Treatment Of Hepatic Metastases Research Articles

Estrogen Receptor Blockade Potentiates Immunotherapy for Liver Metastases by Altering the Liver Immunosuppressive Microenvironment.

The immune microenvironment of the liver plays a major role in controlling the expansion of hepatic metastases and is regulated by estrogen. We show that treatment of tumor-bearing mice with an estrogen receptor degrader potentiated an anti-metastatic effect of immunotherapy. Our results provide mechanistic insight into clinical findings and a rationale for evaluating the efficacy of combination anti-estrogen and immunotherapy for prevention and/or treatment of hepatic metastases in female patients.

Use of Hepatic Artery Infusion Pumps in the Treatment of Hepatic Metastases.

The first trials of hepatic artery infusion pump (HAIP) chemotherapy occurred in the 1990s. The high percentage of recurrent disease after curative resection of colon cancer and perioperative systemic chemotherapy has renewed.

FOCUS phase 3 trial results: Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases (PHP-OCM-301/301A).

9510 Background: Ocular melanoma, the most common intraocular malignancy, frequently metastasizes to the liver but to date there is no established standard of care for hepatic-dominant ocular melanoma patients. The FOCUS trial began as a randomized, Ph 3 trial (301) comparing PHP with best alternative care (BAC). The trial was subsequently amended (301A) to halt the BAC arm due to enrollment concerns. Methods: Eligible patients with hepatic-dominant ocular melanoma were randomized 1:1 to receive PHP or BAC (investigator’s choice of TACE, pembrolizumab, ipilimumab, or dacarbazine) on the 301 trial. All eligible patients received PHP on the 301A trial. PHP patients could receive up to 6 PHP treatments, repeated every 6-8 weeks with melphalan dosed at 3.0mg/kg ideal body weight (IBW). Patients with progressive disease (PD) were discontinued from study treatment and all patients are followed until death. Patientswere imaged every 12 (±2) weeks until PD. The primary endpoint, ORR (per RECIST 1.1) as assessed by Independent Review Committee, was characterized by the point estimate and 95% CI for each group (PHP and BAC). Results: 144 patients were enrolled overall; 102 were assigned to PHP (301: n = 43; 301A: n = 59) and 42 were assigned to BAC. 91 PHP patients received treatment (301: n = 40; 301A: n = 51) and 32 BAC patients received treatment. ORR among PHP patients was 35.2% (32/91; 95% CI: 25.44-45.88%). ORR among BAC patients was 12.5% (4/32; 95% CI: 3.51-28.99%; p= 0.0154). The median DOR was 14 months for PHP patients and not calculable for BAC patients. The DCR among PHP patients was 73.6% (67/91; 95% CI: 63.35-82.31%) and among BAC patients was 37.5% (12/32; 95% CI: 21.10-56.31%; p= 0.0002). The median PFS was 9.03 months (95% CI: 6.34-11.56) among PHP patients and was 3.12 months (95% CI: 2.89-5.65) among BAC patients ( p= 0.0007). The median OS was 20.53 months (95% CI: 16.59-24.35) among PHP patients and was 14.06 months (95% CI: 9.99-19.78) among BAC patients. With the last treatment occurring in May 2021, the OS, DOR, and PFS data continues to mature as patients are still being followed for survival. Among the 94 patients assessed for safety after treatment with PHP, 42.6% of patients experienced a serious treatment-emergent adverse event, the majority of which were hematological, transient in nature, and resolved without sequelae. There were no treatment related deaths in the trial. Conclusions: In this analysis of data from the FOCUS trial, PHP demonstrates superior ORR, DOR, DCR, PFS, and OS in comparison with BAC in the treatment of hepatic metastases from ocular melanoma. This therapy offers a potential option for patients with this rare indication that is associated with a poor prognosis and few treatment options. Clinical trial information: NCT02678572.

Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases: Preliminary results of FOCUS (PHP-OCM-301/301A) phase III trial.

