Surgery vs TACE in HCC
•
0 likes•35 views
Surgery vs TACE in HCC
Report
Share
Report
Share
Recommended
Pre operative liver function assessment
This document discusses the importance of pre-operative liver function assessment prior to liver surgery. It outlines several methods of evaluating liver function, including clinical scoring systems like the Child-Turcotte-Pugh score, dynamic tests that measure hepatic uptake and excretion such as indocyanine green retention and nuclear scintigraphy, and volumetric measurements using CT scans. No single test can fully assess liver function, so a combination is recommended, along with surgical judgment, to determine the severity of any underlying liver disease, tumor extent, predicted post-operative liver remnant, and risk of hepatic failure. This helps select appropriate patients and procedures to optimize surgical outcomes.
Adjuvant intravesical chemotherapy
This document discusses the treatment of non-muscle invasive bladder cancer. It begins by outlining risk stratification into low, intermediate, and high risk groups based on tumor grade and stage. For high risk disease, the primary treatment is intravesical BCG immunotherapy, with intravesical chemotherapy as an alternative. Maintenance BCG therapy provides the best chance of preventing recurrence and progression. Side effects are discussed and managed based on their severity. Second line options in the event of BCG failure include a second course of BCG, combination BCG+interferon therapy, or radical cystectomy for high risk cancers.
Recommended
Pre operative liver function assessment
This document discusses the importance of pre-operative liver function assessment prior to liver surgery. It outlines several methods of evaluating liver function, including clinical scoring systems like the Child-Turcotte-Pugh score, dynamic tests that measure hepatic uptake and excretion such as indocyanine green retention and nuclear scintigraphy, and volumetric measurements using CT scans. No single test can fully assess liver function, so a combination is recommended, along with surgical judgment, to determine the severity of any underlying liver disease, tumor extent, predicted post-operative liver remnant, and risk of hepatic failure. This helps select appropriate patients and procedures to optimize surgical outcomes.
Adjuvant intravesical chemotherapy
This document discusses the treatment of non-muscle invasive bladder cancer. It begins by outlining risk stratification into low, intermediate, and high risk groups based on tumor grade and stage. For high risk disease, the primary treatment is intravesical BCG immunotherapy, with intravesical chemotherapy as an alternative. Maintenance BCG therapy provides the best chance of preventing recurrence and progression. Side effects are discussed and managed based on their severity. Second line options in the event of BCG failure include a second course of BCG, combination BCG+interferon therapy, or radical cystectomy for high risk cancers.
TOGA trial
1) The ToGA trial showed that for patients with HER2-positive advanced gastric cancer, adding trastuzumab to chemotherapy resulted in a 26% reduction in the risk of death compared to chemotherapy alone, prolonging median survival by nearly 3 months.
2) Secondary endpoints including progression-free survival, time to progression, overall response rate, and duration of response were also significantly improved with the addition of trastuzumab.
3) The addition of trastuzumab to chemotherapy was well tolerated with no significant differences in overall safety profile or rates of cardiac adverse events between the two treatment arms.
Sunitinib alone or after nephrectomy in metastatic renal cancer
This document summarizes a clinical trial comparing sunitinib alone to nephrectomy followed by sunitinib in patients with metastatic renal cell carcinoma. The trial was a prospective, multicenter, randomized phase 3 trial that enrolled 450 patients between 2009-2017. The primary endpoint was overall survival and secondary endpoints included progression-free survival, objective response rate, and clinical benefit. The results showed that sunitinib alone was not inferior to nephrectomy followed by sunitinib for overall survival and progression-free survival. Nephrectomy is still recommended for symptomatic patients.
PORTEC 3 trial
This document summarizes the results of the PORTEC-3 trial which compared adjuvant chemoradiation therapy (CTRT) to radiation alone in patients with high risk endometrial cancer. The trial included patients with high risk factors like grade 3 endometrioid cancer, stage II-III disease, or clear cell or serous histology. It found that while CTRT improved failure-free survival by 11% compared to radiation alone, there was only a 5% improvement in overall survival. CTRT was also associated with more toxicities but they were generally rapid to recover from. The benefits of CTRT need to be weighed against the increased costs and treatment duration associated with its toxicities. The conclusion
Gestational trophoblastic neoplasia
This document discusses gestational trophoblastic disease (GTD), which includes pre-malignant and malignant conditions originating from the placenta. It covers the spectrum of conditions, risk factors, clinical presentation, diagnosis, staging, and treatment approaches. GTD ranges from complete and partial hydatidiform moles to invasive moles, choriocarcinoma, and other rare types. Diagnosis involves hCG levels, imaging, and pathology. Treatment depends on the stage and includes chemotherapy, surgery, and radiation. The goal is to normalize hCG levels and prevent resistance or recurrence through combination therapies and maintenance protocols.
Secondary tumours of ovary
This document discusses the case of a 46-year-old post-menopausal woman presenting with abdominal distension and discomfort. Imaging revealed a large pelvic mass arising from the left ovary. Frozen section during surgery was suggestive of malignancy or adenocarcinoma. Histopathological examination of the surgical specimens confirmed an infiltrating adenocarcinoma involving both ovaries and lymph nodes, consistent with a Krukenberg tumor from a gastric primary cancer. Secondary tumors of the ovary (STOs), such as Krukenberg tumors, account for 6-10% of ovarian cancers and most commonly arise from stomach, colorectal, breast and appendiceal primary cancers.
