Surgery After Downstaging of Unresectable Hepatic Tumors With Intra-Arterial Chemotherapy

Meric, Funda; Patt, Yehuda Z.; Curley, S. A.; Chase, Judy L.; Roh, Mark S.; Vauthey, Jean Nicolas; Ellis, Lee M.

doi:10.1007/s10434-000-0490-2

Cited by 100 publications

(57 citation statements)

References 33 publications

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“…Curative treatment is the main goal, of HCC treatment, but only few patients (10-15%) with HCC are fit for this kind of treatment at diagnosis (4,45), therefore persistent screening of "at risk" patients is mandatory for early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…More than 80% of HCC patients present with liver cirrhosis. Less than 20% of these patients present with resectable tumors either because tumor related factors (such as local extension of the tumor, multicentric HCC), or because of the advanced liver disease (4), which affects liver function. Actual treatment of HCC is represented by curative treatment (LR, LT and RFA), local control or bridging therapy that includes RFA, TACE and in some cases LR (before LT), and palliation therapy consisting of targeted therapy, chemotherapy and radiotherapy (5).…”

Section: Introductionmentioning

confidence: 99%

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Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Grigorie¹,

Alexandrescu²,

Smira³

et al. 2017

chr

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RezumatObiectivul acestui studiu este acela de a evalua rezultatele pacienţilor trataţi pentru hepatocarcinom (CHC) într-un centru de Chirurgie Generalã şi Transplant Hepatic. Material şi metode: Acest studiu retrospectiv include 844 pacienţi diagnosticaţi cu CHC şi trataţi chirurgical cu intenţie de radicalitate. Singurele metode de tratament curativ pentru CHC, la ora actualã sunt reprezentate de rezecţia hepaticã (RH) şi transplantul hepatic (TH). Ablaţia tumoralã poate fi indicatã în tratamentul CHC precoce, în cazurile la care rezecţia sau transplantul hepatic nu se pot efectua. La 518 pacienţi s-a practicat rezecţie hepaticã, 162 au beneficiat de transplant hepatic, iar 164 pacienţi au fost trataţi prin distrucţie cu radiofrecvenţã (RFA). 615 pacienţi (73%) au prezentat cirozã hepaticã. Rezultate: Morbiditatea şi mortalitatea înregistrate pentru întreg lotul de pacienţi au fost de 30% şi respectiv 4,3%. Supravieţuirea la 5 ani a fost de 39% cu diferenţe semnificative statistic între pacienţii la care s-a practicat RH comparativ cu cei transplantaţi şi Chirurgia (2017)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Grigorie¹,

Alexandrescu²,

Smira³

et al. 2017

chr

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“…Combined therapy, consisting of an intra-arterial infusion of a cytotoxic agent and systemic administration of interferon-α was reportedly useful as a palliative treatment for HCC patients with major vascular involvement [1] . Additional therapy following HAIC, including surgery, MCT, PEI, and extra chemotherapy, might be another option for the prolongation of survival in advanced HCC patients [18,39] . Moreover, the identification of tumors which are more sensitive to cytotoxic agents, and the reason for this are also important areas for future research.…”

Section: Discussionmentioning

confidence: 99%

Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with tumor thrombosis of the portal vein

Lai

Shih²,

Jeng³

et al. 2003

WJG

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AIM: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with poor prognosis. The aim of this prospective study was to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) for patients with this disease. METHODS:Eighteen HCC patients with PVTT were treated with HAIC via a subcutaneously implanted injection port. A course of chemotherapy consisted of daily cisplatin (10 mg for one hour) followed by 5-fluorouracil (250 mg for five hours) for five continuous days within a given week. The patients were scheduled to receive four consecutive courses of HAIC. Responders were defined in whom either a complete or partial response was achieved, while non-responders were defined based on stable or progressive disease status. The prognostic factors associated with survival after treatment were analyzed. RESULTS:Six patients exhibited partial response to this form of HAIC (response rate = 33 %). The 3, 6, 9, 12 and 18-month cumulative survival rates for the 18 patients were 83 %, 72 %, 50 %, 28 %, and 7 %, respectively. Median survival times for the six responders and 12 non-responders were 15.0 (range, 11-18) and 7.5 (range, 1-13) months, respectively. It was demonstrated by both univariate and multivariate analyses that the therapeutic response and hepatic reserve function were significant prognostic factors.

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“…Indeed, even staged resections of hepatic metastases are undertaken with or without neoadjuvant chemotherapy to accomplish complete resection. 21 Our univariate analysis identified a number of variables affecting outcome. However, multivariable logistic regression analysis identified only perioperative blood transfusion and positive hepatoduodenal lymph nodes as independent and clinically significant correlates of both survival and recurrence.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Resection for Colorectal Metastases

Zakaria¹,

Donohue²,

Que³

et al. 2007

Annals of Surgery

265

223

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Introduction: Predictors of outcome in patients with metastatic colorectal cancer remain inconsistent. We aimed to identify predictors of outcome in these patients, to develop a prognostic scoring system, and to assess the general applicability of the current major risk scoring systems. Materials and Methods: Following IRB approval, medical records of 662 consecutive patients undergoing resection of colorectal metastases to the liver during 1960 to 1995 were reviewed. Clinicopathologic and outcome data were assessed from records and mailed questionnaire. Clinicopathologic variables were tested using univariate and multivariate analyses; best-fit models were then generated to study the effect of each independent risk factor on outcome. To validate existing scoring models, our independent data set was applied to those scores. The relative concordance probability estimates were calculated for these models and compared with that of the proposed Mayo model. Results:The overall and disease-specific 5-year survival rates were 37% and 42%, respectively. The probability of recurrence at any site was 65% at 5 years. Perioperative blood transfusion and positive hepatoduodenal nodes were the major determinants of survival and recurrence. To assess the general applicability of the proposed risk scoring systems, we imported the data from our patient population into 3 other scoring systems. Neither survival nor recurrence among our patients was stratified discretely by any of the scoring systems. Based on probability estimates, all models were only marginally better than chance alone in predicting outcome. Conclusion: Broad application of risk scoring systems for patients with metastatic colorectal cancer has limited clinical value and refinement and external validation should be undertaken before utilization.

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Surgery After Downstaging of Unresectable Hepatic Tumors With Intra-Arterial Chemotherapy

Abstract: Hepatic resection or ablation after tumor downstaging with HAI therapy is a viable option for patients with unresectable HCC. However, given the high rate of recurrence of metastases from CRC, hepatic resection or ablation after downstaging with HAI should be used with caution.

Cited by 100 publications

References 33 publications

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with tumor thrombosis of the portal vein

Hepatic Resection for Colorectal Metastases

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