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1. Zsíros J, Maibach R, Shafford E, Brugieres L, Brock P, Czauderna P, Roebuck D, Childs M, Zimmermann A, Laithier V, Otte JB, de Camargo B, MacKinlay G, Scopinaro M, Aronson D, Plaschkes J, Perilongo G: Successful treatment of childhood high-risk hepatoblastoma with dose-intensive multiagent chemotherapy and surgery: final results of the SIOPEL-3HR study. J Clin Oncol; 2010 May 20;28(15):2584-90
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  • [Title] Successful treatment of childhood high-risk hepatoblastoma with dose-intensive multiagent chemotherapy and surgery: final results of the SIOPEL-3HR study.
  • PURPOSE: The primary objective was to determine the efficacy of a newly designed preoperative chemotherapy regimen in an attempt to improve the cure rate of children with high-risk hepatoblastoma.
  • PATIENTS AND METHODS: High risk was defined as follows: tumor in all liver sections (ie, Pretreatment Extension IV [PRETEXT-IV]), or vascular invasion (portal vein [P+], three hepatic veins [V+]), or intra-abdominal extrahepatic extension (E+), or metastatic disease, or alpha-fetoprotein less than 100 ng/mL at diagnosis.
  • Patients were treated with alternating cycles of cisplatin and carboplatin plus doxorubicin (preoperatively, n = 7; postoperatively, n = 3) and delayed tumor resection.
  • RESULTS: Of the 151 patients (150 evaluable for response) 118 (78.7%) achieved a partial response to chemotherapy.
  • Complete resection of the liver tumor could be achieved in 115 patients (76.2%) either by partial hepatectomy (55.6%) or by liver transplantation (20.6%).
  • In 106 children (70.2%), complete resection of all tumor lesions (including metastases) was achieved.
  • Among the patients with initial lung metastases, 52.2% achieved complete remission of the lung lesions with chemotherapy alone.
  • In half of the patients with initial PRETEXT-IV tumor as the only high-risk feature, the tumor could be completely resected with partial hepatectomy.
  • EFS and OS for all patients with PRETEXT-IV tumor were 68% and 69%, respectively, and they were 56% and 62%, respectively, for patients with metastasis.
  • CONCLUSION: The applied treatment rendered a great proportion of tumors resectable, and, in comparison with previously published results, led to an improved survival in patients with high-risk hepatoblastoma.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Hepatoblastoma / drug therapy. Hepatoblastoma / surgery. Liver Neoplasms / drug therapy. Liver Neoplasms / surgery
  • [MeSH-minor] Adolescent. Carboplatin / administration & dosage. Chemotherapy, Adjuvant. Child. Child, Preschool. Cisplatin / administration & dosage. Doxorubicin / administration & dosage. Female. Humans. Infant. Male. Preoperative Care. Prospective Studies. Risk Factors. Survival Analysis. Treatment Outcome

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  • (PMID = 20406943.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 80168379AG / Doxorubicin; BG3F62OND5 / Carboplatin; Q20Q21Q62J / Cisplatin
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2. Rodenbach M, Eyol E, Seelig MH, Berger MR: Combination treatment of CC531-lac-Z rat liver metastases by chemoembolization with pemetrexed disodium and gemcitabine. J Cancer Res Clin Oncol; 2005 May;131(5):289-99
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  • [Title] Combination treatment of CC531-lac-Z rat liver metastases by chemoembolization with pemetrexed disodium and gemcitabine.
  • PURPOSE: The aim of this study was to evaluate the combination effect of pemetrexed disodium (MTA; Alimta; LY 231514) and gemcitabine (GEM) administered by hepatic artery and portal vein chemoembolization (HACE and PVCE) in a colorectal cancer rat liver metastasis model.
  • To generate diffuse liver metastasis, 4 x 10(6) tumor cells were implanted into the portal vein of male WAG/Rij rats.
  • MTA (30 mg/kg, 60 mg/kg, and 90 mg/kg) was administered locoregionally by portal vein chemoembolization (PVCE) and compared with repeated systemic intravenous injection.
  • GEM (50 mg/kg) was also given locoregionally by hepatic artery chemoembolization (HACE) as well as systemically.
  • Efficacy of treatment in terms of liver metastases burden was determined at the end of the experiment by measuring the beta-galactosidase activity of CC531-lac-Z cells with a chemoluminescence assay.
  • RESULTS: Combination experiments in vitro showed a more than additive tumor cell reduction after sequential exposure to MTA preceding GEM (observed/expected ratio [O/E] = 0.73).
  • Simultaneous drug exposure showed less than additive combination effects (O/E ratios > or = 1.25).
  • In vivo, locoregional administration by HACE with GEM was significantly more effective than systemic intravenous bolus treatment (P = 0.03).
  • Portal vein chemoembolization with MTA performed immediately after tumor cell inoculation was ineffective.
  • Repeated systemic treatment with MTA yielded a slight reduction in tumor cell load that was significant versus control at the medium and high doses (60 mg/kg, P = 0.009; 90 mg/kg, P = 0.046) but not versus intraportal chemoembolization.
  • The combination treatment of systemic (60 and 90 mg/kg) or locoregional (60 mg/kg) MTA with HACE using GEM (50 mg/kg) resulted in more than 80% tumor growth inhibition; this antineoplastic combination effect was maximally additive.
  • CONCLUSION: A regimen-dependent synergistic combination effect of both drugs was found in vitro.
  • In animals, hepatic artery chemoembolization with GEM was superior to systemic intravenous bolus treatment.
  • Portal vein chemoembolization with MTA was ineffective.
  • The optimal in vitro regimen of MTA (intravenous or PVCE) preceding GEM (HACE) resulted in a maximally additive tumor growth inhibition.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Deoxycytidine / analogs & derivatives. Glutamates / therapeutic use. Guanine / analogs & derivatives. Liver Neoplasms / secondary. Liver Neoplasms / therapy
  • [MeSH-minor] Animals. Antineoplastic Agents / therapeutic use. Cell Line, Tumor. Chemoembolization, Therapeutic. Colorectal Neoplasms. Combined Modality Therapy. Death. Disease Models, Animal. Male. Neoplasm Metastasis. Pemetrexed. Rats. Rats, Inbred Strains