Peritoneal malignancies
Pathological evaluation plays a key role in managing peritoneal surface malignancies (PSM). The document discusses several aspects of pathological evaluation and reporting of cytoreductive surgery specimens for PSM, including:
1. Labeling, handling, gross description, sectioning, and microscopic findings for specimens.
2. Disease-specific recommendations for evaluating colorectal, ovarian, and appendiceal tumors.
3. Differences between classifications like WHO, AJCC, and PSOGI for appendiceal tumors, and recommendations to use the more objective PSOGI system.
Molecular profiling in breast cancer
Breast cancer is a multi-step disease caused by genetic changes and influenced by mutagenic and nonmutagenic risk factors. It was originally theorized in the 1950s-1960s that breast cancer is a systemic disease and positive lymph nodes indicate a host-tumor relationship allowing metastasis. Current research analyzes gene expression profiles to better understand breast cancer development and identify gene signatures.
More Related Content
More from Mebanshanbor Garod
TOGA trial
1) The ToGA trial showed that for patients with HER2-positive advanced gastric cancer, adding trastuzumab to chemotherapy resulted in a 26% reduction in the risk of death compared to chemotherapy alone, prolonging median survival by nearly 3 months.
2) Secondary endpoints including progression-free survival, time to progression, overall response rate, and duration of response were also significantly improved with the addition of trastuzumab.
3) The addition of trastuzumab to chemotherapy was well tolerated with no significant differences in overall safety profile or rates of cardiac adverse events between the two treatment arms.
Sunitinib alone or after nephrectomy in metastatic renal cancer
This document summarizes a clinical trial comparing sunitinib alone to nephrectomy followed by sunitinib in patients with metastatic renal cell carcinoma. The trial was a prospective, multicenter, randomized phase 3 trial that enrolled 450 patients between 2009-2017. The primary endpoint was overall survival and secondary endpoints included progression-free survival, objective response rate, and clinical benefit. The results showed that sunitinib alone was not inferior to nephrectomy followed by sunitinib for overall survival and progression-free survival. Nephrectomy is still recommended for symptomatic patients.
PORTEC 3 trial
This document summarizes the results of the PORTEC-3 trial which compared adjuvant chemoradiation therapy (CTRT) to radiation alone in patients with high risk endometrial cancer. The trial included patients with high risk factors like grade 3 endometrioid cancer, stage II-III disease, or clear cell or serous histology. It found that while CTRT improved failure-free survival by 11% compared to radiation alone, there was only a 5% improvement in overall survival. CTRT was also associated with more toxicities but they were generally rapid to recover from. The benefits of CTRT need to be weighed against the increased costs and treatment duration associated with its toxicities. The conclusion
Gestational trophoblastic neoplasia
This document discusses gestational trophoblastic disease (GTD), which includes pre-malignant and malignant conditions originating from the placenta. It covers the spectrum of conditions, risk factors, clinical presentation, diagnosis, staging, and treatment approaches. GTD ranges from complete and partial hydatidiform moles to invasive moles, choriocarcinoma, and other rare types. Diagnosis involves hCG levels, imaging, and pathology. Treatment depends on the stage and includes chemotherapy, surgery, and radiation. The goal is to normalize hCG levels and prevent resistance or recurrence through combination therapies and maintenance protocols.
Secondary tumours of ovary
This document discusses the case of a 46-year-old post-menopausal woman presenting with abdominal distension and discomfort. Imaging revealed a large pelvic mass arising from the left ovary. Frozen section during surgery was suggestive of malignancy or adenocarcinoma. Histopathological examination of the surgical specimens confirmed an infiltrating adenocarcinoma involving both ovaries and lymph nodes, consistent with a Krukenberg tumor from a gastric primary cancer. Secondary tumors of the ovary (STOs), such as Krukenberg tumors, account for 6-10% of ovarian cancers and most commonly arise from stomach, colorectal, breast and appendiceal primary cancers.
Peritoneal malignancies
Pathological evaluation plays a key role in managing peritoneal surface malignancies (PSM). The document discusses several aspects of pathological evaluation and reporting of cytoreductive surgery specimens for PSM, including:
1. Labeling, handling, gross description, sectioning, and microscopic findings for specimens.
2. Disease-specific recommendations for evaluating colorectal, ovarian, and appendiceal tumors.
3. Differences between classifications like WHO, AJCC, and PSOGI for appendiceal tumors, and recommendations to use the more objective PSOGI system.
Molecular profiling in breast cancer
Breast cancer is a multi-step disease caused by genetic changes and influenced by mutagenic and nonmutagenic risk factors. It was originally theorized in the 1950s-1960s that breast cancer is a systemic disease and positive lymph nodes indicate a host-tumor relationship allowing metastasis. Current research analyzes gene expression profiles to better understand breast cancer development and identify gene signatures.
More from Mebanshanbor Garod (8)
Sunitinib alone or after nephrectomy in metastatic renal cancer
Sunitinib alone or after nephrectomy in metastatic renal cancer
Surgery vs TACE in HCC
- 16. •
- 17. • • • • •
- 18. • • • •
- 22. • • • • • •
- 23. • • • •
- 24. • • • • • •
- 25. • • • •
- 26. •