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Improvement of prognosis for unresectable biliary tract cancer

World Journal of Gastroenterology 2013年第1期19卷 72-77页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Naminatsu Takahara Naoki Sasahira Hirofumi Kogure Suguru Mizuno Hiroshi Yagioka Yukiko Ito Natsuyo Yamamoto Kenji Hirano Nobuo Toda Minoru Tada Masao Omata Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Kanto Central HospitalTokyo 158-8531Japan Department of Gastroenterology JR Tokyo General HospitalTokyo 151-8528Japan Department of Gastroenterology Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Mitsui Memorial HospitalTokyo 101-8643Japan Yamanashi Prefectural Hospital Organization Yamanashi 400-8506Japan

AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract ***:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively *** patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December *** survival and time-to-progression were analyzed and compared ***:No patient characteristics were significantly different among the three *** gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the *** Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line *** Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with *** Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination *** median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P unresectable biliary tract cancer has improved *** three effective drugs(gemcitabine,p

关键词： unresectable Biliary tract cancer Gemcitabine Platinum analogs Fluoropyrimidine

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Gastrojejunostomy in patients with unresectable pancreatic head cancer-the use of Roux loop significantly shortens the hospital length of stay

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World Journal of Gastroenterology 2013年第45期19卷 8321-8325页

作者： Dariusz Szymanski Adam Durczynski Michal Nowicki Janusz Strzelczyk Department of General and Transplant Surgery Barlicki University Hospital Medical University of Lodz 0-153 Lodz Poland

AIM:To evaluate the use of the Roux loop on the postoperative course in patients submitted for gastroenteroanastomosis(GE).METHODS:Non-jaundiced patients(n=41)operated on in the Department of General and Transplant Surgery in Lodz,between January 2010 and December 2011 were *** tumor was considered unresectable when liver metastases or major vascular involvement were *** were randomized to receive Roux(n=21)or conventional GE(n=20)on a prophylactic ***:The mean time to nasogastric tube withdrawal in Roux GE group was shorter(1.4±0.75 vs2.8±1.1,Punresectable pancreatic cancer is easy to perform,decreases the incidence of DGE and lowers hospitalization time.

关键词： unresectable pancreatic cancer Roux and conventional gastroeneteroanastomosis Gastroenteroanastomosis Delayed gastric emptying Hospital length of stay

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Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

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World Journal of Clinical Cases 2018年第9期6卷 259-273页

作者： Ze-Feng Zhang Yu-Jun Luo Quan Lu Shi-Xue Dai Wei-Hong Sha Department of Gastroenterology and Hepatology Guangdong Geriatrics Institute Guangdong General Hospital Guangdong Academy of Medical Sciences

AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The i

关键词： unresectable Hepatocellular carcinoma Hepatectomy Conversion therapy Salvage surgery Downstaging

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Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis

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World Journal of Gastroenterology 2015年第6期21卷 1982-1988页

作者： Kenta Baba Akihiko Oshita Mohei Kohyama Satoshi Inoue Yuta Kuroo Takuro Yamaguchi Hiroyuki Nakamura Yoichi Sugiyama Tatsuya Tazaki Masaru Sasaki Yuji Imamura Yutaka Daimaru Hideki Ohdan Atsushi Nakamitsu Department of Surgery JA Hiroshima General Hospital Department of Gastroenterological and Transplant Surgery Applied Life Sciences Institute of Biomedical and Health Sciences Hiroshima University Department of Pathology JA Hiroshima General Hospital

A 72-year-old woman with a sigmoid colon cancer and a synchronous colorectal liver metastasis(CRLM),which involved the right hepatic vein(RHV)and the inferior vena cava(IVC),was referred to our *** metastatic lesion was diagnosed as initially unresectable because of its invasion into the confluence of the RHV and *** she had undergone laparoscopic sigmoidectomy for the original tumor,she consequently had 3 courses of modified 5-fluorouracil,leucovorin,and oxaliplatin(m FOLFOX6)plus *** tomography revealed a partial response,and the confluence of the RHV and IVC got free from cancer *** 3 additional courses of m FOLFOX6 plus cetuximab,preoperative percutaneous transhepatic portal vein embolization(PTPE)was performed to secure the future remnant liver ***,a right hemihepatectomy was *** postoperative course was *** patient was discharged from the hospital on postoperative day *** had neither local recurrence nor distant metastasis 18 mo after the last surgical *** multidisciplinary strategy,consisting of conversion chemotherapy using FOLFOX plus cetuximab and PTPE,could contribute in facilitating curative hepatic resection for initially unresectable CRLM.

