China
Africa
Explore chapters and articles related to this topic
Abdominal Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Methotrexate treatment may be administered on a case-by-case basis. As an adjuvant, methotrexate may be needed in the event that hCG levels continue to increase after the laparoscopic procedure to ensure systemic eradication of the trophoblast [22]. Treatment with preoperative systemic methotrexate with a subsequent surgical procedure would be a reasonable approach in the care of a patient with an abdominal pregnancy with placental implantation to the abdominal viscera and blood vessels. If the placenta is attached to vital organs, it should be left in situ for absorption or second surgery [8]. When the pregnancy was only partially removed because of deep implantation into the parenchyma of viscera, transcatheter arterial chemoembolization of the feeding artery with a methotrexate lipiodol emulsion can be performed to control bleeding before or after surgery.
Biliary Tract Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Hemant M. Kocher, Vincent S. Yip, Ajit T. Abraham
Photodynamic therapy (PDT) involves the intravenous administration of a photosensitizer such as sodium porfimer, which localizes preferentially in tumor tissue over 24–48 hours. Subsequent endoscopic laser illumination of the tumor bed with a specific wavelength of light activates the porfimer, generating oxygen free radicals and causing cancer-cell death. One prospective randomized trial of 39 patients comparing stenting plus PDT vs. stenting alone showed increased median survival (493 vs. 98 days), improved stabilization of Karnofsky performance status, less cholestasis, and better quality of life scores.97 But the larger UK Photostent-02 trial with 92 patients showed a shorter overall survival with PDT plus stenting compared to stenting alone (6.2 vs. 9.8 months; HR, 1.56; p = 0.048). Fewer patients (20%) in the PDT/stenting arm received subsequent chemotherapy than in the stenting alone arm (41%). Although overall survival was significantly improved among those who had chemotherapy compared with those who did not, adjusting for this does not completely explain the excess risk from PDT.98 Other local ablation strategies such as radiofrequency ablation and ethanol injection are unproven. Loco-regional therapies such as irreversible electroporation, transcatheter arterial chemoembolization, and radioembolization with91 Y microspheres need further evaluation with randomized trials.
Stomach, Duodenum, Liver, and Central Hepatobiliary Tract
Published in Tiziana Rancati, Claudio Fiorino, Modelling Radiotherapy Side Effects, 2019
Giovanni Mauro Cattaneo, Livia Marrazzo
In a dose escalation study (Ren et al. 2011), 40 HCC CP Class (CPC)-A patients were assigned to two subgroups based on tumor diameter (<10 cm or ≥10 cm). Radiotherapy was combined with transcatheter arterial chemoembolization (TCA). Escalation was achieved by increments of 4 Gy starting from 46 Gy (2 Gy/fraction). Dose-limiting toxicity was defined as the development of grade ≥ 3 acute hepatic or gastrointestinal toxicity or any grade 5 treatment-related adverse event during irradiation or RILD within 4 months after irradiation. In the group of patients with tumor diameter ≥10 cm, 1 patient receiving 52 Gy developed RILD. The patient’s uninvolved normal liver volume was 827 cm3 and the mean dose to normal liver was 13 Gy. Toxicity depended more on liver baseline function than dosimetry parameters.
Long-term efficacy of microwave ablation in the treatment of subcapsular hepatocellular carcinomas of ≤3 cm in diameter: a multicenter, propensity score-matched study
Published in International Journal of Hyperthermia, 2022
Jundong Yao, Binbin Liu, Xiaohui Wang, Jie Yu, Zhigang Cheng, Zhiyu Han, Fangyi Liu, Rongqin Zheng, Wen Cheng, Qiang Wei, Songyuan Yu, Kai Li, Peng Chen, Yanchun Luo, Xiaoling Yu, Ping Liang
We used data from a multicenter database, which included the Chinese PLA General Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Harbin Medical University Cancer Hospital, the Second Affiliated Hospital of Nanjing University of Chinese Medicine, and Wuhan University of Science and Technology Tianyou Hospital. From January 2012 to December 2018, a total of 430 patients (532 lesions) with HCCs who underwent MWA were screened out. The diagnosis of HCC was based on needle biopsy (n = 293) or typical imaging features (n = 137). The inclusion criteria were as follows: (a) number of nodules of ≤3 and diameter of ≤3 cm, (b) Child-Pugh grade of A or B, (c) initial onset of HCC, and (d) perioperative laboratory test results that met the surgical standards. The exclusion criteria were as follows: (a) vascular and/or bile duct invasion on imaging, (b) preoperative chemotherapy and/or transcatheter arterial chemoembolization (TACE), (c) history of liver transplantation, (d) extrahepatic metastasis, (e) history of other organ malignancies, (f) tumor adjacent to large blood vessels and/or hila, (g) presence of both subcapsular and non-subcapsular tumors, and (h) incomplete data. A subcapsular location was defined as location of a tumor within 5 mm of the liver capsule. According to the tumor location, the patients were divided into subcapsular (n = 143) and non-subcapsular (n = 287) groups (Figure 1).
The Preoperative Prognostic Nutritional Index in Hepatocellular Carcinoma After Curative Hepatectomy: A Retrospective Cohort Study and Meta-Analysis
Published in Journal of Investigative Surgery, 2021
Xiaoxiao Fan, Guoqiao Chen, Yirun Li, Zhaoqi Shi, Lifeng He, Daizhan Zhou, Hui Lin
Before carrying out curative hepatectomy, HCC patients were fully assessed. According to Child-Pugh grade, there were 181 patients for grade A. The rest six HCC patients of grade B were changed to grade A after conservative treatment. The data in our study were collected before nutritional interventional approaches. The definition of curative hepatectomy is R0 hepatectomy [17]. The ways of follow-up in this study were outpatient examination and telephone interview. The routine evaluated measurements, including abdominal enhanced CT and serum AFP, were performed to monitor the incidence of recurrence. At the first year after curative hepatectomy, the time of follow-up was every three months, and then six months thereafter. Routinely, patients with recurrence would receive transcatheter arterial chemoembolization (TACE) or other salvage treatments. The final time of follow-up for patients was in February 2018 and the median was 23 months (range from 1 to 60).
Risk factors of intrahepatic biloma and secondary infection after thermal ablation for malignant hepatic tumors
Published in International Journal of Hyperthermia, 2019
Jia Liu, Yuxuan Wu, Erjiao Xu, Qiannan Huang, Huolin Ye, Lei Tan, Rongqin Zheng, Qingjing Zeng, Kai Li
Between January 2010 and December 2018, a total of 2772 ultrasound-guided thermal ablations were performed for patients with liver tumors in the Third Affiliated Hospital of Sun Yat-Sen University (Guangzhou, People’s Republic of China). The inclusion criteria used to select patients were as follow: (1) clinically or pathologically diagnosed with malignant hepatic tumors; (2) receiving radical radiofrequency ablation (RFA) or microwave ablation (MWA) treatment; and (3) undergone follow-up for >6 months. The exclusion criteria were as follows: (1) follow-up period of <6 months and (2) bile duct injury induced by other treatment before thermal ablation, such as transcatheter arterial chemoembolization (TACE). The criteria used for diagnosing bile duct injury were the observation of upstream bile duct dilatation, because of bile duct stenosis after thermal ablation, and the formation of a biloma. In addition, the time interval between the most recent RFA and TACE should have been more than 3 months [5].