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1. Tsukada K, Takada T, Miyazaki M, Miyakawa S, Nagino M, Kondo S, Furuse J, Saito H, Tsuyuguchi T, Kimura F, Yoshitomi H, Nozawa S, Yoshida M, Wada K, Amano H, Miura F, Japanese Association of Biliary Surgery, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Japan Society of Clinical Oncology: Diagnosis of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg; 2008;15(1):31-40

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Diagnosis of biliary tract and ampullary carcinomas.
  • Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed.
  • Neither definite methods for early diagnosis nor specific markers are available in this disease.
  • When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out.
  • Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice.
  • Although rare, abdominal pain and pyrexia, as well as abnormal findings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases.
  • On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure difficult.
  • Multidetector computed tomography (MDCT), in particular--one of the methods of enhanced CT--is useful for decision of surgical criteria, because MDCT shows findings such as localization and extension of the tumor, and the presence or absence of remote metastasis.
  • Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients.
  • However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer.
  • [MeSH-major] Ampulla of Vater. Biliary Tract Neoplasms / diagnosis. Carcinoma / diagnosis
  • [MeSH-minor] Endoscopy, Digestive System. Evidence-Based Medicine / methods. Humans. Magnetic Resonance Imaging / methods. Tomography, X-Ray Computed / methods. Ultrasonography / methods

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  • (PMID = 18274842.001).
  • [ISSN] 0944-1166
  • [Journal-full-title] Journal of hepato-biliary-pancreatic surgery
  • [ISO-abbreviation] J Hepatobiliary Pancreat Surg
  • [Language] eng
  • [Publication-type] Journal Article; Practice Guideline; Research Support, Non-U.S. Gov't
  • [Publication-country] Japan
  • [Other-IDs] NLM/ PMC2794353
  • [Investigator] Kai M; Kimura Y; Sawada S; Shimizu H; Nakagawara H; Nakachi K; Yoshitome H; Saisyo H; Ryu M; Shikata S; Nimura Y
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2. Saisho T, Okusaka T, Ueno H, Morizane C, Okada S: Prognostic factors in patients with advanced biliary tract cancer receiving chemotherapy. Hepatogastroenterology; 2005 Nov-Dec;52(66):1654-8
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  • [Title] Prognostic factors in patients with advanced biliary tract cancer receiving chemotherapy.
  • BACKGROUND/AIMS: Prognostic factors in patients with advanced biliary tract cancer receiving chemotherapy have not been fully examined.
  • This study investigated prognostic factors in patients with advanced biliary tract cancer receiving chemotherapy.
  • METHODOLOGY: Sixty-five consecutive chemo-naive patients with advanced biliary tract cancer, who received chemotherapy, were analyzed retrospectively to investigate prognostic factors.
  • RESULTS: Median survival time and overall survival rates at 1 and 2 years were 180 days, 21%, and 5%, respectively.
  • The median survival times for these three groups were 246, 152, and 33 days, respectively.
  • CONCLUSIONS: The results may be helpful for predicting life expectancy, determining treatment strategies, and designing future clinical trials in patients with advanced biliary tract cancer.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biliary Tract Neoplasms / drug therapy. Biliary Tract Neoplasms / mortality. Biomarkers, Tumor / analysis. Cause of Death. Palliative Care
  • [MeSH-minor] Adult. Age Factors. Aged. Analysis of Variance. Biopsy, Needle. Dose-Response Relationship, Drug. Drug Administration Schedule. Female. Humans. Immunohistochemistry. Liver Function Tests. Male. Middle Aged. Multivariate Analysis. Neoplasm Staging. Probability. Prognosis. Proportional Hazards Models. Retrospective Studies. Risk Assessment. Sex Factors. Survival Analysis

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  • (PMID = 16334750.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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3. Kasuya K, Shimazu M, Suzuki M, Kuroiwa Y, Usuda J, Itoi T, Tsuchida A, Aoki T: Novel photodynamic therapy against biliary tract carcinoma using mono-L: -aspartyl chlorine e6: basic evaluation for its feasibility and efficacy. J Hepatobiliary Pancreat Sci; 2010 May;17(3):313-21

