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1.
J Cancer Res Ther ; 17(5): 1141-1156, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34850761

RESUMO

The Expert Consensus reviews current literatures and provides clinical practice guidelines for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The main contents include the following: (1) clinical evaluation of GGN; (2) procedures, indications, contraindications, outcomes evaluation, and related complications of thermal ablation for GGN; and (3) future development directions.


Assuntos
Hipertermia Induzida/métodos , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Lesões Pré-Cancerosas/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Consenso , Prova Pericial , Humanos
2.
Mater Sci Eng C Mater Biol Appl ; 129: 112389, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34579908

RESUMO

Nanocarriers have been widely employed to deliver chemotherapeutic drugs for cancer treatment. However, the insufficient accumulation of nanoparticles in tumors is an important reason for the poor efficacy of nanodrugs. In this study, a novel drug delivery system with a self-assembled amphiphilic peptide was designed to respond specifically to alkaline phosphatase (ALP), a protease overexpressed in cancer cells. The amphiphilic peptide self-assembled into spherical and fibrous nanostructures, and it easily assembled into spherical drug-loaded peptide nanoparticles after loading of a hydrophobic chemotherapeutic drug. The cytotoxicity of the drug carriers was enhanced against tumor cells over time. These spherical nanoparticles transformed into nanofibers under the induction of ALP, leading to efficient release of the encapsulated drug. This drug delivery strategy relying on responsiveness to an enzyme present in the tumor microenvironment can enhance local drug accumulation at the tumor site. The results of live animal imaging showed that the residence time of the morphologically transformable drug-loaded peptide nanoparticles at the tumor site was prolonged in vivo, confirming their potential use in antitumor therapy. These findings can contribute to a better understanding of the influence of drug carrier morphology on intracellular retention.


Assuntos
Antineoplásicos , Nanopartículas , Animais , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Doxorrubicina , Portadores de Fármacos , Sistemas de Liberação de Medicamentos , Liberação Controlada de Fármacos
3.
Zhongguo Fei Ai Za Zhi ; 24(5): 305-322, 2021 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-33896152

RESUMO

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
.


Assuntos
Neoplasias Pulmonares/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Técnicas de Ablação , Tomografia Computadorizada Quadridimensional , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem
4.
BMC Gastroenterol ; 20(1): 174, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503426

RESUMO

BACKGROUND: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction. METHODS: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated. RESULTS: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P = 0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P = 0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P = 0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P > 0.05). CONCLUSIONS: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colestase/cirurgia , Tumor de Klatskin/cirurgia , Stents , Idoso , Neoplasias dos Ductos Biliares/sangue , Neoplasias dos Ductos Biliares/complicações , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Bilirrubina/sangue , Colangite/epidemiologia , Colangite/etiologia , Colestase/sangue , Colestase/etiologia , Feminino , Humanos , Incidência , Icterícia/sangue , Icterícia/etiologia , Icterícia/cirurgia , Tumor de Klatskin/sangue , Tumor de Klatskin/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
5.
Sci Rep ; 10(1): 4434, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32157110

RESUMO

The study aimed to compare the tumor response to and complications of doxorubicin-eluting CalliSphere bead-transarterial chemoembolization (DEB-TACE) using small- and medium-sized beads in patients with hepatocellular carcinoma (HCC) who underwent multiple rounds of oncology therapies. Sixty patients with intermediate stage HCC who had previously received multiple oncology therapies underwent DEB-TACE with CalliSpheres of 100-300 µm (small bead group, n = 34) or 300-500 µm (medium bead group, n = 26) in diameter between October 2016 and December 2018. Adverse events and the response rate of the index tumor based on the modified Response Evaluation Criteria in Solid Tumors at 3 months post-TACE were compared between the groups. The rates of complete response, partial response, stable disease, and progressive disease were 35.4%, 29.4%, 17.6%, and 17.6%, respectively, for the small bead group and 33.1%, 23.1%, 20.8%, and 23.0%, respectively, for the medium bead group, showing no significant between-group differences (P > 0.05). Common Terminology Criteria for Adverse Events version 4.0 grade 3/4 adverse events were reported in 8 patients in the small bead group and in no patients in the medium bead group, showing a significant group difference (P < 0.01). Major complications included 8 events of ischemic hepatitis, 2 of biloma, and 2 of severe liver abscess. DEB-TACE using CalliSpheres of 300-500 µm was associated with a comparable rate of tumor response but lower rate of complications compared with that using CalliSpheres of 100-300 µm for HCC treatment in patients who had already undergone multiple rounds of oncology therapies.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica/métodos , Doxorrubicina/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Microesferas , Pessoa de Meia-Idade , Prognóstico , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos
6.
Philos Trans A Math Phys Eng Sci ; 377(2149): 20180227, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31130096

