BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies often lead to a poor prognosis.AIM To assess the safety and efficacy of transarterial chemoembolization(TACE)with donafenib and immune checkpoint inhibitors(ICIs)for unresectable HCC.METHODS We retrospectively assessed the data of patients with HCC who underwent TACE combined with donafenib and an ICI(tislelizumab or cedilimumab).Patients received oral donafenib daily for 2 weeks before TACE,followed by tislelizumab or cedilimumab 200 mg intravenously on day 1 of a 21-day therapeutic cycle.The primary endpoints were objective response rate,disease control rate,and duration of response according to the modified RECIST criteria.The secondary endpoint was presence of treatment-related adverse events(TRAEs).RESULTS The median follow-up was 7.8 months(95%CI:5.0-11.8 months).The objective response rate was 60.0%(18/30),while the disease control rate was 93.3%.The median duration of response in confirmed responders was 6.6 months(95%CI:1.3-12.9 months).The median progression-free survival was 11.8 months(95%CI:8.3-15.4 months).More than half of the patients survived until the end of the study.Grade>3 TRAEs occurred in 40%of the patients with no grade 5 TRAEs reported.The most common grade 3/4 TRAE was palmar-plantar erythrodysesthesia,a dermatologic condition characterized by painful redness and swelling of the palms and soles,with an incidence of 56.7%.No ICI-related adverse effects were observed.CONCLUSION TACE combined with donafenib and ICI is a promising and safe therapeutic regimen for unresectable HCC.展开更多
Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown pr...Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.展开更多
In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein lig...In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.展开更多
BACKGROUND Transarterial chemoembolization(TACE)is a main treatment for advanced hepatocellular carcinoma(HCC),but tumors often become resistant.Combining TACE programmed cell death(ligand)1[PD-(L)1]inhibitors and mol...BACKGROUND Transarterial chemoembolization(TACE)is a main treatment for advanced hepatocellular carcinoma(HCC),but tumors often become resistant.Combining TACE programmed cell death(ligand)1[PD-(L)1]inhibitors and molecular targeted therapies(MTT)may improve outcomes,but its role in preventing TACE resistance requires further investigation.AIM To compare if TACE plus PD-(L)1 inhibitors and MTT reduces TACE resistance and improves survival in advanced HCC compared to TACE alone.METHODS We analyzed 721 patients:532 received TACE only,and 72 received TACE with PD-(L)1 inhibitors and MTT.After matching patient characteristics,144 patients(72 pairs)were compared.Tumor progression after 3 treatment cycles was measured.RESULTS The combination group exhibited significantly lower TACE resistance rates compared to the monotherapy group(9.7%vs 38.8%,P<0.001).Moreover,patients in the combination group experienced prolonged progression-free survival(progression-free survival:17.5 months vs 9.1 months,P=0.004)and overall survival(overall survival:20.8 months vs 16.4 months,P=0.008).These findings underscore the efficacy of combination therapy in enhancing therapeutic outcomes in advanced HCC.CONCLUSION Adding immunotherapy and targeted drugs to TACE significantly reduces treatment resistance and improves survival in advanced liver cancer,suggesting it may become a new standard treatment.展开更多
Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showe...Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.展开更多
BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling lo...BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.展开更多
AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a tot...AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a total of 41 HCC nodules(≤3 cm in diameter)were treated with TACE followed by computed tomograghy(CT)-guided percutaneous microwave coagulation therapy(PMCT) within 1-3 wk. RESULTS:By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci.In seven foci,incomplete necrosis of the surrounding parenchyma was observed.Serum alpha- fetoprotein(AFP)levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels.The follow-up period was 6-31 mo,and all patients remained alive.One patient had a recurrence in the subsegments of the liver,and another patient had a recurrence near the original lesion. CONCLUSION:Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.展开更多
BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for wait...BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.展开更多
BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatm...BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatment of UESL in children.AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019.The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava.The NAT included preoperative transcatheter arterial chemoembol ization(TACE)and systemic chemotherapy.The patients were 4 boys and 2 girls with a mean age of 7 years.The longest tumor at presentation ranged from 8.6 to 14.8 cm(mean,12 cm).Extrahepatic metastases were present in 2 cases.Preoperative systemic chemotherapy was administered 3 wk after TACE.Tumor resection was performed 3 wk after one or two cycles of NAT.The patients received systemic chemotherapy after surgery.RESULTS All patients successfully underwent NAT and complete resection.The tumor volumes decreased by 18.2%–68.7%,with a mean decrease of 36%after 1 cycle of NAT(t=3.524,P=0.017).According to the Response Evaluation Criteria In Solid Tumors criteria,4 patients had a partial response and underwent surgery,while 2 had stable disease and received another cycle of NAT before surgery.Massive tumor necrosis was seen on pathological examination of the surgical specimen:>90%necrosis in two,>50%necrosis in three,and 25%necrosis in 1,with an average of 71.8%.Post-NAT complications included fever,nausea and vomiting,and mild bone marrow suppression.Elevated alanine transaminase levels occurred in all patients,which returned to normal within 7–10 d after treatment.No cardiac or renal toxicity,severe hepatic dysfunction,bleeding and nontarget embolization were observed in the patients.The median follow-up period was 8 years with an overall survival of 100%.CONCLUSION NAT effectively reduced tumor volume,cleared the tumor margin,and caused massive tumor necrosis.This may be a promising choice for successful surgery of UESL in children.展开更多
This article discusses the article written by Tan et al.Transarterial chemoembol-ization(TACE)is one of the main treatment methods for advanced hepatocellular carcinoma(HCC).There are other vascular interventional the...This article discusses the article written by Tan et al.Transarterial chemoembol-ization(TACE)is one of the main treatment methods for advanced hepatocellular carcinoma(HCC).There are other vascular interventional therapies,including drug-eluting bead TACE,transarterial radioembolization,and hepatic arterial infusion chemotherapy.TACE combined with anti-angiogenesis therapy may improve tumor control and prolong progression free survival.The combination therapy of TACE and immunotherapy may improve the clinical efficacy of HCC.In future research,more basic and clinical studies are needed to explore the immunogenic intervention therapy.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still hav...BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC.Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.展开更多
Objective: To investigate the safety and efficacy of Transcatheter Arterial Chemoembolization (TACE), sequential Microwave Ablation (MWA) combined with targeted therapy and immunotherapy versus TACE combined with targ...Objective: To investigate the safety and efficacy of Transcatheter Arterial Chemoembolization (TACE), sequential Microwave Ablation (MWA) combined with targeted therapy and immunotherapy versus TACE combined with targeted therapy and immunotherapy in the treatment of large hepatocellular carcinoma (defined as tumor diameter > 5 cm). Methods: The prospective cohort study was conducted, with 81 patients with large hepatocellular carcinoma who were admitted to Jingzhou Central Hospital from 2018 to 2022, they were divided into two groups, 41 patients received TACE sequential MWA combined with targeted therapy and immunotherapy (observation group), and 40 patients received single TACE combined with targeted therapy and immunotherapy (control group). The short-term efficacies after 3 months of treatment, the Disease Control Rate (DCR), the Overall Survival (OS), adverse drug reactions and complications were compared and analyzed between the two groups. Results: The Objective Response Rate (ORR) of the observation group was significantly higher than that of the control group (ORR: 85.4% vs 57.5%, P = 0.005), The median Progression-Free Survival (PFS) and median OS of the observation group were better than those of the control group (mPFS: 16 months vs 10 months, P = 0.004;mOS: 39 months. vs 24 months, P = 0.008). The 1-, 2- and 3-year progression-free survival rates of the observation group were 72.9%, 50.4%, and 25.6%, and those of the control group were 30.4%, 11.0%, and 3.7%. The 1-, 2- and 3-year overall survival rates of the observation group were 78.9%, 71.7%, and 65.2%, and those of the control group were 65.1%, versus 42.1% and 36.9%. There was no significant difference in the incidence of adverse drug reactions and complications between the two groups. In this study, the adverse drug reactions were mild in Grades 1 - 2. Conclusion: TACE sequential MWA combined with targeted therapy and immunotherapy has efficacy and safety.展开更多
AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal...AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.展开更多
