Background Radiofrequency ablation （RFA） followed by transarterial chemoembolization （TACE） for unresectable primary liver cancer （PLC） has not been widely discussed. In this study, the outcome of the combinatio...Background Radiofrequency ablation （RFA） followed by transarterial chemoembolization （TACE） for unresectable primary liver cancer （PLC） has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated. Methods From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4＋8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small （〈3.0 cm）, 33 with medium （3.1-5.0 cm）, and 68 with large （〉5.0 cm） tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later. Results Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 （13.5%） cases, by laparoscopic approach in 19 （15.7%）, and through laparotomy in the remaining 92 （72.4%）. RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model. Conclusion RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicatinq the peripheral viable tissue and micro-metastasis.展开更多
Purpose:To present the early results of pirarubicin-eluting microsphere transarterial chemoembolization(PETACE)for patients with unresectable hepatocellular carcinoma(HCC).Materials and methods:We retrospectively anal...Purpose:To present the early results of pirarubicin-eluting microsphere transarterial chemoembolization(PETACE)for patients with unresectable hepatocellular carcinoma(HCC).Materials and methods:We retrospectively analyzed 55 consecutive patients with HCC who received PE-TACE between April 1,2015 and August 30,2016.The complication rate,tumor response rate,progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Adverse events were generally mild and included abdominal pain and fever,although a major complication was reported in 1 patient(1.8%).During a median follow-up of 10.0 months(range,3.0-24.0 months),14 patients(25.5%)achieved a complete tumor response,25(45.5%)had a partial response,9(16.4%)showed stable disease,and 7(12.7%)had disease progression.The 1-month overall response rate was 70.9%,and the local tumor response rate was 89.0%.The 1-month tumor response rate was 100%for Barcelona Clinic Liver Cancer(BCLC)stage A or B disease and 62.8%for BCLC stage C disease.The median PFS was 6.1 months(95%confidence interval[95%CI],3.4-8.8 months;range,1.0-24.0 months).The median OS was 11.0 months(95%CI,7.1-14.9 months;range,2.0-24.0 months).Kaplan-Meier analysis(log-rank test)found significant differences in OS between patients grouped by tumor number(P=0.006),tumor size(P=0.035),and Eastern Cooperative Oncology Group(ECOG)score(P=0.005).The tumor number(1 vs.>2)was the only factor independently associated with OS(hazard ratio[HR],2.867;95%CI,1.330-6.181;P=0.007).Conclusions:PE-TACE for unresectable HCC may be safe,with favorable tumor response rates and survival time,especially in patients with a single large tumor.Longer follow-up using a larger series is necessary to confirm these preliminary results.展开更多
Objective: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepato- cellular carcinoma (HCC). Methods: Of 126 patients with resecta...Objective: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepato- cellular carcinoma (HCC). Methods: Of 126 patients with resectable HCC, 62 received preoperative TACE (TACE group) and the remaining 64 patients were selected as controls (non- TACE group). Perioperative risk factors including liver function alteration, mean blood loss during op- eration, mean time of clamping the porta hepatis, length of operation, postoperative abdominal drain- age at day 1, 2 and 3, morbidity and mortality were compared between the two groups. Results: Neither significant difference in liver func- tion alteration nor mortality was observed between the two groups. More severe hepatic cirrhosis, lon- ger operation time, more blood loss and postopera- tive abdominal drainage were noted in the TACE group than in the non-TACE group. There was no significant difference in postoperative morbidity be- tween the two groups. Conclusions: Preoperative TACE for resectable HCC increases surgical difficulty and risk, and therefore should be considered prudently according to the indi- viduality of patients.展开更多
Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are c...Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are clinically silent until late presentation with major effects. Initial treatment aims to control carcinoid syndrome with somatostatin analogs. Even if there is metastatic spread, surgical resection of the primitive tumor should be discussed in cases of retractile mesenteritis, small bowel ischemia or subocclusive syndrome in order to avoid any acute complication, in particular at the beginning of somatostatin analog treatment. The choice of treatment depends on the symptoms, general health of the patient, tumor burden, degree of uptake of radionuclide, histological features of the tumor, and tumor growth. Management strategies include surgery for cure (which is rarely achieved) or for cytoreduction, radiological interventions (transarterial embolization or radiofrequency ablation), and chemotherapy (interferon and somatostatin analogs). New biological agent and radionuclide targeted therapies are under investigation. Diffuse and non-evolving lesions should also be simplymonitored. Finally, it has to be emphasized that it is of the utmost importance to enroll these patients with a rare disease in prospective clinical trials assessing new therapeutic strategies.展开更多
基金This research was supported by a grant from the National Natural Science Foundation of China （No. 30772122）.
