The Choi response criteria for inferior vena cava tumor thrombus in renal cell carcinoma treated with targeted therapy

Objectives

To evaluate the prognostic significance of the Choi criteria for assessing the responses of a renal mass and inferior vena cava (IVC) tumor thrombus in patients with renal cell carcinoma (RCC) receiving targeted therapy.

Materials and methods

We reviewed the medical records of 22 patients diagnosed with RCC and IVC thrombus between 2005 and 2012. The efficacy of targeted therapy in renal mass and IVC tumor thrombus was evaluated using response evaluation criteria in solid tumors (RECIST) and Choi criteria, respectively. Overall survival was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling.

Results

There were no significant differences in overall survival between patients with partial response (PR) and nonresponse according to RECIST criteria (19.3 vs 43 months; p = 0.212) or Choi criteria (9.0 vs 23.3 months; p = 0.109) in primary tumor. Regarding the response of IVC tumor thrombi, according to Choi criteria, nine patients (40.9 %) demonstrated PR and longer survival than patients with stable disease (7.2 vs 23.3 months; p = 0.014). In multivariable analysis, response to IVC thrombus according to Choi criteria was the only significant predictive factor. Patients with IVC thrombus who demonstrate the PR according to Choi criteria were at 0.35-fold greater overall risk of death compared with patients who did not demonstrate this response (p = 0.043).

Conclusions

A response according to Choi criteria in IVC tumor thrombus was an independent prognostic predictor in patients with RCC and IVC thrombus who receive targeted therapy.     

Venovenous bypass in renal cell carcinoma with caval tumor thrombus

We describe two patients with a T3bN2M0 renal cell carcinoma with caval extension to the hepatic veins in which we successfully utilized extracorporeal femoralaxillary venovenous bypass for tumor thrombus resection. The inherent advantage of this modified venovenous bypass are discussed with a current review of the literature.     

Severe vaginal bleeding due to vaginal metastasis from renal cell carcinoma with inferior vena cava tumor thrombus: A case report

Rationale:Renal cell carcinoma (RCC) is the most common type of kidney cancer and is the second most common urologic neoplasm. Vaginal metastasis from RCC is extremely rare clinically.Patient concerns:A 56-year-old woman presented with intermittent vaginal bleeding that had persisted for 1 month. Enhanced computed tomography examination suggested a vaginal mass (3 × 2 × 2 cm), right kidney tumor (15 × 12 × 10 cm), and an inferior vena cava tumor thrombus. During gynecologic examination, the mass was necrotic and caused uncontrollable vaginal bleeding.Diagnoses:Based on clinical and imaging examinations and the pathology, she was diagnosed as vaginal metastasis from RCC.Interventions:The patient received percutaneous transcatheter arterial embolization to stop uncontrollable vaginal bleeding, and then treated with targeted therapy.Outcomes:Vaginal bleeding disappeared after interventional embotherapy. However, disease progressed, and the patient died 9 months later.Lessons:In cases of vaginal bleeding, the possibility of metastatic renal cell carcinoma should be considered. Percutaneous transcatheter arterial embolization is an effective and novel treatment for uncontrollable vaginal bleeding caused by vaginal metastasis of RCC.     

Inferior vena caval tumor thrombus extending into the right atrium in a patient with pancreatic cancer

Venous thromboembolism is a common complication in patients with cancer and an important cause of morbidity and mortality. Idiopathic thrombosis, migratory or recurrent thrombophlebitis may be the first manifestation of an occult malignancy. While deep venous thrombosis and pulmonary embolism are the most common thrombotic conditions in patients with malignant disease, tumor thrombus may be seen in inferior vena cava, mainly in patients with renal cell carcinoma, hepatocellular carcinoma, testicular tumors or adrenal carcinoma. Although pancreatic cancer is one of the cancers that are most strongly associated with thrombotic complications along with cancers of ovary and brain, there has been no report about presence of thrombus in the inferior vena cava in pancreatic cancer. We report a female patient with pancreatic cancer associated with tumor thrombus extending from the inferior vena cava to the right atrium     

Value of quantitative parameters of enhanced MRI in predicting collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus

<正>Objective To explore the value of quantitative parameters of enhanced MRI in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.Methods Sixty-seven patients with renal cell carcinoma and inferior vena cava tumor thrombus who underwent radical resection and inferior vena cava venography in the First Medical Center,PLA General Hospital from May 2006 to January 2021 were included retrospectiv...     