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  • [Title] Novel photodynamic therapy against biliary tract carcinoma using mono-L: -aspartyl chlorine e6: basic evaluation for its feasibility and efficacy.
  • BACKGROUND: Recently, a second-generation photosensory agent for photodynamic therapy (PDT), mono-L: -aspartyl chlorine e6 (NPe6), which degrades rapidly in vivo, has been developed.
  • We evaluated its feasibility and efficacy for treatment in biliary tract carcinoma.
  • METHODS: A transmittance of semiconductor laser light (664 nm), sensitivity of a human biliary tract carcinoma cell line, and disorder to normal tissue including Glissonian constructs and adjacent hepatocytes were investigated.
  • RESULTS: The transmittance of the laser was 85-91% through yellow clear bile and that of the bile including 50 microg/ml NPe6 was 17-48%.
  • The NOZ cell-tumor volume was reduced significantly 14 days after irradiation in the PDT group (PDT 69.9 +/- 44.6 mm(3) vs control 296.3 +/- 239.9 mm(3) P < 0.05).
  • No severe hepatic disorder including Glisson components was observed by the histological findings.
  • CONCLUSION: NPe6 PDT was effective in carcinomas even in the presence of bile, and causes no serious complication for the liver and Glisson structure.
  • Therefore, NPe6 PDT will be a useful candidate as a new therapy for biliary tract carcinomas.
  • [MeSH-major] Biliary Tract Neoplasms / drug therapy. Photochemotherapy / methods. Photosensitizing Agents / therapeutic use. Porphyrins / therapeutic use
  • [MeSH-minor] Cell Line, Tumor. Dose-Response Relationship, Drug. Feasibility Studies. Gallbladder Neoplasms / drug therapy. Hepatocytes / drug effects. Humans. Lethal Dose 50

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  • (PMID = 20464561.001).
  • [ISSN] 1868-6982
  • [Journal-full-title] Journal of hepato-biliary-pancreatic sciences
  • [ISO-abbreviation] J Hepatobiliary Pancreat Sci
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Photosensitizing Agents; 0 / Porphyrins; P4ROX5ELT2 / Talaporfin
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4. Mastoraki A, Papanikolaou IS, Konstandiadou I, Sakorafas G, Safioleas M: Facing the challenge of treating gallbladder carcinoma. Review of the literature. Hepatogastroenterology; 2010 Mar-Apr;57(98):215-9
MedlinePlus Health Information. consumer health - Gallbladder Cancer.

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  • Gallbladder carcinoma (GBC) remains the most common biliary tract malignancy and is characterized as an aggressive and highly lethal disease.
  • There is also a wide discrepancy among sources regarding the epidemiology of the tumor.
  • Despite recent research on the therapeutic strategies against gallbladder neoplastic disorders, surgical resection appears the only potentially curative approach.
  • In addition, surgical removal of gallbladder tumor does not necessarily guarantee patient's long-term recovery.
  • Alternative therapies, such as radio and chemotherapy proved insufficient.
  • The aim of this review was to evaluate the results of surgical treatment for GBC with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease.
  • [MeSH-major] Gallbladder Neoplasms / surgery
  • [MeSH-minor] Humans. Neoplasm Staging. Prognosis