文摘Background Radiofrequency ablation （RFA） followed by transarterial chemoembolization （TACE） for unresectable primary liver cancer （PLC） has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated. Methods From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4＋8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small （〈3.0 cm）, 33 with medium （3.1-5.0 cm）, and 68 with large （〉5.0 cm） tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later. Results Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 （13.5%） cases, by laparoscopic approach in 19 （15.7%）, and through laparotomy in the remaining 92 （72.4%）. RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model. Conclusion RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicatinq the peripheral viable tissue and micro-metastasis.
文摘Purpose:To present the early results of pirarubicin-eluting microsphere transarterial chemoembolization(PETACE)for patients with unresectable hepatocellular carcinoma(HCC).Materials and methods:We retrospectively analyzed 55 consecutive patients with HCC who received PE-TACE between April 1,2015 and August 30,2016.The complication rate,tumor response rate,progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Adverse events were generally mild and included abdominal pain and fever,although a major complication was reported in 1 patient(1.8%).During a median follow-up of 10.0 months(range,3.0-24.0 months),14 patients(25.5%)achieved a complete tumor response,25(45.5%)had a partial response,9(16.4%)showed stable disease,and 7(12.7%)had disease progression.The 1-month overall response rate was 70.9%,and the local tumor response rate was 89.0%.The 1-month tumor response rate was 100%for Barcelona Clinic Liver Cancer(BCLC)stage A or B disease and 62.8%for BCLC stage C disease.The median PFS was 6.1 months(95%confidence interval[95%CI],3.4-8.8 months;range,1.0-24.0 months).The median OS was 11.0 months(95%CI,7.1-14.9 months;range,2.0-24.0 months).Kaplan-Meier analysis(log-rank test)found significant differences in OS between patients grouped by tumor number(P=0.006),tumor size(P=0.035),and Eastern Cooperative Oncology Group(ECOG)score(P=0.005).The tumor number(1 vs.>2)was the only factor independently associated with OS(hazard ratio[HR],2.867;95%CI,1.330-6.181;P=0.007).Conclusions:PE-TACE for unresectable HCC may be safe,with favorable tumor response rates and survival time,especially in patients with a single large tumor.Longer follow-up using a larger series is necessary to confirm these preliminary results.
文摘Objective: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepato- cellular carcinoma (HCC). Methods: Of 126 patients with resectable HCC, 62 received preoperative TACE (TACE group) and the remaining 64 patients were selected as controls (non- TACE group). Perioperative risk factors including liver function alteration, mean blood loss during op- eration, mean time of clamping the porta hepatis, length of operation, postoperative abdominal drain- age at day 1, 2 and 3, morbidity and mortality were compared between the two groups. Results: Neither significant difference in liver func- tion alteration nor mortality was observed between the two groups. More severe hepatic cirrhosis, lon- ger operation time, more blood loss and postopera- tive abdominal drainage were noted in the TACE group than in the non-TACE group. There was no significant difference in postoperative morbidity be- tween the two groups. Conclusions: Preoperative TACE for resectable HCC increases surgical difficulty and risk, and therefore should be considered prudently according to the indi- viduality of patients.
文摘Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are clinically silent until late presentation with major effects. Initial treatment aims to control carcinoid syndrome with somatostatin analogs. Even if there is metastatic spread, surgical resection of the primitive tumor should be discussed in cases of retractile mesenteritis, small bowel ischemia or subocclusive syndrome in order to avoid any acute complication, in particular at the beginning of somatostatin analog treatment. The choice of treatment depends on the symptoms, general health of the patient, tumor burden, degree of uptake of radionuclide, histological features of the tumor, and tumor growth. Management strategies include surgery for cure (which is rarely achieved) or for cytoreduction, radiological interventions (transarterial embolization or radiofrequency ablation), and chemotherapy (interferon and somatostatin analogs). New biological agent and radionuclide targeted therapies are under investigation. Diffuse and non-evolving lesions should also be simplymonitored. Finally, it has to be emphasized that it is of the utmost importance to enroll these patients with a rare disease in prospective clinical trials assessing new therapeutic strategies.
