scholarly journals HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Zhou ◽  
Ning He ◽  
Jiaze Hong ◽  
Tong Yang ◽  
Derry Minyao Ng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Adverse Events ◽  
Liver Metastases ◽  
Hepatic Metastasis ◽  
Focused Ultrasound ◽  
Progression Free Survival ◽  
High Intensity Focused Ultrasound ◽  
Entire Cohort

Abstract Background The purpose of this study was to explore the efficacy and safety of high intensity focused ultrasound (HIFU) in gastric cancer with liver metastasis (GCLM) patients who were contraindicated for either hepatectomy or radiofrequency ablation (RFA). Methods This is a prospective, observational study on GCLM patients with 1–3 liver metastases. The primary gastric lesions were thoroughly resected and any case that exhibited extra-hepatic metastasis was excluded. A 1:2:2 propensity score-matching analysis was performed using a logistic regression model on the HIFU group, best supportive care (BSC) group, and palliative chemotherapy (PC) group. The primary endpoints include progression-free survival (PFS) and overall survival (OS). Results Forty patients were finally included, there were 8 cases in HIFU group, 16 cases in BSC group, and 16 cases in PC group. The median follow-up time for the entire cohort was 10 months. The median PFS was 16.5 months in HIFU group, 2 months in BSC group, and 5 months in PC group. The median OS was 27.5 months in the HIFU group, 7 months in the BSC group, and 11.5 months in the PC group. Additionally, no grade 3 or higher adverse events occurred in the HIFU group. Conclusion The results of this study showed that HIFU treatment could improve the long-term prognosis of GCLM patients without a significant increase in the occurrence of adverse events. Compared with PC and BSC, HIFU is the preferred treatment option when GCLM patients without extra-hepatic metastasis are unable to undergo either surgery or RFA.

scholarly journals HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study Running title: HIFU treatment for gastric cancer with liver metastases

2021 ◽  
Author(s):  
Lihu Gu ◽  
Ning He ◽  
Jiaze Hong ◽  
Tong Yang ◽  
Derry Ng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Adverse Events ◽  
Liver Metastases ◽  
Hepatic Metastasis ◽  
Progression Free Survival ◽  
High Intensity Focused Ultrasound ◽  
Hifu Treatment ◽  
Entire Cohort

Abstract Background: The purpose of this study was to explore the efficacy and safety of high intensity focused ultrasound (HIFU) in gastric cancer with liver metastasis (GCLM) patients who were contraindicated for either hepatectomy or radiofrequency ablation (RFA).Methods: This is a prospective, observational study on GCLM patients with 1-3 liver metastases. The primary gastric lesions were thoroughly resected and any case that exhibited extra-hepatic metastasis was excluded. A 1:2:2 propensity score-matching analysis was performed using a logistic regression model on the HIFU group, best supportive care (BSC) group, and palliative chemotherapy (PC) group. The primary endpoints include progression-free survival (PFS) and overall survival (OS). Results: Forty patients were finally included, there were 8 cases in HIFU group, 16 cases in BSC group, and 16 cases in PC group. The median follow-up time for the entire cohort was 10 months. The median PFS was 16.5 months in HIFU group, 2 months in BSC group, and 5 months in PC group. The median OS was 27.5 months in the HIFU group, 7 months in the BSC group, and 11.5 months in the PC group. Additionally, no grade 3 or higher adverse events occurred in the HIFU group.Conclusion: The results of this study showed that HIFU treatment could improve the long-term prognosis of GCLM patients without a significant increase in the occurrence of adverse events. Compared with PC and BSC, HIFU is the preferred treatment option when GCLM patients without extra-hepatic metastasis are unable to undergo either surgery or RFA.

HIFU for the treatment of difficult colorectal liver metastases with unsuitable indications for resection and radiofrequency ablation: A phase I clinical trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16715-e16715
Author(s):  
Tong Yang
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Focused Ultrasound ◽  
Objective Response ◽  
Progression Free Survival ◽  
Complete Response ◽  
High Intensity Focused Ultrasound ◽  
Hifu Treatment ◽  
Grade 3

e16715 Background: Previous studies showed that high intensity focused ultrasound (HIFU) treatment could treat liver tumor and pancreatic cancer, with fewer serious adverse reactions.To evaluate the safety and efficacy of HIFU for patients with colorectal liver metastases(CRLM) that were contraindicated for resection and radiofrequency ablation. Methods: Patients between 20 to 80 years of age with 1-3 liver metastases from colorectal cancer were included. The primary colorectal lesions were thoroughly resected and any case with extra-hepatic metastasis was excluded. Ultrasound guided HIFU system was employed and target region ablation was achieved with repeated sonications from the deep to shallow regions of the tumor section by section. Results: Thirteen patients were enrolled. Pain was the most common adverse events(AEs) (n = 8), followed by fatigue (n = 7), increased aspartate aminotransferase (AST) (n = 7), increased alanine aminotransferase(ALT) (n = 5), and skin edema (n = 4). No grade≥3 AEs occurred.The majority of patients (76.9%) had a complete response and the remaining three patients achieved partial response. The objective response rate was 100% after the first HIFU treatment. Nine patients relapsed but most were isolated only in the liver (8/9). The median follow-up was 25 months. The 2-year progression-free survival (PFS) was 16.7%, and median PFS was 9 months. Notably, the 2-year overall survival (OS) was 77.8%, and median OS was 25 months. Conclusions: This study indicates that HIFU treatment is safe, has an excellent tumor response and long-termprognosis even when the foci in risky locations, and is probably a considerable option for patients who were unsuitable for other local treatments.