RESUMO

The hybrid perovskites are coordination frameworks with the same topology as the inorganic perovskites, but with properties driven by different chemistry, including host-framework hydrogen bonding. Like the inorganic perovskites, these materials exhibit many different phases, including structures with potentially exploitable functionality. However, their phase transformations under pressure are more complex and less well understood. We have studied the structures of manganese and cobalt guanidinium formate under pressure using single-crystal X-ray and powder neutron diffraction. Under pressure, these materials transform to a rhombohedral phase isostructural to cadmium guanidinium formate. This transformation accommodates the reduced cell volume while preserving the perovskite topology of the framework. Using density-functional theory calculations, we show that this behaviour is a consequence of the hydrogen-bonded network of guanidinium ions, which act as struts protecting the metal formate framework against compression within their plane. Our results demonstrate more generally that identifying suitable host-guest hydrogen-bonding geometries may provide a route to engineering hybrid perovskite phases with desirable crystal structures. This article is part of the theme issue 'Mineralomimesis: natural and synthetic frameworks in science and technology'.

7.
J BUON ; 24(1): 150-157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941964

RESUMO

PURPOSE: To compare the performance of 10 currently staging systems (TNM, Okuda, GETCH, CLIP, CUPI, JIS, CIS, MELD, mJIS, mCLIP) for predicting survival in advanced hepatocellular carcinoma (HCC) patients. METHODS: A total of 133 consecutive advanced HCC patients between January 2014 and December 2014 were enrolled in the study. The Kaplan-Meier method compared by the log-rank test was used to estimate the survival distribution. Ranking of staging systems was done by using the concordance index (c-index) to compare the discriminatory capacity. The area under the curve (AUC) was performed to assess the mortality prediction. RESULTS: The median survival of all 133 patients was 7.5 months. The survival rates at 6, 12, 18 and 24 months were 56%, 30%, 19% and 15%, respectively. CIS and CUPI systems had better performances in survival distribution. CIS, TNM and CLIP systems were the top three ranking staging systems. CIS had the best mortality prediction at 6, 18 and 24 months and CLIP had the best mortality prediction at 12 months. CONCLUSIONS: The CIS system was the most informative staging system for predicting survival in advanced HCC patients with mainly hepatitis B virus etiology.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Área Sob a Curva , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
8.
Cardiovasc Intervent Radiol ; 42(1): 87-94, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29740688

RESUMO

PURPOSE: The present study compared the safety and efficacy of oxycodone with those of fentanyl under non-intubated general anaesthesia in percutaneous microwave ablation (MWA) of a liver tumour abutting the capsule. MATERIALS AND METHODS: Thirty-eight patients underwent MWA of liver cancers abutting the capsule. Patients received 0.1 mg/kg oxycodone (O group) or 1 µg/kg fentanyl (F group) prior to the start of ablation. Both groups received continuous infusions of propofol for non-intubated general anaesthesia during ablation. The primary outcomes were the pain scores (11-point numeric rating scale, NRS) within 24 h after MWA. Vital signs, body movement during ablation, and opioid side effects after ablation were recorded. The need for additional analgesics was recorded 24 h after MWA. RESULTS: The pain NRS scores were lower in the O group than in the F group at 0.5 (P = 0.035), 3 (P = 0.002), and 6 h (P = 0.001) after MWA, and fewer patients required additional analgesics in the O group (6 of 20 vs. 13 of 18, P = 0.022) within 24 h. The average 24-h dose of dezocine was 5.5 ± 4.1 mg in the F group and 2.1 ± 3.3 mg in the O group (P = 0.008). A significant reduction in the respiratory rate (P = 0.020) and more body movements were observed in the F group (P = 0.027) during ablation with non-intubated general anaesthesia. No differences in post-operative nausea and vomiting (PONV) were observed between the two groups, but dizziness occurred significantly more often in the O group (P = 0.033). No significant differences in other vital signs were observed before, during, and after the procedure. CONCLUSIONS: Oxycodone provides better analgesia and reduces post-operative opioid consumption without significant respiratory or hemodynamic instability.


