scholarly journals Interventional Oncology Approach to Hepatic Metastases

2020 ◽  
Vol 37 (05) ◽  
pp. 484-491
Author(s):  
Cathal O'Leary ◽  
Michael C. Soulen ◽  
Susan Shamimi-Noori
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Interventional Oncology ◽  
Hepatic Metastases ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Curative Intent ◽  
Locoregional Therapies ◽  
Metastatic Liver

AbstractMetastatic liver disease is one of the major causes of cancer-related morbidity and mortality. Locoregional therapies offered by interventional oncologists alleviate cancer-related morbidity and in some cases improve survival. Locoregional therapies are often palliative in nature but occasionally can be used with curative intent. This review will discuss important factors to consider prior to palliative and curative intent treatment of metastatic liver disease with locoregional therapy. These factors include those specific to the tumor, liver function, liver reserve, differences between treatment modalities, and patient-specific considerations.

scholarly journals Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data

2017 ◽  
Vol 34 (02) ◽  
pp. 145-166 ◽  
Author(s):  
Susan Shamimi-Noori ◽  
Carin Gonsalves ◽  
Colette Shaw
Keyword(s):  
Liver Disease ◽  
Surgical Resection ◽  
Thermal Ablation ◽  
Tumor Burden ◽  
Locoregional Therapy ◽  
Unresectable Disease ◽  
Diffuse Disease ◽  
Locoregional Therapies ◽  
Systemic Agents ◽  
Metastatic Liver

AbstractMetastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.

scholarly journals Decision Making for Selection of Transarterial Locoregional Therapy of Metastatic Neuroendocrine Tumors

2017 ◽  
Vol 34 (02) ◽  
pp. 101-108 ◽  
Author(s):  
Nasya Mendoza-Elias ◽  
Joseph Morrison ◽  
Ali Valeshabad ◽  
Andrew Lipnik ◽  
Ron Gaba
Keyword(s):  
Neuroendocrine Tumors ◽  
Locoregional Therapy ◽  
Patient Specific ◽  
Comparative Efficacy ◽  
Advantages And Disadvantages ◽  
Image Guided ◽  
Locoregional Therapies ◽  
Oncologic Therapy ◽  
Selection Of ◽  
Guided Therapy

AbstractTransarterial locoregional therapies (LRTs) are indispensable components of the modern interventional oncologic therapy of liver-dominant metastatic neuroendocrine tumors (NETs). The scope of available LRTs and their nuanced differences mandates a thorough understanding of their relative applicability and effectiveness in certain clinical circumstances to prescribe appropriate, patient-specific, image-guided therapy. This article aims to provide an overview of transarterial LRT options for liver-dominant metastatic NETs and therapy selection by reviewing procedure types, their advantages and disadvantages, and comparative efficacy in common case scenarios.

scholarly journals Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers

2018 ◽  
Vol 35 (01) ◽  
pp. 029-034 ◽  
Author(s):  
Samdeep Mouli ◽  
Ramona Gupta ◽  
Neil Sheth ◽  
Andrew Gordon ◽  
Robert Lewandowski
Keyword(s):  
Breast Cancer ◽  
Hepatic Metastases ◽  
The United States ◽  
Locoregional Therapy ◽  
Cancer Death ◽  
Gynecologic Malignancies ◽  
Curative Surgery ◽  
Locoregional Therapies ◽  
Disseminated Disease

AbstractBreast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.

Inadequacy of ultrasonography for monitoring response to treatment of liver metastases.

1993 ◽  
Vol 11 (12) ◽  
pp. 2451-2455 ◽  
Author(s):  
A Giovagnoni ◽  
A Piga ◽  
G Argalia ◽  
G M Giuseppetti ◽  
P Ercolani ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Metastases ◽  
Clinical Course ◽  
Hepatic Metastases ◽  
Response To Treatment ◽  
Close Monitoring ◽  
Focal Lesions ◽  
Therapeutic Decisions ◽  
Metastatic Liver

PURPOSE We prospectively evaluated the clinical efficacy of ultrasonography (US) in monitoring the effect of medical treatment in patients with liver metastases, by comparing serial US assessment with serial magnetic resonance imaging (MRI) evaluation and clinical outcome in a group of 41 patients with solid tumors. PATIENTS AND METHODS Both examinations were performed in patients with metastatic liver disease at the start of a new treatment modality and monthly thereafter for 3 months; close monitoring was prolonged beyond the third month in cases in which there was disagreement between the two techniques and the clinical course was not conclusive. RESULTS Planned follow-up was completed in 37 cases. There was limited concordance between the two examinations: in 21 cases only (56.8%), US and MRI gave concordant information on the evolution of hepatic metastases; in eight cases, both agreed on progression of disease (PD), in 11 cases on stable disease (SD), and in one case each on partial response (PR) and complete response (CR). In the remaining 16 cases (43.2%), there was disagreement between the two examinations. On the basis of subsequent clinical course, this discrepancy was shown to be due to US inadequacy in 13 cases and to MRI inadequacy in one case; in two cases, the clinical course was not conclusive. The most striking limits of US appeared to be twofold: (1) a progressive appearance, with chemotherapy, of a diffusely inhomogeneous structure of the liver, resulting in obscuration of focal lesions (and a subsequent judgement of CR) in cases in which lesions were, on the contrary, detected at MRI and usually confirmed by subsequent clinical course; and (2) false US-determined PD in cases in which lesions proven at baseline MRI were noted at US only after one to two courses of therapy. CONCLUSION We conclude that US, which is known to be inaccurate for screening of liver metastases, is unreliable for the follow-up of metastatic liver disease; despite its wide availability, low cost, and noninvasiveness, critical therapeutic decisions should not be made based on the outcome of this test.

