Appearance Of Liver Metastases Research Articles

Analysis of using high-precision radiotherapy in the treatment of liver metastases regarding toxicity and survival

BackgroundHepatic metastases occur frequently in the context of many tumor entities. Patients with colorectal carcinoma have already developed liver metastases in 20% at the time of diagnosis, and 25–50% develop metastases in the further course of the disease and therapy. The frequent manifestation and the variable appearance of liver metastases result in an interdisciplinary challenge, regarding treatment management. The aim of this study was to evaluate high-precision stereotactic body radiotherapy (SBRT) for liver metastases.MethodsA cohort of 115 patients with 150 irradiated liver metastases was analyzed. All metastases were treated between May 2004 and January 2020 using SBRT. A contrast-enhanced computed tomography (CT) was performed in all patients for treatment planning, followed by image-guided high-precision radiotherapy using cone-beam CT. A median cumulative dose of 35 Gy and a median single dose of 7 Gy was applied.ResultsMedian OS was 20.4 months and median LC was 35.1 months with a 1-year probability of local failure of 18% (95%-CI: 12.0–24.3%). In this cohort, 18 patients were still alive at the time of evaluation. The median FU-time in total was 11.4 months and for living patients 26.6 months. 70.4% of patients suffered from acute toxicities. There were several cases of grade 1 and 2 toxicities, such as constipation (13.9%), nausea (24.4%), loss of appetite (7.8%), vomiting (10.4%), diarrhea (7.8%), and abdominal pain (16.5%). 10 patients (8.7%) suffered from grade 3 toxicities. Late toxicities affected 42.6% of patients, the majority of these affected the gastrointestinal system.ConclusionSBRT is becoming increasingly important in the field of radiation oncology. It has evolved to be a highly effective treatment for primary and metastasized tumors, and offers a semi-curative treatment option also in the case of oligometastatic patients. Overall, it represents a very effective and well-tolerated therapy option to treat hepatic metastases. Based on the results of this work and the studies already available, high-precision radiotherapy should be considered as a valid and promising treatment alternative in the interdisciplinary discussion.

Retrospective analysis of interventional treatment of hepatic metastasis from gastroenteropancreatic neuroendocrine tumors.

To analyze the angiography appearance of liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs), and evaluate the clinical efficacy and prognostic factors of interventional treatment for hepatic metastases. Fifty GEP-NETs patients with hepatic metastases were treated from January 2012 to December 2016, and received transarterial embolization (TAE) in the hepatic tumor or hepatic arterial infusion chemotherapy (HAIC). All patients received 179 times of the intervention therapy in total. Blood supplies were identified in the 50 cases with angiography, which showed that 35 cases had abundant vessels, while 15 cases had poor blood supply. Twenty-two cases were found either collateral blood supply, or portal vein invasion or arterial-portal vein fistula. The best curative efficacy was complete remission (CR) in 4 cases, partial remission (PR) in 28 cases and stable disease (SD) in 18 cases during the process of treatment. The angiography (P=0.047) and the frequency of intervention (P=0.037) showed significantly statistical difference with Kaplan-Meier analysis. The Cox analysis showed that more than 3 times of interventional therapy was an independent prognostic factor. Interventional treatment is safe and effective for GEP-NETs, and is beneficial to patients with main hepatic metastases after endocrine therapy.

Colorectal Cancer Liver Metastases

The purpose of this study was the evaluation of prognostic factors for long-term survival and progression-free survival (PFS) after treatment of colorectal cancer (CRC) liver metastases with magnetic resonance-guided laser-induced interstital thermotherapy (LITT). We included 594 patients (mean age, 61.2 years) with CRC liver metastases who were treated with LITT. The statistical analysis of the long-term survival and PFS were based on the Kaplan-Meier method. The Cox regression model tested different parameters that could be of prognostic value. The tested prognostic factors were the following: sex, age, the location of primary tumor, the number of metastases, the maximal diameter and total volume of metastases and necroses, the quotient of total volumes of metastases and necroses, the time of appearance of liver metastases and location in the liver, the TNM classification of CRC, extrahepatic metastases, and neoadjuvant treatments. The median survival was 25 months starting from the date of the first LITT. The 1-, 2-, 3-, 4-, and 5-year survival rates were 78%, 50.1%, 28%, 16.4%, and 7.8%, respectively. The median PFS was 13 months. The 1-, 2-, 3-, 4-, and 5-year PFS rates were 51.3%, 35.4%, 30.7%, 25.4%, and 22.3%, respectively. The number of metastases and their maximal diameter were the most important prognostic factors for both long-term survival and PFS. Long-term survival was also highly influenced by the initial involvement of the lymph nodes. For patients treated with LITT for CRC liver metastases, the number and size of metastases, together with the initial lymph node status, are significant prognostic factors for long-term survival.

