肝动脉化疗栓塞治疗原发病灶切除的胰腺神经内分泌肿瘤肝转移疗效分析

【摘要】 目的 探讨TACE对于已经切除原发病灶的胰腺神经内分泌肿瘤肝转移（neuroendocrine neoplasm liver metastasis, NELM）的疗效。方法 回顾分析2014年6月至2018年6月诊治的21例胰腺NELM患者入组进行研究,所有病例均行原发病灶切除后针对肝脏病灶进行65例次TACE治疗。分析临床疗效,安全性和有效性;根据影像学检查后实体瘤反应评价标准评价病灶疗效;并随访无疾病生存期（PFS）和总生存期（OS）情况。 结果 所有患者均顺利完成TACE治疗,有效率为81.0%（17/21）;影像学评价中17例达到部分缓解,3例病情稳定,1例出现疾病进展;PFS为（16.6±6.5）个月,OS为（28.0±11.8）个月,所有手术均未出现严重并发症。 结论 TACE治疗原发病灶切除后的胰腺NELM安全有效,其可能因降低肿瘤负荷、阻断分泌功能提高总生存率而获得更多获益。     

选择性肝动脉化疗药物灌注及栓塞治疗肝转移癌

目的 探讨选择性肝动脉化疗药物灌注及栓塞治疗肝转移癌的价值。材料与方法对122例失去手术机会的肝转移癌患者，采用经股动脉穿刺，选择性肝动脉插管灌注化疗药物(ADM，MMC，CDDP，5-FU)，并用ADM及碘化油乳化后检塞肝动脉。结果近期疗效以CT检查结果作为评价标准，总有效率为54％(66／122)，平均生存期22．2个月。0．5、1、2、3年生存率分别是98．3％、80．4％、40．9％、10．6％。结论经肝动脉化疗药物灌注及栓塞治疗是失去手术机会的肝转移癌患者的一种安全、有效的姑息性治疗方法，其不仅能提高疗效，而且能改善患者的生活质量。     

经动脉灌注化疗或栓塞治疗恶性胰岛素瘤肝转移

目的 探讨经动脉灌注化疗或栓塞治疗恶性胰岛素瘤肝转移的临床效果.方法 对9例恶性胰岛素瘤肝转移患者,采用5-FU、表阿霉素、丝裂霉素C和IL-2的化疗方案进行经导管动脉灌注化疗,2例患者还接受了肝动脉化疗栓塞,共2～8个疗程.结果 所有患者均顺利完成介入治疗,无严重并发症.治疗后临床症状消失或明显改善,显效2例、有效7例;影像学疗效评价显效1例、有效7例、无效1例.结论 经动脉灌注化疗或栓塞治疗恶性胰岛素瘤肝转移安全有效.     

DEB-TACE治疗神经内分泌肿瘤肝转移的疗效初探

目的 初步探讨经动脉载药微球化疗栓塞(DEB-TACE)治疗神经内分泌肿瘤(NEN)肝转移的初步疗效及安全性.方法 回顾性分析2019年3月至2020年1月在介入科治疗的27例NEN肝转移患者的临床资料,原发灶位于胰腺20例,十二指肠3例、直肠4例.术前均经病理学确诊.其中12例接受DEB-TACE治疗(DEB-TAC...     

肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析

目的总结分析低-中级别乏血供型神经内分泌肿瘤肝转移（NENLM）经肝动脉栓塞术（TAE）治疗后的近期疗效及安全性。 方法从2016年1月至2019年12月在我院经TAE治疗的不同原发部位的低-中级别NENLM患者中,选取其中术前影像学表现为乏血供型、且术后经影像学复查的42例,分别按照RECIST 1.1和mRECIST标准来评价疗效,分别分析其术后1～3个月客观缓解率（ORR）及疾病控制率（DCR）。术后不良反应分级采用CTCAE （v5.0）标准。 结果TAE治疗对于低-中级别乏血供型NENLM具有显著的减瘤作用,按照RECIST 1.1来评价,ORR为66.7%,DCR为92.9%,按照mRECIST标准来评价,ORR为85.7%,DCR为92.9%,其中CR率为16.7%。不良反应主要为发热（88.1%）、肝区疼痛（78.6%）及肝功能一过性损伤（肝酶升高：40.5%;胆红素升高：19.1%）等,对症处理后均可缓解,无严重术后并发症。 结论部分低-中级别NENLM尽管在术前影像学上主要表现为乏血供特征,但是经TAE治疗后ORR显著,TAE是一种安全且有效的减瘤手段。     

