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Markezana A, Paldor M, Liao H, Ahmed M, Zorde-Khvalevsky E, Rozenblum N, Stechele M, Salvermoser L, Laville F, Goldmann S, Rosenberg N, Andrasina T, Ricke J, Galun E, Goldberg SN. Fibroblast growth factors induce hepatic tumorigenesis post radiofrequency ablation. Sci Rep 2023; 13:16341. [PMID: 37770545 PMCID: PMC10539492 DOI: 10.1038/s41598-023-42819-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
Image-guided radiofrequency ablation (RFA) is used to treat focal tumors in the liver and other organs. Despite potential advantages over surgery, hepatic RFA can promote local and distant tumor growth by activating pro-tumorigenic growth factor and cytokines. Thus, strategies to identify and suppress pro-oncogenic effects of RFA are urgently required to further improve the therapeutic effect. Here, the proliferative effect of plasma of Hepatocellular carcinoma or colorectal carcinoma patients 90 min post-RFA was tested on HCC cell lines, demonstrating significant cellular proliferation compared to baseline plasma. Multiplex ELISA screening demonstrated increased plasma pro-tumorigenic growth factors and cytokines including the FGF protein family which uniquely and selectively activated HepG2. Primary mouse and immortalized human hepatocytes were then subjected to moderate hyperthermia in-vitro, mimicking thermal stress induced during ablation in the peri-ablational normal tissue. Resultant culture medium induced proliferation of multiple cancer cell lines. Subsequent non-biased protein array revealed that these hepatocytes subjected to moderate hyperthermia also excrete a similar wide spectrum of growth factors. Recombinant FGF-2 activated multiple cell lines. FGFR inhibitor significantly reduced liver tumor load post-RFA in MDR2-KO inflammation-induced HCC mouse model. Thus, Liver RFA can induce tumorigenesis via the FGF signaling pathway, and its inhibition suppresses HCC development.
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Affiliation(s)
- Aurelia Markezana
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel.
| | - Mor Paldor
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Haixing Liao
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Elina Zorde-Khvalevsky
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Nir Rozenblum
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Matthias Stechele
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Salvermoser
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Flinn Laville
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Salome Goldmann
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Nofar Rosenberg
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Eithan Galun
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Shraga Nahum Goldberg
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel.
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA.
- Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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Szaraz D, Danek Z, Lipovy B, Krivanek J, Buchtova M, Moldovan Putnova B, Putnova I, Stembirek J, Andrasina T, Divacka P, Izakovicova Holla L, Borilova Linhartova P. Primary cilia and hypoxia-associated signaling in developmental odontogenic cysts in relation to autosomal dominant polycystic kidney disease - A novel insight. Heliyon 2023; 9:e17130. [PMID: 37389068 PMCID: PMC10300219 DOI: 10.1016/j.heliyon.2023.e17130] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
Developmental cysts are pathological epithelial-lined cavities arising in various organs as a result of systemic or hereditary diseases. Molecular mechanisms involved in the formation of developmental odontogenic cysts (OCs) are not fully understood yet; the cystogenesis of renal cysts originating from the autosomal dominant polycystic kidney disease (ADPKD) has been, however, explored in much greater detail. This narrative review aimed i) to summarize molecular and cellular processes involved in the formation and growth of developmental OCs, especially dentigerous cysts (DCs) and odontogenic keratocysts (OKCs), ii) to find if there are any similarities in their cystogenesis to ADPKD cysts, and, based on that, iii) to suggest potential factors, candidate molecules, and mechanisms that could be involved in the DC formation, thus proposing further research directions. Here we suggest a possible association of developmental OCs with primary cilia disruption and with hypoxia, which have been previously linked with cyst formation in ADPKD patients. This is illustrated on the imagery of tissues from an ADPKD patient (renal cyst) and from developmental OCs, supporting the similarities in cell proliferation, apoptosis, and primary cilia distribution in DC/OKC/ADPKD tissues. Based on all that, we propose a novel hypothesis of OCs formation suggesting a crucial role of mutations associated with the signaling pathways of primary cilia (in particular, Sonic Hedgehog). These can lead to excessive proliferation and formation of cell agglomerates, which is followed by hypoxia-driven apoptosis in the centers of such agglomerates (controlled by molecules such as Hypoxia-inducible factor-1 alpha), leading to cavity formation and, finally, the OCs development. Based on this, we propose future perspectives in the investigation of OC pathogenesis.