scholarly journals Long-Term Survival of Two Patients with Liver Metastases from Advanced Gastric Cancer Treated with Radiofrequency Ablation and Chemotherapy

2021 ◽  
pp. 67-72
Author(s):  
Sung Jin Oh
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Advanced Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Subtotal Gastrectomy ◽  
Hepatic Metastases ◽  
Term Survival ◽  
Long Term Survival

Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.

scholarly journals Hypothyroidism and hypopituitarism as immune-related adverse events due to lenvatinib plus pembrolizumab therapy in the immediate postoperative period after laparoscopic hepatectomy for liver metastases from gastric cancer: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kimimasa Sasaki ◽  
Shin Kobayashi ◽  
Masashi Kudo ◽  
Motokazu Sugimoto ◽  
Shinichiro Takahashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Glucose ◽  
Adverse Events ◽  
Blood Glucose Level ◽  
Liver Metastases ◽  
Postoperative Period ◽  
Malignant Tumors ◽  
Fasting Blood Glucose ◽  
Laparoscopic Hepatectomy ◽  
Fasting Blood Glucose Level

Abstract Background Immune checkpoint inhibitors (ICIs) are emerging agents used for the treatment of various malignant tumors. As ICIs are generally used for unresectable malignant tumors, there have been only a few reports of patients who underwent surgery after receiving these drugs. Therefore, it remains unclear how immune-related adverse events (irAEs) affect the postoperative course. Here, we report a patient with advanced gastric cancer who underwent laparoscopic hepatectomy for liver metastases after an objective response with lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism as irAEs in the immediate postoperative period. Case presentation A 73-year-old man had undergone total gastrectomy for pT4aN2M0 gastric cancer followed by adjuvant chemotherapy with S-1 and docetaxel, and developed liver metastases in segments 6 and 7. He was enrolled in phase 2 clinical trial of lenvatinib plus pembrolizumab. He continuously achieved a partial response with the study treatment, and the liver metastases were decreased in size on imaging. The tumors were judged to be resectable and the patient underwent laparoscopic partial hepatectomy for segments 6 and 7. From the 1st postoperative day, the patient continuously presented with fever and general fatigue, and his fasting blood glucose level remained slightly lower than that before the surgery. On the 4th postoperative day, laboratory examination revealed hypothyroidism and hypopituitarism, which were suspected to be irAE caused by lenvatinib plus pembrolizumab after surgery. He received hydrocortisone first, followed by levothyroxine after adrenal insufficiency was recovered. Subsequently, his fever, general fatigue, and any abnormality regarding fasting blood glucose level resolved, and he was discharged on the 12th postoperative day. After discharge, his laboratory data for thyroid and pituitary function remained stable while receiving hydrocortisone and levothyroxine without recurrence of gastric cancer. Conclusion We present a case of laparoscopic hepatectomy after receiving lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism after surgery. Regarding surgery after ICI therapy, it is important to recognize that irAEs might occur in the postoperative period.

scholarly journals Radiofrequency ablation versus traditional liver resection and chemotherapy for liver metastases from gastric cancer

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094050
Author(s):  
Kezhong Tang ◽  
Bo Zhang ◽  
Linping Dong ◽  
Lantian Wang ◽  
Zhe Tang
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Statistical Significance ◽  
Local Treatment ◽  
Long Term Outcomes ◽  
Short And Long Term

Objective To compare the short- and long-term outcomes of radiofrequency ablation (RFA) versus liver resection and chemotherapy for liver metastases from gastric cancer. Methods We retrospectively evaluated 50 patients who underwent curative gastrectomy and local treatments for liver metastases (RFA, n = 20; liver resection, n = 20; and chemotherapy, n = 10) from 2008 to 2018. Results The short- and long-term outcomes of each local treatment were evaluated. The median overall survival (OS) after RFA was similar to that after liver resection (20 vs. 20 months, respectively) and longer than that after chemotherapy (20 vs. 10 months, respectively). The 3-year OS and progression-free survival (PFS) rates after RFA were 20% and 10%, respectively, while those in the liver resection group were 23.5% and 23.5%, respectively. The 3-year OS rate after chemotherapy was 10%. The size and number of metastases were prognostic factors for patients with gastric cancer with liver metastasis without statistical significance. Conclusions Among patients with liver metastasis from gastric cancer, OS and PFS were satisfactory and comparable between RFA and liver resection but better than those of chemotherapy. RFA is an appropriate option for patients with gastric cancer who have a solitary liver metastasis measuring ≤3.0 cm.

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