9510 Background: Ocular melanoma, the most common intraocular malignancy, frequently metastasizes to the liver but to date there is no established standard of care for hepatic-dominant ocular melanoma patients. The FOCUS trial began as a randomized, phase III trial (301) comparing PHP with best alternative care (BAC). The trial was subsequently amended (301A) to remove the BAC arm due to enrollment concerns. Methods: Eligible patients with hepatic-dominant ocular melanoma were randomized 1:1 to receive PHP or BAC (investigator’s choice of TACE, pembrolizumab, ipilimumab, or dacarbazine) on the 301 trial. All eligible patients received PHP on the 301A trial. PHP patients could receive up to 6 PHP treatments, repeated every 6-8 weeks with melphalan dosed at 3.0mg/kg ideal body weight (IBW). Patients with progressive disease (PD) were discontinued from study treatment and all patients are followed until death. Patientswere imaged every 12 (±2) weeks until PD. The primary endpoint, ORR (per RECIST 1.1) as assessed by Independent Review Committee, will be characterized by the point estimate and 95% CI for each group (PHP and BAC). Categorical efficacy variables will be presented as frequency counts and percentages and 95% CI. Time-to-event variables will be summarized using Kaplan-Meier methods (median and 95% CI). Results: 144 patients were enrolled overall; 102 were assigned to PHP (301: n=43; 301A: n=59) and 42 were assigned to BAC. 91 PHP patients received treatment (301: n=40; 301A: n=51) and 32 BAC patients received treatment. At the time of this analysis, 4 PHP patients were still ongoing on study treatment with a minimum follow-up of 24 weeks. 79 PHP-treated patients and 29 BAC-treated patients were evaluable for response. ORR among PHP patients was 32.9% (26/79; 95% CI: 22.75-40.40%). ORR among BAC patients was 13.8% (4/29; 95% CI: 3.89-31.66%). The median PFS was 9.03 months (95% CI: 6.24-11.83) among PHP patients and was 3.06 months (95% CI: 2.69-5.65) among BAC patients; this difference was statistically significant ( p=0.0004). Among the 94 patients assessed for safety after treatment with PHP, 40.4% of patients experienced a serious treatment-emergent adverse event, the majority of which were hematological and resolved without sequelae. There were no treatment related deaths in the trial. Conclusions: In this analysis of preliminary data from the FOCUS trial, PHP demonstrates a statistically superior ORR and significantly prolonged PFS in comparison with BAC in the treatment of hepatic metastases from ocular melanoma. The data is encouraging as efficacious treatments for hepatic metastases from ocular melanoma are desperately needed. These early data show an improvement over the previous phase III study in terms of both efficacy (ORR and PFS) as well as toxicity using second generation filters. Clinical trial information: NCT02678572.

H101 treatment of hepatic metastasis of colorectal cancer with recombinant human adenovirus 5 injection: A phase I clinical trial-TROJAN 021.

3605 Background: Recombinant human adenovirus serotype 5 injection (H101), obtained through genetic engineering to delete the E1B domain and part of the E3 domain and then selectively replicated in tumor cells, has been approved in 2005 for the local treatment of nasopharyngeal carcinoma and head and neck cancers. This trial aimed to evaluate the safety and the preliminary treatment efficacy of H101 combined with standard treatments in patients with liver metastases from colorectal cancer. Methods: In this phase 1, dose-escalation trial (ChiCTR1900027922), 17-75 years old colorectal cancer patients with unresectable liver metastases that failed to first-line therapy were included at The Tenth People's Hospital Affiliated to Tongji University between 2018.9 and 2020.12. All patients received H101 combined with standard therapy (bevacizumab + mFOLFOX6/FOLFIRI). Ultrasound-guided injection of H101 into the liver metastases was performed for all patients, with one of the following doses: 5×1011 vp/injection for the low, 1×1012 vp/injection for the moderate, 2×1012 vp/injection for the moderate-high, and 3×1012 vp/injection for the high dose groups. Intravenous infusion of bevacizumab (5 mg/kg) and administration of standard-dose mFOLFOX6 or FOLFIRI within 48 h after the intratumor injection was performed. The primary endpoint of the trial was the maximum tolerated dose (MTD). The secondary endpoints included safety, tumor responses, and tumor marker CEA. The adverse events (AEs) were monitored according to the NCI Common Terminology Criteria for Adverse Events (CTCAE, Version 3.0) and evaluated within 1 week after injection. Imaging examinations were performed for all patients to evaluate the tumor responses, according to the irRECIST. Results: Finally, 8 patients were included; the numbers of patients in the 4 groups were 1, 3, 3, and 1, respectively. MTD was not observed in this study. No grade >4 AEs were observed. The major AE included fatigue (5/8), fever (4/8), shiver (3/8), abdominal pain (3/8), and night sweat (3/8). The tumor responses included partial response in one patient (moderate dose group), stable disease in 6 patients (1, 1, 3, and 1 in the low, moderate, moderate-high, and high dose groups, respectively), and progressive disease in 1 patient (moderate group). No dose-effect response was found. The tumor marker CEA was reduced in 6 of the 8 patients, including 1 (1/1), 3 (3/3), 2 (2/3), and 0 patients in the low, moderate, moderate-high, and high-dose groups, respectively. Conclusions: The safety of H101 combined with standard therapy for liver metastases from colorectal cancer is acceptable, which also shows certain preliminary efficacy. The phase 2 trial is now ongoing. Clinical trial information: ChiCTR1900027922. [Table: see text]