Assuntos
Técnicas de Ablação/métodos , Analgésicos Opioides/uso terapêutico , Fentanila/uso terapêutico , Neoplasias Hepáticas/cirurgia , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Feminino , Humanos , Fígado/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
9.
Cardiovasc Intervent Radiol ; 42(2): 268-275, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30506169

RESUMO

PURPOSE: To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ). MATERIALS AND METHODS: This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated. RESULTS: Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8-22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031). CONCLUSION: SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.


Assuntos
Colestase/complicações , Colestase/terapia , Radioisótopos do Iodo/uso terapêutico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/terapia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/radioterapia , Feminino , Humanos , Icterícia Obstrutiva/radioterapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Anticancer Drugs ; 29(10): 1021-1025, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30134285

RESUMO

The liver is the most common site of colorectal cancer metastases. The present study aimed to evaluate the efficacy and safety of transarterial chemoembolization (TACE) with raltitrexed and oxaliplatin for colorectal liver metastases in a prospective, multicenter, single-arm trial conducted in 12 hospitals from different areas in China. A total of 90 patients with colorectal liver metastases were enrolled and treated by TACE with raltitrexed 4 mg and oxaliplatin 100 mg, followed by embolotherapy with 50 mg oxaliplatin and 5-20 ml lipiodol, administered every 28 days for four cycles. Patients were followed up every 3 months after the treatment and up to 12 months. The primary endpoint was time to progression. For the full analysis set (FAS), the median time to progression and overall survival were 9.1 and 17.8 months, respectively. The disease control rate in FAS was 71 (78.9%). Grade 3 or 4 adverse events were reported for 24 (26.7%) out of all 90 patients. Grade 3 thrombocytopenia, transglutaminase abnormality, and decreased neutrophil were observed in eight (8.9%), six (6.7%), and five (5.6%) patients, respectively. No unexpected adverse events or toxic deaths were observed. TACE with raltitrexed plus oxaliplatin is feasible, clinically beneficial, and well tolerated with low-grade toxicity for colorectal cancer patients with liver metastases.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioembolização Terapêutica/métodos , Neoplasias Colorretais/terapia , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioembolização Terapêutica/efeitos adversos , China , Neoplasias Colorretais/patologia , Progressão da Doença , Óleo Etiodado/administração & dosagem , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Oxaliplatina/administração & dosagem , Estudos Prospectivos , Quinazolinas/administração & dosagem , Sobrevida , Tiofenos/administração & dosagem
11.
Mol Clin Oncol ; 8(4): 600-602, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29541470

RESUMO

Bronchobiliary fistula (BBF) is a rare condition, defined as an abnormal communication between the bronchial system and the biliary tree. Patients with this condition usually present with massive biliptysis, and the mortality rate is high. BBF has been reported to occur in patients with congenital conditions, complications of trauma, hepatic abscesses and biliary tract obstruction (surgical as well as non-surgical). However, to the best of our knowledge, BBF as a complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) has not been reported to date. We herein report a case of BBF developing as a complication following TACE in a 71-year-old male patient with HCC. The patient was treated by placement of a metallic biliary stent followed by percutaneous transhepatic biliary drainage to decompress the intrahepatic biliary tree, and his symptoms were immediately relieved.

12.
Cardiovasc Intervent Radiol ; 40(11): 1748-1755, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28681222

RESUMO

PURPOSE: To compare effectiveness of transarterial chemoembolization (TACE) combined with microwave ablation (MWA; TACE-MWA) with TACE alone for treating hepatocellular carcinoma (HCC) tumors ≤5 cm. MATERIALS AND METHODS: We reviewed data of 244 patients treated for HCC by TACE-MWA or TACE from June 2014 to December 2015. Median follow-up period was 505 days (TACE-MWA group: 485 days; TACE group: 542 days). Patients were propensity score matched (1:2 ratio); outcomes of TACE-MWA and TACE groups were compared. Primary endpoints were tumor responses, including tumor necrosis rates after initial treatment, tumor responses at 6 months [per modified Response Evaluation Criteria in Solid Tumors (mRECIST)], and time to tumor progression (TTP). Secondary endpoints were overall survival (OS) and re-intervention times. RESULTS: After initial treatments, tumor necrosis rates were higher in the TACE-MWA group (n = 48; 92.1% [58/63]) than the TACE group (n = 96; 46.3% [56/121]; P < 0.001). At 6 months' follow-up, the TACE-MWA group had better tumor responses (CR + PR + SD [per mRECIST]: TACE-MWA, 95.8%; TACE, 64.5%; P < 0.001). The TACE-MWA group had better TTP (P < 0.001), but did not significantly differ in OS (P = 0.317). TACE-MWA decreased re-TACE times from 1.90 to 0.52; and re-MWA times from 0.22 to 0.17. In subgroup analysis, TACE-MWA also showed better TTP in patients with tumors ≤3 cm (P < 0.001) and 3-5 cm (P = 0.004). CONCLUSIONS: Compared with TACE, TACE-MWA leads to better responses for HCC tumors ≤5 cm.


