Subsequent Treatment after Transarterial Chemoembolization Failure/Refractoriness: A Review Based on Published Evidence

Background: The aims of this study were to evaluate the efficacy of additional treatment, especially lenvatinib-transarterial chemoembolization (TACE) sequential therapy, for unresectable hepatocellular carcinoma (HCC). Methods: Consecutive 56 patients who underwent lenvatinib treatment were reviewed. Oncological aggressiveness of tumor was estimated using a dynamic CT enhancement pattern classification, and clinical impact of subsequent treatment was investigated through analysis of progression-free survival (PFS), post-progression survival (PPS), and multivariate analysis of potential confounders for survival after progression during lenvatinib therapy. Results: Heterogeneous enhancement patterns (Type-3 and -4), which are reportedly associated with higher oncological aggressiveness of HCC, were associated with better objective response to lenvatinib compared to homogeneous enhancement pattern (Type-2) (86 and 85% vs. 53% in modified Response Evaluation Criteria in Solid Tumors), resulting in similar PFS (p = 0.313). Because of significantly worse PPS, overall survival of Type-4 tumor was poor compared to Type-2 or -3 tumors (p = 0.009). However, subgroup of patients who achieved subsequent treatment showed significantly better PPS, regardless of CT enhancement pattern. Multivariate analysis confirmed that use of lenvatinib-TACE sequential treatment after progression during lenvatinib therapy was associated with better PPS (hazard ratio [HR], 0.08; 95% CI, 0.01–0.71; p = 0.023), while Type-4 enhancement pattern was correlated with worse PPS (HR, 2.92; 95% CI, 1.06–8.05; p = 0.039). Conclusion: Oncological aggressiveness of HCC estimated by CT enhancement pattern was predictive of PPS after progression during lenvatinib. Successful subsequent treatment with lenvatinib-TACE sequential therapy may offer survival benefit regardless of CT enhancement pattern of HCC.

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Baseline tumor Lipiodol uptake after transarterial chemoembolization for hepatocellular carcinoma: identification of a threshold value predicting tumor recurrence

Radiology and Oncology ◽

10.1515/raon-2017-0030 ◽

2017 ◽

Vol 51 (4) ◽

pp. 393-400 ◽

Cited By ~ 3

Author(s):

Yusuke Matsui ◽

Masahiro Horikawa ◽

Younes Jahangiri Noudeh ◽

John A. Kaufman ◽

Kenneth J. Kolbeck ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Tumor Recurrence ◽

Tumor Response ◽

Threshold Value ◽

Subsequent Treatment ◽

Washout Rate ◽

Early Tumor ◽

Early Tumor Recurrence

Abstract Background The aim of the study was to evaluate the association between baseline Lipiodol uptake in hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) with early tumor recurrence, and to identify a threshold baseline uptake value predicting tumor response. Patients and methods A single-institution retrospective database of HCC treated with Lipiodol-TACE was reviewed. Forty-six tumors in 30 patients treated with a Lipiodol-chemotherapy emulsion and no additional particle embolization were included. Baseline Lipiodol uptake was measured as the mean Hounsfield units (HU) on a CT within one week after TACE. Washout rate was calculated dividing the difference in HU between the baseline CT and follow-up CT by time (HU/month). Cox proportional hazard models were used to correlate baseline Lipiodol uptake and other variables with tumor response. A receiver operating characteristic (ROC) curve was used to identify the optimal threshold for baseline Lipiodol uptake predicting tumor response. Results During the follow-up period (mean 5.6 months), 19 (41.3%) tumors recurred (mean time to recurrence = 3.6 months). In a multivariate model, low baseline Lipiodol uptake and higher washout rate were significant predictors of early tumor recurrence (P = 0.001 and < 0.0001, respectively). On ROC analysis, a threshold Lipiodol uptake of 270.2 HU was significantly associated with tumor response (95% sensitivity, 93% specificity). Conclusions Baseline Lipiodol uptake and washout rate on follow-up were independent predictors of early tumor recurrence. A threshold value of baseline Lipiodol uptake > 270.2 HU was highly sensitive and specific for tumor response. These findings may prove useful for determining subsequent treatment strategies after Lipiodol TACE.