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  • (PMID = 15657768.001).
  • [ISSN] 0171-5216
  • [Journal-full-title] Journal of cancer research and clinical oncology
  • [ISO-abbreviation] J. Cancer Res. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Glutamates; 04Q9AIZ7NO / Pemetrexed; 0W860991D6 / Deoxycytidine; 5Z93L87A1R / Guanine; B76N6SBZ8R / gemcitabine
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3. Chirica M, Scatton O, Massault PP, Aloia T, Randone B, Dousset B, Legmann P, Soubrane O: Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery? Arch Surg; 2008 Jun;143(6):538-43; discussion 543
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  • [Title] Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery?
  • HYPOTHESIS: A subset of patients with stage IVA hepatocellular carcinoma (HCC) and preserved liver function may benefit from hepatic resection.
  • PATIENTS: Twenty patients who underwent surgical treatment for stage IVA HCC between July 1998 and October 2004 were identified from the database.
  • Five patients (25%) had macroscopic invasion of the portal vein and 2 patients (10%) underwent thrombectomy of the vena cava.
  • The median number of resected tumors per patient was 3, and the median diameter of the largest tumor was 60 mm.
  • With a median follow-up of 23 months, 14 patients (70%) developed recurrence.
  • Treatment of recurrence was possible in 10 patients and included transarterial chemoembolization in 7 patients (35%), of whom 2 (10%) had radiofrequency ablation first, and systemic chemotherapy in 3 patients (15%).
  • Median survival time was 32 months, and the actuarial 1-, 3-, and 5-year survival rates were 73%, 56%, and 45%, respectively.
  • Patients with stage IVA HCC should be followed up by a multidisciplinary team because recurrence is common and sequential treatments may prolong survival.
  • [MeSH-minor] Biopsy. Female. Follow-Up Studies. Hepatectomy / methods. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local / diagnosis. Neoplasm Recurrence, Local / epidemiology. Neoplasm Staging. Retrospective Studies. Survival Rate / trends. Time Factors. Tomography, X-Ray Computed

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  • [CommentIn] Arch Surg. 2008 Dec;143(12):1235-6; author reply 1236 [19075180.001]
  • (PMID = 18559745.001).
  • [ISSN] 1538-3644
  • [Journal-full-title] Archives of surgery (Chicago, Ill. : 1960)
  • [ISO-abbreviation] Arch Surg
  • [Language] eng
  • [Publication-type] Case Reports; Comparative Study; Journal Article
  • [Publication-country] United States
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4. Schwartz JD, Sung M, Schwartz M, Lehrer D, Mandeli J, Liebes L, Goldenberg A, Volm M: Thalidomide in advanced hepatocellular carcinoma with optional low-dose interferon-alpha2a upon progression. Oncologist; 2005 Oct;10(9):718-27
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  • PURPOSE: To evaluate thalidomide in advanced hepatocellular carcinoma (HCC) and to evaluate combined thalidomide and low-dose interferon-alpha2a (IFN-alpha2a) after tumor progression on thalidomide.
  • Systemic therapy is minimally effective in HCC and tumor angiogenesis is a potential therapeutic target.
  • PATIENTS AND METHODS: Patients with unresectable HCC were eligible if they had preserved hepatic and renal function.
  • Tumor invasion of the portal vein or vena cava, large (>10 cm) tumor, and younger age were associated with shorter overall survival.
  • Six patients stopped therapy because of side effects, including two patients (5%) with grade 4 arteriothrombotic events.
  • [MeSH-major] Carcinoma, Hepatocellular / drug therapy. Interferon-alpha / administration & dosage. Liver Neoplasms / drug therapy. Thalidomide / therapeutic use
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Cytokines / blood. Disease Progression. Drug Therapy, Combination. Female. Humans. Male. Middle Aged. Recombinant Proteins

