Transarterial chemoembolization(TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma(HCC), preserved liver function, absence of cancer-related symptoms and no evidence...Transarterial chemoembolization(TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma(HCC), preserved liver function, absence of cancer-related symptoms and no evidence of vascular invasion or extrahepatic spread(i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer staging system). The rationale for TACE is that the intra-arterial injection of a chemotherapeutic drug such as doxorubicin or cisplatin followed by embolization of the blood vessel will result in a strong cytotoxic effect enhanced by ischemia. However, TACE is a very heterogeneous operative technique and varies in terms of chemotherapeutic agents, treatment devices and schedule. In order to overcome the major drawbacks of conventional TACE(c TACE), non-resorbable drug-eluting beads(DEBs) loaded with cytotoxic drugs have been developed. DEBs are able to slowly release the drug upon injection and increase the intensity and duration of ischemia while enhancing the drug delivery to the tumor. Unfortunately, despite the theoretical advantages of this new device and the promising results of the pivotal studies, definitive data in favor of its superiority over c TACE are still lacking. The recommendation for TACE as the standard-of-care for intermediate-stage HCC is based on the demonstration of improved survival compared with best supportive care or suboptimal therapies in a meta-analysis of six randomized controlled trials, but other therapeutic options(namely, surgery and radioembolization) proved competitive in selected subsets of intermediate HCC patients. Other potential fields of application of TACE in hepato-oncology are the pre-transplant setting(as downstaging/bridging treatment) and the early stage(in patients unsuitable to curative therapy). The potential of TACE in selectedadvanced patients with segmental portal vein thrombosis and preserved liver function deserves further reports.展开更多
Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent drop...Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.展开更多
Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrenc...Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain high.In contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC.Herein,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.展开更多
Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastati...Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities(i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.展开更多
目的三阴性乳腺癌(Triple Negative Breast Cancer,TNBC)是难治性的恶性肿瘤。纳秒脉冲电场(Nanosecond Pulsed Electric Field,nsPEF)是一种新型的局部消融方法,适用于浅表肿瘤的治疗。本研究旨在探究nsPEF消融小鼠TNBC的合适场强,并...目的三阴性乳腺癌(Triple Negative Breast Cancer,TNBC)是难治性的恶性肿瘤。纳秒脉冲电场(Nanosecond Pulsed Electric Field,nsPEF)是一种新型的局部消融方法,适用于浅表肿瘤的治疗。本研究旨在探究nsPEF消融小鼠TNBC的合适场强,并验证其治疗效果。方法分别利用0、20、30 kV/cm的场强进行小鼠4T1肿瘤消融细胞凋亡的研究,并探究免疫细胞浸润的情况。结果30 kV/cm场强组肿瘤完全消融率达54.5%,脉冲后0 h和24 h肿瘤细胞总体凋亡率分别为74.0%、34.8%。CD8^(+)和CD4^(+)T细胞主要位于对照组肿瘤边缘,脉冲后肿瘤内部浸润增加,特别是在消融边界区。结论30 kV/cm的场强可有效消融小鼠TNBC,nsPEF促进免疫细胞向肿瘤内部浸润。展开更多
Background:Although radiofrequency ablation(RFA)is a minimally invasive treatment for early-stage hepatocellular carcinoma(HCC),it remains unclear whether RFA achieves favorable outcomes in pa-tients aged≥80 years.Th...Background:Although radiofrequency ablation(RFA)is a minimally invasive treatment for early-stage hepatocellular carcinoma(HCC),it remains unclear whether RFA achieves favorable outcomes in pa-tients aged≥80 years.This study aimed to determine the efficacy and safety of RFA for HCC in patients aged≥80 years.Methods:A total of 512 naïve patients with HCC who had undergone RFA from January 2001 to December 2016 were enrolled.They were categorized into the≥80-year-old group and the control group(aged<80 years).The primary endpoint was overall survival(OS),and the secondary endpoints were recurrence-free survival,complications associated with RFA,and cause of death.Propensity score matching was performed to adjust for patients’sex,liver function,tumor number,tumor diameter,and hepatitis C virus infection.Finally,the data of 68 patients in the≥80-year-old group and 68 in the control group were analyzed;their baseline characteristics,primary endpoint,and secondary endpoints were compared.Results:There were significant differences in the alanine aminotransferase level and prothrombin time between the groups.The cumulative OS rate was not significantly different between the groups(P=0.83):98.5%,87.9%,and 50.5%in the≥80-year-old group and 94.1%,72.8%,and 49.3%in the control group at 1,3,and 5 years,respectively.Age≥80 years was not significantly associated with OS in multivariate analyses.Liver-related death occurred in 17 patients in the≥80 year-old group and in 16 patients in the control group(P=1.00).Conclusions:RFA is safe and effective for the treatment of patients with HCC aged≥80 years.展开更多