Objective: To prepare Pingyangmycin gelatin microspheres (PYM-GMS) for carotid artery embolization therapy and to study the release characteristics in vivo and in vitro. Methods: PYM-GMS was prepared by optical doubl...Objective: To prepare Pingyangmycin gelatin microspheres (PYM-GMS) for carotid artery embolization therapy and to study the release characteristics in vivo and in vitro. Methods: PYM-GMS was prepared by optical double-phase emulsified condensation polymerization. Through UV-spectrophotometer drug content and encapsulation rate were measured. The characteristics of drug release in vitro which could simulate the actual state in vivo were tested by HPLC. Three ways of vein drop, artery perfusion and artery embolization were contrasted. Under the supervision of X-ray, PYM-GMS were perfused into the external carotid artery of rabbits by superselective artery embolization. Blood samples were tested at different time and analyzed statistically. Results: The roundness of PYM-GMS was 1.02?.005. The mean diameter was 85.6 mm, 78% of them ranging from 50-200 mm, which fitted the use of embolization. PYM content and encapsulation rate were 6.8% and 91.3% respectively. 70% of the drug was released in 3 h in the simulated environment in vivo and total drug was released after more than 6 h. After artery embolization with small dosage of PYM-GMS, the local drug concentration was 8 times higher than the blood drug concentration and the high level of local drug concentration was kept for more than 120 min. Conclusion: External carotid artery embolization with PYM-GMS, which significantly reduced the circulating drug level and employment dosage, could prolong the duration higher drug concentration and suit the purpose of targeted tumor therapy.展开更多
Objective： Interventional embolization therapy is well accepted in cancer treatment, but patient may suffer from a moderate-to-severe pain after therapy and its quality of life （QoL） is influenced, this study is to...Objective： Interventional embolization therapy is well accepted in cancer treatment, but patient may suffer from a moderate-to-severe pain after therapy and its quality of life （QoL） is influenced, this study is to observe the efficacy and safety of transdermal fentanyl （TDF） in the management of pain caused by interventional embolization therapy. Methods： Morphine 10mg and TDF 25μg/h were immediately used in 52 patients who had moderate-to-severe pain complicated by interventional embolization therapy, the pain intensity was evaluated by visual analogue scale （VAS）. If VAS≥4 at t2 h after treatment, the dosage of TDF added into 50 μg/h. At 0h, 12h, 24h, 72h, 1 week, 2 weeks after TD, the vas and adverse events were observed respectively. Result： There was an obvious decrease in VAS at 12h after TDF treatment in the patients of which only 9 patients used 50ug/h dosage after partial splenic embolization （PSE） therapy. Most patients got satisfactory pain relief both the TDF 25 μg/h and TDF 50 μg/h group （VAS 0-1）. The adverse events were nausea, vomiting and dizzy, especially in the TDF 50 μg/h group. No respiratory depression was observed and only one patient got retention of urine. Conclusion： TDF was effective and safe in the treatment of moderate-to-severe pain after interventional embolizafion therapy.展开更多
AIM To study the effects of hepatic arterial infusion chemotherapy (HAI) or embolization (HAE) in the treatment of primary hepatic carcinoma (PHC) and the factors influencing the effects. METHODS Follow up informa...AIM To study the effects of hepatic arterial infusion chemotherapy (HAI) or embolization (HAE) in the treatment of primary hepatic carcinoma (PHC) and the factors influencing the effects. METHODS Follow up information in 188 patients (166 males and 22 females) with PHC treated with HAI ( n =82) or HAE ( n =106) were analyzed retrospectively. RESULTS The overall therapeutic effects were as follows: symptomatic relief in 59 6%; tumor shrinkage in 55%, blood AFP decrease in 37 8% and the overall survival rates of 1/2, 1, 2 and 3 years after treatment being 75 4%, 46%, 23 5% and 14 7%, respectively. The mean survival time was 12 2 months and the longest survival period was 50 months after treatment. In the HAI group the 1/2, 1, 2 and 3 years survival rates were 61 0%, 25 4%, 4 5% and 0%, respectively, the mean survival time being 7 7 months; in the HAE group the survival rates were 86 8%, 61 7%, 37 8% and 26 1%, respectively, the mean survival time being 15 7 months. Eighteen patients received secondary surgery. Seven factors influencing the therapeutic effects were analyzed. CONCLUSION Those cases of PHC with or without mild liver cirrhosis, stages Ⅰ and Ⅱ, single tumor, tumor size less than 10cm in diameter, no cancerous thrombus within the portal vein or hepatic arterio venous fistula, and HAE treatment time more than 3 times had better therapeutic effects than the contrast cases. To overcome these influencing factors and to adopt the comprehensive therapy would improve the effects of HAI or HAE in the treatment of PHC.展开更多
