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1.
World J Gastroenterol ; 25(28): 3704-3721, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391767

RESUMO

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.


Assuntos
Carcinoma Hepatocelular/terapia , Hepatectomia , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/terapia , Técnicas de Ablação/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Antivirais/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica/métodos , Quimioterapia Adjuvante/métodos , Humanos , Fígado/patologia , Fígado/cirurgia , Fígado/virologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Radiocirurgia/métodos , Resultado do Tratamento , Radioisótopos de Ítrio/administração & dosagem
2.
Expert Rev Gastroenterol Hepatol ; 13(9): 899-905, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31104533

RESUMO

Background: Transarterial radioembolization (TARE) is used to treat unresectable colorectal cancer with liver metastases (CRCLM). This study aimed to assess survival after TARE and to identify potential prognostic factors in this patient population. Methods: Patients with unresectable and chemorefractory CRCLM treated with TARE at our institution between February 2006 and September 2015 were included in the study. Survival rate, hepatic tumor response, and potential prognostic factors were analyzed. Results: In the 43 study patients, the mean follow-up was 15.0 ± 14.2 months, with a median survival of 13.0 months and 1-, 2-, 3-, 4-, and 5-year survival rates of 52.1%, 24.9%, 21.4%, 21.4%, and 7.1%, respectively. The mean activity of yttrium-90 administered was 1.55 ± 0.28 GBq for the disease-controlled group and 1.19 ± 0.27 GBq for the progressive disease group (p= 0.031). Survival was correlated with Child-Pugh class (p< 0.001), hepatic tumor response (p= 0.001), and baseline carcinoembryonic antigen (CEA) level (p= 0.013). Conclusion: Child-Pugh class B, low degree of hepatic tumor response, and normal baseline CEA levels are prognostic factors for poorer survival after TARE in patients with unresectable and chemorefractory CRCLM. Hepatic tumor response is related to radiation activity delivered to the liver.


Assuntos
Braquiterapia/métodos , Neoplasias Colorretais/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/mortalidade , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/secundário , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico
5.
Phys Med ; 58: 114-120, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30824142

RESUMO

PURPOSE: Radio-guided surgery with ß- decays is a novel technique under investigation. One of the main advantages is its capability to detect small (⩽0.1 ml) samples after injecting the patient with low activity of radiopharmaceutical. This paper presents an experimental method to quantify this feature based on ex-vivo tests on specimens from meningioma patients. METHODS: Patients were enrolled on the basis of the standard uptake value (SUV) and the tumour-to-non-tumour activity ratio (TNR) resulted from 68Ga-DOTATOC PET exams. After injecting the patients with 93-167 MBq of 90Y-DOTATOC, 26 samples excised during surgery were analyzed with a ß- probe. The radioactivity expected on the neoplastic specimens was estimated according to the SUV found in the PET scan and the correlation with the measured counts was studied. The doses to surgeon and medical personnel were also evaluated. RESULTS: Even injecting as low as 1.4 MBq/kg of radiotracer, tumour residuals of 0.1 ml can be detected. A negligible dose to the medical personnel was confirmed. CONCLUSIONS: Radio-guided surgery with ß- decays is a feasible technique with a low radiation dose for both personnel and patient, in particular if the patient is injected with the minimum required activity. A correlation greater than 80% was observed between the measured counts and the expected activity for the lesion samples based on the individual SUV and the TNR. This makes identifiable the minimum injectable radiotracer activity for cases where 90Y is the utilized radionuclide.


Assuntos
Partículas beta , Tomografia por Emissão de Pósitrons , Cirurgia Assistida por Computador/métodos , Radioisótopos de Ítrio/administração & dosagem , Humanos , Injeções , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Exposição Ocupacional/análise , Octreotida/administração & dosagem , Octreotida/análogos & derivados , Doses de Radiação
6.
J Vasc Interv Radiol ; 30(3): 293-297, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819468