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  • (PMID = 16249352.001).
  • [ISSN] 1083-7159
  • [Journal-full-title] The oncologist
  • [ISO-abbreviation] Oncologist
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA90584; United States / NIDDK NIH HHS / DK / DK60498; United States / NCI NIH HHS / CM / N01-CM-17103
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Cytokines; 0 / Interferon-alpha; 0 / Recombinant Proteins; 4Z8R6ORS6L / Thalidomide; 76543-88-9 / interferon alfa-2a
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5. Kim HY, Kim JD, Bae SH, Park JY, Han KH, Woo HY, Choi JY, Yoon SK, Jang BK, Hwang JS, Kim SG, Kim YS, Seo YS, Yim HJ, Um SH, Korean Liver Cancer Study Group: A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma. Korean J Hepatol; 2010 Dec;16(4):355-61
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  • [Title] A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma.
  • BACKGROUND/AIMS: Transarterial chemoembolization (TACE) has long been used as a palliative therapy for unresectable hepatocellular carcinoma (HCC).
  • High-dose hepatic arterial infusion chemotherapy (HAIC) has showed favorable outcomes in patients with intractable, advanced HCC.
  • The enrollment criteria were good liver function, main portal vein invasion (including vascular shunt), infiltrative type, bilobar involvement, and/or refractory to prior conventional treatment (TACE, radiofrequency ablation, or percutaneous ethanol injection), and documented progressive disease.
  • There were no serious adverse effects in the high-dose HAIC group, while hepatic complications occurred more often in the TACE group.
  • CONCLUSIONS: High-dose HAIC appears to improve the tumor response and survival outcome compared to conventional TACE using doxorubicin in patients with intractable, advanced HCC.
  • [MeSH-major] Antibiotics, Antineoplastic / administration & dosage. Carcinoma, Hepatocellular / therapy. Doxorubicin / administration & dosage. Liver Neoplasms / therapy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Chemoembolization, Therapeutic. Cisplatin / administration & dosage. Fluorouracil / administration & dosage. Humans. Infusions, Intra-Arterial. Magnetic Resonance Imaging. Prospective Studies. Retrospective Studies. Severity of Illness Index. Survival Rate. Tomography, X-Ray Computed

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  • [CommentIn] Korean J Hepatol. 2010 Dec;16(4):353-4 [21415577.001]
  • (PMID = 21415578.001).
  • [ISSN] 1738-222X
  • [Journal-full-title] The Korean journal of hepatology
  • [ISO-abbreviation] Korean J Hepatol
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] Korea (South)
  • [Chemical-registry-number] 0 / Antibiotics, Antineoplastic; 80168379AG / Doxorubicin; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
  • [Other-IDs] NLM/ PMC3304604
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6. Kudo M, Ueshima K: Positioning of a molecular-targeted agent, sorafenib, in the treatment algorithm for hepatocellular carcinoma and implication of many complete remission cases in Japan. Oncology; 2010 Jul;78 Suppl 1:154-66
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  • [Title] Positioning of a molecular-targeted agent, sorafenib, in the treatment algorithm for hepatocellular carcinoma and implication of many complete remission cases in Japan.
  • Sorafenib, a molecular-targeted agent that inhibits tumor cell proliferation and angiogenesis by inhibiting RAF serine-threonine kinase and VEGF, PDGF, Flt-3, c-Kit receptor tyrosine kinase, was approved in Europe and North America in 2007 and in Japan on May 20, 2009.
  • According to the consensus statements of the Japan Society of Hepatology in 2010, sorafenib is recommended for advanced HCC with extrahepatic spread or major vascular invasion such as invasion of the 1st branch of the portal vein or the main portal branch of the portal vein in patients with Child-Pugh A liver function.
  • In addition to that, transcatheter arterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) refractory HCC patients with Child-Pugh A liver function are also candidates of sorafenib monotherapy as a second-line treatment option.
  • Factors indicating systemic cancer spread, including multiple liver lesions, lymph node metastases, adrenal metastases, lung metastases and vascular invasion, were completely absent in both cases of CR by 2 and 1 year, respectively.
  • Similarly, three tumor markers (AFP, PIVKA-II, and AFP-L3) completely returned to normal values.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Benzenesulfonates / therapeutic use. Carcinoma, Hepatocellular / drug therapy. Liver Neoplasms / drug therapy. Protein Kinase Inhibitors / therapeutic use. Pyridines / therapeutic use. Receptors, Vascular Endothelial Growth Factor / antagonists & inhibitors
  • [MeSH-minor] Algorithms. Humans. Niacinamide / analogs & derivatives. Phenylurea Compounds. Survival Rate. Treatment Outcome

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  • [Copyright] Copyright (c) 2010 S. Karger AG, Basel.
  • (PMID = 20616599.001).
  • [ISSN] 1423-0232
  • [Journal-full-title] Oncology
  • [ISO-abbreviation] Oncology
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Benzenesulfonates; 0 / Phenylurea Compounds; 0 / Protein Kinase Inhibitors; 0 / Pyridines; 25X51I8RD4 / Niacinamide; 9ZOQ3TZI87 / sorafenib; EC 2.7.10.1 / Receptors, Vascular Endothelial Growth Factor
  • [Number-of-references] 32
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7. Gogia S, Befeler AS: Treating hepatocellular carcinoma without liver transplantation. Curr Gastroenterol Rep; 2009 Feb;11(1):69-75
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  • Choice of treatment depends on the size and location of the tumor and hepatic reserve.
  • Liver transplantation provides the best chance for long-term survival and can be performed regardless of hepatic reserve, but it requires small tumor sizes and is available to only a few patients.
  • All other treatments require adequate hepatic reserve.
  • Surgical resection, percutaneous ethanol injection, and radiofrequency ablation are effective treatments for patients with good hepatic reserve and small tumors isolated to the liver.
  • With metastasis, portal vein invasion, or large bilobar disease and intact hepatic function, modest improvements in survival have occurred with the use of sorafenib, a recently approved targeted chemotherapy agent.
  • Patients with poor hepatic function or low performance status should receive only supportive care.
  • [MeSH-major] Carcinoma, Hepatocellular / therapy. Liver Neoplasms / therapy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Benzenesulfonates / therapeutic use. Catheter Ablation / methods. Chemoembolization, Therapeutic / methods. Combined Modality Therapy / methods. Humans. Liver Cirrhosis / complications. Liver Transplantation. Niacinamide / analogs & derivatives. Phenylurea Compounds. Practice Guidelines as Topic. Protein Kinase Inhibitors / therapeutic use. Pyridines / therapeutic use