The effectiveness of particle radiotherapy for hepatocellular carcinoma associated with inferior vena cava tumor thrombus

Background

The prognosis of patients who have hepatocellular carcinoma (HCC) associated with inferior vena cava tumor thrombus (IVCTT) is very poor, and effective treatment modalities are extremely limited. The objective of this study was to determine the therapeutic efficacy of particle radiotherapy for HCC with IVCTT.

Methods

Between June 2001 and January 2009, 16 evaluable patients who had HCC with IVCTT were treated with particle radiotherapy. They were divided into 2 groups: 6 were treated with curative intent; 10 with palliative intent. The local tumor control rates, overall survival rates, and toxicities were evaluated.

Results

All tumors treated with particle radiotherapy remained controlled without local recurrence at the last follow-up. The overall survival rates for the 16 patients at 1 and 3?years were 61.1 and 36.7%, respectively. We observed a significant difference in the survival rates according to treatment policy. The median survival time was 25.4?months for patients treated with curative intent and 7.7?months for those treated with palliative intent. The one-year survival rates were 100.0 and 33.3%, respectively. No Grade 3 or higher treatment-related toxicities were observed.

Conclusions

Particle radiotherapy is thought to be potentially effective and safe for HCC with IVCTT. Considering the current lack of effective and less-invasive local therapy for HCC with IVCTT, particle radiotherapy may therefore be an attractive new therapeutic approach for this type of HCC.     

Surgical treatment of renal cell carcinoma with a tumor thrombus extending into the right atrium

Summary We experienced surgical treatment on two patients having renal cell carcinoma with a tumor thrombus extending into the right atrium. In these patients, we performed nephrectomy, dissection of lymph nodes and removal of a tumor thrombus using cardiopulmonary bypass. One died of multiple organ failure 42 days postoperatively; the other was discharged from the hospital and is currently doing well 12 months after the operation. Cardiopulmonary bypass combined with hypothermia and low blood flow significantly facilitated removal of the tumor thrombus extending into the right atrium without the risk of pulmonary embolism or brisk hemorrhage.     

How to proceed in the case of a tumour thrombus in the inferior vena cava with renal cell carcinoma

Renal cell carcinoma accounts for about 3% of all malignant tumours in humans at adult age. The occurrence of a tumour thrombus in the inferior vena cava was recorded in 4% up to 10% of patients. In the period of 2006–2014 in the Department of Surgery of the Teaching Hospital and Faculty of Medicine in Pilsen we operated a total of 12 patients at the age from 44 to 80 for renal cell carcinoma with a tumour thrombus. Our results have proven clearly the benefit of nephrectomy with tumour thrombectomy in patients with renal cell carcinoma growing through the venous system.     

Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report

This is a case report of a 45‐year‐old patient admitted with the symptom of bilateral leg swelling. Ultrasonography revealed a hyperechoic mass in the right lobe of the liver, which invaded the right hepatic vein (RHV) and extended into the inferior vena cava (IVC) and right atrium (RA). Based on the high alpha‐fetoprotein (AFP) level and the ultrasonography findings, the patient was diagnosed as having hepatocellular carcinoma (HCC) with a RHV, IVC, and RA tumor thrombus and secondary Budd–Chiari syndrome (BCS). HCC with a tumor thrombus extending into the IVC and RA has rarely been observed, and as a cause of secondary BCS, this type of HCC has been even more rarely reported.     