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  • (PMID = 20583415.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Greece
  • [Number-of-references] 34
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5. Kaiho T, Tanaka T, Tsuchiya S, Yanagisawa S, Takeuchi O, Miura M, Saigusa N, Hayasaka A, Matsuzaki O, Miyazaki M: A case of small cell carcinoma of the common bile duct. Hepatogastroenterology; 2005 Mar-Apr;52(62):363-7
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  • [Title] A case of small cell carcinoma of the common bile duct.
  • Small cell carcinoma occasionally occurs in the gastrointestinal tract, but rarely in the biliary tract.
  • We report a case of small cell carcinoma which occurred in the common bile duct.
  • Computed tomography and ultrasonography showed a mass near the pancreas head and dilatation of the intrahepatic bile ducts.
  • Endoscopic nasobiliary drainage was undertaken, and it revealed obstruction of the common bile duct.
  • The patient was diagnosed preoperatively as having extrahepatic bile duct cancer.
  • Upon laparotomy, a tumor was found to be located in the middle common bile duct.
  • The main trunk of the portal vein and the right hepatic artery were resected concomitantly because of tumor involvement.
  • Postoperative pathological examination revealed well-differentiated papillary adenocarcinoma on the surface of the bile duct lumen, but a large part of the extraductal component was small cell carcinoma.
  • The patient then underwent two postoperative courses of systemic chemotherapy.
  • Nevertheless, she died of cancer recurrence eight months after the operation, which showed that the tumor had a highly lethal nature, with rapid and widespread dissemination.
  • Further therapeutic trials are needed to improve survival in such cases.
  • [MeSH-major] Bile Duct Neoplasms / diagnosis. Carcinoma, Small Cell / diagnosis. Common Bile Duct
  • [MeSH-minor] Aged. Chemotherapy, Adjuvant. Cholangiopancreatography, Magnetic Resonance. Fatal Outcome. Female. Humans. Neoplasm Recurrence, Local. Pancreaticoduodenectomy / methods. Tomography, X-Ray Computed. Ultrasonography

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  • (PMID = 15816436.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Greece
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6. Huang SF, Ko CW, Chang CS, Chen GH: Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor. Hepatogastroenterology; 2003 Jul-Aug;50(52):1115-8
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  • [Title] Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor.
  • BACKGROUND/AIMS: To study and review the clinical manifestations, microbiology, comorbidity, and diagnosis of liver abscess after transarterial chemoembolization for malignant hepatic tumor.
  • METHODOLOGY: We retrospectively reviewed 1374 patients who underwent 2581 transarterial chemoembolization procedures due to malignant hepatic tumors over an 8-year period.
  • All the patients had hyperechoic spots with reverberative shadows on sonograms or low attenuation areas with different Hounsfield units on computed tomography scan, which expressed the 100% incidence (7 of 7) of gas-forming abscesses.
  • No patients died of liver abscess after aspiration, drainage, or debridement of abscess combined with parenteral antibiotic treatment.
  • Biliary tract diseases, found in 4 patients, were the most common comorbidity.
  • CONCLUSIONS: Liver abscess after transarterial chemoembolization is a very rare complication, which usually develops in patients with biliary tract disease.
  • However, the prognosis is good after adequate clearance of pus and antibiotic treatment.
  • [MeSH-major] Carcinoma, Hepatocellular / drug therapy. Chemoembolization, Therapeutic / adverse effects. Liver Abscess / etiology. Liver Neoplasms / drug therapy
  • [MeSH-minor] Biliary Tract Diseases / epidemiology. Common Bile Duct / pathology. Comorbidity. Drainage. Female. Humans. Male. Middle Aged. Neoplasm Invasiveness. Prognosis. Retrospective Studies

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  • (PMID = 12845993.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Greece
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7. Melichar B, Cerman J Jr, Dvorák J, Jandík P, Mergancová J, Melicharová K, Tousková M, Krajina A, Voboril Z: Regional chemotherapy in biliary tract cancers--a single institution experience. Hepatogastroenterology; 2002 Jul-Aug;49(46):900-6
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  • [Title] Regional chemotherapy in biliary tract cancers--a single institution experience.
  • BACKGROUND/AIMS: The prognosis of biliary tract cancers is poor.
  • The aim of the present report was to analyze retrospectively the effectiveness of regional chemotherapy in patients with biliary tract cancers treated at a single institution.
  • METHODOLOGY: Thirty-two patients with biliary tract cancers, 17 patients with cholangiocarcinoma and 15 patients with gallbladder carcinoma, were treated by regional administration of the chemotherapy, usually the combination of 5-fluorouracil, cisplatin and folinic acid.
  • Eighteen patients with inoperable tumors received no surgical treatment, 10 patients were treated by palliative resection (cohort B), and 4 patients received radical surgery (cohort C).
  • One out of 12 patients (8%) in cohort A and 1 out of 10 patients (10%) in cohort B survived more than 5 years.
  • After intraarterial chemotherapy, a significant increase was observed in the absolute numbers of CD3+, CD3+CD8+ and CD8+CD28+ lymphocytes, as well as an increase in CD3+CD4+ and natural killer lymphocytes.
  • CONCLUSIONS: Regional chemotherapy is active in controlling the disease, and seems to result in prolongation of survival in patients with biliary tract cancer.
  • Administration of regional chemotherapy is also associated with a rise of circulating lymphocyte numbers.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biliary Tract Neoplasms / drug therapy. Cholangiocarcinoma / drug therapy. Infusions, Intra-Arterial
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Cisplatin / administration & dosage. Cohort Studies. Combined Modality Therapy. Czech Republic. Female. Fluorouracil / administration & dosage. Follow-Up Studies. Humans. Leucovorin. Lymphocyte Count. Male. Middle Aged. Palliative Care. Retrospective Studies. Survival Analysis