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  • (PMID = 19166662.001).
  • [ISSN] 1534-312X
  • [Journal-full-title] Current gastroenterology reports
  • [ISO-abbreviation] Curr Gastroenterol Rep
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Benzenesulfonates; 0 / Phenylurea Compounds; 0 / Protein Kinase Inhibitors; 0 / Pyridines; 25X51I8RD4 / Niacinamide; 9ZOQ3TZI87 / sorafenib
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8. Shirabe K, Kajiyama K, Harimoto N, Masumoto H, Fukuya T, Ooya M, Maehara Y: Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion. World J Gastroenterol; 2009 Jun 7;15(21):2632-7
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  • [Title] Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion.
  • AIM: To investigate the prognostic factors in patients with hepatocellular carcinoma (HCC) accompanied by microscopic portal vein invasion (PVI).
  • METHODS: Of the 267 patients with HCC undergoing hepatic resection at Aso Iizuka Hospital, 71 had PVI.
  • After excluding 16 patients with HCC that invaded the main trunk and the first and second branches of the portal vein, 55 patients with microscopic PVI were enrolled.
  • RESULTS: The patients with HCC accompanied by microscopic invasion were divided into two groups: solitary PVI (PVI-S: n = 44), and multiple PVIs (PVI-M: n = 11).
  • The number of portal vein branches invaded by tumor thrombi was 5.4 +/- 3.8 (2-16) in patients with PVI-M.
  • Operative procedure was not a significant prognostic factor in patients with PVI-M.
  • Patients with HCC and PVI-M may also be good candidates for adjuvant chemotherapy.
  • [MeSH-major] Carcinoma, Hepatocellular / pathology. Liver Neoplasms / pathology. Neoplasm Invasiveness / pathology. Neoplasm Recurrence, Local / pathology. Portal Vein / pathology

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  • (PMID = 19496194.001).
  • [ISSN] 2219-2840
  • [Journal-full-title] World journal of gastroenterology
  • [ISO-abbreviation] World J. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] China
  • [Other-IDs] NLM/ PMC2691495
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9. Abulkhir A, Limongelli P, Healey AJ, Damrah O, Tait P, Jackson J, Habib N, Jiao LR: Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg; 2008 Jan;247(1):49-57
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  • [Title] Preoperative portal vein embolization for major liver resection: a meta-analysis.
  • INTRODUCTION: Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency.
  • The current study examined the impact of portal vein embolization on liver resection.
  • METHOD: A comprehensive Medline search to identify all registered literature in the English language on portal vein embolization.
  • Twenty-three patients had transient liver failure following resection after PVE (2.5%) but 7 patients developed acute liver failure and died (0.8%).
  • The reason for nonresection following PVE (n = 158, 15%) included inadequate hypertrophy of remnant liver (n = 18), severe progression of liver metastasis (n = 43), extrahepatic spread (n = 35), refusal to surgery (n = 1), poor general condition (n = 1), altered treatment to transcatheter artery embolization or chemotherapy (n = 24), complete remission after treatment with 3 cycles of fluoracil and interferon alpha in a patient with hepatocellular carcinoma (n = 1), incomplete pre- or postembolization scanning (n = 8).
  • Of those who underwent laparotomy without resection, (n = 27) reasons included intraoperative finding of peritoneal dissemination (n = 15), portal node metastasis (n = 2), severe invasion of the tumor to the hepatic artery and portal vein (n = 1), and gross tumoral extension precluding curative resection (n = 9).
  • Two techniques were used for portal vein embolization: percutaneous transhepatic portal embolization, (PTPE) and transileocolic portal embolization, (TIPE).
  • CONCLUSION: PVE is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant.
  • [MeSH-major] Embolization, Therapeutic / methods. Hepatectomy / methods. Liver Neoplasms / therapy. Portal Vein. Preoperative Care

