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 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.

Long-term results of selective internal radioembolization (SIRT) to control progressive liver metastases of gastro-intestinal stromal tumors (GIST) beyond treatment with tyrosine kinase inhibitors (TKI).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11538-11538
Author(s):  
Peter Hohenberger ◽  
Nils Rathmann ◽  
Karen Buesing ◽  
Franka Menge ◽  
Steffen Diehl
Keyword(s):  
Liver Metastases ◽  
Treatment Options ◽  
Hepatic Metastases ◽  
Progression Free Survival ◽  
Long Term Results ◽  
Mutational Status ◽  
Exon 9 ◽  
Exon 11

11538 Background: Liver and peritoneum are the main area of metastatic spread in GIST. Liver resection does not play a role for hepatic metastases in comparison to f.e. colorectal cancer. If hepatic metastases are the only or major area of tumor progression and are resistant to available TKIs due to a missing mutation in KIT/PDGFRA/SDH ( ‘wildtype’) or after treatment with 1st/2nd/3rd/4th line therapy, interventional radioembolization with yttrium-90 (90Y) microspheres are promising treatment options, as radiation doses as high as 200Gy can be applied locally. We analyzed the long-term results of SIRT with respect to hepatic-progression-free survival (HEP-PFS) in a consecutive cohort of patients.. Methods: From 1/2008 to 1/2018, 25 pts (12f, 13m) with biopsy proven liver metastases of GIST which were the only (n = 13) or the dominant site of progression (n = 12) were treated by SIRT. Median age at GIST diagnosis had been 51.8 yrs and when receiving SIRT was 57.6yrs (range, 18–75yrs). The mutational status was ‘wildtype’ (n = 7, 2 NF-1), exon 11 (n = 7), exon 11+2nd mutation (n = 6), exon 9 (n = 3), exon 9+2ndmut (n = 1), and, exon 13 (n = 1). All patients except of two had prior TKI therapy: 1 line n = 3, 2 lines n = 11, 3-4 lines n = 9. Follow-up after SIRT was done via dynamic MRI and contrast-enhanced (CE)-CT, the median follow-up is 30.6 mos (range, 12-100mos) and all patients were followed until death. Results: The median hepatic-progression free survival (HEP-PFS) after SIRT was 17 months (range, 5-53+, 95%CI 11.8-22.1 mos). Of the patients with concomitant extrahepatic disease, the extraHEP-PFS was median 10 months. Twelve patients received next-line TKI therapy for progressive extrahepatic disease, whereas six patients required this for progressive liver metastases. When comparing the results according to the mutational status, patients with a ‘wildtype’ tumor showed a better median HEP-PFS of 19 mos (range, 12-53+, 95%CI 16.7-21.2 mos.) in comparison to KIT exon 9/11/13 mutated patients with only 14 months (range, 4-34 mos., 95%CI 6.5-21.4 mos), p < 0.11 (Wilcoxon). Conclusions: 90Y radioembolization (SIRT) offers a safe and effective treatment for patients with liver metastases of GISTs being the dominant site of tumor progression and with no drug treatment options available. In patients known to have no mutation in KIT/PDGFRA (wt, also NF-1 associated) it looks whether the results might be even more promising and SIRT could be used in early treatment lines.

Stereotactic body radiotherapy (SBRT) in combination with surgery for primary and metastatic liver tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 347-347
Author(s):  
Erik Lappinen ◽  
Ngoc Thai ◽  
Kusum Tom ◽  
Akhtar Khan ◽  
Ellen Day ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Hepatic Metastases ◽  
Normal Liver ◽  
Liver Parenchyma ◽  
Metastatic Lesion ◽  
Hepatic Lesions ◽  
Unresectable Metastasis ◽  
Metastatic Liver Tumors ◽  
Metastatic Liver