Hepatic Metastasis in Newly Diagnosed Esophageal Cancer: A Population-Based Study.

BackgroundThe hepatic metastasis pattern of esophageal cancer (EC) has not been fully explored. The primary objective of this study was to explore the predictors of esophageal cancer with hepatic metastasis (ECHM) at the time of diagnosis. In addition, we also analyzed the factors affecting ECHM prognosis.MethodsWe used the Surveillance, Epidemiology and End Result (SEER) database to identify ECHM patients at the time of initial diagnosis. The ECHM predictors were identified using multivariate logistic regression. Multivariate Cox regression and competing survival risk analyses were performed to identify factors associated with all-cause mortality and EC-specific mortality of ECHM, respectively.ResultsA total of 10,965 eligible EC patients were identified in the SEER database between 2010 and 2016, of which 1,197 were ECHM patients, accounting for 10.9% of the entire cohort. In the whole cohort, eight ECHM predictors (age, primary site, grade, histology type, T staging, N staging, insurance status, and number of extrahepatic metastatic sites) were determined using multivariate logistic regression analysis. Multivariate Cox regression and multivariate competing survival risks models confirmed that the male sex, advanced age, squamous cancer, and multiple extrahepatic metastasis increased the risk of both all-cause and EC-specific mortality, whereas chemotherapy and chemotherapy plus radiotherapy significantly reduced the risk of both.ConclusionsThis study explored population-level predictors of hepatic metastasis at the time of EC diagnosis and analyzed the clinical characteristics affecting the prognosis in ECHM patients. These findings may provide clinicians with a reference for the screening and treatment of hepatic metastasis in EC.

Prognostic factors of survival in stage IV colorectal cancer with synchronous liver metastasis: Negative effect of the KRAS mutation.

The aim of the present study was to identify predictive parameters of survival in patients affected by stage IV colorectal cancer with synchronous and bilateral liver metastases. A retrospective cohort study was performed. Patients diagnosed between January 2013 and December 2018 were included in the present study. Data on the histopathological, clinical and treatment factors (chemotherapy as the first measure or resection of the primary tumor) were collected. The effect of each variable on survival was evaluated using Cox regression analysis. A total of 104 patients were included [43 women (41.3%) and 61 men (58.7%); mean age, 63 years]. The long-term survival rate at 36 months was 29% (median, 25 months). Kaplan-Meier analysis was used to estimate that survival was higher in patients with wild-type KRAS tumors (42%) than in patients with mutated KRAS tumors (9%; P=0.001). In the multivariate analysis, KRAS mutation (HR, 2.484; 95% CI, 1.472-4.192), T4 tumors (HR, 1.795; 95% CI, 1.045-3.084), resection/local treatment of hepatic metastases (HR, 0.447; 95% CI, 0.222-0.901), Eastern Cooperative Oncology Group performance status (HR, 1.632; 95% CI, 1.182-2.254), were revealed to have independent predictive value. The type of treatment (chemotherapy or resection of the primary tumor) did not influence the survival. The results indicated that mutation of the KRAS gene was an important prognostic factor and associated with survival.

Comparison of transarterial bland and chemoembolization for neuroendocrine tumours: a systematic review and meta-analysis.