Aggressive surgical resection for hepatocellular carcinoma with tumor thrombus extending to inferior vena cava and synchronous pulmonary metastasis

We describe a 66-year-old man having hepatocellular carcinoma with tumor thrombus extending into the inferior vena cava and synchronous pulmonary metastasis. He was referred to Chiba University Hospital on May, 2000, complaining of emaciation. Radiological findings showed a huge hepatocellular carcinoma in the entire right lobe and tumor thrombus extended into the intrapericardial inferior vena cava. He also had a solitary pulmonary metastasis in the left pulmonary lobe (stage IVB). Right hemihepatomy was performed under total hepatic vascular exclusion without cardiopulmonary bypass, and tumor thrombus was completely removed. Thoracoscopic wedge resection of pulmonary metastasis was also performed. The patient had an uneventful postoperative course. Histopathological examination revealed that the tumor was moderately differentiated hepatocellular carcinoma The patient is still alive after 26 months with pulmonary recurrence, but without hepatic recurrence. To our knowledge, there has been no reported case of resection for both hepatocellular carcinoma invading the inferior vena cava and synchronous pulmonary metastasis. In conclusion, aggressive surgical resection for advanced hepatocellular carcinoma concomitant with pulmonary resection may bring about better prognosis in highly selected patients.     

Gallbladder cancer with tumor thrombus in the superior vena cava

BACKGROUND:Gastrointestinal cancers,especially pancreatobiliary cancers,are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage,especially of the abdomen and lower limbs.This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava(SVC)with resultant SVC obstruction,while on gefitinibbased anti-epidermal growth factor receptor(EGFR)therapy.METHODS:A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy.She had disease recurrence and received systemic chemotherapy followed by gefitinib-based anti-EGFR therapy.Subsequently,while on gefitinib-based therapy,she presented with clinical signs and symptoms suggestive of SVC thrombosis.RESULTS:A whole body PET scan revealed a metabolically active tumor thrombus in the SVC,besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen.She was treated with antithrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief.She continues to survive on the day of writing this report.CONCLUSIONS:This rare complication,though theoretically possible,is unreported because of the short overall survival of advanced gallbladder cancer patients.This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients,we may come across such cases more frequently in the future.     

Successful management of the hepatocellular carcinoma with inferior vena cava tumor thrombus: A case report

Rationale:Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is traditionally considered an advanced-stage cancer with a poor prognosis. There is no standard treatment for patients diagnosed as HCC with IVCTT.Patient concerns:A 52-year-old man was admitted to our hospital because of suspected hepatic mass during a health examination.Diagnoses:Computed tomography (CT) showed a hepatic mass approximately 4.3 cm × 6.3 cm in size located in segment VII of the liver, with thrombus in the inferior vena cava. The mass exhibited a pattern of early enhancement and washout on contrast-enhanced CT. Alpha-fetoprotein was 614.1 ng/mL (normal value, <8 ng/mL). The preoperative diagnosis was HCC with IVCTT.Interventions:Two months after stereotactic body radiotherapy combined with sorafenib therapy, a planned open anatomical resection of the right posterior lobe of the liver was performed.Outcomes:The patient is alive without disease 12 months after surgery, and the level of alpha-fetoprotein is normal.Lessons:The patient diagnosed as HCC with IVCTT was successfully treated by stereotactic body radiotherapy combined with molecularly targeted drugs followed by surgical treatment. If confirmed in future studies, this would suggest a promising strategy for the management of HCC with IVCTT.     

Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus

Despite surgical removal of tumors with portal vein tumor thrombus(PVTT) in hepatocellular carcinoma(HCC) patients, early recurrence tends to occur, and overall survival(OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization(TACE); subcutaneous administration of interferon-alpha(IFN-α) and intra-arterial infusion of 5-fluorouracil(5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy(5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.     

Long-term surviving patient with inferior vena cava tumor thrombus and extrahepatic metastasis after spontaneous ruptured hepatocellular carcinoma