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  • (PMID = 12143237.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin; Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil
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8. Morine Y, Shimada M, Ikegami T, Imura S, Kanemura H, Arakawa Y, Hanaoka J, Kanamoto M, Nii A: Usefulness of gemcitabine combined with 5-fluorouracil and cisplatin (GFP) in patients for unresectable biliary carcinoma. Hepatogastroenterology; 2009 Mar-Apr;56(90):307-12
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Usefulness of gemcitabine combined with 5-fluorouracil and cisplatin (GFP) in patients for unresectable biliary carcinoma.
  • BACKGROUND/AIMS: Advanced biliary carcinoma have poor prognosis and chemotherapy has been shown to have little impact.
  • The aim of the present study is to clarify the effectiveness of GEM combined with CDDP and 5FU (GFP) therapy for unresectable biliary carcinoma.
  • METHODOLOGY: Fourteen patients with biliary carcinoma (4 patients; gallbladder cancer, 10 patients; biliary tract) who had no prior chemotherapy were enrolled.
  • A triple combination of agents was administered with a 4-week cycle GFP chemotherapy consisting of GEM at 1000 mg/m2 on days 1 and of 5-FU at 250 mg/m2 and CDDP at 3mg/m2 on days 1 to 5.
  • RESULTS: No patient achieved CR, while five patients achieved PR as assessed by RECIST.
  • Stable disease was observed in 9 (64.3%) patients.
  • According to the tumor site, overall response rate was 20.0% in biliary tract carcinoma, on the other hand, 25.0% in gallbladder carcinoma.
  • CONCLUSIONS: The significant antitumor activity of GFP chemotherapy has been seen in patients with advanced biliary carcinoma.
  • However, further evaluation in large numbers of patients is needed to determine the difference in chemosensitivity according to the tumor site.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bile Duct Neoplasms / drug therapy. Gallbladder Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Chi-Square Distribution. Cisplatin / administration & dosage. Cisplatin / adverse effects. Deoxycytidine / administration & dosage. Deoxycytidine / adverse effects. Deoxycytidine / analogs & derivatives. Female. Fluorouracil / administration & dosage. Fluorouracil / adverse effects. Humans. Male. Middle Aged. Statistics, Nonparametric. Survival Rate. Treatment Outcome

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  • (PMID = 19579588.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Greece
  • [Chemical-registry-number] 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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9. Kimura Y, Arai K, Iwasaki Y, Takahashi K, Yamaguchi T, Takahashi T: [A case of intrahepatic bile duct necrosis following hepatic arterial infusion chemotherapy]. Gan To Kagaku Ryoho; 2002 Nov;29(12):2071-3
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  • [Title] [A case of intrahepatic bile duct necrosis following hepatic arterial infusion chemotherapy].
  • A 51-year-old man underwent partial hepatectomy in July 2000 for metastatic liver tumor after gastrectomy for gastric cancer.
  • His body temperature sometimes rose above 38 degrees C in June and jaundice appeared in August 2001.
  • Based on an enhanced CT scan of the liver showing a low-density area along intrahepatic biliary tracts and hepatic arteriography showing stenosis of the proper hepatic artery, we diagnosed bile duct necrosis and hepatic necrosis.
  • Bile duct necrosis is a serious complication in arterial infusion chemotherapy, and the infusion chemotherapy should be suspended or the dose should be reduced for patients with abnormalities shown by hepato-biliary function tests.
  • [MeSH-major] Antibiotics, Antineoplastic / administration & dosage. Bile Ducts, Intrahepatic / pathology. Infusions, Intra-Arterial / adverse effects
  • [MeSH-minor] Alkaline Phosphatase / blood. Humans. Liver Neoplasms / drug therapy. Liver Neoplasms / secondary. Male. Middle Aged. Mitomycin / administration & dosage. Mitomycin / adverse effects. Necrosis. gamma-Glutamyltransferase / blood