Assuntos
Técnicas de Ablação/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Humanos , Fígado/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
13.
Abdom Radiol (NY) ; 42(6): 1781-1787, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28180923

RESUMO

PURPOSE: To compare the technical success and accuracy of hepatic microwave ablation (MWA) using non-enhanced and enhanced T1-weighted imaging early after ablation. Patients were evaluated with regard to the ablation zone and local tumor progression (LTP). METHODS: This retrospective study conducted between September 2014 and December 2015 which consisted of 56 patients with 56 hepatic malignant lesions who underwent percutaneous MWA. Non-enhanced and contrast-enhanced T1-weighted imagings were performed within 2 days after tumor ablation. The efficacy of ablation assessed according to the hyperintense middle zone on non-enhanced T1-weighted images and the non-enhanced area on contrast-enhanced T1-weighted images were compared. The development of LTP during ≥7 months of follow-up served as the end point. RESULTS: On the non-enhanced T1-weighted images, the ablated region had a characteristic two-zone structure featuring a hyperintense middle zone and a surrounding hypointense band. Among the 56 patients, LTP developed in ten including seven lesions, in which both the non-enhanced T1-weighted and portal-phase images showed incomplete tumor ablation. In two of the remaining three patients, incomplete tumor ablation was detected on the non-enhanced T1-weighted images, whereas the corresponding portal-phase images showed complete ablation. In the remaining patient, no residual tumor was detected on either the non-enhanced T1-weighted or the portal-phase images. In the 46 patients without LTP, there was no evidence of residual tumor on the non-enhanced T1-weighted or portal-phase images obtained early after ablation. CONCLUSIONS: Non-enhanced T1-weighted images are useful in assessing the therapeutic efficacy of MWA of liver tumors early after the procedure.


Assuntos
Ablação por Cateter/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética/métodos , Micro-Ondas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Progressão da Doença , Gadolínio DTPA , Humanos , Aumento da Imagem/métodos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Necrose , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
14.
Int J Gynaecol Obstet ; 137(1): 45-50, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28098341

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of prophylactic intraoperative uterine artery embolization (UAE) during cesarean delivery as conservative treatment for patients with abnormally invasive placenta. METHODS: A retrospective cohort study enrolled patients surgically diagnosed with abnormally invasive placenta who underwent cesarean delivery at the First Affiliated Hospital of Nanjing Medical University, Nanjing, China, between February 1, 2012, and February 28, 2015. Postpartum estimated blood loss, blood transfusions, hysterectomy, and adverse events were compared between patients who underwent cesarean delivery only (control group) and those who underwent concurrent prophylactic intraoperative UAE (UAE group). RESULTS: There were 45 patients included in the study; 26 and 19 in the UAE and control groups, respectively. Among patients who did not undergo hysterectomy owing to placenta accreta, the mean estimated blood loss was lower among patients in the UAE group (P=0.005); however, among patients who did undergo hysterectomy for placenta increta or percreta, no difference in mean estimated blood loss was observed (P=0.973). There were no differences in the hysterectomy rate (P=0.639) or incidence of requiring massive blood transfusion (P=0.050) between the groups. Only one patient in the UAE group experienced uterine necrosis. CONCLUSION: Prophylactic intraoperative UAE was relatively safe and effective for reducing postpartum hemorrhage among patients with placenta accreta. The potential benefits could be lower among patients with placenta increta or percreta.