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Enforced inactivity in the elderly and diabetes risk: initial estimates of the burden of an unintended consequence of COVID-19 lockdown

10.1101/2020.06.06.20124065 ◽

2020 ◽

Cited By ~ 1

Author(s):

Courtney Kipps ◽

Mark Hamer ◽

Neil Hill ◽

Paula Lorgelly

Keyword(s):

Physical Activity ◽

Older Adults ◽

Primary Care ◽

Unit Cost ◽

Population Attributable Risk ◽

Population Attributable Fraction ◽

Glycated Haemoglobin ◽

Subsequent Treatment ◽

Published Evidence ◽

The Cost

ABSTRACTBackgroundOlder adults and those with underlying health conditions were advised to stay at home to help reduce the spread of COVID-19 however little advice on regular physical activity was given to those at risk. We modelled the effects of enforced inactivity on diabetes burden using published evidence.MethodsUsing Health Survey for England data, we estimated the prevalence of pre-diabetes and physical activity in adults aged 70 and older. The number of new diabetes cases directly attributed to lockdown were calculated using population attributable risk. Unit cost estimates of the additional burden on primary care and the cost of complications to secondary care were taken from the literature.ResultsFrom 9 million older (≥70yrs) people living in England, 2.1 million could be defined as pre-diabetic (glycated haemoglobin 42<48 mmol/mol). The estimated population attributable fraction (0.281) (assuming relative risk of diabetes from inactivity=3.3, 40% physically active) would give rise to 392,948 new cases of diabetes which we argue are directly attributed to a prolonged period of lockdown. We estimate that the cost of screening and testing these patients in primary care (£35m), their subsequent treatment and management (£229m), and complications (£909m) would equate to an additional £1.17bn to the health care system.ConclusionsInactivity related to lockdown in previously active older adults may contribute up to £1.17b in additional healthcare costs through a potential increase in diabetes. Clear advice about the importance of physical activity may reduce this potential economic burden during global pandemics.

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Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-19-00322 ◽

2020 ◽

Vol 63 (5) ◽

pp. 1618-1635

Author(s):

Céline Richard ◽

Mary Lauren Neel ◽

Arnaud Jeanvoine ◽

Sharon Mc Connell ◽

Alison Gehred ◽

...

Keyword(s):

Systematic Review ◽

Cochrane Library ◽

Neurodevelopmental Outcomes ◽

Frequency Following Response ◽

Ovid Medline ◽

Published Evidence ◽

Mesh Terms ◽

Potential Applicability ◽

Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

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Surgery for Lung Cancer and the Consequences for the Swallow

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.162 ◽

2016 ◽

Vol 1 (13) ◽

pp. 162-168

Author(s):

Pippa Hales ◽

Corinne Mossey-Gaston

Keyword(s):

Lung Cancer ◽

Treatment Options ◽

Vocal Cord Palsy ◽

Subsequent Treatment ◽

Physiological Reserve ◽

Palliative Phase ◽

And Function ◽

The Impact ◽

Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

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OC.05.6 GENDER-RELATED DIFFERENCES IN SCCA-IGM LEVELS IN HEPATOCELLULAR CARCINOMA PATIENTS TREATED WITH TRANSARTERIAL CHEMOEMBOLIZATION

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30542-9 ◽

2020 ◽

Vol 52 ◽

pp. S20-S21

Author(s):

F. Pelizzaro ◽

F. Soldà ◽

R. Cardin ◽

A. Imondi ◽

A. Sartori ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization

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Minimizing Carry-Over Effects After Treatment Failure and Maximizing Therapeutic Outcome

Zeitschrift für Psychologie ◽

10.1027/2151-2604/a000180 ◽

2014 ◽

Vol 222 (3) ◽

pp. 171-178 ◽

Cited By ~ 3

Author(s):

Mareile Hofmann ◽

Nathalie Wrobel ◽

Simon Kessner ◽

Ulrike Bingel

Keyword(s):

Treatment Failure ◽

Human Subjects ◽

Subsequent Treatment ◽

Clinical Samples ◽

Administration Route ◽

Healthy Human ◽

Negative Experiences ◽

Analgesic Treatment ◽

Balanced Design ◽

Carry Over

According to experimental and clinical evidence, the experiences of previous treatments are carried over to different therapeutic approaches and impair the outcome of subsequent treatments. In this behavioral pilot study we used a change in administration route to investigate whether the effect of prior treatment experience on a subsequent treatment depends on the similarity of both treatments. We experimentally induced positive or negative experiences with a topical analgesic treatment in two groups of healthy human subjects. Subsequently, we compared responses to a second, unrelated and systemic analgesic treatment between both the positive and negative group. We found that there was no difference in the analgesic response to the second treatment between the two groups. Our data indicate that a change in administration route might reduce the influence of treatment history and therefore be a way to reduce negative carry-over effects after treatment failure. Future studies will have to validate these findings in a fully balanced design including larger, clinical samples.

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