Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

AbstractHepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

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Guidelines of the Association of Polish Surgeons and the Polish Society of Surgical Oncology on the accreditation of healthcare centers providing cytoreductive surgery and HIPEC for primary and secondary peritoneal cancers

Polish Journal of Surgery ◽

10.5604/01.3001.0014.1476 ◽

2020 ◽

Vol 92 (4) ◽

pp. 47-53

Author(s):

Tomasz Jastrzębski ◽

Piotr Richter ◽

Wojciech Zegarski ◽

Adam Dziki ◽

Grzegorz Wallner ◽

...

Keyword(s):

Cytoreductive Surgery ◽

Systemic Treatment ◽

Survival Rates ◽

Surgical Oncology ◽

Surgical Team ◽

Surgical Interventions ◽

Peritoneal Cancer ◽

Polish Society ◽

Patient Groups

Surgical interventions in patients with peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and systemic treatment are becoming more common and, when applied to selected patient groups, they reach 5-year survival rates of 32–52%. Good clinical outcomes require experienced and well-equipped healthcare centers, experienced surgical team and adequate patient qualification process. As a result of the discussion on the need for evaluation of quality of care and treatment outcomes and at the request of the Peritoneal Cancer Section of the Polish Society of Surgical Oncology, accreditation standards have been developed and the Accreditation Committee has been established for healthcare centers providing cytoreductive surgery and HIPEC for the management of primary and secondary peritoneal cancers.

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Hourglass-Like Constriction of the Brachial Plexus in the Posterior Cord: A Case Report

Neurosurgery ◽

10.1093/neuros/nyx171 ◽

2017 ◽

Vol 82 (1) ◽

pp. E1-E5 ◽

Cited By ~ 8

Author(s):

Yasunobu Nakagawa ◽

Hitoshi Hirata

Keyword(s):

Brachial Plexus ◽

Treatment Options ◽

Surgical Approaches ◽

Mri Findings ◽

Surgical Interventions ◽

Residual Symptoms ◽

Arm Pain ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

Short Tau Inversion Recovery

Abstract BACKGROUND AND IMPORTANCE Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). CLINICAL PRESENTATION A 9-yr-old boy experienced worsening left arm pain and difficulty in elevating the shoulder. Sequentially, severe palsy emerged when extending the wrist, thumb, and fingers. Based on the clinical picture, we diagnosed him with NA. The oblique coronal T2-weighted short-tau inversion recovery images showed mildly diffuse enlargement and hyperintensity of the brachial plexus. He showed few signs of improvement and interfascicular neurolysis was performed 11 mo after the onset. One of the fascicles in the posterior cord had developed an hourglass-like constriction. Electrical stimulation confirmed that the fascicle supplied forearm muscles. His wrist and finger extension had almost recovered at the 12-mo postoperative visit. CONCLUSION Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.

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Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

Frontiers in Oncology ◽

10.3389/fonc.2021.650394 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yun Huang ◽

Zeyu Zhang ◽

Weijun Liao ◽

Kuan Hu ◽

Zhiming Wang

Keyword(s):

Hepatocellular Carcinoma ◽

Combination Therapy ◽

Adverse Events ◽

Tumor Thrombus ◽

Stereotactic Body Radiation Therapy ◽

Transcatheter Arterial Chemoembolization ◽

Case Series ◽

Advanced Hepatocellular Carcinoma ◽

Advanced Hcc ◽

Arterial Chemoembolization

Background and AimAlthough the treatment effect and availability of therapeutic options for advanced hepatocellular carcinoma (HCC) are limited, the downstaging strategy may improve patient prognosis. This study aimed to investigate the potential of combination therapy as a downstaging strategy for treating advanced HCC with portal vein tumor thrombus (PVTT).MethodsThis retrospective case series included patients having advanced HCC with PVTT, who received the combination therapy of sorafenib, camrelizumab, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) from January 2019 to December 2019 in Xiangya Hospital, Central South University. The downstaging rate, treatment responses, progression-free survival (PFS), overall survival (OS), disease control rate, and toxicities were evaluated.ResultsOf the 13 patients, HCC downstaging was achieved in 4 (33.3%) patients who later received hepatectomy. The overall response rate was 41.7%, and the disease control rate was 50.0%. The median PFS time was 15.7 months, with a 1-year PFS rate of 58.3%, whereas the median OS was not reached after 1 year (1-year OS, 83.3%). No severe adverse events or grade 3–4 adverse effect was observed in 12 of the 13 enrolled patients; therapy had to be discontinued in only one patient due to adverse events, who was excluded from the study. The most common adverse effect was fever (n = 4, 33.3%), followed by skin reaction (n = 3, 25%).ConclusionA combination therapy comprising sorafenib, camrelizumab, TACE, and SBRT is an effective downstaging strategy for advanced HCC with PVTT and is associated with few adverse events.

