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Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children

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World Journal of Clinical Cases 2022年第19期10卷 6437-6445页

作者： Min He Jia-Bin Cai Can Lai Jun-Qing Mao Jie-Ni Xiong Zhong-Hai Guan Lin-Jie Li Qiang Shu Mei-Dan Ying Jin-Hu Wang Department of Surgical Oncology The Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhou 310052Zhejiang ProvinceChina Department of Radiology The Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhou 310052Zhejiang ProvinceChina Cancer Center Zhejiang UniversityHangzhou 310058Zhejiang ProvinceChina

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatment of UESL in children.AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019.The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava.The NAT included preoperative transcatheter arterial chemoembol ization(TACE)and systemic chemotherapy.The patients were 4 boys and 2 girls with a mean age of 7 years.The longest tumor at presentation ranged from 8.6 to 14.8 cm(mean,12 cm).Extrahepatic metastases were present in 2 cases.Preoperative systemic chemotherapy was administered 3 wk after TACE.Tumor resection was performed 3 wk after one or two cycles of NAT.The patients received systemic chemotherapy after surgery.RESULTS All patients successfully underwent NAT and complete resection.The tumor volumes decreased by 18.2%–68.7%,with a mean decrease of 36%after 1 cycle of NAT(t=3.524,P=0.017).According to the Response Evaluation Criteria In Solid Tumors criteria,4 patients had a partial response and underwent surgery,while 2 had stable disease and received another cycle of NAT before surgery.Massive tumor necrosis was seen on pathological examination of the surgical specimen:>90%necrosis in two,>50%necrosis in three,and 25%necrosis in 1,with an average of 71.8%.Post-NAT complications included fever,nausea and vomiting,and mild bone marrow suppression.Elevated alanine transaminase levels occurred in all patients,which returned to normal within 7–10 d after treatment.No cardiac or renal toxicity,severe hepatic dysfunction,bleeding and nontarget embolization were observed in the patients.The me

关键词： Undifferentiated embryonal sarcoma of the liver unresectable Neoadjuvant therapy Transcatheter arterial chemoembolization Systemic chemotherapy

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 indications of any combinations of conversion the

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

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

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 enrolled.The tumor was considered unresectable when liver metastases or major vascular involvement were confirmed.Patients were randomized to receive Roux(n=21)or conventional GE(n=20)on a prophylactic basis.RESULTS: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

Improvement of prognosis for unresectable biliary tract cancer

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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 cancer.METHODS: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 analyzed.These 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 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In 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 monotherapy.In 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 therapy.The 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 recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improv

关键词： unresectable Biliary tract cancer Gemcitabine Platinum analogs Fluoropyrimidine

Conversion surgery for gastric cancer patients:A review

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World Journal of Gastrointestinal Oncology 2018年第11期10卷 398-409页

作者： Tommaso Zurleni Elson Gjoni Michele Altomare Stefano Rausei Department of Surgery ASST Valle OlonaBusto Arsizio 21052Italy Department of Surgery ASST Valle OlonaGallarate.21013Italy

Gastric cancer(GC) is the third most common cancer-related cause of death worldwide. In locally advanced tumors, neoadjuvant chemotherapy has recently been introduced in most international Western guidelines. For metastatic and unresectable disease, there is still debate regarding correct management and the role of surgery. The standard approach for stage IV GC is palliative chemotherapy. Over the last decade, an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent. The objective of the present review is to analyze the literature regarding this approach, known as "conversion surgery", which has become one of the most commonly adopted therapeutic options. It is defined as a treat-ment aiming at an R0 resection after chemotherapy in initially unresectable tumors. The 13 retrospective studies analyzed, with a total of 411 patients treated with conversion therapy, clearly show that even if standardization of unresectable and metastatic criteria, post-chemotherapy resectability evaluation and timing of surgery has not yet been established, an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone. Additional larger sample-size randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach.

关键词： Metastatic gastric cancer Gastric cancer Conversion surgery R0 resection Stage IV gastric cancer Palliative chemotherapy unresectable gastric cancer

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 hospital.The metastatic lesion was diagnosed as initially unresectable because of its invasion into the confluence of the RHV and IVC.After she had undergone laparoscopic sigmoidectomy for the original tumor,she consequently had 3 courses of modified 5-fluorouracil,leucovorin,and oxaliplatin(m FOLFOX6)plus cetuximab.Computed tomography revealed a partial response,and the confluence of the RHV and IVC got free from cancer invasion.After 3 additional courses of m FOLFOX6 plus cetuximab,preoperative percutaneous transhepatic portal vein embolization(PTPE)was performed to secure the future remnant liver volume.Finally,a right hemihepatectomy was performed.The postoperative course was uneventful.The patient was discharged from the hospital on postoperative day 13.She had neither local recurrence nor distant metastasis 18 mo after the last surgical intervention.This 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

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

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.METHODS:Patients who were treated with gemcitabine and S-1 combination therapy in the previous prospective studies were divided into groups of unresectable and recurrent cases.The tumor response,time-toprogression,overall survival,toxicity,and dose intensity were compared between these two groups.RESULTS:Response rate of the recurrent group was higher than that of the unresectable group(40.0%vs25.5%;P=0.34).Median time-to-progression of the recurrent and unresectable groups were 8.7 mo(95%CI),1.2 mo,not reached)and 5.7 mo(95%CI:4.0-7.0 mo),respectively(P=0.14).Median overall survival of the recurrent and the unresectable groups were 16.1 mo(95%CI:2.0 mo-not reached)and 9.6 mo(95%CI:7.1-11.7 mo),respectively(P=0.10).Dose intensities were significantly lower in the recurrent groups(gemcitabine:recurrent group 83.5%vs unresectable group 96.8%;Punresectable group 91.8%;Punresectable group 55%;P=0.04).CONCLUSION:Not only the efficacy but also the toxicity and dose intensity were significantly different between unresectable and recurrent biliary tract cancer.

关键词： Biliary tract cancer unresectable Recurrent Pooled