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Affiliation(s)
- David Szaraz
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Zdenek Danek
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Bretislav Lipovy
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Burns and Plastic Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Jan Krivanek
- Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Marcela Buchtova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Barbora Moldovan Putnova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Pathological Morphology and Parasitology, University of Veterinary Sciences, Palackého tř. 1946/1, 61242 Brno-Královo Pole, Czech Republic
| | - Iveta Putnova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Anatomy, Histology and Embryology, University of Veterinary and Pharmaceutical Sciences, Palackého tř. 1946/1, 61242 Brno-Královo Pole, Czech Republic
| | - Jan Stembirek
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Clinic of Maxillofacial Surgery, University Hospital Ostrava, 17. Listopadu 1790/5, 70800 Ostrava-Poruba, Czech Republic
| | - Tomas Andrasina
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Petra Divacka
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Internal Medicine and Gastroenterology, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Lydie Izakovicova Holla
- Clinic of Stomatology, Institution Shared with St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, 60200 Brno, Czech Republic
| | - Petra Borilova Linhartova
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Clinic of Stomatology, Institution Shared with St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, 60200 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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Andrasina T, Rohan T, Panek J, Kovalcikova P, Kunovsky L, Ostrizkova L, Valek V. Corrigendum to "The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis - Randomized study". [Eur. J. Radiol. 142 (2021) 109830]. Eur J Radiol 2022; 148:110180. [PMID: 35114534 DOI: 10.1016/j.ejrad.2022.110180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Tomas Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic.
| | - Jiri Panek
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Petra Kovalcikova
- Institute of Biostatistics and Analyses, Masaryk University, Brno 625 00, Czech Republic
| | - Lumir Kunovsky
- Department of Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic; Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Lenka Ostrizkova
- Department of Hematooncology, Oncology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Vlastimil Valek
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
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Rohan T, Andrasina T, Juza T, Matkulcik P, Červinka D, Svobodova I, Novotná V, Bernard V, Valek V, Goldberg SN. Experimental model of occluded biliary metal stent recanalization using irreversible electroporation via a tubular catheter. Int J Hyperthermia 2021; 38:393-401. [PMID: 33682581 DOI: 10.1080/02656736.2021.1875061] [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] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To demonstrate the feasibility of irreversible electroporation (IRE) for treating biliary metal stent occlusion in an experimental liver model. METHODS AND MATERIALS IRE was performed using an expandable tubular IRE-catheter placed in nitinol stents in the porcine liver. A 3-electrode IRE-catheter was connected to an IRE-generator and one hundred 100μs pulses of constant voltage (300, 650, 1000, and 1300 V) were applied. Stent occlusion was simulated by insertion of liver tissue both ex vivo (n = 94) and in vivo in 3 pigs (n = 14). Three scenarios of the relationship between the stent, electrodes, and inserted tissue (double contact, single contact, and stent mesh contact) were studied. Electric current was measured and resistance and power calculated. Pigs were sacrificed 72 h post-procedure. Harvested samples (14 experimental, 13 controls) underwent histopathological analysis. RESULTS IRE application was feasible at 300 and 650 V for the single and double contact setup in both ex vivo and in vivo studies. Significant differences in calculated resistance between double contact and single contact settings were observed (ex-vivo p ˂ 0.0001, in-vivo p = 0.02; Mann-Whitney). A mild temperature increase of the surrounding liver parenchyma was noted with increasing voltage (0.9-5.9 °C for 300-1000 V). The extent of necrotic changes in experimental samples in vivo correlated with the measured electric current (r2 = 0.39, p = 0.01). No complications were observed during or after the in-vivo procedure. CONCLUSION Endoluminal IRE using an expandable tubular catheter in simulated metal stent occlusion is feasible. The relationship of active catheter electrodes to stent ingrowth tissue can be estimated based on resistance values.
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Affiliation(s)
- T Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - T Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - T Juza
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - P Matkulcik
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - D Červinka
- Faculty of Electrical Engineering and Communication, Department of Power Electrical and Electronic Engineering, Brno University of Technology, Brno, Czech Republic
| | - I Svobodova
- Department of Pathology, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - V Novotná
- Faculty of Electrical Engineering and Communication, Department of Power Electrical and Electronic Engineering, Brno University of Technology, Brno, Czech Republic
| | - V Bernard
- Faculty of Medicine, Department of Biophysics, Masaryk University, Brno, Czech Republic
| | - V Valek
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
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Andrasina T, Rohan T, Panek J, Kovalcikova P, Kunovsky L, Ostrizkova L, Valek V. The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis - Randomized study. Eur J Radiol 2021; 142:109830. [PMID: 34230002 DOI: 10.1016/j.ejrad.2021.109830] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/06/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To analyse whether endobiliary radiofrequency ablation prior metal stent insertion in malignant biliary stenosis show improved survival or stent patency. METHODS 76 patients with histologically proven malignant biliary stenosis have been enrolled in a prospective, randomized study. In control arm, 40 patients underwent self-expandable metal stent insertion. In experimental arm, the endoluminal ablation with a bipolar radiofrequency catheter was performed immediately before stent insertion. A subgroup analysis of cholangiocarcinoma was performed (22 vs 21 patients). The objective of the study was to determine the rate of complications, duration of the stent patency and the survival of patients (Kaplan-Meier analysis). RESULTS No major complications related to the stent insertion and the endoluminal ablation were found. The mean primary stent patency was 5.2 (95% CI 0.7-12.8) vs 4.8 months (95% CI 0.8-18.2) months (p = 0.79) in control and experimental group, respectively, in the subgroup analysis with cholangiocarcinoma 4.5 (95% CI 0.8-10.3) and 9.6 (95% CI 5.2-11.2) months (p = 0.029). The median survival since the insertion of the stent was 6.8 (95 %CI 3.0-10.6) vs 5.2 (95 %CI 2.4-7.9) months (p = 0.495) and since the initial drainage 9.8 (95 %CI 6.9-12.7) vs 9.1 (95 %CI 5.4-12.7) months (p = 0.720) in the control and experimental arm. CONCLUSION Endobiliary radiofrequency ablation prior metal stent insertion showed increased patency rate only in patients with cholangiocarcinoma, on the other hand, no improvement in survival was demonstrated in this randomized clinical study.
