre-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
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Liapi E, Georgiades CC, Hong K, Geschwind JFH. Transcatheter arterial chemoembolization: current technique and future promise. Tech Vasc Interv Radiol 2008; 10:2-11. [PMID: 17980314 DOI: 10.1053/j.tvir.2007.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Transarterial chemoembolization is the mainstay of catheter based interventional oncologic therapies. This article describes the history of the procedure, selection of appropriate candidates, technical aspects of procedure performance, results, complications, and appropriate follow-up. In addition, the limitations and challenges of the procedure are outlined. Finally, the reader is introduced to novel and promising techniques and devices that hold future promise for transarterial therapy of malignancies.
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Affiliation(s)
- Eleni Liapi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Cardiovascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cause of all malignancies and causes approximately one million deaths each year. Surgical liver resection is the only cure for HCC; however, few patients are eligible to undergo this procedure. Hepatic artery chemoembolization (HACE) is a technique that delivers high concentrations of chemotherapeutic agents and blocks the blood supply to the liver for prolonged periods of time. HACE has demonstrated an overall increase in survival. The HACE procedure, pre- and postprocedure complications, and the care required by patients with HCC are critical for oncology nurses to understand.
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Affiliation(s)
- Bridget A Cahill
- Department of Medicine, Northwestern Medical Faculty Foundation, Chicago, IL, USA.
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Krishnan S, Lin EH, Gunn GB, Chandra A, Beddar AS, Briere TM, Das P, Delclos ME, Janjan NA, Crane CH. Conformal Radiotherapy of the Dominant Liver Metastasis. Am J Clin Oncol 2006; 29:562-7. [PMID: 17148992 DOI: 10.1097/01.coc.0000236210.41199.91] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of conformal radiotherapy (RT) of the dominant liver metastasis as palliative treatment of patients with unresectable colorectal cancer liver metastases. METHODS We retrospectively reviewed the hospital and RT records of 17 patients with unresectable colorectal liver metastases who had been treated with palliative RT to the dominant liver metastasis at our institution. RESULTS The median size of the dominant liver metastasis was 10 cm (range, 3-19 cm). Twelve patients (71%) had evidence of extrahepatic disease. A median of 2 (range, 0-4) prior chemotherapy regimens had been administered. Median radiation dose was 42 Gy (range, 7.5-72 Gy). Concurrent chemotherapy included celecoxib in 1 (6%), capecitabine in 6 (35%), and both agents in 9 (53%) patients. Frequencies of acute diarrhea, nausea, vomiting, fatigue, hand-foot syndrome, and neutropenia were 29%, 47%, 6%, 29%, 7%, and 0%, respectively (all grade 2 or lower; no grade 3 toxicities). No late toxicities were noted. With a median follow-up time of 9.2 months, the median actuarial overall survival time from RT was 12.6 months (95% confidence interval [CI]: 3.3-40.9 months). The actuarial in-field local control rate was 62% at 6 months. The median actuarial time to in-field, out-of-field hepatic and distant progression were 6.8, 3.9, and 4.1 month, respectively (95% CIs, 3.9-15.8, 1.8-6.3, and 1.8-11.5 months, respectively). CONCLUSIONS Conformal RT to the dominant liver metastasis as palliative therapy for unresectable colorectal cancer liver metastases has an acceptable toxicity profile and may improve survival. This approach merits further exploration.
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Affiliation(s)
- Sunil Krishnan
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Lewandowski RJ, Thurston KG, Goin JE, Wong CYO, Gates VL, Van Buskirk M, Geschwind JFH, Salem R. 90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol 2006; 16:1641-51. [PMID: 16371530 DOI: 10.1097/01.rvi.0000179815.44868.66] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this phase II study was to determine the safety and efficacy of TheraSphere treatment (90Y microspheres) in patients with liver-dominant colorectal metastases in whom standard therapies had failed or were judged to be inappropriate. MATERIALS AND METHODS Twenty-seven patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 135-150 Gy. Safety and toxicity were assessed according to the National Cancer Institute's Common Toxicity Criteria, version 3.0. Response was assessed with use of computed tomography (CT) and was correlated with response on [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET). Survival from first treatment was estimated with use of the Kaplan-Meier method. RESULTS Tumor response measured by FDG PET imaging exceeded that measured by CT imaging for the first (88% vs 35%) and second (73% vs 36%) treated lobes. Tumor replacement of 25% or less (vs >25%) was associated with a statistically significant increase in median survival (339 days vs 162 days; P = .002). Treatment-related toxicities included mild fatigue (n = 13; 48%), nausea (n = 4; 15%), and vague abdominal pain (n = 5; 19%). There was one case of radiation-induced gastritis from inadvertent deposition of microspheres to the gastrointestinal tract (n = 1; 4%). Three patients (11%) experienced ascites/pleural effusion after treatment with TheraSphere as a consequence of liver failure in advanced-stage metastatic disease. With the exception of these three patients whose sequelae were not considered to be related to treatment, all observed toxicities were transient and resolved without medical intervention. CONCLUSION TheraSphere administration appears to provide stabilization of liver disease with minimal toxicity in patients in whom standard systemic chemotherapy regimens have failed.