AIM:To evaluate the efficacy and safety of combination therapy with recombinant adenovirus p53 injection (rAdp53) and transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC)...AIM:To evaluate the efficacy and safety of combination therapy with recombinant adenovirus p53 injection (rAdp53) and transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC).METHODS:A total of 82 patients with advanced HCC treated only with TACE served as control group.Another 68 patients with HCC treated with TACE in combination with recombinant adenovirus-p53 injection served as p53 treatment group.Patients were followed up for 12 mo.Safety and therapeutic effects were evaluated according to the improvement in clinical symptoms,leukocyte count,Karnofsky and RECIST criteria.Survival rate was calculated with Kaplan-Meier method.RESULTS:The total effective rate was 58.3% for p53 treatment group,and 26.5% for control group (P < 0.05).The incidence of gastrointestinal symptoms was lower in p53 treatment group than in control group (P < 0.05).The 3-,6-and 12-mo survival rates were significantly higher for p53 treatment group than for control group (P < 0.01).The combination treatment was well tolerated with such adverse events as fever (51.5%,P=0.006) and pain of muscles and joints (13.2%,P=0.003),which were significantly higher than the chemotherapy.Except for these minor adverse effects,no severe vector-related complications were identified.With respect to the efficacy,patients in p53 treatment group had less gastrointerestinal symptoms (P=0.062),better improvement in tumor-related pain (P=0.003),less downgrade of leukocyte counts (P=0.003) and more upgrade of Karnofsky performance score (P=0.029) than those in control group.The total effective rate (CR + PR) for p53 treatment group and control group was 58.3% and 26.5%,respectively,with distributions of different effect in two groups (P=0.042).The survival rates were 89.71%,76.13%,and 43.30% for p53 treatment group,and 68.15%,36.98%,and 24.02% for control group,respectively,3,6 and 12 mo after treatment,suggesting that the survival rates are significantly higher for p53 treatment group than for control group (P=0.0002).CONCLUSION:The rAd-p53 gene therapy in combination with TACE is a safe and effective treatment modality for advanced HCC.展开更多
Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy...Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.展开更多
Retroperitoneal hemorrhage is a possible complication that has been noticed in COVID-19 patients on anticoagulant therapy. The data related to treatment and outcomes in this condition are scarce. We present a case ser...Retroperitoneal hemorrhage is a possible complication that has been noticed in COVID-19 patients on anticoagulant therapy. The data related to treatment and outcomes in this condition are scarce. We present a case series of four COVID-19 patients with lumbar artery bleeding, who were treated with transcatheter arterial embolization using embolization particles. The procedure was executed without any complications, and hemostasis was achieved in all four patients. Despite the patients survived the procedure, one patient died due to respiratory failure three weeks after the procedure, and one died due to hypovolemic shock two days later. Considering the ongoing state of COVID-19 pandemic, it is essential to be aware of transcatheter arterial embolization as a safe and effective procedure for treating retroperitoneal hemorrhage in COVID-19 patients.展开更多
BACKGROUND Hepatocellular carcinoma is an aggressive tumor,and its latency and lack of clinical symptoms mean that most patients are already in the late stage when diagnosed.Large tumor volume and metastasis are the m...BACKGROUND Hepatocellular carcinoma is an aggressive tumor,and its latency and lack of clinical symptoms mean that most patients are already in the late stage when diagnosed.Large tumor volume and metastasis are the main reasons for not attempting surgery.Portal vein embolization and associated liver partition and portal vein ligation for staged hepatectomy are commonly used in clinical practice to increase the volume of remnant liver to allow surgical resection;however,research in this area is currently lacking.CASE SUMMARY A 48-year-old male patient with a history of viral hepatitis B for at least 30 years attended our center with a hepatic space-occupying lesion detected 3 d previously.Enhanced computed tomography scanning of the upper abdomen revealed a large mass in the right lobe of the liver,centered on the right posterior lobe,with the larger section measuring about 14 cm×10 cm×14 cm.He successfully underwent conversion therapy for a large right liver tumor after combined hepatic artery ligation and transcatheter arterial chemoembolization,and finally had an opportunity to undergo right hemi-hepatectomy and cholecystectomy.He remained asymptomatic with no obvious abnormalities on computed tomography scanning review at 2 mo after surgery.CONCLUSION This case highlights new ideas and provides a reference for conversion therapy of large liver tumors.