Ultrasonography Appearances of Hepatic Metastases from Female Breast Cancer in Patients in Central Sudan

Background: Breast cancer is the most prevalent cause of cancer-related death both worldwide and in Sudan. Metastases from breast cancer most frequently occur in the liver. Objective: The purpose of this study was to evaluate the appearance of liver metastases on ultrasonography images in female breast cancer patients in Central Sudan. Materials and methods: Between 2002 and 2007, 108 breast cancer patients diagnosed with liver metastases underwent grey scale ultrasonography. Data were analyzed using Microsoft Excel 2010, software. Results: Of these 108 patients, multiple liver metastases were observed on ultrasonography in 92% of cases, whereas a single metastasis was observed in the remaining 8% cases. Liver metastases from breast cancer showed hypoechoic, hyperechoic, mixed (hypoechoic and hyperechoic), and isoechoic signals in 70%, 21%, 6%, and 3% of cases, respectively. Conclusion: Ultrasonography improves the detection and characterization of multiple metastases with a

Surgical Treatment of Melanoma Liver Metastases

The appearance of liver metastases during the follow-up of a patient with a skin melanoma has classically been considered a sign of a very poor prognosis. There are limited therapeutic options, since these lesions are non-resectable and form part of a disseminated disease in several organs.In certain cases, in those where the disease is restricted to the liver or accompanied by a resectable extra-hepatic disease, hepatectomy can be useful, obtaining acceptable survivals of about 25% at 5 years, although hepatic or skin recurrence is usually early.The limited number of patient cases published, the absence of randomised studies, and the heterogeneity of the series, make it difficult to reach conclusions so as to recommend which patients may benefit from liver resection, with an acceptable level of scientific evidence, and thus define its real usefulness. There are also no action plans defined as to when and what type of adjuvant therapy we should use.

Tratamiento quirúrgico de las metástasis hepáticas de melanoma

The appearance of liver metastases during the follow-up of a patient with a skin melanoma has classically been considered a sign of a very poor prognosis. There are limited therapeutic options, since these lesions are non-resectable and form part of a disseminated disease in several organs.In certain cases, in those where the disease is restricted to the liver or accompanied by a resectable extra-hepatic disease, hepatectomy can be useful, obtaining acceptable survivals of about 25% at 5 years, although hepatic or skin recurrence is usually early.The limited number of patient cases published, the absence of randomised studies, and the heterogeneity of the series, makes it difficult to reach conclusions to be able to recommend which patients may benefit from liver resection, with an acceptable level of scientific evidence, and thus define its real usefulness. There are also no action plans defined as to when and what type of adjuvant therapy we should use.

Liver resection for liver metastases from nondigestive endocrine cancer: Extrahepatic disease burden defines outcome

For patients with hepatic nondigestive endocrine metastases (HNEM), the role of liver resection is not well-defined. We reviewed outcomes for patients who underwent liver resection for HNEM at 2 centers to identify predictors of survival. From 1991 to 2010, 51 patients underwent liver resection for HNEM. Primary tumor types were adrenal gland (n = 26), thyroid (n = 11), testicular germ cell (n = 9), and ovarian granulosa cell (n = 5). 28 patients (55%) had synchronous or early (diagnosed within 12 months after primary tumor resection) liver metastases. At liver resection, 26 patients (51%) had extrahepatic metastases, and 7 (14%) had ≥2 sites of extrahepatic metastases. 32 patients (63%) had major liver resection and 19 (37%) had a simultaneous extrahepatic procedure. 90-day postoperative morbidity and mortality rates were 27% and 2%, respectively. After median follow-up of 20 months (range, 1-144), the 5-year overall and recurrence-free survival rates were 58% and 37%, respectively. Survival was not affected by primary tumor type. In multivariate analysis, ≥2 sites of extrahepatic metastases (hazard ratio [HR] = 4.80; 95% confidence interval [CI] = 1.18-19.50; P = .028) and interval of ≤12 months between primary tumor resection and diagnosis of liver metastases (HR = 5.33; 95% CI = 1.11-25.71; P = .037) were associated with worse overall survival after liver resection. For selected patients, liver resection for HNEM is associated with long-term survival. The number of extrahepatic sites of metastasis and the timing of appearance of liver metastases should be considered in patient selection.

