Arterial chemoembolization with epirubicin in unresectable hepatocellular-carcinoma in cirrhosis.

No reliable therapy has yet been established for unresectable hepatocellular carcinoma (HCC). Encouraging data in terms of response rate and survival have been reported with intra-arterial chemotherapy combined with venooclusive materials, specifically ethiodized oil and gelatin sponge. To evaluate the activity and tolerance of a new chemoembolization protocol in cirrhotic patients with HCC, 22 patients were treated with epirubicin (50 mg) and ethiodized oil (10-15 ml), administered through hepatic arterial catheters, followed by gelatin sponge. Patient characteristics were: median age 70 years (range, 59-77); ECOG performance status 0-1 in 15 and 2 in 7 cases; Child's A disease in 11 and B in 11; TNM stage II in 9, stage III in 3 and stage IVA in 10 cases. Histologically documented cirrhosis was present in all cases. A total of 53 courses of therapy has been delivered. All patients were evaluable for response and toxicity. Three partial remissions (13%), 2 stabilizations of disease and 17 progressions have been observed. Median time to progression was 4 months, with a median survival of 7.6 months (range, 1-26+ months). Significant differences in survival (p = 0.001) have been observed between patients at stage II-III (21 months) and those at stage IVA (3 months), and between patients with Child's A disease (10 months) and Child's B disease (4 months) (p= 0.02). The treatment was well tolerated, with only 2 cases of WHO grade I pain and 2 cases of grade I fever. In conclusion, our results indicate that the schedule has only limited activity and does; not seem to offer any sure advantage over other treatments modalites in HCC.

Megestrol acetate in unresectable hepatocellular carcinoma.

AIMS AND BACKGROUND: No consolidated medical treatment has yet been established for unresectable hepatocellular carcinoma (HCC). A possible interference of hormones in the pathogenesis and cellular growth of HCC has been suggested. METHODS: To evaluate the activity and tolerance of progestins in HCC, patients were treated with megestrol acetate orally at a dose of 160 mg daily until progression of disease or grade III-IV toxicity was observed. RESULTS: Eleven patients entered the study and were assessable for response and side effects. Median duration of treatment was 80 days (range 60-150). No major responses were observed, 4 patients had stabilization of disease for at least 2 months, and 7 had progressive disease. Median time to disease progression was 3 months (range 2-5). Three patients required interruption of treatment because of toxicity (2 patients had worsening of concomitant diabetes and 1 patient had gastric bleeding). CONCLUSIONS: The results of the present study suggest that hormone therapy with megestrol acetate has no significant role in HCC.

Medical treatment of hepatocellular carcinoma: any progress?

BACKGROUND: Hepatocellular carcinoma (HCC) remains one of the most common neoplasms worldwide. Curative treatment options include liver transplantation or resection. Unfortunately, most patients still have unresectable or untransplantable HCC due to disease extension or comorbid factors and are therefore candidate only for palliative treatments. METHODS: In this review we have analyzed the different medical approaches employed in the treatment of HCC in an attempt to better define their roles. RESULTS: Palliative medical treatments including systemic chemotherapy, immunotherapy or hormonal manipulation rarely influence survival of the patients. Although a high response rate is often reported with new local therapies such as transcatheter arterial embolization, intraarterial chemotherapy or percutaneous ethanol injection, the real impact of these treatment modalities on patient survival remains to be determined. CONCLUSION: One way to improve the diagnosis of HCC patients would be an appropriate approach to evaluate new drugs or treatment modalities. To answer all the open questions, further trials, possibly randomized, should be conducted on a substantial number of patients with homogeneous prognostic factors.

[Early and systematic use of ultrasonography in emergency patients with renal colic: analysis of the actual diagnostic efficacy]. / Impiego precoce e sistematico dell'ecografia nei pazienti ricoverati d'urgenza per colica renale: analisi della reale efficacia diagnostica.

In this study, the diagnostic yield of ultrasonography (US) in the early phase of acute urinary obstruction was retrospectively assessed and compared with that of clinical examination. 351 patients were admitted to our emergency department because of suspected renal colic over an 11 months' period: urinary obstruction was subsequently confirmed with other examinations in 76 of them, who were all submitted to renal US within 2 hours of the onset of symptoms. Emergency US results were then retrospectively compared with clinical and laboratory data and the cost of each US exam was calculated. Thirty-nine of 76 patients had negative US findings (51.3%). In the extant 37 patients, US showed hydronephrosis (which was mild in 13 patients and moderate in 6) and renal stones (in 18 patients). Hydronephrosis was associated with renal stones or increased parenchymal echogenicity in 5 and 6 patients, respectively. Pain, which was always severe, was not a useful sign for diagnostic purposes. In contrast, all the 37 patients with abnormal US findings (hydronephrosis, renal stones and increased parenchymal echogenicity) exhibited specific clinical and laboratory abnormalities such as hematuria, ketonuria and marked blood pressure increase (diastolic pressure > 100 mmHg). The same abnormalities, although less severe (mild hematuria and ketonuria and increased diastolic pressure not exceeding 100 mmHg) were nevertheless present in all the 39 patients with negative US findings and yet having a renal colic. The cost of each emergency US exam (calculated on the basis of literature tables and reference cost) was approximately It. L. 104,000. The corresponding total cost for submitting to US all the 76 patients with renal colic was approximately It. L. 7,900,000. In the early phase of urinary obstruction, the association of hematuria, ketonuria and increased blood pressure was more reliable than US findings-the latter method yielding a 51.3% false-negative rate. The presence and severity of the above clinical and laboratory abnormalities might thus represent a criterion to select the patients who are less likely to have positive US findings. This should allow the cost of medical and non-medical staff, equipment and materials to be reduced. As for our personal series, It. L. 28,000,000 was the estimated additional cost of performing US routinely in all the remaining (275) patients with suspected renal colic.