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The document summarizes studies on using radioactive iodine-labeled lipiodol (131I lipiodol) as a neoadjuvant treatment for hepatocellular carcinoma (HCC) prior to liver resection or transplantation. It found that 131I lipiodol allowed resection of larger HCC tumors (>3cm) with 3-year survival of 42%. For liver transplantation, 131I lipiodol prior to the procedure led to 5-year survival of 77% for HCC of all sizes, compared to 18% without neoadjuvant treatment, and no patients who received 131I lipiodol experienced HCC recurrence.
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![The Results of neo-adjuvant intra-arterial [ 131 I]lipiodol in liver resection and transplantation for HCC B. Launois, J.L. Raoul, L.A. Veilhan, B. Meunier, K. Boudjema, M. S. Metcalfe, G.J. Maddern Departments of Surgery University of Rennes (France) University of Adelaide (Australia) Bucharest (Romania) 9-11 April, 2003](https://image.slidesharecdn.com/4-100812070206-phpapp01/85/4-1-320.jpg)
![Surgery for HCC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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The document discusses guidelines for evaluating and treating hepatic metastases from colorectal cancer. It recommends investigations like CT, MRI, and ultrasound to evaluate metastases. Metastases are considered immediately resectable if the surgery is technically possible and leaves at least 40% of liver volume. Resection may be possible but risky if it requires complex procedures. Factors like number, size and location of metastases impact prognosis but are not absolute contraindications to resection. Repeat resection of recurrent metastases can provide long-term survival.
Radiation Therapy: Nutritional Strategies to Improve Outcomes
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
Epatocarcinoma: trapianto o resezione? A chi e perche? - Gastrolearning®
Gastrolearning XVII lezione
Epatocarcinoma: trapianto o resezione? A chi e perche? - Prof. U. Cillo (Università di Padova).
Advances in cholangiocarcinoma
This document summarizes key points about the management of intrahepatic cholangiocarcinoma. It finds that surgical resection provides the best chance for long-term survival, with 5-year survival rates of 20-30% for resectable disease. For unresectable tumors, options include liver transplantation in select patients and local therapies like radiofrequency ablation, transarterial chemoembolization, and yttrium-90 microsphere treatment, which have shown some promise for improving survival. Systemic chemotherapy with gemcitabine and cisplatin is the standard first-line treatment based on improved survival seen in a phase III trial, while various targeted agents in combination with chemotherapy are under investigation in clinical trials
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
This document discusses adjuvant chemotherapy for colorectal cancer. It finds that for stage III cancer, 6 months of FU-FA + oxaliplatin is the standard treatment, based on evidence from trials like MOSAIC showing a 5-year disease-free and overall survival benefit. For stage II cancer, evidence is less clear but some benefit was seen in QUASAR from 5-FU regimens. FOLFOX showed minimal additional benefit over 5-FU for stage II in MOSAIC. Patient selection is important given heterogeneity in stage II prognosis.
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
This document discusses adjuvant chemotherapy for colorectal cancer. It finds that for stage III cancer, 6 months of FU-FA + oxaliplatin is the standard treatment, based on evidence from trials like MOSAIC showing a 5-6% improvement in disease-free and overall survival rates. For stage II cancer, evidence is less clear but trials like QUASAR showed a small (~3%) overall survival benefit from chemotherapy. The document questions whether shorter treatment durations could be equally effective.
Gi tumour
This document discusses the use of radiosurgery, specifically CyberKnife, for gastrointestinal (GI) tumours. It provides an overview of common GI cancers such as liver, pancreatic and colorectal cancers. It then discusses various treatment options for these cancers including surgery, chemotherapy, radiotherapy, radiosurgery, stereotactic body radiation therapy and targeted therapies. It focuses on the use of CyberKnife for treatment of liver tumours such as hepatocellular carcinoma and liver metastases. Key benefits of CyberKnife highlighted are its precision, ability to track tumour motion, and delivery of high radiation doses in a short course of treatment.
Epatocarcinoma: nulla di nuovo sotto il sole - Gastrolearning®
Gastrolearning II modulo/13a lezione
Epatocarcinoma: nulla di nuovo sotto il sole
Relatore: Prof. Massimo Colombo (Milano)
Discussants: Prof. F. Farinati (Padova), Prof.ssa E. Villa (Modena), Prof. A. Grieco (Roma).
Neuroendocrine tumors in 2015
1) The document discusses the role of targeted therapy in neuroendocrine tumors. It covers topics such as the evolution of terminology and classification of NETs, the use of biomarkers and imaging in diagnosis and monitoring, and current therapeutic approaches including somatostatin analogs.