Hepatocellular carcinoma(HCC)was the sixth most common cancer and the third cause of cancer-related deaths worldwide in 2020.Liver resection and transplantation remain the cornerstone for patients with early-stage dis...Hepatocellular carcinoma(HCC)was the sixth most common cancer and the third cause of cancer-related deaths worldwide in 2020.Liver resection and transplantation remain the cornerstone for patients with early-stage disease and represent the only option for potential cure in HCC.However,fewer than 10%of patients are considered suitable for surgery at the time of diagnosis.Locoregional therapies,defined as minimally invasive image-guided liver tumour-directed procedures,are integral to in the management of HCC.This review discusses the role of locoregional therapies in HCC management in the emergence of immune and systemic treatments.展开更多
文摘Transarterial chemoembolization(TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma(HCC), preserved liver function, absence of cancer-related symptoms and no evidence of vascular invasion or extrahepatic spread(i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer staging system). The rationale for TACE is that the intra-arterial injection of a chemotherapeutic drug such as doxorubicin or cisplatin followed by embolization of the blood vessel will result in a strong cytotoxic effect enhanced by ischemia. However, TACE is a very heterogeneous operative technique and varies in terms of chemotherapeutic agents, treatment devices and schedule. In order to overcome the major drawbacks of conventional TACE(c TACE), non-resorbable drug-eluting beads(DEBs) loaded with cytotoxic drugs have been developed. DEBs are able to slowly release the drug upon injection and increase the intensity and duration of ischemia while enhancing the drug delivery to the tumor. Unfortunately, despite the theoretical advantages of this new device and the promising results of the pivotal studies, definitive data in favor of its superiority over c TACE are still lacking. The recommendation for TACE as the standard-of-care for intermediate-stage HCC is based on the demonstration of improved survival compared with best supportive care or suboptimal therapies in a meta-analysis of six randomized controlled trials, but other therapeutic options(namely, surgery and radioembolization) proved competitive in selected subsets of intermediate HCC patients. Other potential fields of application of TACE in hepato-oncology are the pre-transplant setting(as downstaging/bridging treatment) and the early stage(in patients unsuitable to curative therapy). The potential of TACE in selectedadvanced patients with segmental portal vein thrombosis and preserved liver function deserves further reports.
文摘Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.
文摘Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain high.In contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC.Herein,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.
文摘Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities(i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.
文摘Background:Although radiofrequency ablation(RFA)is a minimally invasive treatment for early-stage hepatocellular carcinoma(HCC),it remains unclear whether RFA achieves favorable outcomes in pa-tients aged≥80 years.This study aimed to determine the efficacy and safety of RFA for HCC in patients aged≥80 years.Methods:A total of 512 naïve patients with HCC who had undergone RFA from January 2001 to December 2016 were enrolled.They were categorized into the≥80-year-old group and the control group(aged<80 years).The primary endpoint was overall survival(OS),and the secondary endpoints were recurrence-free survival,complications associated with RFA,and cause of death.Propensity score matching was performed to adjust for patients’sex,liver function,tumor number,tumor diameter,and hepatitis C virus infection.Finally,the data of 68 patients in the≥80-year-old group and 68 in the control group were analyzed;their baseline characteristics,primary endpoint,and secondary endpoints were compared.Results:There were significant differences in the alanine aminotransferase level and prothrombin time between the groups.The cumulative OS rate was not significantly different between the groups(P=0.83):98.5%,87.9%,and 50.5%in the≥80-year-old group and 94.1%,72.8%,and 49.3%in the control group at 1,3,and 5 years,respectively.Age≥80 years was not significantly associated with OS in multivariate analyses.Liver-related death occurred in 17 patients in the≥80 year-old group and in 16 patients in the control group(P=1.00).Conclusions:RFA is safe and effective for the treatment of patients with HCC aged≥80 years.
文摘Hepatocellular carcinoma(HCC)was the sixth most common cancer and the third cause of cancer-related deaths worldwide in 2020.Liver resection and transplantation remain the cornerstone for patients with early-stage disease and represent the only option for potential cure in HCC.However,fewer than 10%of patients are considered suitable for surgery at the time of diagnosis.Locoregional therapies,defined as minimally invasive image-guided liver tumour-directed procedures,are integral to in the management of HCC.This review discusses the role of locoregional therapies in HCC management in the emergence of immune and systemic treatments.
