Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

scholarly journals Long-term survival of 11 years with multidisciplinary therapy for hepatocellular carcinoma metastasis to the ovary and peritoneum: a case report

2021 ◽  
Author(s):  
Satoko Motegi ◽  
Takeshi Yokoo ◽  
Ryosuke Nozawa ◽  
Rie Azumi ◽  
Yuzo Kawata ◽  
...  
Keyword(s):  
Percutaneous Ethanol Injection ◽  
Hepatic Functional Reserve ◽  
Functional Reserve ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
Long Term Survival ◽  
Chiari Syndrome ◽  
Ethanol Injection Therapy

AbstractWe herein report a rare case of HCC metastases to the ovary and peritoneum in a 61-year-old female patient who has achieved 11-year survival with multidisciplinary therapy. The patient was diagnosed with HCC during balloon angioplasty performed for Budd–Chiari syndrome in 1994 and underwent partial hepatectomy twice. Five years after the second hepatectomy, allochronic recurrence of a single nodule detected in S8 was treated by radiofrequency ablation, followed by percutaneous ethanol injection therapy and stereotactic body radiotherapy. However, her α-fetoprotein level rose to 1862 ng/mL within one year and computed tomography revealed a large pelvic tumor suggesting HCC metastasis to the ovary. The subsequent laparotomy revealed one 11-cm left ovarian tumor, one small right ovarian nodule, and numerous peritoneal nodules. Bilateral salpingo-oophorectomy and peritoneal resection of as many nodules as possible were performed. Combination therapy with intravenous 5-fluorouracil plus cisplatin and ramucirumab monotherapy effectively suppressed tumor progression with maintenance of hepatic functional reserve, and she has achieved long-term survival of 11 years, illustrating that multidisciplinary therapy with favorable hepatic functional reserve maintenance can contribute to long-term survival in HCC with extrahepatic spread.

scholarly journals PERCUTANEOUS DIRECT OZONE INJECTION – SOLID TUMOUR

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Praveen K. Saxena
Keyword(s):  
Ultrasound Guidance ◽  
Survival Rates ◽  
Percutaneous Ethanol Injection ◽  
Curative Surgery ◽  
Term Survival ◽  
Primary Tumors ◽  
Ethanol Injection ◽  
Small Primary ◽  
Transplant Candidates ◽  
Ozone Injection

This lecture defines the scope of Direct Ozone Injection into solid tumors, and introduces attendees to the ways in which Direct Ozone can be given under ULTRASOUND guidance (USG). Percutaneous USG guided Ozone injection is an exciting approach to destroying inoperable primary tumors or metastases in the liver in the treatment of hepatocellular (HCC), fewer than 40% of patients are candidates for surgery, and the rate of recurrence after curative surgery is high. Percutaneous techniques like Ozone Absolute alcohol & RFA are widely used for metastatic and small primary tumors. It serves as a bridge for transplant candidates, especially in relation to small primary lesions. Percutaneous Ozone is a minimally invasive, repeatable procedure with few complications. It is performed under Ultrasound guidance. Ozone results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection (PEI). Long-term survival rates are also better. Our series of 4 patients compared well than the patients treated with Trans catheter arterial chemoembolization (TACE) Cholangiocarcinoma’s with obstructive biliary system responded well with direct USG Guided Ozone Injections.

Surgery of ulcus cruris venosum

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 156-162 ◽  
Author(s):  
C. Schwahn-Schreiber
Keyword(s):  
Subcutaneous Tissue ◽  
Ulcus Cruris ◽  
Healing Time ◽  
Ulcus Cruris Venosum ◽  
Venous Stasis ◽  
Morphological Alterations ◽  
First Choice ◽  
Choice Of Treatment ◽  
Chronic Compartment Syndrome ◽  
Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

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