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  • [CommentIn] Ann Surg. 2008 Sep;248(3):499-500; author reply 500 [18791376.001]
  • (PMID = 18156923.001).
  • [ISSN] 0003-4932
  • [Journal-full-title] Annals of surgery
  • [ISO-abbreviation] Ann. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Meta-Analysis
  • [Publication-country] United States
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10. Uenishi T, Hirohashi K, Haba T, Wakasa K, Kubo S, Shuto T, Tanaka H, Yamamoto T, Tanaka S, Kinoshita H: Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma. Hepatogastroenterology; 2003 Jul-Aug;50(52):1140-2
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  • [Title] Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma.
  • A 57-year-old man, who had undergone hepatic arterial infusion chemotherapy with right portal occlusion for hepatocellular carcinoma was admitted to our hospital because of severe abdominal pain.
  • Angiography revealed an interrupted right hepatic artery.
  • Arterial portograms revealed complete obstruction of the right portal vein and a small left branch of the portal vein.
  • Despite anticoagulant therapy with urokinase for portal vein thrombosis, the patient died from hepatorenal failure.
  • The right hepatic artery was obstructed due to direct invasion of tumor.
  • There were diffuse thrombi in the left portal branches surrounded by tumor infiltrating along Glisson's sheath to the peripheral portion of the left lobe.
  • [MeSH-major] Bile Duct Neoplasms / complications. Bile Ducts, Intrahepatic. Cholangiocarcinoma / complications. Portal Vein. Venous Thrombosis / etiology
  • [MeSH-minor] Carcinoma, Hepatocellular / complications. Carcinoma, Hepatocellular / drug therapy. Fatal Outcome. Hepatic Artery / pathology. Humans. Male. Middle Aged. Neoplasm Invasiveness. Neoplasms, Multiple Primary / complications


11. Tanaka S, Shimada M, Shirabe K, Maehara S, Harimoto N, Tsujita E, Sugimachi K, Maehara Y: A novel intrahepatic arterial chemotherapy after radical resection for advanced hepatocellular carcinoma. Hepatogastroenterology; 2005 May-Jun;52(63):862-5
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  • [Title] A novel intrahepatic arterial chemotherapy after radical resection for advanced hepatocellular carcinoma.
  • BACKGROUND/AIMS: Advanced hepatocellular carcinoma (HCC) with portal vein invasion and/or intrahepatic metastasis has an unfavorable prognosis even after radical hepatic resection.
  • The aim of this study was to evaluate the effectiveness of a novel postoperative adjuvant chemotherapy given through the hepatic artery and based on biochemical modulation using cisplatin (CDDP) and 5-fluorouracil (5-FU).
  • METHODOLOGY: Fifteen patients with advanced HCC with portal vein invasion into the main trunk and/or intrahepatic metastases of more than 3 segments were included in this study.
  • After radical hepatic resection, the patients were divided to two groups: the adjuvant chemotherapy group (n=7) given the novel arterial infusion regimen with CDDP and 5-FU, and the control group (n=8) given no adjuvant chemotherapy.
  • RESULTS: Three-year survival rate of the adjuvant chemotherapy group tended to be significantly longer compared to that for the control group (p < 0.05).
  • Most of the tumor recurrence was in the remnant liver, 5 cases in both of the groups.
  • All of the intrahepatic recurrences are multiple in the control group, but in the adjuvant chemotherapy group, 2 cases of the recurrences showed a localized tumor surgically resected.
  • It is noteworthy that the occurrence of multiple recurrence was significantly later in the adjuvant chemotherapy group compared to the control group (18.9 months vs. 6.5 months; p<0.05).
  • CONCLUSIONS: Our data suggest that this novel adjuvant chemotherapy can improve the postoperative prognosis of patients with the advanced HCC.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Hepatocellular / drug therapy. Hepatectomy. Infusions, Intra-Arterial. Liver Neoplasms / drug therapy
  • [MeSH-minor] Aged. Catheters, Indwelling. Chemotherapy, Adjuvant. Cisplatin / administration & dosage. Combined Modality Therapy. Disease Progression. Drug Administration Schedule. Female. Fluorouracil / administration & dosage. Humans. Liver / pathology. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Portal Vein / pathology. Prognosis

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  • (PMID = 15966221.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Randomized Controlled Trial
  • [Publication-country] Greece
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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12. Ishiko T, Doi K, Beppu T, Hirota M, Ogawa M: [A case report of advanced huge hepatocellular carcinoma (H.C.C.) accompanied by tumor embolism to the inferior caval vein (Vv3) that was treated with surgical extended right lobectomy after multimodal therapy]. Gan To Kagaku Ryoho; 2002 Nov;29(12):2416-20
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [A case report of advanced huge hepatocellular carcinoma (H.C.C.) accompanied by tumor embolism to the inferior caval vein (Vv3) that was treated with surgical extended right lobectomy after multimodal therapy].
  • We performed multimodal therapy for a huge hepatocellular carcinoma with tumor embolism (Vv3), for which excision was judged impossible.
  • After treatment, a hepatectomy to the primary lesion was finally carried out and long-term survival was achieved.
  • A tumor embolism, which invaded the inferior vena cava, was also seen.
  • The residual liver was judged to have insufficient capacity for a right hepatic lobectomy.
  • A percutaneous transhepatic portal embolism (PTPE) was carried out against the right portal vein to increase in the left lobe capacity.
  • The chemo-radiotherapy (36 Gy to the right hepatic vein and systemic administration of CDDP) and transcatheter arterial chemoembolization were added to the feeding arteries of the hepatic tumor.
  • When a decrease in the postcaval vein tumor embolism was observed, the extended right hepatic lobectomy was performed.
  • Though lung metastasis and new lesions in left lobe were seen in a recurrence, two years and ten months since the start of the systemic chemotherapy.
  • This case suggested that even if a huge liver cancer with vascular invasion is judged impossible to excise, multimodal therapy with the aim of surgical treatment helps retain the possibility to later chose hepatectomy for the primary lesion and improve prognosis.
  • [MeSH-major] Carcinoma, Hepatocellular / therapy. Hepatectomy. Liver Neoplasms / therapy. Neoplastic Cells, Circulating / pathology
  • [MeSH-minor] Cisplatin / administration & dosage. Combined Modality Therapy. Embolization, Therapeutic. Humans. Male. Middle Aged. Vena Cava, Inferior / pathology

