scholarly journals Irreversible Electroporation Treatment With Intraoperative Biliary Stenting for Unresectable Perihilar Cholangiocarcinoma: A Pilot Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Po-Chih Yang ◽  
Yan-Jun Chen ◽  
Xiao-Yong Li ◽  
Chih-Yang Hsiao ◽  
Bing-Bing Cheng ◽  
...  
Keyword(s):  
Stent Placement ◽  
Irreversible Electroporation ◽  
Progression Free Survival ◽  
Carbohydrate Antigen ◽  
Biliary Stent ◽  
Perihilar Cholangiocarcinoma ◽  
Total Serum ◽  
Medical Centers ◽  
Serum Carbohydrate Antigen ◽  
One Year

BackgroundTreating perihilar cholangiocarcinoma (PHCC) is particularly difficult due to the fact that it is usually in an advanced stage at the time of diagnosis. Irreversible electroporation treatment (IRE) involves the local administration of a high-voltage electric current to target lesions without causing damage to surrounding structures. This study investigated the safety and efficacy of using IRE in conjunction with intraoperative biliary stent placement in cases of unresectable PHCC.MethodsThis study enrolled 17 patients with unresectable Bismuth type III/IV PHCC who underwent IRE in conjunction with intraoperative biliary stent placement (laparotomic) in two medical centers in Asia between June 2015 and July 2018. Analysis focused on the perioperative clinical course, the efficacy of biliary decompression, and outcomes (survival).ResultsMean total serum bilirubin levels (mg/dL) on postoperative day (POD) 7, POD30, and POD90 were significantly lower than before IRE (respectively 3.46 vs 4.54, p=0.007; 1.21 vs 4.54, p<0.001; 1.99 vs 4.54, p<0.001). Mean serum carbohydrate antigen 19-9 (CA19-9, U/ml) levels were significantly higher on POD3 than before the operation (518.8 vs 372.4, p=0.001) and significantly lower on POD30 and POD90 (respectively 113.7 vs 372.4, p<0.001; 63.9 vs 372.4, p<0.001). No cases of Clavien-Dindo grade III/IV adverse events or mortality occurred within 90 days post-op. The median progression-free survival was 21.5 months, and the median overall survival was 27.9 months. All individuals who survived for at least one year did so without the need to carry percutaneous biliary drainage (PTBD) tubes.ConclusionsIt appears that IRE treatment in conjunction with intraoperative biliary stent placement is a safe and effective approach to treating unresectable PHCC. The decompression of biliary obstruction without the need for PTBD tubes is also expected to improve the quality of life of patients.

Percutaneous irreversible electroporation (IRE) in the treatment of hepatocellular carcinoma (HCC) and metastatic colorectal cancer (mCRC) to the liver: A retrospective analysis of the University of Miami experience.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 272-272
Author(s):  
Arturo Loaiza-Bonilla ◽  
Katuska J Barbery ◽  
Evelyn Perez-Rojas ◽  
Tatiana Froud ◽  
Jose M Yrizarry ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Irreversible Electroporation ◽  
Progression Free Survival ◽  
Complete Response ◽  
Median Number ◽  
Percutaneous Ablation ◽  
Kaplan Meier ◽  
Best Response ◽  
One Year ◽  
The One

272 Background: Percutaneous ablation and transarterial chemo- or radioembolization are commonly used in the treatment of HCC and mCRC to the liver. IRE using the Nanoknif is more versatile than other ablative modalities (such as RFA) in that tumors abutting vascular structures can be treated with IRE without compromise of the vessels or concern for the heat sink effect of nearby blood flow. Methods: We examined the records of patients (pts) referred for IRE for HCC and mCRC. The procedures were all done percutaneously under general anesthesia using a standard protocol. The primary endpoint was progression-free survival (PFS). Responses were assessed using the modified RECIST criteria. Results: Between 1/2010 and 8/2011, 49 pts underwent percutaneous ablation of unresectable HCC and mCRC liver tumors using IRE – 33 with HCC and 16 with mCRC. A total of 76 lesions were treated in 62 sessions; the median number of lesions treated per patient was 1 (range 1-4) and the median tumor size treated was 2.1cm (range 0.8-6). After IRE, 20 pts (41%) had a complete response (CR), 19 (39%) had a partial response and 10 (20%) had stable disease as their best response. The Kaplan-Meier estimated median PFS was 11.3 months (95% CI 9.6-12.9) for all pts, 11.6 months (95% CI 10.2-12.9) for HCC pts, and 10.4 months (95% CI 5.4-15.4) for mCRC patients. The one-year PFS was significantly higher for pts achieving a CR compared to those who did not achieve a CR (75% versus 59%, log rank p = 0.05). The number of liver lesions at baseline and size of the treated lesions were not associated with any differences in survival. The IRE was complicated in 6 pts (12%) by pneumothorax (2), pleural effusion (2), and atrial flutter/fibrillation during anesthesia (2). All pts recovered fully from these complications. One pt died within 1 month of the IRE due to disease progression. Conclusions: IRE of liver tumors is safe. The PFS rates for pretreated mCRC and unresectable HCC are promising. A complete lack of enhancement of the treated lesion on the post-IRE CT scan appears to be associated with longer survival.