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies often lead to a poor prognosis.AIM To assess the safety and efficacy of transarterial chemoembolization(TACE)with donafenib and immune checkpoint inhibitors(ICIs)for unresectable HCC.METHODS We retrospectively assessed the data of patients with HCC who underwent TACE combined with donafenib and an ICI(tislelizumab or cedilimumab).Patients received oral donafenib daily for 2 weeks before TACE,followed by tislelizumab or cedilimumab 200 mg intravenously on day 1 of a 21-day therapeutic cycle.The primary endpoints were objective response rate,disease control rate,and duration of response according to the modified RECIST criteria.The secondary endpoint was presence of treatment-related adverse events(TRAEs).RESULTS The median follow-up was 7.8 months(95%CI:5.0-11.8 months).The objective response rate was 60.0%(18/30),while the disease control rate was 93.3%.The median duration of response in confirmed responders was 6.6 months(95%CI:1.3-12.9 months).The median progression-free survival was 11.8 months(95%CI:8.3-15.4 months).More than half of the patients survived until the end of the study.Grade>3 TRAEs occurred in 40%of the patients with no grade 5 TRAEs reported.The most common grade 3/4 TRAE was palmar-plantar erythrodysesthesia,a dermatologic condition characterized by painful redness and swelling of the palms and soles,with an incidence of 56.7%.No ICI-related adverse effects were observed.CONCLUSION TACE combined with donafenib and ICI is a promising and safe therapeutic regimen for unresectable HCC.
基金Supported by 2023 Hebei Provincial Medical Scientific Research Project Plan,No.20231304.
文摘Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.
基金Supported by the National Natural Science Foundation of China,No.82404058Shanghai Municipal Commission of Health and Family Planning,No.2024ZZ2049Beijing Xisike Clinical Oncology Research Foundation,No.Y-HS202401-0011.
文摘In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.
文摘BACKGROUND Transarterial chemoembolization(TACE)is a main treatment for advanced hepatocellular carcinoma(HCC),but tumors often become resistant.Combining TACE programmed cell death(ligand)1[PD-(L)1]inhibitors and molecular targeted therapies(MTT)may improve outcomes,but its role in preventing TACE resistance requires further investigation.AIM To compare if TACE plus PD-(L)1 inhibitors and MTT reduces TACE resistance and improves survival in advanced HCC compared to TACE alone.METHODS We analyzed 721 patients:532 received TACE only,and 72 received TACE with PD-(L)1 inhibitors and MTT.After matching patient characteristics,144 patients(72 pairs)were compared.Tumor progression after 3 treatment cycles was measured.RESULTS The combination group exhibited significantly lower TACE resistance rates compared to the monotherapy group(9.7%vs 38.8%,P<0.001).Moreover,patients in the combination group experienced prolonged progression-free survival(progression-free survival:17.5 months vs 9.1 months,P=0.004)and overall survival(overall survival:20.8 months vs 16.4 months,P=0.008).These findings underscore the efficacy of combination therapy in enhancing therapeutic outcomes in advanced HCC.CONCLUSION Adding immunotherapy and targeted drugs to TACE significantly reduces treatment resistance and improves survival in advanced liver cancer,suggesting it may become a new standard treatment.
基金supported by grants from the National Natural Science Foundation of China(82270682)the Natural Science Foundation of Zhejiang Province(LQ21H030007 and LQ20H30006)。
文摘Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.
文摘BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.
文摘AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a total of 41 HCC nodules(≤3 cm in diameter)were treated with TACE followed by computed tomograghy(CT)-guided percutaneous microwave coagulation therapy(PMCT) within 1-3 wk. RESULTS:By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci.In seven foci,incomplete necrosis of the surrounding parenchyma was observed.Serum alpha- fetoprotein(AFP)levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels.The follow-up period was 6-31 mo,and all patients remained alive.One patient had a recurrence in the subsegments of the liver,and another patient had a recurrence near the original lesion. CONCLUSION:Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.
