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Regional Therapy of Liver Metastases: A Surgeon’s View
Published in Neville Willmott, John Daly, Microspheres and Regional Cancer Therapy, 2020
In the only phase III prospective randomized trial published to date,109 61 patients were randomized to one of three groups: 20 control patients received no treatment, 22 patients received hepatic artery embolization with lyophilized dura mater, and 19 patients received hepatic artery infusions of 5-FU (Chapter 6) and DSM. Treatment in this latter group consisted of four daily, consecutive injections initially containing 500 mg 5-FU mixed with 900 mg DSM every 28 days. In each subsequent session the patient received two injections every 28 days. In these sessions the dose of DSM varied from 300 to 900 mg according to an amount determined for each individual patient. Hepatic artery embolization showed no survival benefit when compared with controls; however, there did appear to be some survival benefit with the third group receiving 5-FU and DSM, although this did not reach statistical significance. When the patient population was broken down into subgroups, the longest median survival was seen in a subgroup with smallest tumor burden (<50% hepatic replacement at presentation), a situation in which extrahepatic metastases should not be the sole determinant of survival: controls, 10 months; hepatic artery embolization, 10.2 months; and 5-FU + DSM, 23.6 months.
Gastrointestinal cancer
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Justin S Waters, David Cunningham
Hepatocellular carcinoma is a common disease worldwide but its incidence in Europe and the USA is low. Systemic chemotherapy has proved largely ineffective in inducing tumour remissions, or in prolonging survival of patients with inoperable disease. In contrast, a variety of regional therapies have been used successfully to reduce the mass of tumours confined to the liver; however, the impact of such treatment on survival is not established. Liver tumours derive the majority of their blood supply from the hepatic artery, whereas normal liver parenchyma is supplied mostly by the portal vein. This provides the rationale for two strategies: Intrahepatic arterial chemotherapy, andSelective hepatic artery embolization.
Hepatic tumors
Published in Prem Puri, Newborn Surgery, 2017
Benjamin A. Farber, William J. Hammond, Michael P. La Quaglia
Liver resections for hemangiomas have declined with better understanding of the biologic behavior of these tumors, improvements in pharmacotherapy, advances in endovascular techniques, and better pediatric intensive care. Reports have argued for surgery to be a last recourse after pharmacotherapy for the tumor, medical management of CHF, and endovascular interventions have all failed to achieve symptomatic control and tumor regression.11,30,31 Kassarjian et al.30 reported a series of 15 patients managed with endovascular interventions with one death in a patient who had diffuse liver hemangioma, severe CHF, and hypothyroidism. Dickie et al.11 reported a series of 16 patients with no mortality and only 2 patients who required surgery (a left lobectomy and an orthotopic liver transplant). In contrast, Moon et al. have employed hepatic resection as a primary treatment modality for solitary, resectable, and symptomatic lesions. They used hepatic artery embolization as a second line of treatment, with one death from postoperative hemorrhage among nine patients who underwent surgery. Surgery and open biopsy are also indicated when a distinction cannot be made between a HB and a hemangioma.25
Novel and emerging targets for cholangiocarcinoma progression: therapeutic implications
Published in Expert Opinion on Therapeutic Targets, 2022
Lionel A. Kankeu Fonkoua, Pedro Luiz Serrano Uson Junior, Kabir Mody, Amit Mahipal, Mitesh J. Borad, Lewis R. Roberts
The management of CCA can be complex and often requires a multidisciplinary evaluation taking into account disease- (location, extent, and vascular involvement) and patient-related (ECOG performance status, comorbidities, and personal goals) factors, as well as provider/center expertise. Surgical resection or liver transplant are the only curative modalities for CCA but are restricted to patients with early-stage disease. Unfortunately, the majority of patients have locally advanced or metastatic disease at diagnosis, and are ineligible for these potentially curative therapies. For patients with unresectable locally advanced but non-metastatic CCA, locoregional therapies including bland hepatic artery embolization, transarterial radioembolization, stereotactic body radiation therapy or proton beam therapy may have utility in achieving at least partial tumor control and extending survival. However, eventually, CCAs almost always progress locally or become metastatic. For patients with progressive and metastatic disease, palliative chemotherapy and targeted therapy are the only treatment options, but survival outcomes remain dismal with an overall 5-year survival of less than 5%[51]. Thus, there is an unmet need for novel therapies for patients with incurable stage CCA.
Long-term outcomes of ultrasound-guided percutaneous microwave ablation versus resection for colorectal cancer liver metastases: a propensity-score matched study
Published in International Journal of Hyperthermia, 2021
Zhe Huang, YongLong Pan, PingPing Zhou, ShanShan Li, Kaiyan Li
Studies have reported that the size of metastatic lesions has little effect on the survival of patients with CRCLM [16]. Our study found that for CRCLM lesions ≥3 cm in diameter, the long-term survival rate was higher in the resection group than in the ultrasound-guided PMWA group. This was because ensuring the ablation effect on lesions with a diameter of ≥3 cm is difficult [17]. In addition, for lesions with a diameter of ≥3 cm, multiple overlapping ablation strategies are often required, and some residual tumor cells may persist. In our study, the proportion of patients with a margin size of <5 mm in the PMWA group was greater than that in the resection group (43/68 vs. 21/43), especially for tumors >3 cm (29/30 vs. 17/33). The LTPFS of the PMWA group was shorter, which is in line with previous research [12,18]. Thus, the therapeutic effect of ultrasound-guided PMWA is lower than that of surgical treatment. Furthermore, a large tumor volume is associated with greater tumor burden, higher probability of distant metastasis, and worse prognosis. Thus, hepatic artery embolization chemotherapy combined with ultrasound-guided PMWA therapy or multiple needle ablation may be considered. Bland embolization and radiofrequency thermal ablation within the same session have proven to be an effective and safe treatment [19]. Expanding the range of ablation could further improve patient prognosis [20].
Development of cisplatin-loaded hydrogels for trans-portal vein chemoembolization in an orthotopic liver cancer mouse model
Published in Drug Delivery, 2021
Xinxiang Yang, Wai-Ho Oscar Yeung, Kel Vin Tan, Tak-Pan Kevin Ng, Li Pang, Jie Zhou, Jinyang Li, Changxian Li, Xiangcheng Li, Chung Mau Lo, Weiyuan John Kao, Kwan Man
Primary liver cancer in China accounts for half of the total global cases, in which 70–90% are hepatocellular carcinoma (HCC) (Torre et al., 2016). Transarterial chemoembolization (TACE) remains a standard treatment for intermediate stage HCC and one of the primary choices for downstaging of advanced HCC before liver resection or transplantation (Otto et al., 2013; Sieghart et al., 2015). In conventional TACE, chemotherapeutic agents emulsified with radiopaque Lipiodol are injected through the hepatic artery followed by an embolic particle (Raoul et al., 2019). Chemotherapeutic agents exert a locoregional cytotoxicity against tumor growth and the hepatic artery embolization result in ischemic effects on tumor growth (Golfieri et al., 2011; Lewis & Dreher, 2012). This ability ensures local delivery of chemotherapeutic agents to some extent, thus reducing the undesired systemic side effects and preserving the liver remnant. Lipiodol-based TACE is generally tolerated in most cases, although 4–7% patients undertake major complications (e.g. hepatic abscess, infarction and pulmonary embolism) with near 1% mortality in one month (Liapi & Geschwind, 2011). The survival benefit has been controversial for inconsistent and unstable therapeutic efficacy of TACE (Lencioni et al., 2012; Idee & Guiu, 2013). Such deficit leads to our study to explore the use of biofunctional biomaterials as a novel chemoembolization alternative.