Perfusion characterization of liver metastases from endocrine tumors: Computed tomography perfusion

To assess prospectively parameters of computed tomography perfusion (CT p) for evaluation of vascularity of liver metastases from neuroendocrine tumors. This study was approved by the hospital's institutional review board. All 18 patients provided informed consent. There were 30 liver metastases from neuroendocrine tumors. Patients were divided into three groups depending on the appearance of the liver metastases at the arterial phase of morphological CT (hyperdense, hypodense and necrotic). Sequential acquisition of the liver was performed before and for 2 min after intravenous injection of 0.5 mg/kg contrast medium, at 4 mL/s. Data were analyzed using deconvolution analysis to calculate blood flow (BF), blood volume (BV), mean transit time (MTT), hepatic arterial perfusion index (HAPI) and a bi-compartmental analysis was performed to obtain vascular permeability-surface area product (PS). Post-treatment analysis was performed by a radiologist and regions of interest were plotted on the metastases, normal liver, aorta and portal vein. At the arterial phase of the morphological CT scan, the aspects of liver metastases were hyperdense (n = 21), hypodense (n = 7), and necrotic (n = 2). In cases of necrotic metastases, none of the CT p parameters were changed. Compared to normal liver, a significant difference in all CT p parameters was found in cases of hyperdense metastases, and only for HAPI and MTT in cases of hypodense metastases. No significant difference was found for MTT and HAPI between hypo- and hyperdense metastases. A significant decrease of PS, BV and BF was demonstrated in cases of patients with hypodense lesions PS (23 ± 11.6 mL/100 g per minute) compared to patients with hyperdense lesions; PS (13.5 ± 10.4 mL/100 g per minute), BF (93.7 ± 75.4 vs 196.0 ± 115.6 mL/100 g per minute) and BV (9.7 ± 5.9 vs 24.5 ± 10.9 mL/100 g). CT p provides additional information compared to the morphological appearance of liver metastases.

Genes that mediate colon cancer metastasis to liver

15049 Background: Metastasis is a complex series of steps in which cancer cells leave the original tumor site and migrate to a distant organ. Certain cancers tend to spread to specific organ sites. For example, colorectal cancer commonly metastasizes to the liver. The appearance of liver metastases has long been regarded as an ominous sign and is a leading cause of colorectal cancer-related morbidity and mortality. In one-third of patients who die of colorectal cancer, metastatic disease is found only in the liver_meaning that it is imperative to uncover the underlying mechanism of liver metastasis and then to further exploit effectively treating methods. Methods and Results: We firstly established a mouse model of liver metastasis through orthotopic inoculation of parental colon cancer cell line in mouse colon. Metastatic activity was assayed by bioluminescence imaging of luciferase-transduced cells. After two generations of inoculation, we got a stable mouse model of liver metastasis and two colon cancer cell lines with high tendency of liver metastasis. To compare the patterns of gene expression between parental and liver metastatic colon cancer cell lines, transcriptomic microarray was performed. A total of 73 unique genes were found to be overexpressed in colon cancer cell with high tendency of liver metastasis. The top 10 genes (including LERK, Calbindin, S100, et al) with at least a ten-fold change in expression level were selected and confirmed by quantitative PCR and Western Blotting. These genes were either overexpressed by retroviral system in parental cells, or downregulated by RNAi technique in cells with high tendency of liver metastasis. We found that they not only could enhance tumor cell migration and invasion in vitro, but also are required for the liver metastasis of colon cancer cells in animal experiment. Finally, we investigated the gene signature in 40 human samples of metastatic liver tumor and primary colon tumor. Conclusion: Taken together, our results indicated that the 10 genes are not only molecular makers but also functional mediators of liver-specific metastasis, which might provide the plausible molecular targets to overcome liver metastasis, resulting in a huge difference for many patients with colon cancer. No significant financial relationships to disclose.