Treatment of hepatic metastases from neuroendocrine tumours improves survival and symptom relief. Hepatic arterial embolotherapy techniques include transarterial chemoembolization (tace) and bland embolization (tae). The relative efficacy of the techniques is controversial. The purpose of the present study was to use a meta-analysis and systematic review to compare tace with tae in the treatment of hepatic metastases. A literature search identified studies comparing tace and tae for treatment of hepatic metastases. Outcomes of interest included overall survival (os), progression-free survival (pfs), radiographic response, complications, and symptom control. The hazard ratios (hrs) and odds ratios (ors) were estimated and pooled. Eight studies and 504 patients were included. No statistically significant differences between tace and tae were observed for os at 1, 2, and 5 years or for hrs [1-year or: 0.72; 95% confidence interval (ci): 0.27 to 1.94; p < 0.52; 2-year or: 0.69; 95% ci: 0.43 to 1.11; p < 0.12; 5-year or: 0.91; 95% ci: 0.37 to 2.24; p < 0.85; hr: 0.96; 95% ci: 0.73 to 1.24; p < 0.74]. No statistically significant differences between tace and tae were observed for pfs at 1, 2, and 5 years or for hrs (1-year or: 0.71; 95% ci: 0.38 to 1.55; p < 0.30; 2-year or: 0.83; 95% ci: 0.33 to 2.06; p < 0.69; 5-year or: 0. 91; 95% ci: 0.37 to 2.24; p < 0.85; hr: 0.99-1.74; 95% ci: 0.74 to 1.73; p < 0.97). Both techniques are safe and effective for symptom control. No statistically significant differences between tace and tae were observed for os and pfs.

Evaluation of the Safety and Feasibility of Same-Day Holmium-166 -Radioembolization Simulation and Treatment of Hepatic Metastases

PurposeTo evaluate the safety and feasibility of same-day treatment, including the simulation procedure for assessment of intrahepatic and extrahepatic distribution of the microspheres, with holmium-166 (166Ho)-radioembolization. Materials and MethodsThis was a secondary analysis of patients included in the 4 prospective studies (HEPAR I, HEPAR II, HEPAR PLuS, and SIM) on 166Ho-radioembolization. The technical success rate of the same-day treatment protocol, defined as the number of patients who completed the same-day treatment, was measured. Total in-room time, duration of the scout procedure, time to imaging, and duration of the treatment procedure were recorded. Reasons for discontinuation or adjustment of treatment were identified. Adverse events that occurred during the treatment day were recorded. ResultsOne hundred five of 120 scheduled patients completed the same-day treatment with 166Ho-radioembolization (success rate, 88%). After the simulation procedure, treatment was cancelled in 15 patients because of extrahepatic deposition (n = 8), suboptimal tumor targeting (n = 1), unanticipated vascular anatomy (n = 5), and dissection (n = 1). In another 14 patients, the treatment plan was adjusted. The median total procedure time (ie, simulation, imaging, and treatment) was 6:39 hours:minutes (range, 3:58–9:17 hours:minutes). Back pain was a major same-day treatment-related complaint (n = 28). Conclusion166Ho-radioembolization as a same-day treatment procedure is feasible in most selected patients, although treatment was adjusted in 12% of patients and cancelled in 12% of patients. This approach might be beneficial for a select patient population, such as patients needing a radiation segmentectomy.

Impact of primary tumour location on colorectal liver metastases: A systematic review

BACKGROUNDColorectal cancer (CRC) is the third most common cause of cancer-related death worldwide. Despite significant advances in screening, surgical management and adjuvant therapies, average 5-year survival seldom exceeds 60% in most developed nations. Metastatic disease represents the primary cause of mortality in patients with CRC, and the liver is the most common location for distant tumour spread. Up to 25% of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40% will develop metachronous disease in the course of follow-up. It has been suggested that primary tumour location [right side versus left side, primary tumour location (PTL)] can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms. This suggestion is not universally accepted and there have been conflicting reports in the literature to date.AIMTo provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases (CRCLM).METHODSMEDLINE, EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria.RESULTSA total of 41 studies were identified that met predefined inclusion criteria for this review. In 21 out of 38 studies that provided data on overall survival, a statistically significant improvement in overall survival was reported in patients with left sided primary tumours. These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference. Eight studies noted a similar trend towards improved disease-free or progression-free survival. Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL; for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC.CONCLUSIONTaken together, the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC. The mechanisms responsible for this variation remain poorly understood, but are likely to relate to molecular, histological and embryological differences, as well as inherent differences in therapeutic sensitivity.

Percutaneous ultrasound guided radiofrequency and microwave ablation in the treatment of hepatic metastases. A monocentric initial experience.