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  • (PMID = 12484005.001).
  • [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] 0 / Antibiotics, Antineoplastic; 50SG953SK6 / Mitomycin; EC 2.3.2.2 / gamma-Glutamyltransferase; EC 3.1.3.1 / Alkaline Phosphatase
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10. Aldrighetti L, Arru M, Ronzoni M, Salvioni M, Villa E, Ferla G: Extrahepatic biliary stenoses after hepatic arterial infusion (HAI) of floxuridine (FUdR) for liver metastases from colorectal cancer. Hepatogastroenterology; 2001 Sep-Oct;48(41):1302-7
Hazardous Substances Data Bank. FLOXURIDINE .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Extrahepatic biliary stenoses after hepatic arterial infusion (HAI) of floxuridine (FUdR) for liver metastases from colorectal cancer.
  • Hepatic arterial infusion of floxuridine is an effective treatment for unresectable hepatic metastases from colorectal cancer.
  • Despite its pharmacological advantage of higher tumor drug concentration with minimal systemic toxicity, hepatic arterial infusion of floxuridine is characterized by regional toxicity, including hepatobiliary damage resembling idiopathic sclerosing cholangitis (5-29% of treated cases).
  • Unlike previous reports describing biliary damage of both intrahepatic and extrahepatic ducts, a case series of extrahepatic biliary stenosis after hepatic arterial infusion with floxuridine is herein described.
  • Between September 1993 and February 1999, 54 patients received intraarterial hepatic chemotherapy based on continuous infusion of floxuridine (dose escalation 0.15-0.30 mg/kg/day for 14 days every 28 days) plus dexamethasone 28 mg.
  • Five patients (9.2%) developed biliary toxicity with jaundice and cholangitis (3 cases), alterations of liver function tests and radiological features of biliary tract abnormalities.
  • They received from 9 to 19 cycles (mean 14.5 +/- 6.3 cycles) of floxuridine infusion with a total drug delivered dose ranging from 20.3 to 41.02 mg/kg (mean: 31.4 +/- 13.5 mg/kg).
  • Extrahepatic biliary sclerosis was discovered by computed tomography scan and ultrasound, followed by endoscopic retrograde cholangiopancreatography and/or percutaneous cholangiography in 3 cases.
  • Radiological findings included common hepatic duct complete obstruction in 1 case, common hepatic duct stenosis in 2 cases, common bile duct obstruction in 1 case, and intrahepatic bile ducts dilation without a well-recognized obstruction in 1 case.
  • Two patients were treated by sequentially percutaneous biliary drainage and balloon dilation while 1 patient had an endoscopic transpapillary biliary prosthesis placed.
  • The present series suggests that in some patients receiving hepatic arterial infusion of floxuridine extrahepatic biliary stenosis may represent the primary event leading to a secondary intrahepatic biliary damage that does not correlate with specific floxuridine toxicity but results from bile stasis and infection, recurrent cholangitis and eventually biliary sclerosis.
  • Aggressive research for extrahepatic biliary sclerosis is advised, since an early nonsurgical treatment of extrahepatic biliary stenosis may prevent an irreversible intrahepatic biliary sclerosis worsening the prognosis of metastatic liver disease.
  • [MeSH-major] Adenocarcinoma / secondary. Cholestasis, Extrahepatic / chemically induced. Colorectal Neoplasms / drug therapy. Floxuridine / adverse effects. Infusions, Intra-Arterial. Liver Neoplasms / secondary
  • [MeSH-minor] Aged. Cholangiography. Cholangitis, Sclerosing / chemically induced. Cholangitis, Sclerosing / diagnosis. Cholangitis, Sclerosing / therapy. Dose-Response Relationship, Drug. Female. Follow-Up Studies. Humans. Liver Function Tests. Male. Middle Aged. Stents


