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Métodos Terapéuticos y Terapias MTCI
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1.
Ann Oncol ; 27(2): 267-74, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26578731

RESUMEN

BACKGROUND: Systemic chemotherapy typically converts previously unresectable liver metastases (LM) from colorectal cancer to curative intent resection in ∼15% of patients. This European multicenter phase II trial tested whether hepatic artery infusion (HAI) with triplet chemotherapy and systemic cetuximab could increase this rate to 30% in previously treated patients. PATIENTS AND METHODS: Participants had unresectable LM from wt KRAS colorectal cancer. Main non-inclusion criteria were advanced extra hepatic disease, prior HAI and grade 3 neuropathy. Irinotecan (180 mg/m(2)), oxaliplatin (85 mg/m(2)) and 5-fluorouracil (2800 mg/m(2)) were delivered via an implanted HAI access port and combined with i.v. cetuximab (500 mg/m(2)) every 14 days. Multidisciplinary decisions to resect LM were taken after every three courses. The rate of macroscopic complete resections (R0 + R1) of LM, progression-free survival (PFS) and overall survival (OS) were computed according to intent to treat. RESULTS: The patient population consisted of 42 men and 22 women, aged 33-76 years, with a median of 10 LM involving a median of six segments. Up to 3 extrahepatic lesions of <1 cm were found in 41% of the patients. A median of six courses was delivered. The primary end point was met, with R0-R1 hepatectomy for 19 of the 64 previously treated patients, 29.7% (95% confidence interval 18.5-40.9). Grade 3-4 neutropenia (42.6%), abdominal pain (26.2%), fatigue (18%) and diarrhea (16.4%) were frequent. Objective response rate was 40.6% (28.6-52.3). Median PFS and OS reached 9.3 (7.8-10.9) and 25.5 months (18.8-32.1) respectively. Those with R0-R1 hepatectomy had a median OS of 35.2 months (32.6-37.8), with 37.4% (23.6-51.2) alive at 4 years. CONCLUSION: The coordination of liver-specific intensive chemotherapy and surgery had a high curative intent potential that deserves upfront randomized testing. PROTOCOL NUMBERS: EUDRACT 2007-004632-24, NCT00852228.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Hepatectomía , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Hígado/cirugía , Adulto , Anciano , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Cetuximab/uso terapéutico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/uso terapéutico , Arteria Hepática , Humanos , Infusiones Intraarteriales , Irinotecán , Hígado/patología , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/uso terapéutico , Oxaliplatino , Proteínas Proto-Oncogénicas p21(ras)/genética , Resultado del Tratamiento
2.
Gastroenterol Clin Biol ; 18(2): 168-71, 1994.
Artículo en Francés | MEDLINE | ID: mdl-8013800

RESUMEN

Two cases of sclerosing cholangitis after oily arterial chemoembolization are reported. In one patient angiocholitis with liver abscesses, in the other patient gradual cholestasis were the main clinical features. In both cases, endoscopic retrograde cholangiogram showed a stricture of the common hepatic bile duct and, in one case, irregularities of intrahepatic biliary tree. Histologic examination of the liver in the two patients pointed out the involvement of small bile ducts and arteriolar endarteritis obliterans. Ischaemia is likely to be the main mechanism of these two cases of sclerosing cholangitis as well as in those described after FUDR intra-arterial chemotherapy. The prevalence of sclerosing cholangitis after arterial oily chemoembolization is probably underestimated because of a non specific clinical presentation and need to be precise by further study.


Asunto(s)
Colangitis Esclerosante/etiología , Embolización Terapéutica/efectos adversos , Aceite Yodado/efectos adversos , Carcinoma Hepatocelular/terapia , Colangiopancreatografia Retrógrada Endoscópica , Colangitis Esclerosante/diagnóstico por imagen , Colangitis Esclerosante/patología , Endarteritis/etiología , Endarteritis/patología , Resultado Fatal , Femenino , Conducto Hepático Común/diagnóstico por imagen , Humanos , Neoplasias del Íleon/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad
4.
Acta Radiol ; 30(4): 415-8, 1989.
Artículo en Inglés | MEDLINE | ID: mdl-2550043

RESUMEN

Computed tomography (CT) was performed in 54 patients with hepatocellular carcinoma three weeks after transcatheter arterial chemotherapy using iodized oil and doxorubicin with or without gelfoam embolization. Patients with iodized oil retention in the tumor greater than 50 per cent of tumor size survived longer than patients with retention of less than 50 per cent. Differences were also found within Okuda stages I and II, but they were significant only in Okuda stage I (p less than 0.0001). These results suggest a possible relationship between iodized oil retention and survival. In addition to Okuda stage, several factors affected iodized oil retention: tumor vascularity, tumor size, portal thrombosis and Gelfoam embolization. These factors may thus influence the prognosis after transcatheter arterial chemotherapy.


Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Doxorrubicina/administración & dosificación , Embolización Terapéutica , Aceite Yodado , Neoplasias Hepáticas/diagnóstico por imagen , Adulto , Anciano , Angiografía , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/terapia , Doxorrubicina/uso terapéutico , Portadores de Fármacos , Femenino , Esponja de Gelatina Absorbible , Humanos , Aceite Yodado/metabolismo , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Tomografía Computarizada por Rayos X
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