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Hiroshi Seki Toshirou Ozaki Makoto Shiina 《Cardiovascular and interventional radiology》2009,32(4):679-686
The purpose of this study was to assess retrospectively the sequential treatment of hepatic arterial infusion (HAI) chemotherapy
followed by systemic therapy using oxaliplatin plus 5-flourouracil (5-FU) and leucovorin, namely, FOLFOX, for patients with
liver metastases from colorectal cancer. We reviewed 20 patients with unresectable liver metastases from colorectal cancer.
Patients were initially treated with HAI chemotherapy until disease progression (5-fluorouracil, 1000 mg/m2 intra-arterial infusion, weekly) and then with FOLFOX thereafter (FOLFOX4, n = 13; modified FOLFOX6, n = 7). Adverse events, tumor response, and time to progression for each therapy were evaluated retrospectively, and overall
survival was estimated. Toxicity of HAI chemotherapy was generally mild. Of 20 patients, adverse events leading to treatment
discontinuation occurred in only 1 patient (5%) during initial therapy using HAI chemotherapy, while 9 patients (45%) exhibited
adverse events during subsequent FOLFOX therapy. For HAI chemotherapy and FOLFOX, objective response rates were 85.0% and
35.0%, respectively, and median time to progression was 11.6 and 5.1 months, respectively. Median overall survival was 30.1 months.
In conclusion, the sequence of HAI chemotherapy followed by FOLFOX is a promising treatment strategy for the long-term use
of active chemotherapeutic agents, leading to a superior tumor response and fewer toxic effects in patients with unresectable
liver metastases from colorectal cancer. 相似文献
3.
Hepatic arterial embolization has been shown to be a safe and effective method for the palliation of symptoms in patients
with metastatic disease, particularly those with secondary deposits from endocrine tumors. This review examines the indications
for the procedure, discusses some aspects of technique, and assesses the potential benefits and complications of the method. 相似文献
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肝动脉栓塞治疗外伤性肝破裂出血 总被引:1,自引:0,他引:1
目的探讨肝动脉栓塞术治疗外伤性肝破裂出血的临床疗效、关键技术及其并发症。资料与方法回顾性分析经B超及CT证实的外伤性肝破裂出血患者50例,采用超选择插管至病变血管,用明胶海绵和(或)弹簧圈栓塞,术后观察止血效果。结果 9例单纯用明胶海绵颗粒栓塞,41例用明胶海绵颗粒+钢圈联合栓塞。47例一次肝动脉栓塞后即成功止血;3例于首次栓塞后12~72 h复发出血,行第二次肝动脉栓塞后有2例完全止血康复,1例于第二次栓塞后2周并发肝脓肿和腹腔感染而死亡。49例随访3个月~3年无复发出血。结论肝动脉导管栓塞治疗外伤性肝破裂出血安全、有效。 相似文献
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Nishiofuku H Tanaka T Sakaguchi H Yamamoto K Inoue M Sueyoshi S Shinnkai T Hasegawa M Kichikawa K 《Cardiovascular and interventional radiology》2009,32(4):796-800
We describe herein a patient who had hepatic metastases with an arteriovenous shunt and was treated by hepatic arterial infusion
chemotherapy. The arteriovenous shunt was diagnosed by 99mTc-macroaggregated albumin scintigraphy and hepatic venous embolization was performed to reduce shunt flow. 相似文献
6.