RESUMO

PURPOSE: To analyze the cost-effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database. MATERIALS AND METHODS: Cost as measured by total treatment-related reimbursement in patients diagnosed with ICC who received chemotherapy alone or chemotherapy and yttrium-90 radioembolization was assessed in the SEER Medicare cancer database (1999-2012). Survival analysis was performed, and incremental cost-effectiveness ratios were generated. RESULTS: The study included 585 patients. Average age at diagnosis was 71 years (standard deviation: 9.9), and 52% of patients were male. Twelve percent of patients received chemotherapy with radioembolization (n = 72), and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% confidence interval [CI]: 894-1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705-925) for chemotherapy alone (P = .02). Patients who received combination therapy were slightly younger (71 vs 69 years, P = .03). No significant differences were observed between treatment groups in age at treatment, sex, race, or city size. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59-0.97, P = .029). The incremental cost-effectiveness ratio, a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28). CONCLUSIONS: Combination therapy of ICC with chemotherapy and radioembolization is associated with higher median survival and can be a cost-effective treatment, with a median cost of $50,058.65 per additional year of survival.


Assuntos
Neoplasias dos Ductos Biliares/economia , Neoplasias dos Ductos Biliares/radioterapia , Quimiorradioterapia/economia , Colangiocarcinoma/economia , Colangiocarcinoma/radioterapia , Embolização Terapêutica/economia , Custos de Cuidados de Saúde , Medicare/economia , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/economia , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/economia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Neoplasias dos Ductos Biliares/patologia , Quimiorradioterapia/efeitos adversos , Colangiocarcinoma/patologia , Análise Custo-Benefício , Bases de Dados Factuais , Custos de Medicamentos , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Programa de SEER , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Radioisótopos de Ítrio/efeitos adversos
7.
J Vasc Interv Radiol ; 30(3): 298-304.e2, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819469

RESUMO

PURPOSE: To retrospectively assess the efficacy and safety of radioembolization with yttrium-90 (90Y) resin microspheres as a second-line option in patients with liver metastases from pancreatic adenocarcinoma. MATERIALS AND METHODS: Thirty-three patients with metastatic pancreatic adenocarcinoma that progressed despite systemic chemotherapy and other treatments directed at primary tumors and metastases were treated with 90Y radioembolization at 1 of 3 institutions from 2011 through 2017. Data from laboratory and imaging studies at 2, 4, 8, and 12 weeks after treatment were analyzed. Tumor response was assessed with Response Evaluation Criteria In Solid Tumors version 1.1 and adverse events with Common Terminology Criteria for Adverse Events version 4.0. RESULTS: Imaging results showed partial response in 8 patients (42%), stable disease in 7 (37%), and progressive disease in 4 (21%). Median overall survival times after radioembolization and diagnosis of the primary tumor were 8.1 (95% CI, 4.8-12.5) and 20.8 (95% CI, 14.2-29.0) months, respectively. Radioembolization did not produce major hepatic toxicity, and changes in liver enzyme levels were rarely grade ≥ 3 during the 12-week follow-up. The exceptions were 3 patients with grade 3 increased alkaline phosphatase (week 2) and bilirubin levels (week 4), increased bilirubin level (week 12), and decreased albumin level (week 12), respectively. Most reported complications were grade ≤ 2, with 2 patients showing short-term radioembolization-related grade 3 abdominal distention, abdominal pain, fatigue, or ascites. CONCLUSIONS: Yttrium-90 radioembolization provided a meaningful survival benefit in patients with liver metastases from pancreatic adenocarcinoma that progressed despite previous therapies. Adverse events and liver toxicity were tolerable and only occasionally severe (grade ≥ 3).


Assuntos
Adenocarcinoma/radioterapia , Adenocarcinoma/secundário , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Radioisótopos de Ítrio/efeitos adversos
8.
J Vasc Interv Radiol ; 30(3): 314-319, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819470