11. Lee DK: Drug-eluting stent in malignant biliary obstruction. J Hepatobiliary Pancreat Surg; 2009;16(5):628-32
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  • [Title] Drug-eluting stent in malignant biliary obstruction.
  • INTRODUCTION: In unresectable malignant bile duct obstruction, endoscopic stent insertion is the treatment of choice.
  • However, the current stent allows only mechanical palliation of the obstruction, and has no anti-tumor effect.
  • Currently, in the vascular field, the drug-eluting stent (DES) is very highly favored.
  • MATERIAL AND METHODS: The requirements for a DES in a non-vascular tract, such as the bile duct, are far different from those of a DES to be used in the vascular tract.
  • The non-vascular DES must suppress tumor proliferation as well as mucosal hyperplasia.
  • For example, the non-vascular stent might be covered with a membrane that gradually releases a chemo-agent.
  • We do not have much experience with DES in the bile duct.
  • Nonetheless, we are continuously testing many anti-tumor agents in animal and human studies.
  • CONCLUSION: We expect and hope DES will work effectively for tumor cells in diverse ways and, more importantly, will prolong stent patency and the patients' survival periods.
  • But considerable investigation and a clinical study of DES will be required to achieve these goals.
  • [MeSH-major] Bile Duct Neoplasms / therapy. Cholestasis / pathology. Cholestasis / therapy. Drug-Eluting Stents
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Catheterization / instrumentation. Endoscopy, Digestive System / methods. Female. Humans. Male. Prognosis. Risk Assessment. Treatment Outcome

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  • (PMID = 19554255.001).
  • [ISSN] 1436-0691
  • [Journal-full-title] Journal of hepato-biliary-pancreatic surgery
  • [ISO-abbreviation] J Hepatobiliary Pancreat Surg
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 24
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12. Tan MC, Linehan DC, Hawkins WG, Siegel BA, Strasberg SM: Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathologic response. J Gastrointest Surg; 2007 Sep;11(9):1112-9
Hazardous Substances Data Bank. LEUCOVORIN .

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  • [Title] Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathologic response.
  • These have been associated with normalization of [(18)F]fluoro-2-deoxy-D-glucose (FDG) uptake (complete metabolic response) on follow-up Positron Emission Tomography with [(18)F]fluoro-2-deoxy-D-glucose (FDG-PET) scans in some patients.
  • It is unclear how often complete metabolic response is indicative of complete tumor destruction.
  • We analyzed a subset of patients who had neoadjuvant chemotherapy for hepatic metastases from colorectal adenocarcinoma.
  • (1) FDG-avid hepatic lesions before initiation of chemotherapy;.
  • (2) complete metabolic response of the same lesions after chemotherapy; and (3) histopathologic examination of hepatic lesions.
  • Complete pathologic response was defined as no histologically identifiable viable tumor.
  • Seven lesions had complete metabolic response and disappeared on computed tomography (CT); of these, six still contained viable tumor.
  • We conclude that complete metabolic response on FDG-PET after neoadjuvant chemotherapy is an unreliable indicator of complete pathologic response.
  • Therefore, currently, curative resection of liver metastases in these patients should not be deferred on the basis of FDG-PET findings.
  • [MeSH-major] Liver Neoplasms / diagnostic imaging. Liver Neoplasms / drug therapy. Positron-Emission Tomography
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Angiogenesis Inhibitors / therapeutic use. Antibodies, Monoclonal / therapeutic use. Antibodies, Monoclonal, Humanized. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bevacizumab. Chemotherapy, Adjuvant. Colorectal Neoplasms / pathology. Drug Therapy, Combination. Female. Fluorouracil / therapeutic use. Glucose-6-Phosphate / analogs & derivatives. Humans. Leucovorin / therapeutic use. Male. Middle Aged. Neoadjuvant Therapy. Organoplatinum Compounds / therapeutic use. Treatment Outcome