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  • (PMID = 12484089.001).
  • [ISSN] 0385-0684
  • [Journal-full-title] Gan to kagaku ryoho. Cancer & chemotherapy
  • [ISO-abbreviation] Gan To Kagaku Ryoho
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin
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13. Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK, Schurr PG, Liebl L, Thieltges S, Gawad KA, Schneider C, Izbicki JR: En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg; 2008 Feb;247(2):300-9
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  • [Title] En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients.
  • BACKGROUND: To assess in-hospital complication rates and survival duration after en bloc vascular resection (VR) for infiltration of pancreatic malignancies in major vessels.
  • METHODS: Between 1994 and 2005, 585 patients underwent potentially curative pancreatic resection without adjuvant chemotherapy.
  • RESULTS: One hundred twenty-eight VR+ patients underwent portal or superior mesenteric vein resection and 13 hepatic artery (HA) or superior mesenteric artery (SMA) resection.
  • In 5 patients, synchronous VR addressing both the mesenterico-portal axis and either the HA or SMA was performed.
  • From the 100 patients with pancreatic adenocarcinoma, histopathology confirmed "true" vascular invasion in 77 patients.
  • Twenty-three patients had peritumoral inflammation, mimicking tumor invasion.
  • Median survival was 15 months (11.2-18.8) in patients with histopathologic proven vascular invasion and 16 months (14.0-17.9) in those without (P = 0.86).
  • Two-year survival probabilities were 36% (without) versus 34% (with vascular invasion; P = 0.9).
  • Among VR+ patients with histopathologically evidenced vascular invasion, 19 survived longer than 30 months, and 6 were still alive 5 years after surgery.
  • Evidence of vascular invasion had no adverse impact on survival.
  • CONCLUSION: Postoperative morbidity and mortality rates after en bloc VR are comparable with "standard" pancreatectomy procedures.
  • Median survival of 15 months in patients with vascular invasion is superior to that of patients who undergo palliative therapy and nearly equals that of patients who are not in need for VR.
  • [MeSH-major] Adenocarcinoma. Hepatic Artery / surgery. Mesenteric Arteries / surgery. Mesenteric Veins / surgery. Pancreatic Neoplasms. Portal Vein / surgery. Vascular Surgical Procedures / methods
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Follow-Up Studies. Germany / epidemiology. Hospital Mortality / trends. Humans. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Pancreatectomy / methods. Retrospective Studies. Survival Rate / trends. Time Factors. Treatment Outcome

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  • [CommentIn] Ann Surg. 2009 Feb;249(2):349; author reply 349-50 [19212194.001]
  • (PMID = 18216537.001).
  • [ISSN] 0003-4932
  • [Journal-full-title] Annals of surgery
  • [ISO-abbreviation] Ann. Surg.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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14. Fishman EK: From the RSNA refresher courses: CT angiography: clinical applications in the abdomen. Radiographics; 2001 Oct;21 Spec No:S3-16
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  • The development of spiral computed tomography (CT) and subsequently multidetector CT has provided unparalleled opportunities for advancement of CT technology and clinical applications.
  • In the evaluation of pancreatic disease, the use of multidetector CT angiography enables the radiologist to produce vascular maps that clearly show tumor invasion of vasculature and the relationship of vessels to pancreatic masses.
  • Anatomic areas for which the three-dimensional display is especially helpful include the confluence of the portal vein and the superior mesenteric vein and the more distal portions of the portal vein.
  • CT angiography has proved extremely valuable for applications such as preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation, pretreatment planning for patients considered for hepatic arterial infusion chemotherapy, and pretreatment evaluation of portal vein patency for a variety of reasons.
  • [MeSH-major] Angiography / methods. Radiography, Abdominal. Tomography, X-Ray Computed / methods

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  • (PMID = 11598244.001).
  • [ISSN] 0271-5333
  • [Journal-full-title] Radiographics : a review publication of the Radiological Society of North America, Inc
  • [ISO-abbreviation] Radiographics
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 27
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15. Shirabe K, Shimada M, Tsujita E, Aishima S, Maehara S, Tanaka S, Takenaka K, Maehara Y: Prognostic factors in node-negative intrahepatic cholangiocarcinoma with special reference to angiogenesis. Am J Surg; 2004 Apr;187(4):538-42
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  • METHODS: A retrospective study was performed to review prognostic factors and recurrence patterns (1) in 22 patients with node-negative IHCC after curative hepatic resection and (2) in 49 patients who underwent resection and lymph node dissection for IHCC.
  • RESULTS: The significant poor prognostic factors in node-negative IHCC were the presence of intrahepatic metastasis, portal vein invasion of cancer cells, and high microvessel counts.
  • CONCLUSIONS: The factors linked to poor prognosis in IHCC were tumor angiogenesis and the presence of intrahepatic metastasis.
  • Because intrahepatic recurrence was common, regional and adjuvant chemotherapy to the liver may improve the outcome of patients with these risk factors and node-negative IHCC.
  • [MeSH-minor] Female. Humans. Male. Microcirculation. Middle Aged. Prognosis. Recurrence. Retrospective Studies. Survival Rate. Treatment Outcome