关键词： Initial y unresectable Colorectal liver metastasis

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Interventional treatment for unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第37期20卷 13453-13465页

作者： Satoru Murata Takahiko Mine Fumie Sugihara Daisuke Yasui Hidenori Yamaguchi Tatsuo Ueda Shiro Onozawa Shin-ichiro Kumita Department of Radiology/Center for Advanced Medical Technology Nippon Medical School

Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization(TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidatesfor systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies(TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

关键词： unresectable Hepatocellular carcinoma Intermediate-stage Advanced-stage Interventional

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Treatment outcomes of chemotherapy between unresectable and recurrent biliary tract cancer

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World Journal of Gastroenterology 2014年第48期20卷 18452-18457页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Yukiko Ito Ichiro Yasuda Nobuo Toda Hiroshi Yagioka Saburo Matsubara Keiji Hanada Hiroyuki Maguchi Hideki Kamada Osamu Hasebe Tsuyoshi Mukai Yoshihiro Okabe Iruru Maetani Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo 113-8655 Japan Department of Gastroenterology Japanese Red Cross Medical Center Tokyo 150-8935 Japan First Department of Internal Medicine Gifu University Hospital Gifu 501-1194 Japan Department of Gastroenterology Mitsui MemorialHospital Tokyo 101-8643 Japan Department of Gastroenterology JR Tokyo General Hospital Tokyo 151-8528 Japan Department of Gastroenterology Kanto Central Hospital Tokyo 158-8531 Japan Center for Gastroendoscopy Onomichi General Hospital Hiroshima 722-8508 Japan Center for Gastroenterology Teine-Keijinkai Hospital Hokkaido 006-8555 Japan Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0793 Japan Department of Gastroenterology Nagano Municipal Hospital Nagano 381-8551 Japan Department of Gastroenterology Gifu Municipal Hospital Gifu 500-8513 Japan Department of Gastroenterology Osaka Red Cross Hospital Osaka 543-8555 Japan Division of Gastroenterology Department ofInternal Medicine Toho University Ohashi Medical CenterTokyo 153-8515 Japan

AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.

关键词： Biliary tract cancer unresectable Recurrent Pooled analysis Chemotherapy

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Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors

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World Journal of Gastroenterology 2015年第8期21卷 2450-2459页

作者： Jonathan R Strosberg George A Fisher Al B Benson Lowell B Anthony Bulent Arslan John F Gibbs Edward Greeno Renuka V Iyer Michelle K Kim William J Maples Philip A Philip Edward M Wolin Dasha Cherepanov Michael S Broder Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Medicine Division of Oncology Stanford University Medical Center Stanford Robert H. Lurie Comprehensive Cancer Center of Northwestern University Department of Internal Medicine Division of Medical Oncology University of Kentucky Markey Cancer Center Rush University Medical Center Department of Surgery University at Buffalo - State University of New York Department of Medicine Division of Hematology Oncology and Transplantation University of Minnesota Department of Medical Oncology Roswell Park Cancer Institute Department of Medicine Gastroenterology Mount Sinai School of Medicine Mission Health System Asheville Department of Oncology Karmanos Cancer Institute Partnership for Health Analytic Research LLC

AIM:To evaluate systemic treatment choices in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors(PNETs)and provide consensus treatment ***:Systemic treatment options for pancreatic neuroendocrine tumors have expanded in recent years to include somatostatin analogs,angiogenesis inhibitors,inhibitors of mammalian target of rapamycinand cytotoxic *** this time,there is little data to guide treatment selection and *** therefore assembled a panel of expert physicians to evaluate systemic treatment choices and provide consensus treatment *** appropriateness ratings were collected using the RAND/UCLA modified Delphi *** studying the literature,a multidisciplinary panel of 10 physicians assessed the appropriateness of various medical treatment scenarios on a 1-9 *** were done both before and after an extended discussion of the *** measurements of agreement were made and consensus statements developed from the second round ***:Specialties represented were medical and surgical oncology,interventional radiology,and *** had practiced for a mean of15.5 years(range:6-33).Among 202 rated scenarios,disagreement decreased from 13.2%(26 scenarios)before the face-to-face discussion of evidence to 1%(2)*** the final ratings,46.5%(94 scenarios)were rated inappropriate,21.8%(44)were uncertain,and30.7%(62)were *** statements from the scenarios included:(1)it is appropriate to use somatostatin analogs as first line therapy in patients with hormonally functional tumors and may be appropriate in patients who are asymptomatic;(2)it is appropriate to use everolimus,sunitinib,or cytotoxic chemotherapy therapy as first line therapy in patients with symptomatic or progressive tumors;and(3)beyond first line,these same agents can be *** patients with uncontrolled secretory symptoms,octreotide LAR doses can be titrated u

关键词： unresectable Neuroendocrine carcinomas Neuroendocr

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Evidence based radiation therapy for locally advanced resectable and unresectable gastric cancer

