Extrahepatic Tumor Spread Research Articles

The clinical relevance of tumor marker CEA, CA 19-9 in regional chemotherapy of hepatic metastases of colorectal carcinoma.

Up to December 1986, 50 patients with documented hepatic metastases from colorectal carcinoma were treated with 5-fluoro-2-deoxyuridine (FUDR) using Infusaid pumps. The response of liver metastases to regional chemotherapy was studied by computerized tomography (CT) and carcino-embryonal antigen (CEA), and/or CA 19-9 antigen serum assays. Preoperative CEA values were pathological in 94% of the patients but only 48% had a pathological concentration of the antigen CA 19-9 of over 37 U/ml. The course of CEA and CA 19-9 in combination with the arterial angio-CT reflected the response of liver metastases to regional chemotherapy. A decrease or normalisation of CEA and CA 19-9 after the beginning of therapy is an indication of partial or complete remission of metastases (68% of the patients showed lowered CEA serum values). If the marker continues to rise in serum this is a danger signal of progression of liver metastases or of extrahepatic tumor spread if the tumor stage in the liver remains unchanged.

Hepatocellular carcinoma: assessment of resectability by computed tomography and ultrasound.

A retrospective review of the CT and ultrasound scans from examinations of 30 patients who had hepatocellular carcinoma (hepatoma) was undertaken with special emphasis placed on evaluation of hepatic distribution of tumor, vascular invasion, and extrahepatic spread. Although both CT and ultrasound detected hepatoma in 29 of 30 patients (96%), CT showed more extensive hepatic parenchymal involvement in eight of the patients. Vascular invasion was seen more frequently with ultrasound than with CT. Invasion into the main portal vein was seen by ultrasound in 11 of 30 patients (37%). Extrahepatic spread of tumor was much more frequently detected by CT and was present in 21 of 30 patients (70%). A reasoned approach to the diagnostic workup of hepatomas that will minimize invasive procedures and unnecessary surgery is presented.

Orthotopic liver transplantation in Groningen, The Netherlands (1979-1983).

From March, 1979 to March, 1983, 26 orthotopic liver transplantations and 1 retransplantation were performed in our center. Sixteen patients are alive, 5 beyond 2 years and 1 longer than 4 years after transplantation. The actuarial 1- and 2-year survival is 60%. Factors contributing to this result are patient selection and biliary anastomosis. In cirrhotic patients, the degree of deterioration of liver function correlated with survival; in patients with hepatocellular carcinoma, extrahepatic spread of tumor was the most frequent limiting factor. Choledochocholedochostomy with a widening plasty had a low complication rate providing that the arterial blood supply was undisturbed. Until now, HLA-matching has not contributed to the result of liver transplantation, although the effect for long-term survival is still unknown. The high survival rate and excellent quality of life of long-term survivors justify liver transplantation as treatment for otherwise noncurable liver diseases.

Peripheral hepatic artery embolization in rabbits with VX2 carcinomas of the liver.

The effect of peripheral hepatic artery embolization was investigated in 44 rabbits with VX2 carcinomas of the liver. Embolization of the proper hepatic artery with a 175-mu polystyrene microsphere suspension (dose, 1350 or 2700 particles per rabbit) did not significantly change the survival rate as compared to controls, but did seem to delay extrahepatic tumor spread. Histologic examination suggested that partial tumor necrosis, at best, resulted from the peripheral hepatic artery embolization. It is concluded that the failure to successfully treat hepatic malignancies by means of peripheral hepatic arterial embolization and a permanent occlusive agent is due to arterial revascularization of the liver through vascular proliferation and recanalization of occluded arteries.