文摘BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.
基金Youth Program of Natural Science Foundation of Zhejiang Province,No.LQ20H160027National Natural Science Foundation of China,No.U20A20137。
文摘BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatment of UESL in children.AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019.The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava.The NAT included preoperative transcatheter arterial chemoembol ization(TACE)and systemic chemotherapy.The patients were 4 boys and 2 girls with a mean age of 7 years.The longest tumor at presentation ranged from 8.6 to 14.8 cm(mean,12 cm).Extrahepatic metastases were present in 2 cases.Preoperative systemic chemotherapy was administered 3 wk after TACE.Tumor resection was performed 3 wk after one or two cycles of NAT.The patients received systemic chemotherapy after surgery.RESULTS All patients successfully underwent NAT and complete resection.The tumor volumes decreased by 18.2%–68.7%,with a mean decrease of 36%after 1 cycle of NAT(t=3.524,P=0.017).According to the Response Evaluation Criteria In Solid Tumors criteria,4 patients had a partial response and underwent surgery,while 2 had stable disease and received another cycle of NAT before surgery.Massive tumor necrosis was seen on pathological examination of the surgical specimen:>90%necrosis in two,>50%necrosis in three,and 25%necrosis in 1,with an average of 71.8%.Post-NAT complications included fever,nausea and vomiting,and mild bone marrow suppression.Elevated alanine transaminase levels occurred in all patients,which returned to normal within 7–10 d after treatment.No cardiac or renal toxicity,severe hepatic dysfunction,bleeding and nontarget embolization were observed in the patients.The median follow-up period was 8 years with an overall survival of 100%.CONCLUSION NAT effectively reduced tumor volume,cleared the tumor margin,and caused massive tumor necrosis.This may be a promising choice for successful surgery of UESL in children.
文摘This article discusses the article written by Tan et al.Transarterial chemoembol-ization(TACE)is one of the main treatment methods for advanced hepatocellular carcinoma(HCC).There are other vascular interventional therapies,including drug-eluting bead TACE,transarterial radioembolization,and hepatic arterial infusion chemotherapy.TACE combined with anti-angiogenesis therapy may improve tumor control and prolong progression free survival.The combination therapy of TACE and immunotherapy may improve the clinical efficacy of HCC.In future research,more basic and clinical studies are needed to explore the immunogenic intervention therapy.
基金Supported by Financiamento e IncentivoàPesquisa(FIPE/HCPA)of Hospital de Clínicas de Porto Alegre,No.2020-0473.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC.Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.
文摘Objective: To investigate the safety and efficacy of Transcatheter Arterial Chemoembolization (TACE), sequential Microwave Ablation (MWA) combined with targeted therapy and immunotherapy versus TACE combined with targeted therapy and immunotherapy in the treatment of large hepatocellular carcinoma (defined as tumor diameter > 5 cm). Methods: The prospective cohort study was conducted, with 81 patients with large hepatocellular carcinoma who were admitted to Jingzhou Central Hospital from 2018 to 2022, they were divided into two groups, 41 patients received TACE sequential MWA combined with targeted therapy and immunotherapy (observation group), and 40 patients received single TACE combined with targeted therapy and immunotherapy (control group). The short-term efficacies after 3 months of treatment, the Disease Control Rate (DCR), the Overall Survival (OS), adverse drug reactions and complications were compared and analyzed between the two groups. Results: The Objective Response Rate (ORR) of the observation group was significantly higher than that of the control group (ORR: 85.4% vs 57.5%, P = 0.005), The median Progression-Free Survival (PFS) and median OS of the observation group were better than those of the control group (mPFS: 16 months vs 10 months, P = 0.004;mOS: 39 months. vs 24 months, P = 0.008). The 1-, 2- and 3-year progression-free survival rates of the observation group were 72.9%, 50.4%, and 25.6%, and those of the control group were 30.4%, 11.0%, and 3.7%. The 1-, 2- and 3-year overall survival rates of the observation group were 78.9%, 71.7%, and 65.2%, and those of the control group were 65.1%, versus 42.1% and 36.9%. There was no significant difference in the incidence of adverse drug reactions and complications between the two groups. In this study, the adverse drug reactions were mild in Grades 1 - 2. Conclusion: TACE sequential MWA combined with targeted therapy and immunotherapy has efficacy and safety.