Assuntos
Cesárea/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Embolização da Artéria Uterina/métodos , Adulto , Estudos de Casos e Controles , China , Tratamento Conservador/métodos , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
AJR Am J Roentgenol ; 204(6): 1322-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26001244

RESUMO

OBJECTIVE: The long-term prognosis after hepatic resection for the treatment of hepatocellular carcinoma (HCC) has been disappointing because of the high recurrence rates in the remnant liver, which constitutes the major cause of death. The purpose of this study was to identify the prognostic factors for overall survival after transarterial chemoembolization (TACE) in recurrent HCC after the initial curative surgical resection. MATERIALS AND METHODS: From January 2003 through October 2012, 362 patients who developed recurrent HCC after initial surgical resection and underwent TACE as the first-line therapy were retrospectively studied at a single institution in our hospital. Patients who met our inclusion criteria were followed until December 2012. Prognostic factors for overall survival were analyzed. RESULTS: In total, 287 patients were enrolled. The median overall survival period was 747 days. The 1-, 2-, and 3-year overall survival rates after TACE were 72.9%, 51.8%, and 31.8%, respectively. Multivariate analysis indicated that the number of resected HCCs (≥ 2, p < 0.001), the number (≥ 2, p < 0.001) and size (> 5 cm, p = 0.022) of the recurrent HCCs, and the number of TACE sessions (≤ 3, p < 0.001) are independent risk factors for poor survival after TACE for recurrent HCC after HCC resection. CONCLUSION: TACE appears to be an effective treatment of patients who experienced a recurrence after curative HCC resection. An initial solitary HCC, a solitary recurrence, and recurrent tumor mass 5 cm or smaller are statistically significant independent prognostic factors for survival.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , China/epidemiologia , Feminino , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
16.
PLoS One ; 10(2): e0117168, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25689846

RESUMO

AIMS: This retrospective study was carried out to compare the outcomes between elderly (≥70 years of age) and nonelderly patients (<70 years of age) with advanced hepatocellular carcinoma (HCC) who received sorafenib combined with transarterial chemoembolization (TACE). METHODS: 88 patients with a confirmed diagnosis of advanced HCC were enrolled in this study. Of these, 24 elderly patients were matched with 48 nonelderly patients at a 1:2 ratio using propensity score matching to minimize selection bias. The related adverse events and survival benefits were compared between the two groups. RESULTS: Sorafenib combined with TACE was equally well tolerated in both age groups, and grade 3 or 4 adverse events were similarly observed in 54.2% of elderly and 50.0% of nonelderly patients (P = 0.739). There were no significant differences in survival time between the elderly and nonelderly patients (P = 0.876). Significant prognostic factors for overall survival as identified by multivariate analysis were the Child-Pugh score and portal vein invasion. CONCLUSIONS: Sorafenib combined with TACE may be well tolerated and effective in elderly patients with advanced HCC. Age alone is not a parameter for the treatment of advanced HCC patients.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica , Neoplasias Hepáticas/tratamento farmacológico , Niacinamida/análogos & derivados , Compostos de Fenilureia/efeitos adversos , Compostos de Fenilureia/uso terapêutico , Pontuação de Propensão , Segurança , Fatores Etários , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Artérias , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Compostos de Fenilureia/administração & dosagem , Estudos Retrospectivos , Sorafenibe , Análise de Sobrevida , Resultado do Tratamento
17.
J Vasc Interv Radiol ; 26(2): 223-30, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25645411

RESUMO

PURPOSE: To evaluate the efficacy and safety of transarterial embolization with ethanol-soaked gelatin sponge (ESG) for the treatment of arterioportal shunts (APSs) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 61 patients with unresectable HCC was included in this study, conducted from June 2008 to November 2011. These patients, who were treated with APSs, had received transarterial therapy. They underwent transarterial embolization of the shunt with ESG followed by transarterial chemoembolization if available. Changes in APSs, tumor response (per modified Response Evaluation Criteria in Solid Tumors), postembolization events, patient survival, and prognostic factors were analyzed. RESULTS: The median follow-up period was 13 months (range, 3-34 mo). The immediate APS improvement rate was 97% (59 of 61), and the APS improvement rate at first-time follow-up was 54% (33 of 61). Tumor response at 2 months after first embolization was as follows: complete response in two patients (3.3%), partial response in 24 patients (39.3%), stable disease in 24 patients (39.3%), and progressive disease in 11 patients (18.1%). Survival rates were 79% at 6 months, 50% at 1 year, and 12% at 2 years; the median survival time was 382 days. Maximal tumor size and APS improvement at first-time follow-up were demonstrated to be independent prognostic factors (P < .05). CONCLUSIONS: Transarterial embolization with ESG may be safe and effective for the treatment of APSs in patients with unresectable HCC. Small maximal tumor size (< 5 cm) and an improvement in APSs favored overall survival.