347 Background: Evaluate the feasibility, safety, and efficacy of SBRT in combination with surgery for primary and metastatic liver tumors. Methods: 12 patients completed hepatectomy and SBRT for either hepatocellular carcinoma (HCC) (3) or metastases from colorectal (4), neuroendocrine (2), uterine (2), or sarcoma (1) primary. All patients with metastases completed chemotherapy. Most patients (7) had resection of their operable metastases, total of 19, and gold fiducials placed in the unresectable lesions, total of 9, to facilitate definitive adjuvant SBRT. One patient with an unresectable metastasis received preoperative SBRT. Two patients with HCC had SBRT as a bridge to liver transplant. Two patients had salvage SBRT for recurrence after surgery. All patients completed 4D-CT for ITV definition and SPECT/CT to define functional normal liver parenchyma volume (NLV). MV-fluoro was performed to confirm tumor/fiducial respiratory motion within the PTV. Results: All patients successfully completed a combination of hepatectomy and SBRT. Seventeen hepatic lesions (≤ 2/patient) were treated with SBRT with a mean PTV 186.0 cc (15.1-803.5). The mean dose was 49.3 Gy (39-60) prescribed to the PTV in 5-6 fractions. With median follow-up of 9.2 months (2.8-15.3) there was no RILD > Grade 1 observed. The most common toxicity was Grade ≤ 2 fatigue. Nine patients had reduced SPECT-NLV vs. calculated NLV by a mean of 487.5 cc (p = 0.0004). In 6 of these, the SPECT-NLV vs. the CT-NLV was reduced by a mean of 253.9 cc (44.6 - 1076.2) reflecting the importance of SPECT functional imaging for SBRT planning. Postoperative morbidity was ≤ Grade 1. All surgical margins were negative. Three patients developed intrahepatic failures post SBRT. However, on follow-up imaging no in-field failures have occurred. Conclusions: The combination of liver SBRT with hepatic resection is safe and effective. It can be used preoperatively to increase resectability or to salvage surgical failures. We also report on the combination of limited hepatectomy for peripheral (including bilobar) hepatic metastases with planned SBRT to unresectable metastatic lesion(s). SBRT planning with SPECT/CT allows identification and preservation of the NLV.

scholarly journals MRI-guided laser ablation of neuroendocrine tumor hepatic metastases

2014 ◽  
Vol 3 (1) ◽  
pp. 204798161349975 ◽  
Author(s):  
Jukka Perälä ◽  
Rauli Klemola ◽  
Raija Kallio ◽  
Chengli Li ◽  
Ilkka Vihriälä ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Liver Metastases ◽  
Treatment Options ◽  
Hepatic Metastases ◽  
Current Treatment ◽  
The Body ◽  
Interstitial Laser ◽  
Mri Guided ◽  
Magnetic Resonance Imaging Mri

Background Neuroendocrine tumors (NET) represent a therapeutically challenging and heterogeneous group of malignancies occurring throughout the body, but mainly in the gastrointestinal system. Purpose To describe magnetic resonance imaging (MRI)-guided laser ablation of NET liver metastases and assess its role within the current treatment options and methods. Material and Methods Two patients with NET tumor hepatic metastases were treated with MRI-guided interstitial laser ablation (LITT). Three tumors were treated. Clinical follow-up time was 10 years. Results Both patients were successfully treated. There were no local recurrences at the ablation site during the follow-up. Both patients had survived at 10-year follow-up. One patient is disease-free. Conclusion MRI-guided laser ablation can be used to treat NET tumor liver metastases but combination therapy and a rigorous follow-up schedule are recommended.

scholarly journals Stereotactic Ablative Radiotherapy for the Management of Liver Metastases from Neuroendocrine Neoplasms: A Preliminary Study

2021 ◽  
Author(s):  
John Monte Hudson ◽  
Hans Tse-Kan Chung ◽  
William Chu ◽  
Amandeep Taggar ◽  
Laura Ellen Davis ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Local Control ◽  
Systemic Disease ◽  
Objective Response ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Response To Treatment ◽  
Neuroendocrine Neoplasms ◽  
Stereotactic Ablative Radiotherapy