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World Journal of Gastrointestinal Oncology 2011年第9期3卷 131-136页

作者： Georgios V Koukourakis Department Radiation Oncology Anticancer Institute of Athens "Saint Savvas"

Despite the fact that gastric cancer is decreasing in incidence in the United States,it remains one of the most commonly diagnosed and most fatal cancers *** localised disease,surgery remains the cornerstone of ***,the low overall survival rates at 5 years due to locoregional and distant recurrences has led to a large debate regarding the role of radiation therapy and chemotherapy in addition to curative *** data have shown that,even with improved surgical techniques,locoregional failure rates in these patients ranged between 57% and 88%.Failures were noted in the gastric bed,regional nodes,gastric remnant,anastomosis and duodenal stump,all of which can be encompassed in a regional radiation f ield,indicating the need of further locoregional *** this article,a comprehensive literature review of the reliable medical databases of PubMed and Cochrane is made and we present all available information on the role of radiation therapy in the preoperative and postoperative setting of gastric *** reported show that in locally advanced gastric cancer the addition of radiation therapy post surgery has signif icantly improved diseasefree survival as well as overall ***,in unresectable gastric cancer,the combination of radiation therapy with chemotherapy has significantly improvedmean and overall survival *** role of radiation therapy in patients with resectable gastric cancer is being further evaluated in ongoing phase Ⅲ trials.

关键词： Resectable gastric cancer unresectable gastric cancer Surgery Preoperative treatment Postoperative treatment Radiation therapy

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Proton beam therapy in apneic oxygenation treatment of an unresectable hepatocellular carcinoma: A case report and review of literature

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World Journal of Hepatology 2018年第10期10卷 772-779页

作者： Yi-Lan Lin Department of Radiation Oncology Rinecker Proton Therapy Center

Presented here is the clinical course of a 63-yearold patient with a central, large and unresectable hepatocellular carcinoma(HCC) with liver metastases and tumor invasion of the portal and hepatic veins. After the tumor had been diagnosed, the patient was immediately treated with proton beam therapy(PBT), at a total dose of 60 Gy(relative biological effectiveness) in 20 fractions administered within 4 wk. To manage the respiratory movements, at the Rinecker Proton Therapy Center, apneic oxygenation was given daily, under general anesthesia. The patient tolerated both the PBT and general anesthesia very well, and did now show any signs of acute or late toxicity. The treatment was followed by constant reductions in the tumor marker alpha-fetoprotein and the cholestatic parameters gamma-glutamyltransferase and alkaline phosphatase. The patient commenced an adjuvant treatment with sorafenib, given at 6-wk intervals, after the PBT. Follow-up with regular magnetic resonance imaging has continued for 40 mo so far, demonstrating remarkable shrinkage of the HCC(maximal diameter dropping from approximately 13 cm to 2 cm). To date, the patient remains free of tumor recurrence. PBT served as a safe and effective treatment method for an unresectable HCC with vascular invasion.

关键词： Particle therapy Proton beam therapy Apneic oxygenation unresectable Vascular invasion Hepatocellular carcinoma Intrahepatic metastasis

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Sorafenib Combined with Cryoablation to Treat unresectable Hepatocellular Carcinoma

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Chinese Journal of Cancer Research 2011年第3期23卷 188-193页

作者： Hong Ni Mao Yang Zhi Guo Ti Zhang Department of Interventional Therapy Tianjin 300060China Department of Hepatobiliary Disease Cancer Institute ＆ HospitalTianjin Medical UniversityTianjin 300060China

Objective：To evaluate the efficacy and tolerability of sorafenib combined with cryoablation in treating unresectable hepatocellular carcinoma （HCC）.Methods：Patients with unresectable advanced HCC received cryoablation and sorafenib at a dose of 400 mg twice daily in 4-week cycles on the same day of the *** response,median overall survival and the median time to radiological progression were calculated and the toxicity was ***：Seventy-eight patients with unresectable HCC were involved in this *** median age was 52 years （range,22-81 years）.The Eastern Cooperative Oncology Group （ECOG） performance status scores were 0 （39.7%）,1 （55.1%）,and 2 （5.1%）.Nine （11.5%） patients were at Barcelona clinic liver cancer （BCLC） stage A,twenty-four （30.8%） patients were at stage B and 45 （57.7%） patients were at stage *** （6.4%） achieved partial responses,and 34 （43.6%） achieved stable *** median time to progression （TTP） for all enrolled patients was 6.6 months and the median overall survival （OS） was 12.2 ***：Cryoablation combined with sorafenib demonstrates good efficacy and acceptable tolerability in treating unresectable advanced HCC patients.

关键词： Hepatocellular carcinoma Sorafenib Cryoablation unresectable

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