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  • (PMID = 15041507.001).
  • [ISSN] 0002-9610
  • [Journal-full-title] American journal of surgery
  • [ISO-abbreviation] Am. J. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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16. Roayaie S, Frischer JS, Emre SH, Fishbein TM, Sheiner PA, Sung M, Miller CM, Schwartz ME: Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters. Ann Surg; 2002 Apr;235(4):533-9
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  • [Title] Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters.
  • SUMMARY BACKGROUND DATA: Transplant has been established as a viable treatment of HCC measuring less than 5 cm, but the results for larger tumors have been disappointing.
  • Several studies have shown promising preliminary results when combining transplant with preoperative transarterial chemoembolization and/or perioperative systemic chemotherapy in the treatment of advanced HCC that is not amenable to resection.
  • METHODS: Beginning in October 1991, all patients with unresectable HCC measuring 5 cm or larger, as measured by computed tomography, were considered for enrollment in the authors' multimodality protocol.
  • Entry criteria required that all patients be free of extrahepatic disease based on computed tomography scans of the chest and abdomen and bone scan and have a patent main portal vein and major hepatic veins on duplex ultrasonography.
  • Patients received subselective arterial chemoembolization with mitomycin C, doxorubicin, and cisplatin at the time of diagnosis, repeated as necessary based on tumor response.
  • Mean pathologic tumor diameter was 5.8 +/- 2.7 cm.
  • A tumor size larger than 7 cm and the presence of vascular invasion correlated significantly with recurrence.
  • CONCLUSIONS: A significant proportion of patients with HCC measuring 5 cm or larger can achieve long-term survival after liver transplantation in the context of multimodal adjuvant therapy.
  • [MeSH-major] Carcinoma, Hepatocellular / pathology. Carcinoma, Hepatocellular / therapy. Liver Neoplasms / pathology. Liver Neoplasms / therapy. Liver Transplantation. Outcome and Process Assessment (Health Care)
  • [MeSH-minor] Aged. Antineoplastic Agents / therapeutic use. Chemoembolization, Therapeutic. Chemotherapy, Adjuvant. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Preoperative Care. Prospective Studies. Survival Rate. Time Factors

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  • (PMID = 11923610.001).
  • [ISSN] 0003-4932
  • [Journal-full-title] Annals of surgery
  • [ISO-abbreviation] Ann. Surg.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Other-IDs] NLM/ PMC1422469
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17. Shibata K, Matsumoto T, Yada K, Sasaki A, Ohta M, Kitano S: Factors predicting recurrence after resection of pancreatic ductal carcinoma. Pancreas; 2005 Jul;31(1):69-73
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Clinicopathologic factors were evaluated for tumor recurrences by univariate and multivariate analyses.
  • RESULTS: Mean survival time and actuarial 5-year disease-specific survival were significantly lower in cases of hepatic metastasis (13 months, 0%) and in cases of peritoneal carcinomatosis (15 months, 6.8%) than in cases of local retroperitoneal recurrence (30 months, 21%).
  • Univariate and logistic regression analyses showed undifferentiated adenocarcinoma to be independently associated with hepatic metastasis (odds ratio, 7.4; 95% confidence interval, 1.5-37.0) and invasion of the portal vein to be independently associated with peritoneal carcinomatosis (odds ratio, 4.0; 95% confidence interval, 1.2-12.8).
  • Multivariate analysis showed undifferentiated adenocarcinoma, invasion of the anterior capsule, and invasion of the portal vein to be independent prognostic factors.
  • CONCLUSION: Undifferentiated adenocarcinoma and invasion of the portal vein are predictors of poor outcome and are related to hepatic metastasis and peritoneal carcinomatosis, respectively.
  • Postoperative adjuvant chemotherapy, including intra-arterial chemotherapy, should be selected according to prediction of the patterns of recurrence.
  • [MeSH-minor] Aged. Aged, 80 and over. Cohort Studies. Female. Humans. Liver Neoplasms / secondary. Male. Middle Aged. Neoplasm Invasiveness. Portal Vein / pathology. Retrospective Studies. Survival Rate