60例肝癌经导管肝动脉栓塞化疗(THAE)前由于导管无法超选择插管而行经导管胃十二指肠动脉栓塞。其中45例用羊毛钢圈栓塞,44例成功:11例以导丝人为损伤血管内膜(导管不能插入)后10例闭塞,另4例导管导丝均不能插入。由于胃十二指肠动脉闭塞,THAE时避免了碘油抗癌药混悬剂或明胶海绵颗粒进入胃十二指肠动脉。所有胃十二指肠动脉栓塞的病例无直接并发症。因此认为,胃十二指扬动脉栓塞是安全的,对防止肝癌THAE时栓塞剂返流所致的胃十二指肠损伤具有重要意义。 相似文献
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羟基喜树碱明胶微球肝动脉化疗栓塞治疗肝肿瘤的实验研究 总被引:7,自引:1,他引:7
目的:对羟基喜树碱明胶微球(OPT-ms)进行栓塞特性的实验研究。方法:以草犬为实验对象,比较了肝动脉注射常规型OPT,空白明胶微球和OPT-ms对大鼠肝癌的作用,并以肝动脉注射生理盐水作对照。结果:发现微球栓塞后血管造影可见末梢动脉有不同程度的减少,30d复查未见侧支循环形成。AKP,GPT在肝动脉灌注后3d可达到最大值,7d后明显下降,14d恢复正常,肝功能指标与微球的剂量呈正相关。病理检查有局限性或小灶性坏死,其程度与范围与剂量的大小有关,其它主要脏器无明显改变。结论:OPT-ms对于肝肿瘤治疗是理想的。 相似文献
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采用软X线摄影技术和硅酮灌注技术,对二乙基亚硝胺诱发的大鼠肝癌模型作碘油肝动脉栓塞后的肿瘤门脉血供进行了研究。结果显示:碘油肝动脉栓塞后,较大肿瘤结节(>5mm)的周边部分可见门脉血供存在,而较小肿瘤结节内(<5mm),其肿瘤血供呈现部分或完全来自门脉。作者认为,碘油肝动脉栓塞不可能产生完全性的肿瘤双重血供的栓塞;门脉血供的存在可能是碘油肝动脉栓塞后部分肿瘤细胞残存的一个重要原因。因此,在碘油肝动脉栓塞后有必要进行经门静脉途径的介入治疗。 相似文献
10.
肝动脉化疗栓塞联合门静脉栓塞对非栓塞肝容积的影响 总被引:1,自引:0,他引:1
目的评价肝动脉化疗栓塞(TACE)联合门静脉栓塞(PVE)术对非栓塞肝容积的影响。方法21例肝癌患者行TACE后,分别实施门静脉亚段分支(亚段组)、段分支(段组)以及叶分支(叶组)PVE。其中亚段组5例,段组10例,叶组6例(均为肝右叶)。所有患者于PVE前及术后4周均行肝脏CT扫描检查,分别测量肝脏病变区和非栓塞区容积,观察非栓塞肝脏的容积变化。结果非栓塞肝容积的变化与栓塞肝容积显性相关(r=0.752,P<0.01)。亚段组非栓塞肝容积增加率为(2.4±2.7)%,段组为(11.4±6.7)%(P<0.05)以及叶组为(39.8±19.9)%(Ρ<0.01)。结论肝动脉化疗栓塞联合门静脉栓塞术能安全有效地增加非栓塞肝的容积,为肝癌扩大肝切除术的实施提供了一种切实可行的选择。 相似文献
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Jhih-Wei Chen Ji Hoon Shin Teng-Fu Tsao Heung-Gyu Ko Hyun-Ki Yoon Ki-Chang Han Somrach Thamtorawat Bumsik Hong 《Journal of vascular and interventional radiology : JVIR》2017,28(2):295-301
Nine patients with advanced prostate cancer (stage T4) underwent prostatic arterial embolization (PAE) for refractory prostatic hematuria. Angiograms showed prostatic neovascularity in all cases, and complete PAE was achieved in 8 cases (89% technical success rate). Gross hematuria ceased after PAE in 6 cases, translating to a 67% clinical success rate. There were no PAE-related complications. At 3-month follow-up, 2 cases showed recurrent hematuria, 4 patients had died from PAE-unrelated etiologies, and only 3 patients survived and were without gross hematuria. PAE could represent an alternative option for patients with advanced prostate cancer to control hematuria. 相似文献
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Geschwind JF Ramsey DE Cleffken B van der Wal BC Kobeiter H Juluru K Hartnell GG Choti MA 《Cardiovascular and interventional radiology》2003,26(2):111-117
The purpose of this study was to determine whether
transcatheter arterial chemoembolization (TACE) protocol affects the
total volume of chemotherapy injected into the liver as well as
subsequent arterial patency. A total of 160 patients with primary or
secondary liver cancer were treated with 3 different chemoembolization
protocols at a single institution. Data were analyzed retrospectively.