Assuntos
Fístula Artério-Arterial/terapia , Carcinoma Hepatocelular/terapia , Esponja de Gelatina Absorvível/uso terapêutico , Artéria Hepática/anormalidades , Neoplasias Hepáticas/terapia , Veia Porta/anormalidades , Idoso , Idoso de 80 Anos ou mais , Fístula Artério-Arterial/etiologia , Carcinoma Hepatocelular/complicações , Embolização Terapêutica/métodos , Etanol/uso terapêutico , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
18.
World J Gastroenterol ; 21(1): 373-6, 2015 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-25574114

RESUMO

Herein, we report a new technique that consists of placing two (125)I seed strands and two stents in the right and left intrahepatic bile ducts for the treatment of hilar cholangiocarcinoma. A 75-year-old man presented with jaundice and was diagnosed with Bismuth type IV Klatskin tumor. Abdominal computed tomography (CT) showed intrahepatic and extrahepatic bile duct dilatation and a soft tissue mass in the hepatic hilum. Because curative surgical resection was not possible, we placed (125)I seed strands and stents in the right and left intrahepatic bile ducts. Three months later, abdominal CT showed less intrahepatic and extrahepatic bile duct dilatation than before the procedure. This technique was feasible and could be considered for the treatment of patients with Bismuth type IV tumors.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Ductos Biliares Intra-Hepáticos/efeitos da radiação , Braquiterapia/métodos , Colangiocarcinoma/terapia , Drenagem/instrumentação , Radioisótopos do Iodo/uso terapêutico , Tumor de Klatskin/terapia , Stents , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/radioterapia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Colangiocarcinoma/radioterapia , Terapia Combinada , Humanos , Tumor de Klatskin/patologia , Tumor de Klatskin/radioterapia , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Cardiovasc Intervent Radiol ; 38(1): 177-81, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24798136

RESUMO

PURPOSE: To evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis. METHODS: From March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated. RESULTS: Technical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days. CONCLUSIONS: The newly designed stent is associated with a high degree of technical success and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.


Assuntos
Obstrução Duodenal/cirurgia , Stents , Idoso , Obstrução Duodenal/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Desenho de Equipamento , Feminino , Fluoroscopia , Humanos , Atresia Intestinal , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Resultado do Tratamento
20.
PLoS One ; 9(5): e96620, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24817002

RESUMO

AIMS: The purpose of the present study was to compare the efficacies of transarterial chemoembolization (TACE) combined with sorafenib versus TACE monotherapy for treating patients with advanced hepatocellular carcinoma (HCC). METHODS: We enrolled 321 patients and selected 280 with advanced HCC (Barcelona Clinic Liver Cancer stage C) who underwent TACE therapy between February 2009 and February 2013. TACE alone (monotherapy group) was administered to 198 patients (70.7%), and the remaining 82 (29.3%) underwent repeat combined TACE and sorafenib therapy (combined group). To minimize selection bias, these latter 82 patients were matched using propensity-score matching at a 1∶2 ratio with 164 patients who received TACE monotherapy. The primary endpoints were overall survival (OS) and related subgroup analysis. The secondary endpoints were time to progression (TTP) and treatment-related adverse events. RESULTS: Of the respective patients in the combined and monotherapy groups, 64.6% and 49.2% had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. In the propensity-score-matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003). The TTP was significantly longer in the combined group (2.6 months vs. 1.9 months, respectively, P = 0.001). Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05). Univariate and subsequent multivariate analyses revealed that the addition of sorafenib was an independent predictor of favorable OS and TTP (adjusted hazard ratios, 0.63 and 0.62, respectively; P<0.05 for both). CONCLUSION: Sorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion. Future trials with larger samples are required to validate these preliminary findings.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Niacinamida/análogos & derivados , Compostos de Fenilureia/uso terapêutico , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Terapia Combinada , Diarreia/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Encefalopatia Hepática/etiologia , Humanos , Hipertensão/etiologia , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Compostos de Fenilureia/efeitos adversos , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Dermatopatias/etiologia , Sorafenibe
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