RESUMEN

BACKGROUND: Portal vein tumor thrombus (PVTT) is common in hepatocellular carcinoma (HCC). Recent studies indicate that more aggressive treatments, including surgical resection or locoregional treatment, may benefit selected HCC patients with PVTT. External radiation therapy and infusion chemotherapy were found to achieve good outcomes; however, the use of low-energy x-ray radiation system (INTRABEAM), intraoperative radiation therapy, and portal vein infusion chemotherapy for PVTT has not been reported. We present a case of HCC with PVTT. The patient underwent hemihepatectomy and thrombectomy along with intraoperative radiotherapy (IORT) using a portable INTRABEAM radiation system. Subsequently, to treat PVTT, portal vein infusion chemotherapy with FOLFOX (leucovorin [Folinic acid], fluorouracil, and oxaliplatin) regimen was administered. There were no obvious post-operative complications. After 20 months follow-up period, no obvious tumor recurrence had been observed, and PVTT gradually disappeared completely. CONCLUSIONS: IORT using the INTRABEAM radiation system combined with portal vein infusion chemotherapy is promising for select patients with PVTT.

Asunto(s)

Carcinoma Hepatocelular , Neoplasias Hepáticas , Vena Porta , Trombosis de la Vena/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/terapia , Terapia Combinada , Fluorouracilo/uso terapéutico , Hepatectomía , Humanos , Cuidados Intraoperatorios , Leucovorina/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/terapia , Masculino , Compuestos Organoplatinos/uso terapéutico , Radioterapia Adyuvante , Estudios Retrospectivos , Trombectomía , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/radioterapia , Trombosis de la Vena/cirugía

RESUMEN

BACKGROUND: This study aims to evaluate the effectiveness of hepatic arterial infusion chemotherapy/portal vein infusion chemotherapy (HAIC/PVIC), transcatheter hepatic arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE) for unresectable breast cancer liver metastases (UBCLM). METHODS: The present study included 57 patients. These patients were randomly divided into three groups (n=19, each): HAIC/PVIC group, TACE group and TAE group. Patients in the HAIC/PVIC group were treated with the same systemic chemotherapy regimen previously received by infusion through an intra-arterial and portal vein catheter. Patients in the TACE group received cyclophosphamide, epirubicin and 5-fluorouracil, and embolization. Patients in the TAE group were only treated with embolization. RESULTS: The median number of treatments was 6 (range, 3-13) in the HAIC/PVIC group, 5 (range, 4-9) in the TACE group, and 6 (range, 4-8) in the TAE group. The 1-, 2- and 3-year survival rates for these groups were 18/19 (94.7%), 14/19 (73.7%) and 11/19 (57.9%), 14/19 (73.7%), 9/19 (47.4%) and 8/19 (42.1%), and 8/19 (42.1%), 4/19 (21.1%) and 0/19 (0%), respectively. The median overall survival from the original breast cancer diagnosis was 88 (range, 11-133), 75 (range, 9-115), and 49 (range, 10-64) months in the HAIC/PVIC, TACE and TAE groups, respectively. Grade I-II and grade III-IV bone marrow suppression was observed in 12/19 (63.2%) and 3/19 (15.8%) patients in the HAIC/PVIC group, respectively, in 17/19 (89.5%) and 5/19 (26.3%) patients in the TACE group, respectively, and in 0/19 (0%) and 0/19 (0%) patients in the TAE group, respectively. CONCLUSIONS: HAIC/PVIC with the same regional chemotherapy regimen of the original systemic treatment is feasible, and can benefit patients with UBCLM, who have progressed on prior systemic therapies.