Percutaneous radiofrequency (RFA) and microwave ablation (MWA) are currently the best treatment options forpatients with liver metastases (LM) who cannot undergo a liver resection procedure. Presently, few studies have evaluated theefficacy of tumor ablation in beginner's hands but none at all in hepatic metastasis. Our aim was to report the initial experiencewith ultrasound as a tool to guide tumor ablation in a low volume center with no experience in tumor ablation. We conducted a retrospective cohort study, on a series of 61 patients who had undergone percutaneous US-guided ablations for 82 LM between 2010 and 2015. Long term outcome predictors were assessed using univariate and multivariate analysis. Complete ablation was achieved in 86.9% of cases (53/61). All MWA sessions (20/20) attained ablation margins >5mm, compared to 79% (49/62) for RFA sessions (p=0.031). Ablation time was significantly shorter for MWA, with a median duration of 10 minutes (range: 6-12) vs. 14 minutes (range: 10-19.5, p=0.003). There was no statistically significant difference in local tumor progression (LTP)-free survival rates between MWA and RFA (p=0.154). On univariate analysis, significant predictors for local recurrence were multiple metastases (p=0.013) and ablation margins <5 mm (p<.001), both retaining significance on multivariate analysis. Significant predictors for distant recurrence on both univariate and multivariate analysis were multiple metastases (p<0.001) and non-colorectal cancer metastases (p<0.05). A larger than 5 mm ablation size is critical for local tumor control. We favor the use of MWA due to its ability to achieve ablation in significantlyshorter times with less incomplete ablations.

Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study.

The prognosis for patients with liver metastases from gastric cancer is very poor. Nevertheless, standard therapeutic strategies have not been established yet. The impact of hepatic surgical treatment on survival of patients with metachronous liver metastases from gastric cancer still remains controversial. We conducted a retrospective analysis on records of 436 patients who received radical gastrectomy (with D2 lymphadenectomy, regardless of hepatic surgical treatment) for gastric cancer with metachronous (≥ 3months after gastrectomy) liver metastases in our center between 2001 and 2016. All patients were followed until 2017/10/31 or withdrawn from the follow-up because of death. The median interval for non-hepatic metastases of the 436 patients who underwent radical gastrectomy is 14months. T (P = 0.041), N (P = 0.023) and lymphovascular invasion (P < 0.001) were independent predictors affecting liver metastases-free interval. The overall survival rates for the 436 patients were 44.5, 29.7, 16.3, and 16.3% at 1, 2, 3, and 5years respectively since treatment of hepatic metastases, with a median survival time of 11months. N (P = 0.025), extent of liver metastases (H) (H2 vs. H1, P = 0.036; H3 vs. H1, P < 0.001), and treatment of liver metastatic lesions (P < 0.001) were significant independent prognostic factors for survival after presence of liver metastases. Among H1 and H2 patients, median survival in hepatic surgical treatment group was significantly longer than that in systemic chemotherapy alone group (25 vs. 11months, P = 0.015). Liver examinations should be performed during the first 2years after gastric surgery and continued for 5years for high-risk patients. Active therapeutic strategies may prolong patients' survival compared with supportive treatment alone. Patients with H1, H2 metachronous liver metastases may be considered appropriate candidates for hepatic surgical treatment before embarking on systemic chemotherapy alone. ISRCTN Registry (Retrospectively registered; Reference number: 35067; Date: 02/04/2018).

Which is more effective in the treatment of hepatic metastases from colorectal cancer: SBRT or RFA?

Which is more effective in the treatment of hepatic metastases from colorectal cancer: <scp>SBRT</scp> or <scp>RFA</scp>?

Treatment of hepatic metastases with computed tomography-guided interstitial brachytherapy.

The aim of the present study was to evaluate the efficacy, safety and tolerability of local treatment of liver metastases of various types of cancer using brachytherapy with computed tomography (CT) imaging. Retrospective analysis of 61 patients with unresectable hepatic metastases treated with CT-guided interstitial high dose rate (HDR) brachytherapy of the liver between April 2014 and December 2016 was performed. Patients were treated with a single fractional dose of 15-25 Gy. Statistical analysis was performed on local relapse free survival (LRFS), progression free survival (PFS) and overall survival (OS) rates across the group. In the 6 and 12-month follow-up periods, the 6- and 12-month LRFS rates were 88.7 and 70.7%, PFS rates were 78.1 and 53.8% and the OS rates were 96.7 and 79.6%, respectively. In the Cox regression analysis, the 100% isodose was a statistically significant predictor of LRFS (P=0.01) and PFS (P=0.02), but it was not significant in OS (P=0.07). The 90% isodose was a statistically significant predictor of LRFS (P=0,03) but not significant in PFS (P=0.17) or OS (P=0.25). In all patients, no serious complications were observed. Overall, 30% of patients experienced pain at the injection site, and 50% exhibited nausea or vomiting. In 2 patients, minor subcapsular bleeding occurred without clinical significance, and 1 patient was diagnosed with a pneumothorax that was not clinically significant. Brachytherapy HDR with CT imaging is an effective and safe method of local treatment of liver metastases. The effectiveness of the treatment is probably dose-dependent, and increases with increasing dosage.