Introduction: Liver metastases are common in patients with neuroendocrine neoplasms. The role of stereotactic ablative radiotherapy (SABR) is not well understood in this population. Objective: To evaluate the safety and efficacy of SABR in treating well-differentiated neuroendocrine liver metastases (WD-NELM). Methods: A retrospective review of patients with WD-NELM treated with SABR between January 2015-July 2019. Demographic, treatment and clinical/radiographic follow-up data were abstracted. RECIST 1.1 criteria were applied to each individual target to evaluate the response to treatment. Local control (LC) and progression free survival (PFS) were determined using Kaplan-Meier methodology. Toxicity was reported according to CTCAE v5.0. Results: Twenty-five patients with a total of 53 liver metastases treated with SABR were identified. Most patients (68%) had midgut tumors, were Grade II (80%) and had high volume intrahepatic and/or extrahepatic disease (76%). Median number of liver metastases treated was 2 with a median size of 2.5 cm. Median radiation dose delivered was 50Gy/5 fractions. Median follow-up was 14 months; 24 of the 25 patients were alive at time of analysis. The objective response rate (ORR) was 32%, with improvement or stability in 96% of lesions treated. The median time to best response was 9 months. The 1-year LC and PFS were 92% and 44% respectively. No Grade III/IV acute or late toxicity was identified. Conclusions: Liver SABR is a safe and promising means of providing local control for WD-NELM. This treatment modality should be evaluated in select patients in concert with strategies to manage systemic disease.

Intra-Arterial Injection of Adriamycin/Mitomycin C Lipiodol Suspension in Liver Metastases

1987 ◽  
Vol 28 (3) ◽  
pp. 275-280 ◽  
Author(s):  
H. Kobayashi ◽  
H. Inoue ◽  
J. Shimada ◽  
T. Yano ◽  
T. Maeda ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Liver Metastases ◽  
Contrast Enhancement ◽  
Mitomycin C ◽  
Tumor Size ◽  
Tumor Response ◽  
Hepatic Metastases ◽  
Intravenous Contrast

Intra-arterial injection of a suspension of adriamycin and/or mitomycin C in Lipiodol was performed in 17 patients with hepatic metastases, which at angiography were poorly vascularized. Accumulation of Lipiodol in the tumors was demonstrated at computed tomography (CT) in 15 of 17 patients examined within one week. Follow-up with CT showed that Lipiodol remained in the tumor during the first month in 94 per cent, after 2 months in 31 per cent, and after 3 months in 17 per cent. In the non-tumor part of the liver Lipiodol disappeared earlier, and one month after injection it could no longer be traced on CT. In 8/17 cases (47%) CT, after intra-arterial injection of Lipiodol, gave superior information compared with CT after intravenous contrast enhancement. Tumor response was achieved in 9 of 16 cases. Particularly in metastases originating from cancer of the colon and stomach response was observed with a decrease in tumor size in 8 of 10 patients.

Rapid Response to Treatment of Multiple Myeloma Detected with FDG PET Scanning in Multiple Myeloma - Early Results from Total Therapy III.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 941-941
Author(s):  
Ronald Walker ◽  
L. Jones-Jackson ◽  
Eric Rasmussen ◽  
M. Miceli ◽  
Elias Anaissie ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Significance ◽  
Pet Scan ◽  
M Protein ◽  
Response To Treatment ◽  
Focal Lesions ◽  
Early Results ◽  
Pet Scanning ◽  
Total Therapy

Abstract Fluorodeoxyglucose Positron Emission Tomography (PET) scanning can rapidly detect and quantify changes in tumor metabolism. We present early results from the first 47 patients enrolled in Total Therapy III for multiple myeloma using PET scanning and correlating with serum M protein. Since we have previously demonstrated that diffuse uptake patterns do not have prognostic significance, we have limited our assessment of these 47 patients to those with one or more PET-defined focal lesions (FL) at baseline who have had at least one follow-up PET scan (25 patients). Of this group of 25, 10 have had a second follow-up scan. These whole body PET scans were performed at baseline and at time points corresponding to immediately after two cycles of VDT-PACE, landmarks LMK1 and LMK2. Patients with complete resolution of FL on PET are considered to be in PET-CR. We find that 17/25 (68%) had a decrease in number of FL from baseline to LMK1 and 8/10 (80%) had a decrease in number of FL from baseline to LMK2. In addition, 6/25 (24%) were in PET-CR by LMK1 and 3/10 (30%) in PET-CR by LMK2. Similarly, a decrease in serum M-protein was seen in 16/25 (64%) from baseline to LMK1 and in 8/10 (80%) from baseline to LMK2. At baseline, 10 patients had serum M protein levels of 0.01 g/dl or less. Of these, 8 (80%) had PET-defined focal lesions, demonstrating PET’s ability to monitor tumor metabolism in the face of hypo- or non-secretory disease. Of these, 7 have been enrolled sufficient time to have a second PET scan, with 6/7 (86%) demonstrating a continuing decrease in number of FL in response to treatment. At baseline, PET detected 5 of 47 patients with extramedullary disease (EMD), a finding of severe adverse prognostic significance at baseline. Of these patients, all had FL at baseline PET and all had decreasing number of FL on first follow-up PET scan (two have had a second follow-up scan, one improving and one PET-CR). One of these patients with EMD is nonsecretory. From these data, we conclude that functional imaging with PET scanning offers important and unique information about early tumor response that improves patient management by demonstrating rapid change in response to treatment that not only parallels serum M-protein response but which also is reliable in hypo- or non-secretory disease as well as in detection and monitoring of extramedullary tumor, an ominous condition that is particularly difficult to detect in the hypo- or non-secretory patient.