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  • (PMID = 17623263.001).
  • [ISSN] 1091-255X
  • [Journal-full-title] Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
  • [ISO-abbreviation] J. Gastrointest. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Angiogenesis Inhibitors; 0 / Antibodies, Monoclonal; 0 / Antibodies, Monoclonal, Humanized; 0 / Organoplatinum Compounds; 2S9ZZM9Q9V / Bevacizumab; 40871-47-4 / 2-fluoro-2-deoxyglucose-6-phosphate; 56-73-5 / Glucose-6-Phosphate; Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil; Folfox protocol
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13. Nuzzo G, Giuliante F, Ardito F, Vellone M, Pozzo C, Cassano A, Giovannini I, Barone C: Liver resection for primarily unresectable colorectal metastases downsized by chemotherapy. J Gastrointest Surg; 2007 Mar;11(3):318-24
Hazardous Substances Data Bank. LEUCOVORIN .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Liver resection for primarily unresectable colorectal metastases downsized by chemotherapy.
  • This study was performed prospectively to assess the effect of systemic chemotherapy (FOLFIRI protocol) in patients with initially unresectable colorectal liver metastases (CRLM) and, after performing liver resection in patients with downsized metastases, to compare the postoperative and long-term results with those of patients with primarily resectable CRLM.
  • Records from a prospective database including all consecutive admissions for CRLM between June 2000 and June 2004 were reviewed.
  • The analysis addressed all patients who underwent hepatectomy for primarily resectable CRLM (Group A), or underwent chemotherapy for primarily unresectable CRLM and among these, particularly the patients who were finally resected after downsizing of CRLM (Group B).
  • Forty-two other patients underwent chemotherapy; after an average of nine courses, 18 of them (42.8%) with significantly downsized lesions were explored and 15 (35.7%, Group B) were resected, whereas three had peritoneal metastases.
  • Group B differed from Group A for a significantly higher rate of synchronous CRLM upon diagnosis of colorectal cancer, a larger size of CRLM upon evaluation in our center, and a lower rate of major hepatectomies (20.0% vs. 51.6 %) at surgery.
  • ), disease-free survival rate was 31% vs. 58% (p = 0.04) and, at a median follow-up of 34 months, tumor recurrence rate was 53.3% vs. 28.3% (n.s.).
  • These results show that in about one-third of the patients with primarily unresectable CRLM, downsizing of the lesions by chemotherapy (FOLFIRI protocol) permitted a subsequent curative resection.
  • In these patients, operative risk and survival did not differ from the figures observed in primarily resectable patients and, in spite of a lower disease-free survival with more frequent recurrence, re-resection still represented a valid option to continue treatment.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Colorectal Neoplasms / pathology. Hepatectomy. Liver Neoplasms / drug therapy. Liver Neoplasms / secondary
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Camptothecin / analogs & derivatives. Camptothecin / therapeutic use. Combined Modality Therapy. Female. Fluorouracil / therapeutic use. Humans. Leucovorin / therapeutic use. Male. Middle Aged. Postoperative Complications