Endocrine Tumors of the Ileum: Factors Correlated with Survival

Aim: To evaluate the most important factors correlated with survival in patients with endocrine tumors of the ileum, both at the time of diagnosis and during the follow-up period. Methods: Fifty-nine patients with ileal endocrine tumors diagnosed in our institution between 1990 and 2004 were studied. Results: The study included 36 men (61%) and 23 women (39%). The median age of the patients at the time of diagnosis was 61.4 (range 18–83) years. The median follow-up period was 71.9 (range 5–287) months. Forty patients (67.8%) were still alive at the end of the study; the median survival time was 172 months, and the 5-year survival rate was 78.9%. By univariate analysis, the survival rate was significantly related to female sex (p = 0.024) and flushing alone (p = 0.028) and associated with diarrhea at diagnosis (p = 0.015), weight loss at diagnosis (p = 0.038), Ki-67 level (p = 0.025), stage of disease at diagnosis (p = 0.012), presence of liver metastases at follow-up (p = 0.005), presence of diffuse metastases at diagnosis (p = 0.005) and at follow-up (p = 0.007), and type of surgical approach (overall: p = 0.018; not operated vs. radical surgery: p = 0.008; not operated vs. palliative surgery: p = 0.045). Using multivariate analysis, only female gender (p = 0.012) and the presence of liver metastases at follow-up (p = 0.004) were significantly related to survival. Conclusion: In the present study, female gender and the appearance of liver metastases at follow-up seem to be the main conditions which determine the poor prognosis of patients with ileal endocrine tumors.

Evaluation of Liver Metastases After Radiofrequency Ablation: Utility of 18F-FDG PET and PET/CT

Our objective was to review the CT appearance of liver metastases after radiofrequency ablation and to describe the imaging findings of and utility of (18)F-FDG PET and PET/CT in assessing tumor recurrence after ablation. (18)F-FDG PET and PET/CT can provide added diagnostic information compared with conventional imaging in patients after radiofrequency ablation of liver metastases and can be useful in guiding repeat ablation procedures.

Liver metastases from pancreatic adenocarcinoma: MR imaging characteristics.

To describe the magnetic resonance imaging spectrum of appearances of liver metastases from pancreatic ductal adenocarcinoma. We retrospectively evaluated the MRI exams performed between July 1996 and August 2001 in all patients who had liver metastases from pancreatic adenocarcinoma and histopathologic diagnosis from either the primary pancreatic tumor, liver metastases, or both. Sixteen patients were included in the study. All MR studies were performed at 1.5 T with a standard protocol including T1- and T2-weighted images and serial post-gadolinium spoiled gradient echo (SGE) images. Location, size, number, signal characteristics on T1- and T2-weighted images, and pattern of enhancement on serial gadolinium-enhanced SGE images were assessed. The diameter of metastases ranged from a few millimetres to 4 cm, and 12 patients (75%) had only lesions of 1.5 cm or less. Capsular-based liver metastases were found in 13 patients (81%) and three patients had only capsular-based lesions with a diameter under 1.5 cm. Hypervascular lesions were found in six patients (38%) and hypovascular lesions in 10 patients (62%). Perilesional enhancement was present in 10 patients (62%), with six patients (38%) having ring perilesional enhancement and eight patients (50%) having wedge-shaped perilesional enhancement. On MR imaging, hepatic metastases from pancreatic adenocarcinoma show a range of enhancement patterns. Hypervascular metastases are not rare. Capsular based distribution, small diameter, and perilesional enhancement are common features. This retrospective study describes the MR imaging spectrum of appearances of liver metastases from pancreatic adenocarcinoma in patients with histopathologic confirmation of the diagnosis.

Immunohistological study of NM 23 and C-erbB-2 expression in primary tumor and metastases of colorectal adenocarcinoma.

Immunohistochemical study of expression of nm 23 and c-erbB-2 protein markers in primary tumor and metastases of colorectal adenocarcinoma showed that the incidence and expression of both protein markers in primary tumor tissue tended to increase after the appearance of liver metastases. Peculiarities of protein expression in tumor metastases in lymph nodes and liver and the possibility of using these markers as additional prognostic criteria in colorectal cancer are discussed.