We present a case of long-term survival in a patient with inferior vena cava tumor thrombus (IVCTT) and extrahepatic metastasis after resection for spontaneous ruptured hepatocellular carcinoma (HCC). The patient was a 73-year-old Japanese man previously diagnosed with chronic hepatitis B. He was referred to our emergency room and diagnosed with spontaneous ruptured HCC. The patient was immediately treated with transcatheter arterial embolization, and we then performed second-stage hepatic resection 50 days later. Although des-gamma-carboxy prothrombin was reduced to a normal level after hepatectomy, it gradually increased and computed tomography showed a disseminated tumor in the diaphragm near S2 of the liver with IVCTT and right atrium tumor thrombus. Recurrent HCC was treated with monthly transcatheter arterial infusion chemotherapy (TAI) and conformal radiotherapy (RT) of 40 Gy. After TAI and RT procedures, the disseminated tumor and IVCTT completely disappeared. Four years after TAI and RT procedures, the tumors were well controlled with no local recurrence. About 6−7 years after spontaneous ruptured HCC, lung metastasis and spleen metastasis were detected and resected, respectively. The patient is still alive and doing well over 7 years after spontaneous ruptured HCC.     

Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus

BACKGROUND/AIMS: To study the value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). METHODOLOGY: From January 1997 to December 2001, 63 cases of HCC with portal vein tumor thrombus underwent liver resection combined with PVTT removal (group 1). Between December 2001 and December 2003, 20 patients received adjuvant portal vein chemotherapy (PVC) after the surgical procedures mentioned above (group 2). Treatment outcome and the surgical features in these two groups were studied. RESULTS: The median overall survival in group 2 was significantly longer than that in group 1 (10.9 months vs. 7.8 months, p < 0.05). There were significant differences between the survival of the two groups (log-rank, p < 0.05). In group 1 the 1-, 3-, and 5-year survival rates were 18.0%, 14.8% and 1.6%, respectively. In group 2 the 1-year survival rate was 30%. CONCLUSIONS: Liver resection combined with PVTT removal and the postoperative PVC is beneficial to the survival of HCC patients with PVTT. Postoperative PVC might enhance the effect of these surgical approaches.     

A new classification for hepatocellular carcinoma with portal vein tumor thrombus

Background/purpose

We aimed to correlate the survival of patients with hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) who underwent partial hepatectomy with or without portal thrombectomy with our PVTT classification. Currently, different staging systems for HCC are widely used in clinical practice. However, they lack the refinement in giving prognosis and guiding surgical treatment once macroscopic PVTT is present.

Methods

A retrospective study was carried out, in a single tertiary center, from January 2001 to December 2004 on 441 patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with macroscopic PVTT. Overall survival was examined to determine whether it was correlated with our PVTT classification, and with the TNM staging, Cancer of the Liver Italian Program (CLIP) scoring system, and the Japan Integrated Staging (JIS) scoring system.

Results

With our PVTT classification, the numbers (percentages) of patients with types I, II, III, and IV PVTT were 144 (32.7%), 189 (42.9%), 86 (19.5%), and 22 (5.0%), respectively. The corresponding 1-, 2-, and 3-year overall survival rates for types I to IV PVTT were 54.8, 33.9, and 26.7%; 36.4, 24.9, and 16.9%; 25.9, 12.9, and 3.7%; and 11.1, 0, and 0%, respectively (log-rank of the survival curves P?<?0.0001). Using the TNM system, the majority of patients were classified as stage III (n?=?379 or 85.9%). Similarly, the majority of patients (n?=?388 or 88.0%) were classified as having CLIP scores of 2 (n?=?143, or 32.4%), 3 (n?=?171, or 38.8%), and 4 (n?=?74, or 16.8%). The 1-, 2-, and 3-year overall survivals for these 3 CLIP scores were very similar. Using the JIS score, the majority of patients (n?=?372 or 84.4%) were classified with a JIS score of 2. The 1-, 2-, and 3-year overall survivals of patients with a JIS score of 2 were worse than those of the patients with a JIS score of 1 (this was expected) as well as being worse than those with a JIS score of 3 (this was unexpected). Thus, the latter 3 systems of classification were not refined enough, and they were inadequate for stratifying HCC with macroscopic PVTT treated with partial hepatectomy with or without thrombectomy.

Conclusions

In patients with HCC with macroscopic PVTT treated by partial hepatectomy with or without thrombectomy, our PVTT classification better stratified and predicted prognosis than the TNM staging, CLIP scoring system, and JIS scoring system, which were unrefined and inadequate for this group of patients.