经肝动脉栓塞化疗结合局部消融治疗大肠癌肝转移

目的：研究大肠癌肝转移的综合性介入治疗方法和疗效。方法：对35例大肠癌肝转移患者先行肝动脉造影，留置导管药盒系统，然后根据动脉造影结果分别行经动脉灌注化疗(TAI)10例，经动脉栓塞(TAE)25例，使用药物为草酸铂、CPT11、丝裂霉素C和5-Fu CF。2～3次治疗后，全部患者在CT导向下行消融术，其中9例在激光消融基础上加入无水乙醇。激光消融后1个月复查CT、CEA，判定疗效。结果：2～3次TAI和TAE后病灶缩小17例，不变13例，增大5例。14例CEA阳性者治疗后下降6例，不变5例，增高3例。加用消融术后，CT扫描显示，残癌中央斑点状气化29例，全部汽化6例。其中采用单纯激光消融的20例患者，病灶缩小8例，不变5例，增大7例。采用激光加无水乙醇治疗的9例中，缩小5例，不变2例，增大2例。TAE/TAI后CEA不变或升高的8例中，消融术后下降3例，不变4例，升高1例。结论：①大肠癌肝转移灶主要由肝动脉供血，超选择插管可使病灶染色更为清晰。②留置PCS，行TAI／TAE，使用草酸铂、CPT11及5-Fu序贯化疗方法对转移癌灶有较好的治疗作用。③TAI／TAE不能消除全部病灶，对残癌病灶使用激光或(和)无水乙醇等局部消融是有效的补充。     

肝动脉灌注化疗栓塞治疗原发性肝Ca的应用

肝Ca在我国癌症发病中居第三位，每年死于肝Ca的患者高达12万。外科手术是肝Ca最重要的治疗方法。但由于肝Ca的患者早期无明显的临床症状，个别患者仅肝区不适未引起重视，当出现疼痛等临床症状时，大多以属中晚期，且大部分患者伴随肝硬化而丧失手术时机。据统计就诊者中仅15％-30％的早期患者适宜手术，晚期肝Ca患者自然生存仅1—3个月。如何延长中晚期肝Ca病人的生命，提高其生存质量是当前医务工作者的一个紧迫任务。     

Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update

Liver metastasis is one of the main problems encountered in colorectal cancer management as the liver is the most common metastatic site. Several treatment options are available, among which transarterial chemotherapy has proved effective in achieving some local tumour control, improving the quality of life through symptomatic control as well as survival time. The present paper is intended to provide an overview of the techniques, indications and results of regional chemotherapy, which comprises transarterial chemoembolization (TACE) and chemoperfusion. This treatment approach has symptomatic, palliative, adjuvant and potentially curative objectives. We reviewed the studies involving TACE and chemoperfusion of colorectal liver metastases during the last few years to update the previous reviews published on this subject. The results achieved were so variable, due to the variations in patient selection criteria and regimens used between the different studies. The median survival ranged from 9 to 62 months and the morphological response ranged from 14 to 76%. Technical aspects, results, and complications of this modality will be demonstrated with a detailed analysis and comments.     

Liver metastases of neuroendocrine carcinomas: Interventional treatment via transarterial embolization,chemoembolization and thermal ablation

The aim of this review article is to provide a practical clinical guideline for indication, technical aspects, protocol guideline and strategies for the interventional treatment of liver metastases from neuroendocrine tumors and focusing on the results of various protocols of management. The response to therapy, in the published articles, is calculated on the basis of the following clinical parameters; including symptomatic response (SR), biologic response (BR), morphological response (MR), progress free survival (PFS), and survival periods (SP). Transarterial chemoembolization (TACE) has been associated with SR rates of 60–95%, BR of 50–90%, MR of 33–80%, SR of 20–80 months, and a 5-year survival of between 50% and 65%. PFS was also between 18 and 24 months. In the transarterial embolization (TAE) group, SR was similar to the TACE group, MR was 32% and 82%, survival was between 18 and 88 months with a survival rate of 40–67%, and BR was between 50% and 69%. Radiofrequency ablation (RFA), either percutaneous or during surgery, has been associated with SR of 71–95% for a mean duration of 8–10 months, BR of 65%, and mean SP of 1.6 years after ablation. The mean survival following surgical resection for operable cases is 4.26 years ± S.D.: 1.1.ConclusionThe interventional protocols for the management of liver metastases from neuroendocrine tumors: for oligonodular liver metastatic deposits, local resection or RFA and/or LITT is recommended, while in multinodular diseases with higher tumor load, TACE or TAE is recommended.     

Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation

The aim of this review article is to provide a practical clinical guideline for indication, technical aspects, protocol guideline and strategies for the interventional treatment of liver metastases from neuroendocrine tumors and focusing on the results of various protocols of management. The response to therapy, in the published articles, is calculated on the basis of the following clinical parameters; including symptomatic response (SR), biologic response (BR), morphological response (MR), progress free survival (PFS), and survival periods (SP). Transarterial chemoembolization (TACE) has been associated with SR rates of 60-95%, BR of 50-90%, MR of 33-80%, SR of 20-80 months, and a 5-year survival of between 50% and 65%. PFS was also between 18 and 24 months. In the transarterial embolization (TAE) group, SR was similar to the TACE group, MR was 32% and 82%, survival was between 18 and 88 months with a survival rate of 40-67%, and BR was between 50% and 69%. Radiofrequency ablation (RFA), either percutaneous or during surgery, has been associated with SR of 71-95% for a mean duration of 8-10 months, BR of 65%, and mean SP of 1.6 years after ablation. The mean survival following surgical resection for operable cases is 4.26 years ± S.D.: 1.1.

Conclusion

The interventional protocols for the management of liver metastases from neuroendocrine tumors: for oligonodular liver metastatic deposits, local resection or RFA and/or LITT is recommended, while in multinodular diseases with higher tumor load, TACE or TAE is recommended.     

Transarterial chemoembolization with miriplatin-lipiodol emulsion for neuroendocrine metastases of the liver

Miriplatin, a cisplatin derivative with a high affinity for iodized oil, is a novel chemotherapeutic agent designed for use in the transarterial treatment of hepatocellular carcinoma. This case report describes our experience with transarterial chemoembolization (TACE) using miriplatin in 2 patients with neuroendocrine liver metastases. A 38-year-old man with multiple neuroendocrine liver metastases was treated by whole liver chemoembolization, and a 35-year-old woman with a single hepatic lesion was treated by superselective chemoembolization. No serious adverse events were noted during the interventional procedures, or during the observation period of 3 mo in either patient. Sufficient iodized oil uptake was observed in the hypervascular lesions on the unenhanced computed tomography (CT) at 7 d after the procedure. Contrast-enhanced CT obtained at 3 mo after chemoembolization revealed that all hepatic lesions were substantially reduced in size irrespective of tumor vascularity or degree of cystic degeneration, although iodized oil accumulation was only marginal for lesions with cystic degeneration. Thus, TACE with miriplatin can be a safe and effective therapeutic option for the treatment of neuroendocrine metastases of the liver.     

Adrenal crisis and death following transarterial chemoembolization of sarcoma liver metastases

Adrenal crisis is a life-threatening complication of adrenal insufficiency which is triggered by physiological stressors such as injury, infection or a surgical procedure when the plasma concentration of adrenal corticosteroids is insufficient for physiological requirements. It is associated with a high mortality rate unless early diagnosis and treatment is initiated. We report a case of a patient with metastatic sarcoma and adrenal insufficiency who underwent right hepatic artery chemoembolization to control his intrahepatic metastases. He did not receive stress dose glucocorticoid and his glucocorticoid supplement medication was accidentally discontinued after embolization. He died due to an unrecognized adrenal crisis 2 days after embolization. This case suggests that embolization should be recognized as a stressor to prompt the need to continue chronic replacement of corticosteroids and to consider supplemental stress-dose corticosteroids. There is a growing population of patients on chronic corticosteroids for various conditions who may require tumor embolization. Therefore, it is important to consider adrenal crisis in post-embolization settings since the symptoms are non-specific and mortality can be avoided only if the diagnosis of adrenal crisis is considered and parenteral glucocorticoids administered.     