2) Somatostatin analogs like octreotide and lanreotide are effective in controlling hormonal symptoms in NET patients by binding to somatostatin receptors that are prevalent on many NETs. They have also shown inhibitory effects on tumor proliferation.
3) A phase III study showed octreotide LAR extended time to tumor progression compared to placebo in treatment-naïve patients with well-differentiated midgut NETs
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
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This document discusses adrenal cortical carcinoma (ACC), a rare but aggressive form of cancer. It provides information on the epidemiology, clinical presentation, prognostic factors, treatment approaches including mitotane and chemotherapy, and clinical trials for ACC. Recent studies have found that achieving mitotane plasma levels above 14 mg/L within 3 months of treatment and maintaining these levels is associated with better outcomes for patients with ACC. Larger international collaborations are working to advance the treatment of this disease.CyberKnife in Hepatocellular Carcinoma
CyberKnife is an option in inoperable or medically not suitable for surgery
& in patient with progression / not tolerating systemic therapy
- Initial results are impressive with low toxicity, good response rate
Pts with small tumour, no prior treatment with good performance
treated with high dose have significantly better survival
Dose >45 Gy; 15Gy/# and small vol tumour (<50cc) have better prognosis
There is minimal toxicity with CyberKnife in liver tumours
Addition of chemotherapy along with CyberKnife will be the future
( )Anal scc
This document provides information on a case presentation of anal squamous cell carcinoma, including staging, diagnostic workup, management, prognostic factors, and follow up. Key points include:
- The mean age of diagnosis is 62 years and most common symptom is rectal bleeding. Imaging includes CT, MRI, and PET scans to stage disease.
- Treatment depends on disease stage but typically involves chemoradiation with concurrent 5-FU and mitomycin C or cisplatin. Several trials have shown improved outcomes with chemoradiation compared to radiation alone.
- Follow up involves examination and imaging to monitor for recurrence or metastasis. Prognostic factors include tumor size, response to initial treatment, and presence of late
ECCLU 2011 - N. Clarke - Testicular cancer - Role of surgery in the managemen...
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1) Primary surgery for testis cancer typically involves orchidectomy. Contra-lateral biopsy may also be performed to check the other testis.
2) For early stage disease, primary RPLND or surveillance are options, with chemotherapy sometimes used for high-risk cases.
3) Post-chemotherapy surgery may involve RPLND to remove residual masses, with the timing, extent, and risks of surgery depending on factors like mass size and chemotherapy response.Prostate cancer asco 2020 updates
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2) A key study found that combining pembrolizumab and enzalutamide showed activity in patients with metastatic castration-resistant prostate cancer whose disease had progressed on enzalutamide, with an objective response rate of 12% and durable disease control.
3) Additional results from the conference included findings on predictive biomarkers, outcomes based on site of metastasis, and safety data from combination immunotherapy and targeted therapy trials for advanced prostate cancer.
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)European School of Oncology
The document summarizes current standards and next steps in treating gastric cancer. It discusses how adjuvant chemotherapy and neoadjuvant/perioperative chemotherapy have been shown to improve survival rates compared to surgery alone, increasing 5-year survival by 5-10% and 18% risk reduction respectively. However, tolerance of adjuvant treatments is often poor with high rates of delays, reductions and early termination. Neoadjuvant chemotherapy is better tolerated and may improve R0 resection rates and survival, as supported by several randomized clinical trials.MON 2011 - Slide 20 - P. Rougier - Gastric and pancreatic cancers (part I)
MON 2011 - Slide 20 - P. Rougier - Gastric and pancreatic cancers (part I)European School of Oncology
The document summarizes current standards and next steps in treating gastric cancer. It discusses trends showing falling incidence of distal gastric cancer but rising incidence of proximal gastric cancer. It reviews primary staging procedures and treatments for gastric cancer including surgery, adjuvant treatments, and treatments for advanced cases. It provides evidence that adjuvant chemotherapy and perioperative chemotherapy can increase overall survival rates compared to surgery alone.Treatment Of HCV in CKD Patients - Prof. Hussein El-Fishawy
- Hepatitis C virus (HCV) infection affects an estimated 170-200 million people worldwide and is a major cause of liver disease.
- HCV infection is highly prevalent among patients with end-stage renal disease undergoing hemodialysis, ranging from 1-100% depending on geographic region.
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Cancers hépatiques métastatiques : Actualité 2013-2014
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Epatocarcinoma: trapianto o resezione? A chi e perche? - Gastrolearning®
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31
1) The surgical treatment of portal hypertension has evolved significantly in Egypt over the last century, driven by changes in liver pathology and the development of new techniques.