Totally Laparoscopic Strategies for the Management of Colorectal Cancer with Synchronous Liver Metastasis

AbstractBackground: The purpose of this study is to compare the laparoscopic techniques for the management of colorectal cancer with synchronous liver metastases:Simultaneous laparoscopic liver and colon cancer resec-tion.Simultaneous colon resection and Radiofrequency Ablation (RFA) of liver metastases.Methods: Convenient sample of about 30 patients expected to attend the Oncology Center, Mansoura University (OCMU) Gastro-Enterology Center (GEC) during study period of 3 years (2014-2017) with adenocarcinoma of the colon and rectum with Synchronous Colorectal Liver Metastases (SCRLM) will be considered.Results: Mean operative time was 205 minutes for LLR, in comparison with the resection group, mean operative time for RFA was 185 minutes. Though shorter in time, this did not appear to be statistically significant (p-value=4.41). Mean blood loss for the resection group was 350ml, and mean blood transfusion was 0.89L. On the other hand, mean blood loss for the RFA group was 90ml and mean blood transfusion was 0.76L. This difference between the two groups appeared to be statistically different (p-value=0.01). For the LLA group mean hospital stay 8.4 days and mean recovery time per case was 4.1 days. This was a bit shorter for the RFA group were mean hospital was 8.3 days while mean recovery time per case was 3.6 days. Although shorter, this difference appear to be insignificant statistically. (p-value=0.95/p-value=0.79 respectively).Conclusions: Treatment of hepatic metastasis especially in colorectal hepatic lesion could prolong survival in selected cases, all the results of the systemic reviews and meta-analysis suggested an inferior outcome of non resectional treatment compared to hepatic resection.Minimal invasive approach for treatment of CRLM offers more advantages such as early recovery, less pain, better cosmosis, less blood loss, and reduced morbidity and mortality with equal oncological outcome compared to classic open surgery.

3:18 PM Abstract No. 324 Chemoembolization vs. radioembolization for the treatment of hepatic metastases from breast cancer: a comparative study

3:18 PM Abstract No. 324 Chemoembolization vs. radioembolization for the treatment of hepatic metastases from breast cancer: a comparative study

Curative effect of stereotactic radiotherapy combined with TACE for patients with hepatic metastases of colorectal cancer and influence on the expressions of omentin-1 and Ang-2

Objective To explore the curative effect of stereotactic radiotherapy combined with transcatheter arterial chemoembolization (TACE) for patients with hepatic metastases of colorectal cancer and influence on the expressions of omentin-1 and angiopoietin-2 (Ang-2). Methods A total of 90 patients with hepatic metastases of colorectal cancer from December 2013 to December 2015 in our hospital were selected as the research objects. Patients were divided into observation group and control group according to random number table method with 45 cases respectively. Patients in control group were treated with TACE, and patients in observation group were treated with stereotactic radiotherapy combined with TACE. After treatment, the clinical efficacy, expression levels of plasma omentin-1 and Ang-2, score of quality of life and adverse reaction were compared in the two groups. Results The objective response rate in observation group (82.2%) was significantly higher than that in control group (60.0%), and the difference was statistically significant (χ2=5.409, P=0.020). After treatment, the omentin-1 and Ang-2 expression levels in observation group were lower than those in control group [(43.7±18.1) ng/ml vs. (52.1±17.9) ng/ml, t=2.214, P=0.029; (2.0±0.2) g/L vs. (2.3±0.3) g/L, t=6.028, P<0.001]. The score of quality of life in observation group was significantly higher than that in control group [(87.6±11.2) vs. (68.7±10.3)], and the diffe-rence was statistically significant (t=8.332, P<0.001). There were no differences on the adverse reaction rates such as abnormal liver function (35.6% vs. 42.2%, χ2=0.421, P=0.517), nausea and vomiting (44.4% vs. 37.8%, χ2=0.413, P=0.520), skin injury (6.7% vs. 0, χ2=3.101, P=0.078) and fever (35.6% vs. 31.1%, χ2=0.202, P=0.655) between the two groups. Conclusion The implementation of stereotactic radiotherapy combined with TACE in the treatment of hepatic metastases of colorectal cancer is a safety and effective method. It can significantly reduce the expression levels of plasma omentin-1 and Ang-2, inhibit of tumor angiogenesis, and improve the quality of life of patients. Key words: Colorectal neoplasms; Radiosurgery; Transcatheter arterial chemoembolization; Angiopoietin-2; Omentin-1