不可切除的胰腺癌TAI/TACE治疗后回顾性生存分析

目的通过对不可切除的胰腺癌患者159例经TAI/TACE治疗后的回顾性生存分析,评估影响胰腺癌介入治疗后生存期的因素。方法收集并分析159例胰腺癌患者的TAI/TACE治疗病史资料,并对影响胰腺癌患者TAI/TACE治疗后生存期的因素和治疗模式进行单因素及COX模型多因素分析。结果 159例患者总随访中位生存期(m ST)为10.32个月,总的介入治疗后m ST为8.11个月,总1年累积生存率27.0%,2年累积生存率11.0%,3年累积生存率2.0%,5年累积生存率为0.6%。根据临床反应率(CBR)评估判定介入治疗后能缓解症状的介入次数平均值为2.6次。单因素分析显示影响胰腺癌介入治疗后MST的主要因素有:初次介入治疗前CA19-9值,及其术后变化,初次介入前KPS评分,初次介入前症状,介入治疗前肝功能分级,介入治疗前有无手术史,介入治疗次数。而年龄,性别,初次介入前血红蛋白值,肿瘤分期(Ⅱ~Ⅲ期与Ⅳ期),初次介入时CEA的值,初次介入前后CEA的变化,治疗药物(是否含吉西他滨联合奥沙利铂),治疗方案(TAI/TACE),术前是否存在糖尿病,肿瘤部位(是否为胰头部),病理是否为导管腺癌,均显示差异无明显统计学意义。多因素分析显示对介入治疗后生存期有影响的独立因素是:开始介入治疗时肝功能分级,初治时KPS评分,有无原发灶手术切除史。结论 TAI/TACE对于胰腺癌患者在改善患者症状和延长中位生存期方面有一定的治疗作用,介入治疗后生存期与患者的体力状态,存在症状和有无早期手术治疗有关。     

Hepatic artery infusion and chemoembolization in the management of liver metastases

Hepatic metastases rather than the primary neoplasm usually dictate the course of the disease and the patient's survival. For unresectable disease, intraarterial infusion of chemotherapy, embolization, and chemoembolization are viable alternatives. Intraarterial therapy for hepatic metastases is based on the dual blood supply of the normal liver (portal vein, 75%, and hepatic artery, 25%) and that of the tumors (hepatic artery, 90%). Intraarterial infusion delivers a higher concentration of chemotherapy, whereas chemoembolization adds ischemia and increased contact time with the tumor. Selective vascular occlusion for infusion, redistribution of the blood supply and pulsatile flow enhance the delivery of therapeutic agents to the liver.     

Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: Local control and survival results

Objective

To evaluate the local tumor control and survival data after transarterial chemoembolization with different drug combinations in the palliative treatment of patients with liver metastases of gastric cancer.

Materials and methods

The study was retrospectively performed. 56 patients (mean age, 52.4) with unresectable liver metastases of gastric cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. In total, 310 chemoembolization procedures were performed (mean, 5.5 sessions per patient). The local chemotherapy protocol consisted of mitomycin alone (30.4%), mitomycin and gemcitabine (33.9%), or mitomycin, gemcitabine and cisplatin (35.7%). Embolization was performed with lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST. Survival data from first chemoembolization were calculated according to the Kaplan–Meier method.

Results

The local tumor control was: complete response in 1.8% (n = 1), partial response in 1.8% (n = 1), stable disease in 51.8% (n = 29) and progressive disease in 44.6% (n = 25) of patients. The 1-, 2-, and 3-year survival rate from the start of chemoembolization were 58%, 38%, and 23% respectively. The median and mean survival times were 13 and 27.1 months. A Statistically significant difference between patients treated with different chemotherapy protocols was noted (ρ = 0.045) with the best survival time in the mitomycin, gemcitabine and cisplatin group.

Conclusion

Transarterial chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with gastric cancer.     

氩氦刀冷冻联合经导管动脉化疗栓塞治疗肝脏转移性肿瘤的疗效分析

目的探索和掌握氩氦刀冷冻治疗联合经导管动脉化疗栓塞（TACE）对肝脏转移性肿瘤的治疗方法和疗效。方法对15例肝转移瘤患者进行氩氦刀治疗,术后7～15d再行TACE治疗,另选15例患者只行TACE治疗,对比治疗效果。结果治疗组有效率达100%,明显高于对照组的47%,且氩氦刀治疗患者无严重的不良反应,恢复快。结论氩氦刀创伤小、疗效好,为肝转移瘤的治疗提供了新方法,结合TACE更能提高疗效。