Group 1 (n = 36) consisted of slurry of chemotherapy,
oil and polyvinyl alcohol particles (PVA), group 2 (n =
91), chemotherapy and oil followed by PVA, and group 3
(n = 33), chemotherapy and oil followed by Gelfoam
pledgets. The total volume of chemotherapy injected into the liver was
recorded. Arterial patency was determined during subsequent
chemoembolizations. The mean percentage of total intended chemotherapy
dose administered was 54.6% for group 1, 75.3% for group 2, and
80.6% for group 3. Arterial patency at follow-up angiography was 56%
for group 1, 74% for group 2, and 81% for group 3. The slurry
protocol (group 1) significantly reduced arterial patency and
injectable volume of chemotherapy during TACE. 相似文献
13.
Yeo Ju Kim Hae Giu Lee Jeong Mi Park Yeon Soo Lim Myung Hee Chung Mi Sook Sung Won Jong Yoo Hyun Wook Lim 《Korean journal of radiology》2007,8(4):311-319
Objective
To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).Materials and Methods
Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.Results
In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.Conclusion
P-TACE is feasible and safe in advanced HCC patients with APS. 相似文献14.
Iguchi T Arai Y Inaba Y Yamaura H Sato Y Miyazaki M Shimamoto H 《Cardiovascular and interventional radiology》2008,31(1):86-90
Purpose We retrospectively evaluated the safety and efficacy of preoperative initial hepatic arterial infusion chemotherapy (HAIC)
through a port-catheter system in patients with liver dysfunction due to synchronous and unresectable liver metastases. The
aim of HAIC was to improve patients’ clinical condition for later surgical removal of primary colorectal cancer.
Methods Port-catheter systems were placed radiologically in 21 patients (mean age 58.6 ± 8.1 years) with liver dysfunction due to
synchronous liver metastases from colorectal cancer. Initial HAIC of 1,000 mg/m2 5-fluorouracil was administered weekly as a 5 hr continuous infusion through this system. Surgical removal of the primary
lesion was planned after HAIC improved the liver function.
Results Port-catheter system placement was successful in all patients without severe complications. Patients were followed up for
a median of 309 days (range 51–998 days). After starting HAIC, no severe adverse events that caused drug loss and treatment
postponement or suspension were observed in any of the patients. HAIC was performed a mean of 4.5 ± 3.0 times and the liver
function improved in all patients. Curative (n = 18) or palliative (n = 1) surgical removal of the primary lesion was performed. The remaining 2 patients died because extrahepatic metastases
developed and their performance status worsened; thus, surgery could not be performed. The median survival times of all patients
and the operated patients were 309 and 386 days, respectively.
Conclusion Initial HAIC administration is a safe and efficacious method for improving liver function prior to operative resection of
primary colorectal cancer in patients with liver dysfunction due to synchronous and unresectable liver metastases. 相似文献
15.
Hyo-Cheol Kim Jeong Min Lee Seung Hong Choi Heon Han Sam Soo Kim Sang Hyun Lee Joon Koo Han Byung Ihn Choi 《Korean journal of radiology》2004,5(3):157-163
Objective
This study was undertaken for the purpose of describing the CT features of intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors in patients who were treated with imatinib.Materials and Methods
Eleven patients with intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors, who were treated with imatinib between May 2001 and December 2003, were included in this study. The clinical findings and CT scans were retrospectively reviewed. The metastatic lesions were assessed according to the location, size (greatest diameter), attenuation, and the enhancing pattern before and after imatinib treatment.Results
Prior to the treatment, the sizes and attenuation values of the metastatic lesions ranged from 5 to 20 cm and from 63 to 131 H, respectively. The metastatic lesions showed a heterogeneous enhancement pattern on the contrast-enhanced CT scans. After the treatment, the metastatic lesions became smaller in all 11 patients, and the corresponding attenuation value ranged from 15 to 51 H. The metastatic lesions became homogeneous and cystic in appearance on the follow-up CT scans, mimicking ascites.Conclusion
Intra-abdominal extra-hepatic metastases of patients with gastrointestinal stromal tumors treated with imatinib may appear as well-circumscribed cystic lesions on contrast-enhanced CT. These metastases are likely to become smaller and resemble ascites, but may persist indefinitely on the follow-up CT. 相似文献16.