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  • (PMID = 15968250.001).
  • [ISSN] 1536-4828
  • [Journal-full-title] Pancreas
  • [ISO-abbreviation] Pancreas
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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18. Tashima R, Beppu T, Nakagawa M, Ishiko T, Sugiyama S, Suyama K, Masuda T, Hirota M, Kanemitsu K, Okabe K, Yamanaka T, Sasaki Y, Baba H: [A long-term survival of the patient with hepatocellular carcinoma and advanced portal vein and bile duct tumor thrombosis successfully treated with multimodal treatments]. Gan To Kagaku Ryoho; 2005 Oct;32(11):1805-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [A long-term survival of the patient with hepatocellular carcinoma and advanced portal vein and bile duct tumor thrombosis successfully treated with multimodal treatments].
  • We reported a 60-year-old male patient with hepatocellular carcinoma (HCC) of 5cm in diameter with advanced tumor thrombosis in the left main trunk of portal vein and bile duct.
  • He was treated with multimodal treatments resulting in a long-term survival of more than 4 years.
  • At first, he was treated with transcatheter arterial chemoembolization (TACE) in April 1999, but the therapeutic effect was insufficient.
  • Therefore, we performed an extended left hepatic lobectomy in July.
  • Since six HCCs appeared in a posterior segment in January 2000, we achieved microwave coagulation therapy under laparotomy.
  • Because of diffuse relapse of HCCs in the same segment of the liver, we performed hepatic arterial chemotherapy (HAC) using low-dose CDDP and 5-FU.
  • Since a recurrent tumor was detected at the same therapeutic site with invasion to the diaphragm in September 2002, we performed a partial liver resection with synchronous excision of the diaphragm.
  • We continued TACE and systemic chemotherapy for relapses in and out of the liver.
  • We conclude that a long-term survival in this patient can be attributable to appropriate treatment selections and timing, such as hepatic resection, TACE, HAC and ablation therapies based on changes in diagnostic imaging and tumor markers.
  • In addition, we have to pay attention to keep good hepatic reserve in order to continue treatment for recurrences of HCC.
  • [MeSH-major] Bile Ducts / pathology. Carcinoma, Hepatocellular / therapy. Liver Neoplasms / therapy. Neoplastic Cells, Circulating / pathology. Portal Vein / pathology
  • [MeSH-minor] Biomarkers, Tumor / blood. Catheter Ablation. Chemoembolization, Therapeutic. Combined Modality Therapy. Hepatectomy. Humans. Male. Middle Aged. Reoperation


19. Ikeda K: [Current therapy for hepatocellular carcinoma]. Nihon Rinsho; 2010 Jun;68(6):1129-36
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [Current therapy for hepatocellular carcinoma].
  • Multimodality treatment is applied according to varied stages of hepatocellular carcinoma(HCC), and to varied status of liver function.
  • Surgical resection is regarded as the most radical way of therapy for an early stage of HCC (single large tumor, or small tumor of 3cm or less with 3 nodules or less).
  • Among percutaneous local ablation therapies, radiofrequency ablation is the most effective from the viewpoint of local recurrence and survival rate.
  • Sufficient evidence of the efficacy of chemotherapy is still lacking for advanced stages of HCC with or without portal vein invasion.
  • [MeSH-major] Carcinoma, Hepatocellular / therapy. Liver Neoplasms / therapy
  • [MeSH-minor] Benzenesulfonates / therapeutic use. Catheter Ablation. Combined Modality Therapy. Embolization, Therapeutic / methods. Hepatic Artery. Humans. Neoplasm Recurrence, Local. Neoplasm Staging. Niacinamide / analogs & derivatives. Phenylurea Compounds. Protein Kinase Inhibitors / therapeutic use. Pyridines / therapeutic use

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  • (PMID = 20535967.001).
  • [ISSN] 0047-1852
  • [Journal-full-title] Nihon rinsho. Japanese journal of clinical medicine
  • [ISO-abbreviation] Nippon Rinsho
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Benzenesulfonates; 0 / Phenylurea Compounds; 0 / Protein Kinase Inhibitors; 0 / Pyridines; 25X51I8RD4 / Niacinamide; 9ZOQ3TZI87 / sorafenib
  • [Number-of-references] 33
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20. Caudry M, Ratoanina JL, Escarmant P, Maire JP: [Target volume in radiotherapy of gastric adenocarcinoma]. Cancer Radiother; 2001 Oct;5(5):523-33
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Transliterated title] Les volumes-cibles de la radiothérapie des adénocarcinomes gastriques.
  • A GTV should be considered in preoperative or exclusive radiation therapy.
  • a) A "tumor bed" volume.
  • The risk depends upon the depth of parietal invasion and the nodal status.
  • Parietal infiltration may extend beyond macroscopic limits of the tumor, especially in "linitis plastica".
  • Therefore this volume will include: the tumor and the remaining stomach or their "bed of resection", a part of the transverse colon, the duodenum, the pancreas and the truncus of the portal vein.
  • (1) contiguous microscopic extension from deeply invasive T3 and T4 tumors, that remain amenable to local sterilization with doses of 45-50 Gy, delivered in a CTV including the peritoneal cavity at the level of the gastric bed, and under the parietal incision;.
  • (2) true "peritoneal carcinomatosis", with widespread seeds, where chemotherapy (systemic or intraperitoneal) is more appropriate.
  • This volume must encompass the hepatic pedicle and the splenic hilum.
  • In distal and proximal tumors, involvement of resection margins is of poor prognosis--a radiation boost must be delivered at this level.
  • In tumors invading the distal esophagus, a more complete coverage of mediastinal lymph nodes should be considered, especially in patients in good general condition.
  • In proximal tumors without involvement of the lesser curvature, a full coverage of the hepatic pedicle is not necessary.
  • In contrast, for distal tumors, the hepatic pedicle and the hepatoduodenal ligament should be included whereas the splenic area could be spared.
  • CONCLUSION: Planning the treatment of gastric cancer remains difficult; target volumes must be customized by experienced radiation oncologists according to tumoral and clinical situation.

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  • (PMID = 11715304.001).
  • [ISSN] 1278-3218
  • [Journal-full-title] Cancer radiothérapie : journal de la Société française de radiothérapie oncologique
  • [ISO-abbreviation] Cancer Radiother
  • [Language] fre
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] France
  • [Number-of-references] 65
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