scholarly journals Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

2016 ◽  
Vol 10 (2) ◽  
pp. 410-416 ◽  
Author(s):  
Shuji Akimoto ◽  
Masataka Banshodani ◽  
Masahiro Nishihara ◽  
Junko Nambu ◽  
Yasuo Kawaguchi ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Antibiotic Treatment ◽  
Malignant Tumors ◽  
Standardized Uptake Value ◽  
High Elevation ◽  
Carbohydrate Antigen ◽  
Reactive Protein ◽  
Positron Emission ◽  
Serum Carbohydrate Antigen ◽  
One Year

Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)-computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

Biliary stent placement over a standard papillotomy knife

2011 ◽  
Vol 24 (01) ◽  
Author(s):  
A Weber ◽  
S von Delius ◽  
RM Schmid ◽  
A Meining
Keyword(s):  
Stent Placement ◽  
Biliary Stent

scholarly journals Current FDA-Approved Therapies for High-Grade Malignant Gliomas

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 324
Author(s):  
Jacob P. Fisher ◽  
David C. Adamson
Keyword(s):  
Controlled Trial ◽  
Malignant Gliomas ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
High Grade ◽  
Tumor Treatment ◽  
Free Survival ◽  
Randomized Controlled ◽  
Significant Survival ◽  
One Year

The standard of care (SOC) for high-grade gliomas (HGG) is maximally safe surgical resection, followed by concurrent radiation therapy (RT) and temozolomide (TMZ) for 6 weeks, then adjuvant TMZ for 6 months. Before this SOC was established, glioblastoma (GBM) patients typically lived for less than one year after diagnosis, and no adjuvant chemotherapy had demonstrated significant survival benefits compared with radiation alone. In 2005, the Stupp et al. randomized controlled trial (RCT) on newly diagnosed GBM patients concluded that RT plus TMZ compared to RT alone significantly improved overall survival (OS) (14.6 vs. 12.1 months) and progression-free survival (PFS) at 6 months (PFS6) (53.9% vs. 36.4%). Outside of TMZ, there are four drugs and one device FDA-approved for the treatment of HGGs: lomustine, intravenous carmustine, carmustine wafer implants, bevacizumab (BVZ), and tumor treatment fields (TTFields). These treatments are now mainly used to treat recurrent HGGs and symptoms. TTFields is the only treatment that has been shown to improve OS (20.5 vs. 15.6 months) and PFS6 (56% vs. 37%) in comparison to the current SOC. TTFields is the newest addition to this list of FDA-approved treatments, but has not been universally accepted yet as part of SOC.

scholarly journals Correlation between serum carbohydrate antigen 19-9 levels and computed tomography severity score in patients with nontuberculous mycobacterial pulmonary disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kangjoon Kim ◽  
Seung Hyun Yong ◽  
Su Hwan Lee ◽  
Sang Hoon Lee ◽  
Ah Young Leem ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Disease Activity ◽  
Pulmonary Disease ◽  
Severity Score ◽  
Partial Correlation ◽  
Elevated Serum ◽  
Carbohydrate Antigen ◽  
Chest Ct ◽  
Clinical Biomarker ◽  
Serum Carbohydrate Antigen

AbstractThere is no validated clinical biomarker for disease severity or treatment response for nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the correlation between elevated serum carbohydrate antigen (CA) 19-9 levels and NTM-PD disease activity, defined using an imaging severity score based on chest computed tomography (CT). We retrospectively examined 79 patients with NTM-PD who underwent serum CA19-9 level assessments and chest CT less than 1 month apart. NTM-PD severity was rated using a CT-based scoring system. The correlation between the CT score and serum CA19-9 levels was evaluated. Chest CT revealed nodular bronchiectasis without cavitation in most patients (78.5%). Serum CA19-9 levels were elevated in 19 (24%) patients. Serum CA19-9 levels were positively correlated with the total CT score and bronchiectasis, bronchiolitis, cavity, and consolidation subscores. Partial correlation analysis revealed a significant positive correlation between serum CA19-9 levels and CT scores for total score and bronchiectasis, bronchiolitis, cavitation, and consolidation subscores after controlling for age, sex, and BMI. Serum CA19-9 levels were positively correlated with the CT severity score for NTM-PD. Serum CA19-9 may be useful in evaluating disease activity or therapeutic response in patients with NTM-PD.