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  • (PMID = 17458605.001).
  • [ISSN] 1091-255X
  • [Journal-full-title] Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
  • [ISO-abbreviation] J. Gastrointest. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil; XT3Z54Z28A / Camptothecin; IFL protocol
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14. Fiorentini G, Giovanis P, Leoni M, De Giorgi U, Cariello A, Dazzi C, Caldeo A: Amifostine (Ethyol) as modulator of hepatic and biliary toxicity from intraarterial hepatic chemoembolization: results of a phase I study. Hepatogastroenterology; 2001 Mar-Apr;48(38):313-6
Hazardous Substances Data Bank. AMIFOSTINE .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Amifostine (Ethyol) as modulator of hepatic and biliary toxicity from intraarterial hepatic chemoembolization: results of a phase I study.
  • BACKGROUND/AIMS: Hepatic and biliary toxicity are still significant problems after intraarterial hepatic chemoembolization for liver metastases from large bowel cancers.
  • In about 30-60% of the patients hepatic and biliary toxicity are the limiting aspects of intraarterial hepatic chemoembolization and exclude a lot of patients from a repeated beneficial treatment.
  • Amifostine (Ethyol) is a prodrug that must be dephosphorylated to the free thiol in which form it can detoxify free oxygen radicals generated by radiation, hypoxia and by drugs such anthracyclines, platinum analogues and alkylating agents.
  • Amifostine as inactive prodrug is primarily metabolized at the tissue site by membrane alkaline phosphatase, which is highly active in the cell membranes of normal endothelial cells and biliary tree cells but not in the cell membranes and neovascular capillaries of tumor.
  • The resulting high thiol content in normal liver tissue (biliary cells and hepatocytes) compared with the negligible concentration in liver metastases from large bowel cancers probably provides for selective drug resistance to intraarterial hepatic chemoembolization protecting normal tissue and allowing full therapeutic effect on tumor.
  • CONCLUSIONS: Amifostine can be certainly administered at 300 mg/m2 as intraarterial infusion and could be a significant step to ameliorate the therapeutic ratio of intraarterial hepatic chemoembolization.
  • [MeSH-major] Amifostine / administration & dosage. Biliary Tract / drug effects. Chemoembolization, Therapeutic / adverse effects. Liver / drug effects. Liver Neoplasms / therapy. Prodrugs / administration & dosage. Radiation-Protective Agents / administration & dosage
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Female. Humans. Infusions, Intra-Arterial. Intestinal Neoplasms / pathology. Male. Middle Aged

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  • (PMID = 11379297.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase I; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Prodrugs; 0 / Radiation-Protective Agents; M487QF2F4V / Amifostine
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15. Isayama H: Current topics in pancreato-biliary endotherapy: what can we do? J Hepatobiliary Pancreat Surg; 2009;16(5):589-91
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  • [Title] Current topics in pancreato-biliary endotherapy: what can we do?
  • INTRODUCTION: Endotherapy is progressing steadily, especially for various pancreato-biliary diseases.
  • This article introduced new procedures and devices, and revealed improvement of treatment outcomes.
  • MATERIALS AND METHODS: Biliary covered metallic stent (CMS) has developed, and the indication of CMS placement is changing because of its removability.
  • CMS is effective not only for unresectable biliary malignancies but also for resectable tumors, benign biliary strictures, and benign pancreatic strictures.
  • Drug-eluting CMS can be used as anti-tumor agents.
  • Interventional endoscopic ultrasonography (EUS) has shifted the treatment paradigm because it is possible to approach lesions through the digestive tract wall.
  • The diagnosis and treatment of pancreatic cancer using interventional EUS technique are effective, feasible, and promising.
  • Recently, trans-gastric necrosectomy for an infected pseudocyst was reported as an alternative treatment to surgery.
  • Double- and single-balloon enteroscopy will be performed more frequently to treat the pancreato-biliary disorders in the patients with altered anatomy.
  • Endoscopic papillary large balloon dilation (EPLBD), new procedure to the papilla, can treat large bile duct stones effectively without lithotripsy.
  • These procedures are of very great interest because they alter the treatment algorithms for many pancreato-biliary diseases.
  • [MeSH-major] Biliary Tract Diseases / therapy. Biliary Tract Diseases / ultrasonography. Endoscopy, Digestive System / methods. Pancreatic Diseases / therapy. Pancreatic Diseases / ultrasonography
  • [MeSH-minor] Catheterization / methods. Cholangiopancreatography, Endoscopic Retrograde / methods. Cholangiopancreatography, Endoscopic Retrograde / trends. Endosonography / methods. Endosonography / trends. Female. Forecasting. Humans. Male. Risk Assessment. Stents. Treatment Outcome. Ultrasonography, Interventional

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  • (PMID = 19543686.001).
  • [ISSN] 1436-0691
  • [Journal-full-title] Journal of hepato-biliary-pancreatic surgery
  • [ISO-abbreviation] J Hepatobiliary Pancreat Surg
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Japan
  • [Number-of-references] 27
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