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Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

World Journal of Gastroenterology 2019年第37期25卷 5687-5701页

作者： Breno Boueri Affonso Francisco Leonardo Galastri joaquim mauricio da motta leal filho Felipe Nasser Priscila Mina Falsarella Rafael Noronha Cavalcante Marcio Dias de Almeida Guilherme Eduardo Goncalves Felga Leonardo Guedes Moreira Valle Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Liver Transplant Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil

BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma(HCC)that underwent liver transplant(LT)after drug-eluting beads transarterial chemoembolization(DEB-TACE)for downstaging versus *** survival and tumor recurrence rates were calculated,eligibility for LT,time on the waiting list and radiological response were *** TACE,only patients within Milan Criteria(MC)were *** patients underwent LT in bridging ***-year post-transplant overall survival,recurrence-free survival has no difference between the *** response was observed more frequently in bridging *** in DS group can achieve posttransplant survival and HCC recurrence-free probability,at five years,just like patients within MC in patients undergoing *** To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs *** Prospective cohort study of 200 patients included from April 2011 through June *** group included patients within *** group(out of MC)was divided in 5 subgroups(G1 to G5).Total tumor diameter was≤8 cm for G1,2,3,4(n=42)and was>8 cm for G5(n=22).Downstaging(n=64)and bridging(n=136)populations were not significantly *** survival and tumor recurrence rates were calculated by the Kaplan-Meier ***,eligibility for LT,time on the waiting list until LT and radiological response were *** After TACE,only patients within MC were *** patients underwent LT in bridging group 65.9%(P=0.001).Downstaging population presented:higher number of nodules 2.81(P=0.001);larger total tumor diameter 8.09(P=0.001);multifocal HCC 78%(P=0.001);more post-transplantation recurrence 25%(P=0.02).Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT(P=0.005).Median time on the waiting list was significantly longer in downstaging group 10.6 mo(P=0.028).Five-year posttransplant over

关键词： Hepatocellular carcinoma Down-staging Liver transplantation Localregional therapy Bridging

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Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma

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World Journal of Hepatology 2020年第1期12卷 21-33页

作者： Francisco Leonardo Galastri Felipe Nasser Breno Boueri Affonso Leonardo Guedes Moreira Valle Bruno Calazans Odísio joaquim mauricio motta-leal filho Paolo Rogério Salvalaggio Rodrigo Gobbo Garcia Márcio Dias de Almeida Ronaldo Hueb Baroni Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Diagnostic Radiology The University of Texas MD Anderson Cancer CenterHoustonTX 77230United States Radiology Department Radiology DepartmentHeart Institute(InCor)University of São PauloSão Paulo 05403-900Brazil Teaching and Research Institute São PauloBrazilHospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Liver Transplant Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Department of Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil

BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to ***,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best *** of the response after DEB-TACE still have not been fully *** is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver *** To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).METHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to *** patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were *** and post-chemoembolization imaging studies were performed by computed tomography or magnetic *** radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of *** Two hundred patients with 380 HCCs were *** of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(P<0.001).Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the

关键词： Hepatocellular carcinoma Liver transplantation Response evaluation criteria in solid tumors Neoadjuvant therapy Liver neoplasms

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Peristomal variceal bleeding treated by coil embolization using a percutaneous transhepatic approach

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World Journal of Clinical Cases 2016年第1期4卷 25-29页

作者： Macello José Sampaio Maciel Osvaldo Ignácio Pereira joaquim Maurício motta leal filho Enio Ziemiecki Junior Susyanne Lavor Cosme Moisés Amancio Souza Francisco Cesar Carnevale Radiology Department of Heart Institute Hospital das ClínicasFaculdade de Medicina da Universidade de São Paulo

Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death.A 68-year-old woman who had undergone a palliative colostomy(colorectal carcinoma) presented with a massive hemorrhage from the colostomy *** her oncological status with medial and right hepatic veins thrombosis due to liver metastasis invasion,an emergency transhepatic coil embolization was successfully *** treatment modality for these cases has not been *** transhepatic coil embolization of varices is a safe and effective choice in patients who present with life threatening bleeding and exhibit contraindications to transjugular intrahepatic portosystemic shunt.

关键词： Ectopic variceal bleeding Stomal bleeding Percutaneous transhepatic embolization Colostomy Cirrhosis Hemostasis

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