scholarly journals A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-56
Author(s):  
D R Lim ◽  
M Tsai ◽  
S E Gruchy ◽  
J Jones ◽  
G Williams ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Nova Scotia ◽  
Stent Placement ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Occlusion ◽  
Stent Removal ◽  
Kaplan Meier ◽  
And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

scholarly journals SAT0540 ONE-YEAR OUTCOMES AFTER RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS FROM CHECKPOINT INHIBITORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.2-1227
Author(s):  
E. Berard ◽  
T. Barnetche ◽  
L. Rouxel ◽  
C. Dutriaux ◽  
L. Dousset ◽  
...  
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Symptomatic Treatment ◽  
Musculoskeletal Symptoms ◽  
Day Range ◽  
One Year

Background:Description and initial management of rheumatic immune-related adverse-events (irAEs) from cancer immunotherapies have been reported by several groups but to date, few studies have evaluated the long-term outcomes and management of rheumatic irAEs (1).Objectives:To describe the long-term management and assess the one-year outcomes of patients who experienced rheumatic immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI).Methods:This was a single-centre prospective observational study including patients referred for musculoskeletal symptoms while treated with ICI. After baseline rheumatological evaluation defining the clinical entity presented, follow-up visits were organised according to the type and severity of irAE. At one year, persistence of irAE, ongoing treatment, as well as cancer outcomes were assessed.Results:63 patients were included between September 2015 and June 2018. 24 patients (38%) presented with non-inflammatory musculoskeletal conditions managed with short-term symptomatic treatment and did not require specific follow-up. 39 patients (62%) experienced inflammatory manifestations, mimicking either rheumatoid arthritis (RA, n=19), polymyalgia rheumatica (PMR, n=16), psoriatic arthritis (PsA, n=3) and one flare of a preexisting axial spondyloarthritis. Overall, 32 patients (82%) received systemic glucocorticoids, with a median rheumatic dosage of 15mg/day (range: 5-60mg/day). None of the patients had to permanently discontinue ICI therapy for rheumatic irAE. 20 patients (67%) were still receiving glucocorticoids at one year, with a median dosage of 5mg/day (range: 2-20mg/day). Glucocorticoids were more frequently discontinued for patients with RA-like condition (44%) than PMR-like condition (23%), but no other predictive factor of glucocorticoids withdrawal could be identified. At one year, overall survival and progression-free survival were comparable between patients who were still receiving glucocorticoids for rheumatic irAE and patients who have discontinued. Eight patients required csDMARDs.Conclusion:At one year, a majority of patients required long-term low-dose glucocorticoids for chronic rheumatic irAE, which seems not altering oncological control.References:[1]Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2019 Sep 20.Disclosure of Interests:None declared

Predictive Value of Serum Carbohydrate Antigen 19-9 (CA19-9) for Early Mortality in Advanced Pancreatic Cancer

2017 ◽  
Vol 49 (4) ◽  
pp. 481-486 ◽  
Author(s):  
Pedro L. S. Usón Junior ◽  
Donato Callegaro-Filho ◽  
Diogo D. G. Bugano ◽  
Fernando Moura ◽  
Fernando C. Maluf
Keyword(s):  
Pancreatic Cancer ◽  
Predictive Value ◽  
Advanced Pancreatic Cancer ◽  
Carbohydrate Antigen ◽  
Early Mortality ◽  
Serum Carbohydrate Antigen

scholarly journals Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Tatsuki Ueda ◽  
Masataka Kikuyama ◽  
Yuzo Kodama ◽  
Takafumi Kurokami
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Stent Placement ◽  
Bile Ducts ◽  
Common Bile Duct Stones ◽  
Biliary Stent ◽  
Duodenal Papilla ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Obstructive Cholangitis

Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST) on common bile duct stones (CBDS) disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS.Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP) was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP.Results. CBDS disappearance was observed in 32 (48.5%) of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007andp<0.001, resp.). Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002).Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

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