2) Initially, procedures like splenectomy were used but caused only temporary effects. Total portosystemic shunts were then introduced but were later abandoned due to high mortality and morbidity rates.
3) More selective surgeries and techniques were developed like Hassab's operation and mesocaval shunts but still had issues. The distal splenorenal shunt became more widely used as a selective shunt.
29
This document discusses endoscopic therapies for the management of variceal hemorrhage, specifically endoscopic sclerotherapy (EST) and endoscopic variceal ligation (EVL). It provides background on variceal bleeding and survival rates over time. It then describes the modalities and techniques of EST and EVL, including injection methods, sclerosing agents used, risks, and indications. Randomized controlled trials comparing EST and EVL are summarized, showing higher eradication rates with EVL. In conclusion, endoscopic therapies like EST and EVL are effective for controlling acute variceal bleeding and reducing recurrence when used for primary or secondary prophylaxis.
25
This document discusses chemotherapy options for biliary tree carcinoma. It begins by outlining the increasing mortality rates and poor prognosis of the disease. It then provides detailed information on the anatomical classification, histological classification, definition, risk factors, and problems associated with diagnosis and treatment. The document discusses surgery as the only potentially curative option but notes that most patients present with advanced, unresectable disease. It reviews several palliative chemotherapy regimens and their response rates and survival benefits, with various gemcitabine-based combinations showing the most promise. The challenges of treating this rare cancer are also summarized.
22
This document discusses the multimodal treatment of hepatocellular carcinoma. It begins by noting that 70% of HCC occurs in patients with cirrhosis. Available treatment methods include surgical resection, liver transplantation, transarterial embolization, chemotherapy, and various ablation techniques. Surgical resection has improved and offers the best chance of cure for non-cirrhotic patients, though recurrence rates are high. Liver transplantation offers the best disease-free survival for selected cirrhotic patients meeting criteria such as tumor size and number, but organ shortage is a major limitation. Other treatments such as arterial embolization and chemotherapy have limited or debated efficacy.
20
This document summarizes a study comparing outcomes of surgical treatment for intrahepatic cholangiocarcinoma (ICC) and hilar cholangiocarcinoma (Klatskin tumor). 59 patients who underwent liver resection for these tumors were analyzed. Klatskin tumors required more extensive resections and had higher postoperative morbidity. 5-year survival was similar for both tumor types at around 35%. Expression of the p27 protein was associated with lower recurrence rates and better survival outcomes. Surgical resection remains the primary treatment when possible but molecular markers may help guide future adjuvant therapies.
34
The document discusses the proximal splenorenal shunt procedure for patients with liver cirrhosis and portal hypertension combined with hypersplenism. The procedure involves creating a shunt from the splenic vein to the left renal vein to decompress the portal system. It is indicated for select patients as an alternative to other procedures to prevent variceal bleeding while removing the spleen. However, it carries risks of hepatic encephalopathy, worsening liver function, and is not suitable for future transplantation. The authors' experience with 17 patients who underwent this procedure is presented, along with postoperative outcomes.
33
The document discusses various treatment options for portal hypertension and its complications. It covers surgical procedures like devascularization operations, portosystemic shunts and splenorenal shunts that are aimed at preventing bleeding, stopping active bleeding, and preventing recurrent variceal bleeding. The choice of surgical treatment depends on factors like the severity of bleeding, liver dysfunction, and type of portal hypertension.
32
The document discusses different surgical treatments for portal hypertension between 1877-2003. It lists various types of shunt procedures that were developed over time to reduce portal pressure, including Eck-Pavlov-Vidal shunt in 1967, Warren shunt in 1967, and Starzl auxiliary liver transplantation in 1973. The document also discusses surgical treatments for Budd-Chiari syndrome and ascites, such as portocaval shunts, mesenterico-caval shunts, and LeVeen shunts. It concludes by providing data on the types of shunt procedures performed between 1997-2003 for portal hypertension treatment and their results.
30
TIPSS is a procedure that creates a permanent connection between the portal and hepatic veins to reduce portal hypertension. It has several indications including uncontrolled variceal bleeding and refractory ascites. The procedure involves catheterization of the jugular vein and placement of a stent. Complications can include thrombosis, hemorrhage, and encephalopathy. Success rates are over 80% for variceal bleeding and 50% for ascites, but secondary dysfunction occurs in 40% after 1 year often requiring revision. TIPSS provides immediate reduction in portal pressure and is less invasive than surgical shunting.