基金the National Key R and D Program of China,No.2016YFC0106604the National Natural Science Foundation of China,No.81502591
文摘AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.
基金This work was supported by the National Natural Science Foundation of China (No.30170271).
文摘Objective: To prepare Pingyangmycin gelatin microspheres (PYM-GMS) for carotid artery embolization therapy and to study the release characteristics in vivo and in vitro. Methods: PYM-GMS was prepared by optical double-phase emulsified condensation polymerization. Through UV-spectrophotometer drug content and encapsulation rate were measured. The characteristics of drug release in vitro which could simulate the actual state in vivo were tested by HPLC. Three ways of vein drop, artery perfusion and artery embolization were contrasted. Under the supervision of X-ray, PYM-GMS were perfused into the external carotid artery of rabbits by superselective artery embolization. Blood samples were tested at different time and analyzed statistically. Results: The roundness of PYM-GMS was 1.02?.005. The mean diameter was 85.6 mm, 78% of them ranging from 50-200 mm, which fitted the use of embolization. PYM content and encapsulation rate were 6.8% and 91.3% respectively. 70% of the drug was released in 3 h in the simulated environment in vivo and total drug was released after more than 6 h. After artery embolization with small dosage of PYM-GMS, the local drug concentration was 8 times higher than the blood drug concentration and the high level of local drug concentration was kept for more than 120 min. Conclusion: External carotid artery embolization with PYM-GMS, which significantly reduced the circulating drug level and employment dosage, could prolong the duration higher drug concentration and suit the purpose of targeted tumor therapy.
文摘Objective： Interventional embolization therapy is well accepted in cancer treatment, but patient may suffer from a moderate-to-severe pain after therapy and its quality of life （QoL） is influenced, this study is to observe the efficacy and safety of transdermal fentanyl （TDF） in the management of pain caused by interventional embolization therapy. Methods： Morphine 10mg and TDF 25μg/h were immediately used in 52 patients who had moderate-to-severe pain complicated by interventional embolization therapy, the pain intensity was evaluated by visual analogue scale （VAS）. If VAS≥4 at t2 h after treatment, the dosage of TDF added into 50 μg/h. At 0h, 12h, 24h, 72h, 1 week, 2 weeks after TD, the vas and adverse events were observed respectively. Result： There was an obvious decrease in VAS at 12h after TDF treatment in the patients of which only 9 patients used 50ug/h dosage after partial splenic embolization （PSE） therapy. Most patients got satisfactory pain relief both the TDF 25 μg/h and TDF 50 μg/h group （VAS 0-1）. The adverse events were nausea, vomiting and dizzy, especially in the TDF 50 μg/h group. No respiratory depression was observed and only one patient got retention of urine. Conclusion： TDF was effective and safe in the treatment of moderate-to-severe pain after interventional embolizafion therapy.
文摘AIM To study the effects of hepatic arterial infusion chemotherapy (HAI) or embolization (HAE) in the treatment of primary hepatic carcinoma (PHC) and the factors influencing the effects. METHODS Follow up information in 188 patients (166 males and 22 females) with PHC treated with HAI ( n =82) or HAE ( n =106) were analyzed retrospectively. RESULTS The overall therapeutic effects were as follows: symptomatic relief in 59 6%; tumor shrinkage in 55%, blood AFP decrease in 37 8% and the overall survival rates of 1/2, 1, 2 and 3 years after treatment being 75 4%, 46%, 23 5% and 14 7%, respectively. The mean survival time was 12 2 months and the longest survival period was 50 months after treatment. In the HAI group the 1/2, 1, 2 and 3 years survival rates were 61 0%, 25 4%, 4 5% and 0%, respectively, the mean survival time being 7 7 months; in the HAE group the survival rates were 86 8%, 61 7%, 37 8% and 26 1%, respectively, the mean survival time being 15 7 months. Eighteen patients received secondary surgery. Seven factors influencing the therapeutic effects were analyzed. CONCLUSION Those cases of PHC with or without mild liver cirrhosis, stages Ⅰ and Ⅱ, single tumor, tumor size less than 10cm in diameter, no cancerous thrombus within the portal vein or hepatic arterio venous fistula, and HAE treatment time more than 3 times had better therapeutic effects than the contrast cases. To overcome these influencing factors and to adopt the comprehensive therapy would improve the effects of HAI or HAE in the treatment of PHC.