RESUMO

PURPOSE: To evaluate the feasibility of a same-day yttrium-90 (90Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS: All same-day radioembolization procedures performed over 1 y (February 2017 to January 2018) were included in this single-institutional retrospective analysis, in which 34 procedures were performed in 26 patients (median age, 63 y; 13 women), 19 with liver metastases and 7 with HCC. Yttrium-90 treatment activities were calculated by body surface area method. Tumor imaging response was assessed by Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for liver metastases and modified RECIST for HCC. Clinical side effects and adverse events were graded per Common Terminology Criteria for Adverse Events version 4.0. RESULTS: All planned cases were technically successful, and no cases were canceled for elevated LSF or vascular anatomic reasons. Pretreatment angiography modified the planned 90Y treatment activity in 1 case in which vascular anatomy required a lobar-dose split into 2 for segmental infusions. In 18% of cases, patients were briefly admitted after the procedure for observation or symptom management. Imaging evaluation of initial efficacy at 1 month demonstrated partial response in 25% and stable disease in 67% of patients with liver metastases and partial/complete response in 43% and stable disease in 14% of patients with HCC. Grade ≥ 3 adverse events occurred in 6% of cases, with no systemic therapy-limiting toxicities. The mean total procedure time was 4.2 hours. CONCLUSIONS: A same-day 90Y radioembolization protocol with resin microspheres is feasible in select patients, which can expedite cancer therapy.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Masculino , Microesferas , Pessoa de Meia-Idade , Seleção de Pacientes , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
10.
J Cancer Res Ther ; 15(1): 42-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880753

RESUMO

Introduction: Selective internal radiation therapy (SIRT) is increasingly used in different scenarios. Although portal hypertension (PHT) has been described as a nonclinically relevant finding after SIRT, its real incidence could have been neglected due to the nature of the diseases for which SIRT is indicated. Case Reports: Here we report three cases with clinically relevant late PHT after treatments including SIRT and oxaliplatin among others. Discussion: The sequential use of oxaliplatin and SIRT in patients with colorectal cancer metastases could have additive effects on the liver.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias Colorretais/terapia , Hipertensão Portal/etiologia , Lesões por Radiação/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biópsia , Braquiterapia/métodos , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/métodos , Feminino , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/patologia , Masculino , Microesferas , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Lesões por Radiação/patologia , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/efeitos adversos
11.
Cancer Biother Radiopharm ; 34(4): 231-237, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30758985

RESUMO

Background: The aim of this study was to evaluate the safety and efficacy of repeated administration of 90Y-microspheres in intrahepatic cholangiocarcinoma (ICC) relapsed after the first radioembolization (RE). Methods: Nine patients with ICC relapsed after the first 90Y-RE were enrolled. Six patients presented recurrence in the right hepatic lobe, 3 in the left lobe. All subjects underwent a second administration of 90Y-resin microspheres. Toxicity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE, version 4.02). After the repeated treatment, all patients were submitted to follow-up with laboratory, imaging, and clinical examinations. Results: The mean cumulative activity administered considering both treatments was 2.7 ± 0.5 GBq. After the second treatment, 3 patients presented complete metabolic response (33.3%) and 6 had partial response (66.6%). The following adverse events were registered: transient increased levels of liver enzymes (grade 1 = 4; grade 2 = 2), hyperbilirubinemia (grade 1 = 2), ascites (grade 2 = 1), and duodenal ulcer (grade 2 = 1). Two patients developed a significant shrinking of the targeted hepatic lobe, as for radiation lobectomy. No case of RE-induced liver disease was registered. Median overall survival was 16.5 ± 1.4 months after the first RE. Conclusions: The authors' results suggest that repeated administration of 90Y-microspheres may be considered in patients affected by ICC relapsed after the first 90Y-RE.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Embolização Terapêutica/métodos , Recidiva Local de Neoplasia/terapia , Radioisótopos de Ítrio/administração & dosagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/efeitos da radiação , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Embolização Terapêutica/efeitos adversos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Fígado/diagnóstico por imagem , Fígado/efeitos da radiação , Masculino , Microesferas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Retratamento/efeitos adversos , Retratamento/métodos , Estudos Retrospectivos , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
12.
Am J Surg Pathol ; 43(5): 688-694, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30720534