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Current Treatment Options for Patulous Eustachian Tube: A Review of the Literature

Ear Nose & Throat Journal ◽

10.1177/0145561320932807 ◽

2020 ◽

pp. 014556132093280

Author(s):

Petros Koltsidopoulos ◽

Charalampos Skoulakis

Keyword(s):

Eustachian Tube ◽

Therapeutic Option ◽

Treatment Options ◽

Case Series ◽

Current Treatment ◽

Case Control Studies ◽

Retrospective Case ◽

Level Of Evidence ◽

Surgical Interventions ◽

Patulous Eustachian Tube

Objective: Patulous Eustachian tube (PET) is a clinical condition that is associated with troublesome aural symptoms and is difficult to be treated successfully. The purpose of this review is to examine the published literature regarding the therapeutic value of the current treatment options for PET. Methods: We searched Web of Science, PubMed and Medline from 1999 to 2019. The search focused on papers concerning the clinical evaluation of treatment methods in PET patients. Statistical techniques were not used. Results: Prospective and retrospective case series were the types of trials available for review. We included 28 articles that evaluated the efficacy of various conservative and surgical therapeutic options. The recovery rates ranged from 50% to 100%. In most studies the assessment of efficacy was based on the subjective improvement of patient symptoms as there is no validated outcome tool available. No severe adverse events were observed in any study. Conclusion: On the basis of the available literature, it seems that conservative treatments can be considered as a primary therapeutic option for PET. Concerning the surgical interventions they seem to be a safe and valuable solution in patients with refractory disease. Finally, given the low level of evidence, prospective case–control studies with long follow-up and robust setting looking into the therapeutic approach of PET are required. The need for establishment of standard criteria of PET recovery should be underlined.

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430 BALLOON TAMPONADE UTILIZATION FOR SEVERE ESOPHAGITIS CAUSING HEMORRHAGIC SHOCK

Diseases of the Esophagus ◽

10.1093/dote/doaa087.109 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

S Thaker ◽

G Pajot ◽

A Mikolajczyk ◽

A Lipowska

Keyword(s):

Hemorrhagic Shock ◽

Medical Therapy ◽

Treatment Options ◽

Gastroesophageal Junction ◽

Case Series ◽

Alcoholic Cirrhosis ◽

Severe Bleeding ◽

High Morbidity ◽

Surgical Interventions ◽

Balloon Tamponade

Abstract Esophagitis as a cause of upper gastrointestinal bleeding (UGIB) is a difficult entity to treat and is associated with significant morbidity. Epidemiologic studies note a 7-18% incidence of significant hemorrhage due to esophagitis. Current existing treatment options for UGIB complicated by hemorrhagic shock secondary to severe esophagitis are limited when there is a lack of response to proton pump inhibitor (PPI) medical therapy. Methods We present a case series of two patients who developed hemorrhagic shock from esophagitis, underwent endoscopic evaluation revealing limited treatment options, and ultimately required balloon tamponade resulting in successful resolution of bleeding and improvement in hemodynamics. A 55-year-old male with history of alcoholism complicated chronic pancreatitis and esophagitis presented with seizures. On admission he experienced hemorrhagic nasogastric tube output, anemia unresponsive to transfusions and hemodynamic instability. A 44-year-old patient with decompensated alcoholic cirrhosis was initially admitted for renal failure, and during the hospitalization developed melena and hemorrhagic shock requiring transfusions and vasopressors. The patients were promptly started on PPI infusion. Results Both patients underwent esophagogastroduodenoscopy revealing severe bleeding esophagitis extending from the gastroesophageal junction to the proximal esophagus and no varices. Active bleeding was not amenable to endoscopic therapy and both patients underwent balloon tamponade placement. The first patient required inflation of both the esophageal and gastric balloons for control of hemorrhage for 6 hours whereas the second patient required just gastric balloon inflation for 12 hours. Bleeding, transfusion requirement, and hemodynamics improved in both patients. Second look endoscopy demonstrated resolution of bleeding and hemostatic spray was applied to the esophagus prophylactically. Neither patient had recurrence of bleeding during the hospitalization. Conclusion UGIB secondary to esophagitis is difficult to control due to the highly vascularized nature of the esophagus. Endoscopic therapies are limited in extensive mucosal injury and risks of complications such as perforation are high. Other therapeutic options such as angiography are restricted due to vascular collateralization and surgical interventions have high morbidity and mortality. Balloon tamponade provides a viable treatment option for severe UGIB secondary to esophagitis that is not responsive to medical therapy.

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Capecitabine after Surgical Salvage in Recurrent Squamous Cell Carcinoma of Head and Neck

Otolaryngology ◽

10.1177/0194599817722948 ◽

2017 ◽

Vol 157 (6) ◽

pp. 995-997 ◽

Cited By ~ 1

Author(s):

Poorni M. Manohar ◽

Eli Sapir ◽

Emily Bellile ◽

Paul L. Swiecicki ◽

Alexander T. Pearson ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Treatment Options ◽

Survival Rates ◽

Case Series ◽

Recurrence Free Survival ◽

Free Survival ◽

Recurrent Squamous Cell Carcinoma

Due to the high incidence of recurrent squamous cell carcinoma of the head and neck and the toxicity profile of current salvage regimens, there is a need for tolerable and effective treatment options. We performed a retrospective matched case series to report our experience with recurrent high-risk patients who received capecitabine (CAP) therapy in the adjuvant setting after salvage therapy. The 5-year recurrence-free survival rates for the CAP and control cohorts were 54% (95% CI, 0.27%-0.75%) and 27% (95% CI, 0.09%-0.50%), respectively. Multivariable Cox modeling showed a significant improvement in recurrence-free survival in the CAP cohort (hazard ratio, 0.19; 95% CI, 0.04-0.92; P = .0392). While this was a respective analysis that could not control for all variables, these exploratory findings offer insights that may inform a prospective study to determine CAP efficacy.

