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Hepatocellular Carcinoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Daniel H. Palmer, Philip J. Johnson
Two small randomized trials have shown survival benefit from chemoembolization58,59 (Figure 9.5) and a meta-analysis of 7 trials, incorporating 545 patients, confirmed improved survival compared to supportive care or systemic therapy.60 The general applicability of this meta-analysis is, however, limited in view of its relatively small size, the heterogeneity of the patient populations and of the techniques used, and differences in the choice of chemotherapeutic agent, embolic agent, and the use of lipiodol. The key to successful chemoembolization is patient selection with the ideal candidate having well-preserved liver function and small tumor volume.
Pyogenic Liver Abscess
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Rajeev M. Joshi, Murtaza Dadla, Sandeep Sangale
Abscess formation is a serious complication of transarterial chemoembolization and radiofrequency ablation. Reported incidence of liver abscess following transarterial chemoembolization is 0.3–2.7%, and following radiofrequency ablation is 0.6–2.4% [4]. Incidence is high in metastatic neuroendocrine tumors and sarcomas. Time to abscess formation varies from within the first few days to up to eight weeks after transarterial chemoembolization or after radiofrequency ablation. The diagnosis may be challenging because fever can be a confounding factor – more often due to post-ablation syndrome. Percutaneous aspiration or drainage remains the treatment of choice. Prophylactic use of antibiotics, including prolonged use in high-risk patients, is recommended [4].
Pharmaceutical and Methodological Aspects of Microparticles
Published in Neville Willmott, John Daly, Microspheres and Regional Cancer Therapy, 2020
Yan Chen, Mark A. Burton, Bruce N. Gray
The greatest advantage would be obtained by a drug delivery system that not only enhanced delivery of the drug to the target organ but also prevented loss of the drug in the efferent venous drainage from that organ. Microspheres and microcapsules, collectively referred to as microparticles, have been described for delivery of active agents to target organs.1 Due to their size they are trapped in the micro-vasculature of tissues, when administered via the regional artery, where they release their drug payload. The procedure is termed chemoembolization. Microspheres are monolithic and may contain dispersed drug molecules either in solution or solid form, whereas microcapsules consist of drug concentrated in a central core inside a polymer-rich wall or shell. Figure 1 illustrates the basic structures of these two microparticles, although variations have been described.2
HGF-Based CAR-T Cells Target Hepatocellular Carcinoma Cells That Express High Levels of c-Met
Published in Immunological Investigations, 2023
Haiyan Ma, Wenwen Wei, Dandan Liang, Xing Xu, Dong Yang, Qiong Wang, Yun Wang, Quan Wei, Bin Sun, Xudong Zhao
In 2020, primary liver cancer was reportedly the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide, with hepatocellular carcinoma (HCC) accounting for the majority (75–85%) of cases (Min et al. 2022; Sung et al. 2021). Current treatment options for standard care, including resection, transplantation, local ablation for early tumors are invasive and require significant hospitalization and post-operative care. For intermediate-stage tumors, transarterial chemoembolization (TACE) is offered, while patients diagnosed with advanced tumors are treated with systemic infusion of chemotherapeutic drugs (Llovet et al. 2021). Yet, tumor recurrence after ablation or resection and progression after effective chemoembolization represent significant limitations for their effectiveness as clinical management options for HCC (Forner et al. 2018). Additionally, immunotherapies that employ immune checkpoint inhibitors (such as nivolumab and tremelimumab) show limited efficacy, with only a small proportion of HCC patients showing benefit (Greten et al. 2019). These observations highlight an urgent need for improved HCC treatments that target tumor characteristics more broadly, such as in their expression of common antigens and growth factor receptors, including the Human Growth Factor (HGF) receptor, c-Met.
Impact of Quality Control Circle on Patient Outcomes after Hepatocellular Carcinoma Intervention: A Meta-Analysis
Published in Expert Review of Anticancer Therapy, 2023
Yimin Wang, Yuerong Lai, Li Du, Wenzhen Shen
In conclusion, QCC care after HCC intervention can reduce postoperative complications such as fever, nausea and vomiting, abdominal pain, and loss of appetite, and improve patient health-related education awareness and patient satisfaction with nursing care. However, there are several limitations in our study that warrant further investigation. First, our study consisted of a China-based sample and a small sample size of the included literature. Second, due to a lack of data regarding the imbalances in baseline tumor characteristics, we were unable to assess the influence of baseline tumor characteristics in the present study. Third, there was heterogeneity in HCC interventions across the studies included in our analysis, therefore, it should be considered as a potential limitation of our study. However, interventions used in the included studies were not the focus of our analysis, therefore, it is worth noticing that our conclusions are limited to the effectiveness of QCC in improving the quality of care for patients with HCC. Finally, studies have shown that severe post-transarterial chemoembolization (post-TACE) toxicity is associated with poorer treatment outcomes and shorter overall survival in HCC patients [25]. Therefore, further controlled trials and meta-analyses are needed to address all these concerns.
Intratumoral Pi deprivation benefits chemoembolization therapy via increased accumulation of intracellular doxorubicin
Published in Drug Delivery, 2022
Yang-Feng Lv, Zhi-Qiang Deng, Qiu-Chen Bi, Jian-Jun Tang, Hong Chen, Chuan-Sheng Xie, Qing-Rong Liang, Yu-Hua Xu, Rong-Guang Luo, Qun Tang
The conventional method used to downregulate the expression of ABC transporters and reverse drug resistance in HCC is to introduce novel drugs, including cantharidin, glycyrrhizin and lamivudine, resveratrol and levistolide (Wakamatsu et al., 2007; Zheng et al., 2008; Kim et al., 2014; Ding et al., 2019). Our investigation was undertaken to resolve this unsettled issue by utilizing the local-regional technique to change the tumor chemo-environment. We try to address drug resistance by a subtraction strategy, instead of through addition as is normally done. Since chemoembolization therapy temporarily cuts off the blood supply from the artery, the tumor is isolated for a longer or shorter time, depending on the different embolic agents. This isolation starves cancer cells from nutrients and oxygen, thereby changing the tumor chemical microenvironment for some time and inducing features such as severe hypoxia, which is considered a critical promoter of tumor recurrence and drug resistance (Petrillo et al., 2018; Bao & Wong, 2021). The advantage is that the embolotherapy technique can also be utilized to create a new chemical environment, such as through inducing Pi starvation. In this particular chemo-microenvironment of low Pi stress, the relationship between Pi starvation, the amount of DOX retention, and the tumor necrosis ratio was evidenced.