RESUMO

Selective internal radiation therapy with Y-TheraSphere or Y-SIRSphere is used in the treatment of unresectable hepatic malignancies. To the best of our knowledge, this is the first Y-TheraSpheres series. BTG International Canada Inc. provided nonradiated microspheres from the Nordion manufacturer. The histologic processed microspheres were colorless, refractile, polarizable, 20 to 30 µm in diameter, and an occasional internal bulls'-eye seen with the condenser out and an internal cross seen with polarized light. Identical microspheres were identified in 15 hepatectomy specimens from four centers between February 2016 and March 2018. The patients were usually male (male=10, female=5) with a mean age of 59 years. All patients had a prior diagnosis of hepatocellular carcinoma (HCC) and documented Y-TheraSphere (mean duration from last deployment=32 wk). All surgical pathology specimens in these 15 patients were reviewed, but the microspheres were only identified in the hepatectomy specimens. During manuscript preparation, one case of Y-TheraSpheres gastritis was prospectively identified from a separate patient with a history of HCC and Y-TheraSpheres. In conclusion, recognition of Y-TheraSpheres is important so that one may consider the possibility of a nearby malignancy and or establish the cause of the background inflammatory or radiation-related injury. These structures can be easy to miss because the subtle morphology is distinct from previously reported Y-SIRSphere. Clues to the diagnosis include a history of HCC and background radiation change. We report the characteristic morphology as microspheres that overlap in size with Y-SIRSphere, but can be differentiated based on Y-TheraSpheres' colorless appearance with occasional internal bulls'-eyes with the condenser out and an internal cross with polarized light.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Microscopia de Polarização , Microesferas , Pessoa de Meia-Idade , Tamanho da Partícula , Compostos Radiofarmacêuticos/efeitos adversos , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
13.
Pediatr Blood Cancer ; 66(7): e27510, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30406959

RESUMO

BACKGROUND: Primary malignant liver tumors are rare, accounting for 1% to 2% of all childhood cancers. When chemotherapy fails, transarterial radioembolization with yttrium-90 (TARE-Y90) may offer an alternative therapy as a bridge to surgical resection or liver transplant or for palliation. METHODS: We conducted a retrospective review of 10 pediatric patients with histologically confirmed primary liver malignancy who received treatment with TARE-Y90. RESULTS: The median age at treatment was 5.5 years (range, 2-18 years). Median patient survival from initial diagnosis was 12.5 months (range, 10-28 months), and median patient survival after TARE-Y90 was 4 months (range, 2-20 months). Retreatment was well tolerated in three of 10 patients, with these patients demonstrating the longest survival times (range, 17-20 months). One patient was transplanted 6 weeks after TARE-Y90. By RECIST 1.1 criteria of all target lesions, eight of nine patients had stable disease, and one of nine had progressive disease. By mRECIST criteria (requiring postcontrast arterial phase imaging), two of seven patients had a partial response, four of seven had stable disease, and one of seven had progressive disease. CONCLUSION: TARE-Y90 of unresectable primary liver malignancy is both technically feasible and demonstrates an anticancer effect, and retreatment is well tolerated. TARE-Y90 could be considered as adjunctive therapy in pediatric patients with unresectable hepatic malignancies and could be used as a bridge to surgical resection or liver transplant. More research is required to determine the efficacy of this treatment in children and to define the clinical scenarios where benefit is likely to be optimized.


Assuntos
Carcinoma Hepatocelular , Embolização Terapêutica , Neoplasias Hepáticas , Radioisótopos de Ítrio/administração & dosagem , Adolescente , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Masculino , Taxa de Sobrevida
14.
Arch Orthop Trauma Surg ; 139(5): 623-627, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30539286

RESUMO

INTRODUCTION: Tenosynovial giant-cell tumor also known as pigmented villonodular synovitis (PVS) is a benign but aggressive synovial proliferative disease most often affecting the knee joint. The mainstay of therapy is surgical resection. Due to a high rate of local recurrence, radiosynoviorthesis (RSO) is used as an adjuvant method in many cases. The aim of this study was to compare local recurrence (LR) rates after surgical synovectomy with and without adjuvant RSO. MATERIALS AND METHODS: From 1996 to 2014, 37 surgical interventions were performed in 32 patients with diffuse pigmented villonodular synovitis of the knee. All patients underwent open synovectomy. Adjuvant radiosynoviorthesis (RSO) was applied in 26 cases, the control group consists of 11 cases without RSO. RESULTS: 9 (24%) lesions recurred within a median of 19 months after surgery. Of those 9 recurrences, 3 (17%) were seen in primary disease, 6 (32%) in already recurring cases (n.s.). In 26 RSO treated patients 6 (23%) recurred, in 11 patients of the control group, 3 (27%) recurred (n.s.). CONCLUSIONS: RSO is effective in PVS as also shown in some smaller reports in the literature. But surgery is still the mainstay of therapy. RSO is not a method of compensating for an insufficient surgical approach, but it may reduce the high rate of LR in patients with large and even recurrent diffuse forms of the disease.