Identification of a novel molecule target for the diagnosis, prediction, and treatment of hepatic metastasis of gastric cancer.

53 Background: Hepatic metastasis of gastric cancer has become a growing issue, because effective treatment and specific biomarkers are not available. The aim of this study was to identify a molecule mediating hepatic metastasis, which serves as a diagnostic marker, and to determine its potential as a therapeutic target. Methods: Stable knockdown gastric cancer cells were established using genome editing technique and cell activities were compared to control cells in vitro and in vivo. Tissue expression levels of the candidate molecule were evaluated in 300 patients with gastric cancer and correlated to clinicopathological parameters including patterns of metastasis and recurrences. Results: Global expression analysis revealed that synaptotagmin VII (SYT7) was overexpressed in gastric cancer tissues with hepatic metastasis. Gastric cancer cell lines differentially expressed high levels of SYT7 that positively correlated with those of SNAI1 and TGFB3, and inversely with RGS2. Stable knockout of SYT7 inhibited the proliferation of gastric cancer cells, indicated by increased apoptosis, and decreased cell migration, invasion, and adhesion abilities. The tumorigenicity of SYT7 knockout cells was moderately reduced in a mouse subcutaneous model and more strikingly decreased in a hepatic metastasis model. The protein expression levels of BCL2 and HIF1A were decreased in tumors formed by SYT7 knockout cells, and SYT7 levels in primary gastric cancer tissues were significantly associated with hepatic recurrence, metastasis, and adverse prognosis. Conclusions: SYT7 serves as a target for treating hepatic metastasis of gastric cancer as well as a diagnostic tool.

The place of liver transplantation in the treatment of hepatic metastases from neuroendocrine tumors: Pros and cons.

Liver metastases occur in nearly half of NET patients (MNETs) and heavily affect prognosis, with 5-yr. OS around 19-38%. Although it is difficult to show outcome differences for available treatments, due to the long course of disease, surgery for MNETs remains the most effective option in terms of survival and symptom control. Since MNETs frequently present as an oligo-metastatic, liver-limited disease, unresectable in 80% of cases, liver transplantation (LT) has emerged as a potential curative treatment. Nevertheless, experience with LT for MNETs is limited and burdened by highly heterogeneous outcomes and significant recurrence rate, mostly explained by the variability of selection criteria. Several prognostic factors have been identified: extended surgery on primary tumor associated to LT, elderly patients, pancreatic primary (pNET), extensive liver involvement, poorly differentiated tumors, high Ki67 levels and short wait time to LT. A proper patients' selection based on these data (Milan NET criteria) allows a significant survival advantage over non-transplant strategies, with excellent outcomes in recent series (69-97.2% 5-yr. OS) as opposed to patients undergoing non-surgical treatments (34-50.9%). Evidence indicates LT as the best option for selected patients with MNETs. The use of organs for MNETs is therefore justified.

Treatment of hepatic metastases from medullary thyroid cancer with transarterial embolisation

Transarterial chemoembolisation (TACE) is well established in the treatment of primary hepatocellular carcinoma and of metastatic disease from colorectal and neuroendocrine tumours. There are few published studies on the effectiveness of treating hepatic metastases from medullary thyroid carcinoma with chemoembolisation and none to our knowledge utilising bland particle transarterial embolisation (TAE).Here we describe the management of multifocal hepatic metastases from medullary thyroid cancer in a 39-year-old woman who underwent bland particle TAE with a biochemical and radiological response and discuss the potential for a wider scope of clinical application for bland TAE in hepatic metastases.