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Affiliation(s)
- Robert J Lewandowski
- Department of Radiology, Northwestern Memorial Hospital, 676 North St. Claire, Suite 800, Chicago, Illinois 60611, USA
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Czepielewski MA, Colli M, Harlos T, Silveiro SP, Maraschin J, Copette F, Leitão CB, Rollin GAFS. [Octreotide + bilateral adrenalectomy in the management of ACTH-producing carcinoid tumors]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2005; 49:791-6. [PMID: 16444362 DOI: 10.1590/s0004-27302005000500020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cushing's syndrome (CS) due to ectopic ACTH secretion has a high morbidity and mortality. Thus, rapid treatment of ectopic CS is mandatory. Carcinoid tumors associated with ectopic ACTH (CTu-ACTH) syndrome represent a more severe clinical picture, due to the carcinoid symptoms that worsen the hypercortisolism state. Management of patients with CTu-ACTH should include the control of hypercortisolism, as well as the carcinoid disturbance. We report 3 patients (2F, 1M) with CTu-ACTH (2 pancreatic, 1 occult) who presented with clinical manifestations of CS (n= 3) and carcinoid syndrome (2): 2 were initially investigated for CS and 1 carcinoid syndrome. In all hypokalemia, hypertension and diabetes mellitus were associated with severe hypercortisolism and high ACTH levels. Administration of octreotide-LAR reduced ACTH levels from 230,000 to 30,000 pg/ml in patient 1, and controlled symptoms of carcinoid syndrome and neoplasic lesions in patient 2; treatment with subcutaneous octreotide in patient 3 controlled carcinoid syndrome and partially reduced symptoms of hypercortisolism. All 3 patients were submitted to bilateral adrenalectomy to control CS. Our data show that combined anti-neoplastic therapy may contribute to the stabilization and/or definitive control of CTu-ACTH.
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Affiliation(s)
- Mauro A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, UFRGS.
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Kokudo N, Makuuchi M. Current role of portal vein embolization/hepatic artery chemoembolization. Surg Clin North Am 2004; 84:643-57. [PMID: 15062666 DOI: 10.1016/j.suc.2003.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients.
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Affiliation(s)
- Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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de Wilt JHW, van Etten B, Verhoef C, Eggermont AMM. Isolated hepatic perfusion: experimental evidence and clinical utility. Surg Clin North Am 2004; 84:627-41. [PMID: 15062665 DOI: 10.1016/s0039-6109(03)00233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many patients with tumors confined to the liver are not amenable for surgical resection, and an increasing number of these patients are treated by local ablation methods. Isolated hepatic perfusion is another treatment option especially suitable for patients with multiple or bulky primary or metastatic tumors. and can mediate clinical regression of advanced liver metastases. Experience with IHP is still limited to a few centers in the world because of its technical difficulties, surgery-related morbidity, and unproven efficacy. IHP remains an experimental modality restricted to specialized units dedicated to treating this difficult group of patients. Experimental animal IHP models have led us to explore new ways of improving efficacy, reducing technical difficulties, and minimizing regional and systemic toxicity. Future research should be directed to the identification of suitable biological or chemotherapeutic agents, defining clinical indications, and development of technical modifications to make it more generally applicable.
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Affiliation(s)
- Johannes H W de Wilt
- Erasmus MC (University Medical Center Rotterdam)-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
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Abdalla EK, Pisters PWT. Metastasectomy for limited metastases from soft tissue sarcoma. Curr Treat Options Oncol 2002; 3:497-505. [PMID: 12392639 DOI: 10.1007/s11864-002-0069-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The development of metastatic soft tissue sarcoma (American Joint Committee on Cancer stage IV) is associated with a poor prognosis. Surgical resection of isolated solitary or multiple metastases is the only curative treatment; all other forms of treatment are considered palliative. As with all surgical procedures, patient selection is important to maximize the clinical benefit of metastasectomy and to minimize the risk for treatment-related morbidity. Over the past decade, nonresectional ablative approaches have been developed to manage visceral metastatic disease. These ablative procedures include cryosurgery, radiofrequency tumor ablation, and alcohol injection. All such procedures are considered investigational; outcome should be compared to that achievable with traditional surgical metastasectomy. The optimal sequence of treatments and role for perioperative (combined with metastasectomy) chemotherapy are unknown. Given the potential curative nature of metastasectomy, all patients with metastatic soft tissue sarcoma should be evaluated for the possibility of surgical resection. Patients with good performance status who have radiographically resectable disease should be considered for metastasectomy.
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Affiliation(s)
- Eddie K Abdalla
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Box 444, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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