Assuntos
Braquiterapia/métodos , Articulação do Joelho , Compostos Radiofarmacêuticos/administração & dosagem , Sinovectomia , Sinovite Pigmentada Vilonodular/terapia , Radioisótopos de Ítrio/administração & dosagem , Adulto , Feminino , Humanos , Articulação do Joelho/efeitos da radiação , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Sinovite Pigmentada Vilonodular/radioterapia , Sinovite Pigmentada Vilonodular/cirurgia
15.
J Vasc Interv Radiol ; 30(1): 1-8, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30293734

RESUMO

PURPOSE: To address the feasibility of yttrium-90 (90Y) glass microspheres administered at a boosted dose in large hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: From July 2016 to August 2017, 20 patients who underwent 90Y radioembolization for treatment-naïve HCC met the following inclusion criteria: (i) nodular tumor, (ii) tumor size > 5 cm, (iii) Barcelona Clinic Liver Cancer stage A/B disease, (iv) target perfused tissue dose > 150 Gy, and (v) all tumors treated in 1 session of radioembolization. Follow-up radiologic findings and clinical outcomes were retrospectively reviewed until May 2018. Tumor response was determined per modified Response Evaluation Criteria In Solid Tumors. RESULTS: Mean total radiation activity infused was 4.96 GBq ± 1.82 (median, 4.88 GBq; range, 1.63-9.15 GBq). Mean target perfused tissue dose was 263.5 Gy ± 95.2 (median, 241.6 Gy; range, 156.2-550.6 Gy). The mean number of vials used per treatment was 4.15 ± 1.4 (median, 4; range, 2-7). Complete response rates were 25% at 1 month and 60% at 3 months. Complete response of the primary index tumor was achieved in 16 patients (80%) based on best tumor response. Local progression-free survival and progression-free survival rates were 94.1% and 85.0% at 6 mo and 94.1% and 74.7% at 1 year, respectively. Four patients (20%) had symptomatic (n = 3) or asymptomatic (n = 1) benign biliary strictures. CONCLUSIONS: Radioembolization with a boosted dose in patients with large HCCs may show favorable tumor response, but with considerable biliary complications.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Idoso , Sistema Biliar/efeitos da radiação , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Intervalo Livre de Progressão , Lesões por Radiação/etiologia , Compostos Radiofarmacêuticos/efeitos adversos , Dosagem Radioterapêutica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Carga Tumoral , Radioisótopos de Ítrio/efeitos adversos
16.
Eur J Nucl Med Mol Imaging ; 46(3): 661-668, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30209522

RESUMO

PURPOSE: Patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B according to the Barcelona Clinic Liver Cancer classification) are a heterogeneous group with different degrees of liver function impairment and tumour burden. The recommended treatment is transarterial chemoembolization (TACE). However, patients in this group may be judged as poor candidates for TACE because the risk-benefit ratio is low. Such patients may receive transarterial radioembolization (TARE) only by entering a clinical trial. Experts have proposed that the stage could be further divided into four substages based on available evidence of treatment benefit. We report here, for the first time, the outcome in patients with BCLC-B2 substage HCC treated with TARE. METHODS: A retrospective analysis of the survival of 126 patients with BCLC-B2 substage HCC treated with TARE in three European hospitals was performed. RESULTS: Overall median survival in patients with BCLC-B2 substage was not significantly different in relation to tumour characteristics; 19.35 months (95% CI 8.27-30.42 months) in patients with a single large (>7 cm) HCC, and 18.43 months (95% CI 15.08-21.77 months) in patients with multinodular HCC (p = 0.27). However, there was a higher proportion of long-term survivors at 36 months among those with a single large tumour (29%) than among those with multiple tumours (16.8%). CONCLUSION: Given the poor efficacy of TACE in treating patients with BCLC-B2 substage HCC, TARE treatment could be a better choice, especially in those with a large tumour.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/uso terapêutico , Análise de Sobrevida , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/uso terapêutico
17.
Tech Vasc Interv Radiol ; 21(4): 205-222, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30545499

RESUMO

The rapidly evolving field of interventional oncology comprises both diagnostic and therapeutic procedures for the treatment of various malignancies. With respect to the liver, the most commonly utilized therapeutic procedures include thermal tumor ablation and transarterial embolization. Transarterial embolization techniques include bland embolization, chemoembolization and radioembolization. To safely and effectively perform these transarterial therapies, the interventional radiologist must have a thorough understanding of relevant arterial anatomy and proficiency in optimally delivering the pertinent embolic agent. This article will discuss various angiographic techniques as well as provide a detailed review of relevant hepatic arterial anatomy.