Echogenicity of liver metastases is an independent prognostic factor after potentially curative treatment.

Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment. Retrospective analysis of prospectively collected data. Department of Surgery at a university hospital. One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998. Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy. The echogenic appearance of the liver metastases was assessed by intraoperative ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, P<.001) and recurrence-free survival (log rank, P =.004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucin-secreting tumors were found in the hypoechoic patient group (chi(2), P =.001). Dukes stage of the primary tumor (P =.02), echogenicity of the liver secondaries (P =.04), and diameter of the largest resected metastasis (P =.01) were independent prognostic factors for recurrence-free survival in the Cox regression model. These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection.

Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases

The indication for surgical resection of colorectal liver metastases should be guided by technical feasibility and expected prognostic benefit. The aim of the present study was to analyse the frequency and prognostic significance of lymph node involvement of the hepatoduodenal ligament in the resection of colorectal liver metastases. A series of 126 prospectively documented patients who underwent hepatectomy for metastases of colorectal carcinoma was analysed. The prognostic factors of patients with complete resection (R0) of the metastases were studied by multivariate analysis. R0 resection was achieved in 94 per cent. The 30-day mortality rate was 2 per cent. In all patients, lymph nodes were excised from the hepatoduodenal ligament, and histological evaluation demonstrated tumour infiltration in 28 per cent of the patients. Multivariate analysis revealed nodal involvement of the hepatoduodenal ligament (P < 0.0001) and synchronous or metachronous appearance of liver metastases (P < 0.005) as independent prognostic factors. The 3- and 5-year survival rates were 3 and 0 per cent for lymph node-positive patients compared with 48 and 22 per cent respectively for the node-negative group. Infiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R0 resection of colorectal liver metastases.

Potential value of biliary CEA assay in early detection of colorectal adenocarcinoma liver metastases

Elevation of the biliary CEA level in patients with liver metastases from colorectal carcinoma has been reported. The aim of this study is to determine the potential value of biliary CEA assay in the early detection of liver metastases. Biliary and serum CEA levels were determined in patients operated on for a colorectal cancer and in control groups. Among 13 patients with liver metastases from colorectal carcinomas, biliary CEA levels were markedly elevated (> 40 ng/ml) in nine, moderately elevated (5-40 ng/ml) in two and normal (arbitrarily defined as < 5 ng/ml) in two. Of 28 patients with primary colorectal carcinoma without detectable hepatic secondaries, three had marked CEA elevation in the bile, 10 had moderate CEA elevation and 15 had normal levels. Among nine patients with non-malignant hepatobiliary pathology, there was one marked biliary CEA elevation, one moderate elevation and seven normal levels. None of the 13 individuals with no identified hepatobiliary pathology had elevated biliary CEA levels. The follow-up of patients with a primary colorectal tumour, no evidence of hepatic secondaries and a biliary CEA elevation is of particular interest. If subsequent appearance of liver metastases is found in such cases, intra-operative biliary CEA assay could be considered a valuable diagnostic test. Further studies will then have to prove the possible benefit of a specific treatment for this group of patients.

Experimental model for liver metastasis formation using Lewis lung tumor.

A new experimental model is introduced for liver metastases using intrasplenically injected Lewis lung tumor cells. The appearance of liver metastases was studied in the presence and after the removal of primary tumor. The tumorous foci in the liver proved to be natural metastases and increased in number blocking the activity of the Kupffer cells by carragheenan. This model provides a useful tool to study different aspects of liver metastases.

Histopathological correlation of ultrasound appearances of liver metastases.

We reviewed ultrasound examinations of the liver performed at Yale--New Haven Hospital on patients with biopsy-proven tumors since January 1, 1977, to correlate the ultrasonic appearances with histology. Liver metastases appeared as sonolucent lesions in 37.5% of patients, as mixed sonolucent/echogenic lesions in 37.5%, and as solely echogenic in only 25%. We found a limited correlation between the echogenic pattern of the ultrasound scans and histology. The majority of echogenic metastases were from colonic primaries (54%) or hepatomas (25%). Metastases from lymphomas were extremely sonolucent and sarcomas frequently demonstrated central necrosis. Calcified metastases from mucin-secreting adenocarcinoma of the colon appeared as dense lesions with distal shadowing.