28
The document discusses pathogenesis and management of portal hypertension. It covers hemodynamic assessment of portal hypertension, causes of non-cirrhotic portal hypertension including nodular regenerative hyperplasia. Animal models of portal hypertension are described. The role of nitric oxide and endothelin in regulating vascular tone is discussed. Clinical consequences of cirrhotic portal hypertension include variceal bleeding. Management of acute variceal bleeding involves vasoactive drugs and endoscopic therapy. Secondary prophylaxis to prevent rebleeding involves non-selective beta-blockers or band ligation.
23
This document summarizes various radiation therapy modalities for treating hepatic malignant tumors. It discusses external beam radiotherapy techniques like conventional radiotherapy, 3D conformal radiotherapy, stereotactic radiotherapy, and proton radiotherapy. It also covers internal radiotherapy techniques like selective internal radiotherapy using yttrium microspheres, metabolic radiotherapy with iodine-131 lipiodol, and brachytherapy. The document provides details on each technique's dosimetry, efficacy, and safety considerations.
21
1. The document discusses the history and mechanisms of radiofrequency ablation (RFA) for treating hepatic tumors. RFA uses alternating current within 200-1200 MHz to generate heat and coagulate tissue.
2. RFA can be performed percutaneously, laparoscopically, or during open surgery. Different ablation schemes and needle types are used depending on tumor size and location.
3. Complications of RFA include wound infection, bleeding, and abscesses. Studies show high rates of initial tumor necrosis but frequent recurrence within a year.
19
This document discusses the management of cholangiocarcinoma based on the author's experience at the Mansoura University Gastroenterology Surgical Center in Egypt. Some key points include:
- Cholangiocarcinoma is the second most common malignant liver tumor after hepatocellular carcinoma.
- Surgical resection remains the main treatment when possible but many cases are unresectable due to advanced stage at presentation.
- Of 385 patients treated between 1995-2002, 216 had central cholangiocarcinoma and most (79%) of these were unresectable.
- For unresectable cases, various palliative treatments were used with a mean survival of 5.8
18
The document discusses classification and surgical treatment options for extrahepatic bile duct cancer. It examines preoperative biliary drainage and portal embolization. Surgical techniques discussed include laparoscopy, posterior approach, tumor resection, hepatectomy, and caudate lobe resection. Operative procedures and mortality are analyzed according to tumor location, TNM classification, and staging. Long-term survival outcomes are presented for different patient groups and surgical approaches.
11
1) This document discusses liver surgery for hepatocellular carcinoma (HCC), with a focus on techniques and outcomes in Japan.
2) The use of intraoperative ultrasound during liver surgery has enabled more limited and precise resections, such as subsegmentectomies, while preserving important vascular structures.
3) Hepatic resection for HCC has become much safer over time, with mortality rates decreasing to less than 1% at specialized centers due to techniques like intermittent inflow occlusion and precise limited resections guided by intraoperative ultrasound.
8
This document discusses antiviral therapy peri-liver transplantation. It provides data on primary liver disease in adult transplant recipients, with chronic hepatitis C being the most common at 20.7-40%. It also shows survival rates after transplantation by diagnosis. Therapeutic strategies for patients with HBV, HDV, and HCV undergoing liver transplantation aim to prevent recurrent infection of the graft. Recurrence of HBV infection is related to liver disease and HBV replicative status pre-transplant. Combination therapy with hepatitis B immune globulin and antiviral drugs like lamivudine is most effective for preventing HBV recurrence post-transplant according to various studies cited. Guidelines are provided for HBV prophylaxis and treatment of recurrence after
6
This document discusses liver transplantation for hepatitis C virus (HCV) disease. It outlines that HCV reinfection is common after transplantation, occurring in 87-97% of cases. There are different patterns of HCV recurrence post-transplant, including minimal liver injury, chronic HCV, and cholestatic HCV. Factors associated with increased rates of fibrosis post-transplant include older recipient age, bolus steroid use for rejection, induction with mycophenolic acid, and short duration of prednisone use. High pre-transplant HCV RNA levels are also associated with worse patient and graft survival outcomes.
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Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
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- 1. The Results of neo-adjuvant intra-arterial [ 131 I]lipiodol in liver resection and transplantation for HCC B. Launois, J.L. Raoul, L.A. Veilhan, B. Meunier, K. Boudjema, M. S. Metcalfe, G.J. Maddern Departments of Surgery University of Rennes (France) University of Adelaide (Australia) Bucharest (Romania) 9-11 April, 2003
- 35. Months Overall survival of 52 liver transplant patients
- 36. months Liver transplant survival by tumour diameter <30mm 30-50mm >50mm
- 37. Survival of liver transplants with and without vascular invasion months No vascular invasion Vascular invasion
- 38. months Survival of liver transplants by experimental groups No lipiodol incidental lipiodol
Editor's Notes
- 2