Dose escalation of capecitabine in combination with biweekly cetuximab and hepatic arterial infusion (HAI) of oxaliplatin in patients with liver metastases of colorectal cancer: Preliminary clinical results

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15080-e15080
Author(s):  
A. Viudez ◽  
R. Zárate ◽  
M. Garrido ◽  
J. Rodríguez ◽  
A. Chopitea ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Performance Status ◽  
Hepatic Metastases ◽  
Hepatic Arterial Infusion ◽  
Clinical Results ◽  
Maximum Tolerated Dose ◽  
Ecog Performance Status ◽  
Grade 3

e15080 Background: To determine the maximum-tolerated dose (MTD) and the doses-limiting-toxicities (DLT) of concurrent capecitabine and cetuximab plus HAI of oxaliplatin (LOHP) in patients with hepatic metastases from colorectal cancer (CCR). Methods: Successive cohorts of 3–6 patients (pts) were treated with HAI LOHP (100 mg/m2), biweekly cetuximab (500 mg/m2) and escalation doses of capecitabine (825 mg/m2 BID d1–7:DL1; 1000 mg/m2 BID d1- 7:DL2; 1250 mg/m2 BID d1–7:DL3; 1500 mg/m2 BID d1–7:DL4) recycled every 14 days. Dose-limiting-toxicities (DLT) were defined as any grade 3–4 events, excepting grade 3–4 skin rash. LOHP and cetuximab PK/PD data were prospectively collected. Results: 19 patients (median age: 60; range: 34–74; 52.9% men, 47.1% females) and ECOG performance status of 1 (range 0–2) were treated at 4 DLs (dose level) as follows: DL: 3 pts, DL2: 6 pts, DL 3: 7 pts and DL 4: 3 pts. All pts were evaluable for toxicity. With a median of follow-up of 21.23 months, ORR was 78.9%, all of them partial response, with 4 pts SD (21.1%). Initially, only 4 pts were considered potentially resectable. Among the remaining 15 pts, 4 (20.6%) could be resected after treatment. Disease progression occurred in 15 pts (78.9%; 3 pts in liver only; 4 pts with extrahepatic metastases; 8 cases with both, hepatic and extrahepatic disease). The TTP was 9.6 months. OS has not been reached. 4 pts have died during the follow-up. Grade ¾ toxicities including Hand-foot Syndrome in 3 pts (1 pt at DL1, other at DL3 and other at DL4), diarrhoea in 3 pts ( one at DL3 and 2 at DL4), anaemia in 2 pts (DL2 and DL4), asthenia in 2 pts (DL2 and DL4) and mucositis in 1 pts (DL3). DLT and MTD were established in DL4 (two pts with diarrhoea grade IV with one of them with grade III HFS) Conclusions: Combination therapy with HAI LOHP plus concurrent capecitabine and cetuximab, can be safely administered to patients with liver metastases from CCR. The MTD and DLT was established in 1500 mg/m2 BID d1 to d7 of capecitabine. The Doses-recommended (DR) has not been obtained yet. oxaliplatin PK/PD is best defined through a bicompartimental model. Mature results of PK/PD analysis will be presented at 2009 ASCO Symposium. No significant financial relationships to disclose.

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