scholarly journals Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1914 ◽  
Author(s):  
Mina S. Makary ◽  
Umang Khandpur ◽  
Jordan M. Cloyd ◽  
Khalid Mumtaz ◽  
Joshua D. Dowell
Keyword(s):  
Hepatocellular Carcinoma ◽  
Early Stage ◽  
Transarterial Embolization ◽  
Management Strategies ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Liver Malignancy ◽  
Curative Intent ◽  
Ablative Therapies ◽  
Recent Advances

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.

scholarly journals Treatment of Advanced Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Mahmoud Aryan ◽  
Ellery Altshuler ◽  
Xia Qian ◽  
Wei Zhang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Performance Status ◽  
Staging System ◽  
Tumor Burden ◽  
Systemic Review ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Advanced Hcc ◽  
The Past

Hepatocellular Carcinoma (HCC) is the fifth most common cancer and represents the fourth most common cause of cancer related death worldwide. Treatment of HCC is dictated based upon cancer stage, with the most universally accepted staging system being the Barcelona Clinic Liver Cancer (BCLC) staging system. This system takes into account tumor burden, active liver function, and patient performance status. BCLC stage C HCC is deemed advanced disease, which is often characterized by preserved liver function (Child-Pugh A or B) with potential portal invasion, extrahepatic spread, cancer related symptoms, or decreased performance status. Sorafenib has been the standard treatment for advanced HCC over the past decade; however, its use is limited by low response rates, decreased tolerance, and limited survival benefit. Researchers and clinicians have been investigating effective treatment modalities for HCC over the past several years with a focus on systemic regimens, locoregional therapy, and invasive approaches. In this systemic review, we discuss the management of advanced HCC as well as the ongoing research on various treatment opportunities for these patients.

Parallel Reduction of Plasma Levels of High and Low Molecular Weight Kininogen in Patients with Cirrhosis

1999 ◽  
Vol 82 (11) ◽  
pp. 1428-1432 ◽  
Author(s):  
Cheryl Scott ◽  
Francesco Salerno ◽  
Elettra Lorenzano ◽  
Werner Müller-Esterl ◽  
Angelo Agostoni ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Liver Disease ◽  
Liver Function ◽  
Plasma Levels ◽  
Plasma Concentrations ◽  
Normal Subjects ◽  
Low Molecular Weight ◽  
Major Band ◽  
Sds Page ◽  
Normal Controls

SummaryLittle is known about the regulation of high-molecular-weight-kininogen (HK) and low-molecular-weight-kininogen (LK) or the relationship of each to the degree of liver function impairment in patients with cirrhosis. In this study, we evaluated HK and LK quantitatively by a recently described particle concentration fluorescence immunoassay (PCFIA) and qualitatively by SDS PAGE and immunoblotting analyses in plasma from 33 patients with cirrhosis presenting various degrees of impairment of liver function. Thirty-three healthy subjects served as normal controls. Patients with cirrhosis had significantly lower plasma levels of HK (median 49 μg/ml [range 22-99 μg/ml]) and LK (58 μg/ml [15-100 μg/ml]) than normal subjects (HK 83 μg/ml [65-115 μg/ml]; LK 80 μg/ml [45-120 μg/ml]) (p < 0.0001). The plasma concentrations of HK and LK were directly related to plasma levels of cholinesterase (P < 0.0001) and albumin (P < 0.0001 and P < 0.001) and inversely to the Child-Pugh score (P < 0.0001) and to prothrombin time ratio (P < 0.0001) (reflecting the clinical and laboratory abnormalities in liver disease). Similar to normal individuals, in patients with cirrhosis, plasma HK and LK levels paralleled one another, suggesting that a coordinate regulation of those proteins persists in liver disease. SDS PAGE and immunoblotting analyses of kininogens in cirrhotic plasma showed a pattern similar to that observed in normal controls for LK (a single band at 66 kDa) with some lower molecular weight forms noted in cirrhotic plasma. A slight increase of cleavage of HK (a major band at 130 kDa and a faint but increased band at 107 kDa) was evident. The increased cleavage of HK was confirmed by the lower cleaved kininogen index (CKI), as compared to normal controls. These data suggest a defect in hepatic synthesis as well as increased destructive cleavage of both kininogens in plasma from patients with cirrhosis. The decrease of important regulatory proteins like kininogens may contribute to the imbalance in coagulation and fibrinolytic systems, which frequently occurs in cirrhotic patients.

Urokinase Antigen in Plasma of Patients with Liver Cirrhosis and Hepatoma

1985 ◽  
Vol 54 (03) ◽  
pp. 617-618 ◽  
Author(s):  
J C Kirchheimer ◽  
K Huber ◽  
P Polterauer ◽  
B R Binder
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Function ◽  
Matched Control ◽  
Malignant Growth ◽  
Control Groups ◽  
Impaired Liver Function ◽  
Impaired Liver ◽  
Specific Medication ◽  
History Of

SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.

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