RESUMEN

Pancreatic ductal adenocarcinoma (PDAC) continues to have the poorest prognosis of all gastrointestinal malignancies, even after the tumor has been completely resected. However, only a proportion of patients achieve 5-year survival after resection. The factors predictive of achieving 5-year survival remain unclear. The aim of this study was to investigate the pre- and postoperative clinicopathological characteristics of PDAC patients with a >5-year survival after curative resection. We retrospectively reviewed patients who underwent pancreatectomy for PDAC between January 1995 and December 2011. Logistic regression analysis was performed to determine the predictive factors for 5-year survival. One hundred and fifty-one patients were enrolled, including 38 patients with 5-year survival (actual 5-year survival rate, 25.2%). The independent preoperative factors predictive of achieving 5-year survival included serum albumin levels (odds ratio [OR]: 5.06, 95.0% confidence interval [CI]: 1.49-17.19; P = 0.009) and neoadjuvant chemoradiotherapy (OR: 3.02, 95.0% CI: 1.00-9.08; P = 0.049). Venous infiltration (OR: 2.99, 95.0% CI: 1.09-8.25; P = 0.034), liver recurrence (OR: 0.17, 95.0% CI: 0.04-0.69; P = 0.013), and perioperative portal vein infusion chemotherapy (OR: 3.06, 95.0% CI: 1.09-8.25; P = 0.028) were found to be independent postoperative predictive factors for achieving 5-year survival. Serum albumin levels could be a biomarker for predicting the prognosis of PDAC patients after curative resection. Liver recurrence and perioperative portal vein infusion chemotherapy were independent postoperative factors, suggesting that perioperative portal vein infusion chemotherapy could be promising for improving the survival rate of PDAC patients after curative resection.

Asunto(s)

Pancreatectomía , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/cirugía , Anciano , Anciano de 80 o más Años , Biomarcadores , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/mortalidad , Carcinoma Ductal Pancreático/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Oportunidad Relativa , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Neoplasias Pancreáticas/diagnóstico , Atención Perioperativa , Pronóstico , Curva ROC , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

The outcome of LTx in pediatric patients with FHF of unknown etiology remains inferior to that of LTx in pediatric patients with cholestatic diseases. A higher incidence of steroid-resistant severe rejection has been increasingly recognized among the responsible factors. We assessed the efficacy of the administration of steroids and PGE1 via PVI in the management of LTx for FHF in pediatric patients. In our early cohort (1995-2007), seven patients who underwent LTx for FHF of unknown etiology were treated with conventional immunosuppressive therapy (calcineurin inhibitor and a steroid). Seven of eight grafts (one patient underwent re-LTx) sustained CV and/or CPV associated with ACR, and four patients died of a graft failure or infectious complications that were associated with the treatment for rejection. Of note, the pathological incidence of CV/CPV was significantly higher in recipients with FHF of unknown etiology than in recipients with biliary cholestatic disease during the same study period (87.5% vs. 13.7%, p < 0.00001). From 2008, three patients underwent LTx for cryptogenic FHF with PVI and conventional IS. PVI was well tolerated, and no relevant severe complications were observed. More strikingly, the patients who received PVI overcame biopsy-proven immunological events and are all currently doing well with excellent graft function after more than five yr. We conclude that PVI is technically safe and effective for preventing severe rejection in pediatric patients who undergo LTx for FHF of unknown etiology and that it does not increase the risk of fatal infectious complications.

Asunto(s)

Alprostadil/administración & dosificación , Rechazo de Injerto/prevención & control , Inmunosupresores/administración & dosificación , Fallo Hepático Agudo/cirugía , Trasplante de Hígado , Metilprednisolona/administración & dosificación , Adolescente , Alprostadil/uso terapéutico , Niño , Preescolar , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Lactante , Infusiones Intravenosas , Masculino , Metilprednisolona/uso terapéutico , Vena Porta , Resultado del Tratamiento

RESUMEN

Purpose:To explore the therapeutic effects of h epatectomy and chemotherapy of primary liver cancer(PLC) Methods:The clinical data of 380 PLC patients admitted from Jan uary, 1996 to December, 2003 were divided into two groups: 130 cases underwent h epatectomy (group A), 250 cases underwent hepatectomy and chemotherapy (B group) . Results:The 1-,3-and 5-year recurrence rates in the hepatect omy and chemotherapy group were 21.2%,35.1% and 45.3%. The 1, 3 and 5-y ear overall survival rates in the hepatectomy and chemotherapy group were 68.2%, 50.1% and 21.8%, which were significantly higher than hepatectomy group. The number of chemotherapy courses affected the effect of hepatectomy. Conclusions:Hepatectomy and regional chemotherapy may decrease tumor recurrence rates and improve the disease-free survival rates in patients with PLC.