Assuntos
Angiografia/métodos , Antineoplásicos/administração & dosagem , Quimioembolização Terapêutica/métodos , Embolização Terapêutica/métodos , Artéria Hepática/anatomia & histologia , Neoplasias Hepáticas/terapia , Radiografia Intervencionista , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Humanos
19.
J Vasc Interv Radiol ; 29(12): 1672-1677, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30316674

RESUMO

PURPOSE: To measure the decay activity loss and delivery system residual activity loss of yttrium-90 (Y90) radioembolization treatments across resin and glass microsphere activities. MATERIALS AND METHODS: For Y90 administrations between December 2009 and June 2017 at the study institution, the prescribed activity, prepared activity, and delivered activity were recorded. Six hundred sixty-two administrations were reviewed-345 glass (0.21-8.52 GBq) and 317 resin (0.18-3.28 GBq). Twenty-five patients (all resin) were excluded for arterial stasis or catheter clogging. The percentage and actual losses of activity lost to decay and to delivery system residual were calculated for glass and resin microspheres. RESULTS: The median time between activity premeasurement and administration was 2.20 hours, resulting in a median activity lost to decay of 0.030 GBq or 2.35%, with no significant difference observed between glass and resin despite differences in preparation (P = .0697). Resin showed significantly higher activity lost to delivery system residual than glass (0.039 GBq vs 0.010 GBq, 3.01% vs 0.61%, P < .001). The percent activity lost to residual varied with activity prepared, with a maximum of 20.1% and 16.2% for the smallest activities of resin and glass, respectively. CONCLUSIONS: Residual activity loss differs between glass and resin microspheres. For resin microspheres in particular, percent residual activity loss increases with lower prepared activities. Protocols for activity calculation and preparation, patient dosimetry, and regulatory compliance must take these losses into consideration prospectively.


Assuntos
Embolização Terapêutica/métodos , Vidro , Compostos Radiofarmacêuticos/administração & dosagem , Dosagem Radioterapêutica , Radioisótopos de Ítrio/administração & dosagem , Humanos , Microesferas , Estudos Retrospectivos
20.
J Vasc Interv Radiol ; 29(11): 1511-1518, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30293727

RESUMO

PURPOSE: To retrospectively analyze adverse events (AE) in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 radioembolization in the setting of angiographically apparent arterioportal shunts (APSs). MATERIALS AND METHODS: Thirty-two patients with HCC underwent radioembolization with APSs from January 2011 to September 2016, totaling 34 administrations using resin (6) and glass (28) microspheres. APSs were graded angiographically as segmental (9), ipsilobar (15), contralobar (7), or main portal (2), according to portal perfusion. Tumors were categorized as solitary (9), multifocal (7), or infiltrative (16). Both unilobar (25) and bilobar (7) disease was treated. Child Pugh Score was A (22), B (10), or C (2), with a median Model for End-Stage Liver Disease (MELD)/Na-MELD of 8/8.5. Median procedure dose was 132.6 Gy. AEs were graded using Combined Terminology Criteria for Adverse Events (CTCAE) version 4.0. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). RESULTS: CTCAE grade ≥3 AEs were observed in 22% of patients. Barcelona Clinic Liver Cancer (BCLC) C patients with nonsegmental shunts who received lobar administrations had a grade ≥3 AE rate of 38% compared with the remaining cohort, which was 12% (P = .076). No events were reported in patients with segmental shunts (P = .023). Imaging analysis revealed mRECIST complete response (17), partial response (13), stable disease (3), and progressive disease (1). Overall survival at 6 months and 12 months was 72% and 57%, respectively. CONCLUSIONS: Radioembolization in the setting of APS may have a higher AE profile than reported literature when BCLC-C patients with nonsegmental shunts receive lobar administrations. Segmental shunts are generally well tolerated.


Assuntos
Angiografia , Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Circulação Hepática , Neoplasias Hepáticas/radioterapia , Compostos Radiofarmacêuticos/administração & dosagem , Radioisótopos de Ítrio/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
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