文摘AIM:To evaluate the efficacy and safety of combination therapy with recombinant adenovirus p53 injection (rAdp53) and transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC).METHODS:A total of 82 patients with advanced HCC treated only with TACE served as control group.Another 68 patients with HCC treated with TACE in combination with recombinant adenovirus-p53 injection served as p53 treatment group.Patients were followed up for 12 mo.Safety and therapeutic effects were evaluated according to the improvement in clinical symptoms,leukocyte count,Karnofsky and RECIST criteria.Survival rate was calculated with Kaplan-Meier method.RESULTS:The total effective rate was 58.3% for p53 treatment group,and 26.5% for control group (P < 0.05).The incidence of gastrointestinal symptoms was lower in p53 treatment group than in control group (P < 0.05).The 3-,6-and 12-mo survival rates were significantly higher for p53 treatment group than for control group (P < 0.01).The combination treatment was well tolerated with such adverse events as fever (51.5%,P=0.006) and pain of muscles and joints (13.2%,P=0.003),which were significantly higher than the chemotherapy.Except for these minor adverse effects,no severe vector-related complications were identified.With respect to the efficacy,patients in p53 treatment group had less gastrointerestinal symptoms (P=0.062),better improvement in tumor-related pain (P=0.003),less downgrade of leukocyte counts (P=0.003) and more upgrade of Karnofsky performance score (P=0.029) than those in control group.The total effective rate (CR + PR) for p53 treatment group and control group was 58.3% and 26.5%,respectively,with distributions of different effect in two groups (P=0.042).The survival rates were 89.71%,76.13%,and 43.30% for p53 treatment group,and 68.15%,36.98%,and 24.02% for control group,respectively,3,6 and 12 mo after treatment,suggesting that the survival rates are significantly higher for p53 treatment group than for control group (P=0.0002).CONCLUSION:The rAd-p53 gene therapy in combination with TACE is a safe and effective treatment modality for advanced HCC.
基金supported by National Natural Science Foundation of China (no. 81471759)Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZYLX202117)。
文摘Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.
文摘Retroperitoneal hemorrhage is a possible complication that has been noticed in COVID-19 patients on anticoagulant therapy. The data related to treatment and outcomes in this condition are scarce. We present a case series of four COVID-19 patients with lumbar artery bleeding, who were treated with transcatheter arterial embolization using embolization particles. The procedure was executed without any complications, and hemostasis was achieved in all four patients. Despite the patients survived the procedure, one patient died due to respiratory failure three weeks after the procedure, and one died due to hypovolemic shock two days later. Considering the ongoing state of COVID-19 pandemic, it is essential to be aware of transcatheter arterial embolization as a safe and effective procedure for treating retroperitoneal hemorrhage in COVID-19 patients.
文摘BACKGROUND Hepatocellular carcinoma is an aggressive tumor,and its latency and lack of clinical symptoms mean that most patients are already in the late stage when diagnosed.Large tumor volume and metastasis are the main reasons for not attempting surgery.Portal vein embolization and associated liver partition and portal vein ligation for staged hepatectomy are commonly used in clinical practice to increase the volume of remnant liver to allow surgical resection;however,research in this area is currently lacking.CASE SUMMARY A 48-year-old male patient with a history of viral hepatitis B for at least 30 years attended our center with a hepatic space-occupying lesion detected 3 d previously.Enhanced computed tomography scanning of the upper abdomen revealed a large mass in the right lobe of the liver,centered on the right posterior lobe,with the larger section measuring about 14 cm×10 cm×14 cm.He successfully underwent conversion therapy for a large right liver tumor after combined hepatic artery ligation and transcatheter arterial chemoembolization,and finally had an opportunity to undergo right hemi-hepatectomy and cholecystectomy.He remained asymptomatic with no obvious abnormalities on computed tomography scanning review at 2 mo after surgery.CONCLUSION This case highlights new ideas and provides a reference for conversion therapy of large liver tumors.