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Venous line filtration: a novel technique for cases involving inferior vena caval and right atrial tumor and associated thrombus: a two-case series

Perfusion ◽

10.1177/0267659106070508 ◽

2006 ◽

Vol 21 (6) ◽

pp. 391-394 ◽

Cited By ~ 1

Author(s):

Gregory R Smigla ◽

D Scott Lawson ◽

David D Kaemmer ◽

Ian R Shearer

Keyword(s):

Right Atrium ◽

Tumor Thrombus ◽

Inferior Vena ◽

Venous Return ◽

Vena Cava ◽

Case Series ◽

Venous Drainage ◽

Right Atrial ◽

Arterial Line ◽

First Case

Two patients are presented with right atrial tumors, who were considered to be at risk for tumor thrombus migration down the venous line into the cardiopulmonary bypass (CPB) circuit during surgical excision, which may lead to compromised or interrupted venous drainage. An arterial line filter was placed in the venous line to capture any material that might become dislodged and embolize into the circuit. Vacuum-assisted venous drainage, at approximately -50 mmHg, was used to overcome any resistance caused by the filter in the venous line. In one case, tumor thrombus obstructed the filter, requiring the use of the bypass line around the filter, so venous return could be maintained. In both cases, thrombus was found in the filter. The first case was a 44-year-old female (81 kg, 137 cm, body surface area (BSA) 1.66 m2) who presented with a metastatic pheochromocytoma with associated thrombus arising from the left adrenal gland and extending into the inferior vena cava (IVC) and right atrium. The second case was a 37-year-old male (95 kg, 178 cm, BSA 2.17 m2), who presented with a very large angiosarcoma tumor involving almost the entire right atrium. We have shown that venous line filtration with vacuum-assisted venous drainage can be performed safely, and should be considered in cases where there is tumor thrombus in the vena cava or right atrium, which may threaten venous return.

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Significant response to atezolizumab plus bevacizumab treatment in unresectable hepatocellular carcinoma with major portal vein tumor thrombus: a case report

BMC Gastroenterology ◽

10.1186/s12876-021-02053-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shohei Komatsu ◽

Yoshimi Fujishima ◽

Masahiro Kido ◽

Kaori Kuramitsu ◽

Tadahiro Goto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Treatment Option ◽

Tumor Thrombus ◽

Treatment Options ◽

Significant Response ◽

Portal Vein Tumor Thrombus ◽

Advanced Hcc ◽

Advanced Tumor ◽

Bevacizumab Treatment

Abstract Background Hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (Vp4 PVTT) is an extremely advanced tumor with limited treatment options. Systemic chemotherapy is the only recommended treatment option, and atezolizumab plus bevacizumab has recently emerged as a first-line treatment option. Case presentation We describe the case of an 82-year-old man with unresectable advanced HCC with Vp4 PVTT who achieved a significant response to atezolizumab plus bevacizumab treatment. A single administration of atezolizumab plus bevacizumab ensured significant anti-tumor effects (regression in the tumor size and PVTT, portal vein recanalization, and serum alfa-fetoprotein levels decreased from 90,770 to 89 ng/mL). The patient continued with atezolizumab monotherapy, and after nine consecutive regimens, there was no apparent sign of residual tumor. Conclusions This case demonstrates the powerful anti-tumor effect of atezolizumab plus bevacizumab treatment for advanced HCC with Vp4 PVTT, suggesting that these agents can be a promising treatment option for such refractory tumors.

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Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus

Acta medica Lituanica ◽

10.15388/amed.2021.28.2.10 ◽

2021 ◽

Vol 28 (2) ◽

pp. 10

Author(s):

Arun Kumar Gunasekaran ◽

Amit Malviya ◽

Tony Ete ◽

Animesh Mishra ◽

Bhupen Barman ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Cardiac Failure ◽

Right Atrium ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Hepatic Veins ◽

Rare Presentation ◽

Advanced Hcc

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer and cancer related deaths worldwide. Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor thrombus invasion through the major hepatic veins and of vena cava inferior with continuous extension into the right cardiac cavity. Right heart metastasis without invasion of inferior vena cava (IVC), which may be caused by haematogenous spread of cancer cells, is rarely reported. We report a case of HCC with IVC and right atrium (RA) thrombus in a patient who presented to us with decompensated cardiac failure. Strikingly, the patient was young and with negative serum HBsAg, and anti-HCV results. Our case highlights a rare presentation of metastatic intracardiac tumor thrombus involving the RA in advanced HCC without any symptoms of cardiac failure, and henceforth, the role of screening echocardiography for all patients with advanced HCC especially with vena caval involvement to rule out intracardiac thrombus.

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