肝动脉与腹主动脉间架桥在肝移植中的作用 总被引:1,自引:0,他引:1
目的 改进肝动脉吻合方式,观察肝移植术后移植物恢复情况。方法 2例同种异体背驮式肝移植手术中,利用供体髂动脉进行肝动脉与腹主动脉问架桥,改善供肝动脉供血;观察患者术后肝功能等指标变化。排异反应预防采用FK506和泼尼松二联用药,其他同一般肝移植手术。结果 术后患者供肝恢复良好,2例患者均未出现急性排异反应,痊愈出院。结论 肝动脉与腹动脉吻合或利用供体的髂动脉进行架桥,是预防肝动脉狭窄及栓塞所致并发症的有效方法,值得在肝移植过程中予以选择性加以应用。 相似文献
17.
肝动脉化疗、栓塞治疗原发性肝癌的临床研究(附188例分析) 总被引:2,自引:0,他引:2
目的:研究原发性肝癌肝动脉化疗、栓塞的疗效及其影响因素。材料与方法:回顾性分析188例肝癌肝动脉化疗、栓塞的临床随访资料。结果:总疗效为症状缓解占59.6%,肿瘤缩小占55%,AFP下降占37.8%,半年及1、2、3年生存率分别为75.4%、46%、23.5%、14.7%,平均生存期12.2月,最长已存活50月,获二步手术切除18例,对比分析了7个影响疗效的有关因素。结论:无或轻度肝硬化、早中期、单个肿瘤、直径<10cm、无门脉癌栓或肝动-静脉瘘、行栓塞治疗、治疗次数在3次以上者,其中远期疗效明显优于对应组。克服有关影响因素及综合治疗将会进一步提高肝癌化疗栓塞的疗效 相似文献
18.
Jakobs TF Hoffmann RT Schrader A Stemmler HJ Trumm C Lubienski A Murthy R Helmberger TK Reiser MF 《Cardiovascular and interventional radiology》2009,32(1):38-46
The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency
ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer
liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness
was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of
human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated
using the Kaplan–Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was
96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness
of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months.
There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression,
and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with
the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be
performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients
with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.
Drs. Jakobs and Hoffmann contributed equally to this article. 相似文献
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Radiofrequency Ablation of Colorectal Liver Metastases: Small Size Favorably Predicts Technique Effectiveness and Survival 总被引:2,自引:2,他引:0
Veltri A Sacchetto P Tosetti I Pagano E Fava C Gandini G 《Cardiovascular and interventional radiology》2008,31(5):948-956
The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases
(MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine
nonresectable MTS (0.5–8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during
surgery. The technique was “simple” or “combined” with vascular occlusion. The mean follow-up time was 24.2 months. Complications,
technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major
complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean
of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions ≤3 cm versus 33.3% of lesions >3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%,
and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS ≤3 cm and 23.2
in those with at least one lesion >3 cm (p = 0.006). We conclude that “simple” RFA is safe and successful for MTS ≤3 cm, contributing to prolong survival when patients
can be completely treated.
Presented at CIRSE 2006. 相似文献
20.
Jeong Ho Kim Gi-Young Ko Hyun-Ki Yoon Ho-Young Song Sung-Gyu Lee Kyu-Bo Sung 《Korean journal of radiology》2004,5(3):164-170