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Carrión L, Clemente-Sánchez A, Márquez-Pérez L, Orcajo-Rincón J, Rotger A, Ramón-Botella E, González-Leyte M, Echenagusía-Boyra M, Luis Colón A, Reguera-Berenguer L, Bañares R, Rincón D, Matilla-Peña A. Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study. Therap Adv Gastroenterol 2023; 16:17562848231206995. [PMID: 37920686 PMCID: PMC10619355 DOI: 10.1177/17562848231206995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
Background Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.
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Affiliation(s)
- Laura Carrión
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Clemente-Sánchez
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Márquez-Pérez
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Orcajo-Rincón
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Amanda Rotger
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Enrique Ramón-Botella
- Department of Diagnostic Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Manuel González-Leyte
- Department of Interventional Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Miguel Echenagusía-Boyra
- Department of Interventional Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Arturo Luis Colón
- Department of Hepatobiliary and Pancreatic Surgery, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Laura Reguera-Berenguer
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Rafael Bañares
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Diego Rincón
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, SpainCalle del Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Ana Matilla-Peña
- Department of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network, Instituto de Salud Carlos III, Madrid, Spain
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Tudela-Lerma M, Orcajo-Rincón J, Ramón-Botella E, Álvarez-Luque A, González-Leyte M, Rotger-Regi A, Velasco-Sánchez E, Colón-Rodríguez A. Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. Rev Esp Med Nucl Imagen Mol 2020; 40:82-90. [PMID: 33239249 DOI: 10.1016/j.remn.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.
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Affiliation(s)
- M Tudela-Lerma
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Orcajo-Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - E Ramón-Botella
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Álvarez-Luque
- Servicio de Radiología Vascular e Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M González-Leyte
- Servicio de Radiología Vascular e Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Rotger-Regi
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Velasco-Sánchez
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Colón-Rodríguez
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
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García-Fernández-Bravo I, González-Munera A, Ordieres-Ortega L, Ruiz Chiriboga D, González-Leyte M. Thrombosis of an infrarenal aortic aneurysm secondary to Salmonella enteritidis infection. Revista de Gastroenterología de México (English Edition) 2019. [DOI: 10.1016/j.rgmxen.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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García-Fernández-Bravo I, González-Munera A, Ordieres-Ortega L, Ruiz Chiriboga D, González-Leyte M. Thrombosis of an infrarenal aortic aneurysm secondary to Salmonella enteritidis infection. Rev Gastroenterol Mex (Engl Ed) 2019; 84:522-524. [PMID: 31122795 DOI: 10.1016/j.rgmx.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - A González-Munera
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Ordieres-Ortega
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - D Ruiz Chiriboga
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M González-Leyte
- Unidad de Radiología Vascular, Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
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Caño-Velasco J, Herranz-Amo F, González-Leyte M, Barbas-Bernardos G, Molina Escudero R, Polanco Pujol L, Hernández-Fernández C. [Intense urethrorrhagia after retropubic radical prostatectomy with selective embolization of the internal pudendal artery.]. ARCH ESP UROL 2018; 71:856-859. [PMID: 30560798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Urethrorrhagia after radicalprostatectomy(RP) is very uncommon, regardless of the surgicalapproach used. Arterio-urethral fistula formation betweeninternal pudendal artery branches(IPA) and bulbarurethra is an exceptional finding. METHODS We report what we consider the first series oftwo cases (one has already been published) of urethrorrhagiaafter open retropubic RP due to urethrovascular fistulaformation with its origin in the IPA or in one of its terminalbranches. RESULTS Both cases were diagnosed with contrast-enhancedCT, confirmed with arteriography, and they weretreated with superselective transarterial embolization(STE)with spongostan. After 5 years, the first case maintainserectile function using tadalafil on demand. The other caseis in the 2nd postoperative month. CONCLUSION Severe urethrorrhagia after RP is an exceptionalcomplication. The existence of an arterio-urethralfistula must be considered when both urethrorrhagia andabnormal bulbar enhancement in CT are present. Arteriographyallows to confirm the diagnosis, most frequently involvingIPA distal branches. STE is an effective and safetreatment.
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Affiliation(s)
- Jorge Caño-Velasco
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | - Felipe Herranz-Amo
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | - Manuel González-Leyte
- Servicio de Radiología Vascular Intervencionista. Hospital General Universitario Gregorio Marañón. Madrid. España
| | | | | | - Lucía Polanco Pujol
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
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Demelo-Rodríguez P, Pulfer M, del Toro-Cervera J, González-Leyte M, Echenagusía-Boyra M. Trombólisis fármaco-mecánica: una técnica a considerar en el tratamiento de la trombosis venosa profunda iliofemoral aguda. Angiología 2017. [DOI: 10.1016/j.angio.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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