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Affiliation(s)
- Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Tomas Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic.
| | - Jiri Panek
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Petra Kovalcikova
- Institute of Biostatistics and Analyses, Masaryk University, Brno 625 00, Czech Republic
| | - Lumir Kunovsky
- Department of Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic; Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Lenka Ostrizkova
- Department of Hematooncology, Oncology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Vlastimil Valek
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
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Andrasina T, Juracek J, Zavadil J, Cechova B, Rohan T, Vesela P, Paldor M, Slaby O, Goldberg SN. Thermal Ablation and Transarterial Chemoembolization are Characterized by Changing Dynamics of Circulating MicroRNAs. J Vasc Interv Radiol 2021; 32:403-411. [PMID: 33495063 DOI: 10.1016/j.jvir.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine whether the levels of circulating microRNAs (miRNAs) are altered in patients undergoing thermal ablation and chemoembolization and whether these changes are predictive of a clinical outcome. MATERIAL AND METHODS This prospective study consisted of 43 patients diagnosed with hepatocellular carcinoma (n = 15) and intrahepatic colorectal cancer metastases (n = 28) treated with thermal ablation (n = 23; radiofrequency [n = 6] or microwave [n = 19]), chemoembolization using drug-eluting embolics (n = 18), or both (n = 2). Four blood samples (immediately before the intervention and 60-90 minutes, 24 hours, and 7 days after the intervention) were taken to measure the plasma concentrations of miRNAs related to hypoxia (miR-21 and miR-210), liver injury (miR-122), epithelial-mesenchymal transition (miR-200a), and apoptosis (miR-34a) using miRNA-specific TaqMan assays and quantitative real-time polymerase chain reaction. Tumor burden and treatment response at 3 months were evaluated using the modified response evaluation criteria in solid tumors. The miRNA results were compared with clinical outcomes (Mann-Whitney U test, Wilcoxon matched-pair test). RESULTS Dynamic changes in the circulating miRNA levels were observed following both the interventions. For thermal ablation, significant increases in miR-21, miR-210, miR-122, miR-200a, and miR-34a concentrations peaked 60-90 minutes after the intervention (P < .01). However, for transarterial chemoembolization, maximum increases in the miRNA concentrations were observed at 24 hours after the intervention for miR-21, miR-210, miR-122, miR-200a, and miR-34a (P < .05). The increased concentrations of the circulating miRNAs were followed by a subsequent decline to baseline by 7 days. For the thermal ablation (but not chemoembolization) patients, elevations in the miR-210 and miR-200a levels were associated with early progressive disease at 3 months (P = .040 and P = .012, respectively). CONCLUSIONS Increased but dynamic levels of circulating miRNAs are present following interventional oncologic procedures and may prove useful as biomarkers for the monitoring of clinical outcomes.
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Affiliation(s)
- Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic.
| | - Jaroslav Juracek
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Jan Zavadil
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Barbora Cechova
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic; Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Tomas Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Petra Vesela
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Mor Paldor
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ondrej Slaby
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic; Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
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Prochazka V, Hlavsa J, Kunovsky L, Farkasova M, Potrusil M, Andrasina T, Litavcova A, Mazanec J, Dolina J, Ostrizkova L, Eid M, Kovalcikova P, Pavlik T, Kala Z. Correlation of survival length after pancreaticoduodenectomy for pancreatic head adenocarcinoma depending on tumor characteristics detected by means of computed tomography and resection margins status. Neoplasma 2020; 67:1319-1328. [PMID: 32614234 DOI: 10.4149/neo_2020_190923n955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
Pancreatic carcinoma is an aggressive tumor with a grim prognosis. Accurate staging is essential for indicating surgery in patients with borderline resectable tumors. This paper examines the correlation between pre-operation characteristics of tumors found on CT, infiltration of individual resection margins as confirmed by a pathologist, and the survival of patients with resectable pancreatic head ductal adenocarcinoma. This prospective cohort study involved patients operated on for pancreatic head adenocarcinoma, which was clearly resectable based on the staging CT and intraoperative observation between 2011-2014. Only patients without postoperative complications who underwent adjuvant chemotherapy were analyzed. Seventy-nine patients were assessed, of which 16 (20.3%) had R0 resection and 63 (79.7%) had R1 resection. Patients with R1 results had up to 2.7 times higher risk of death than patients with R0 resection. We found a trend towards shorter survival associated with a closer relationship of the tumor to the superior mesenteric vein/portal vein (SMV/PV) wall in the pre-operation CT examination. Patients with a tumor interface between the vein wall of up to 180 ° circumference had up to 1.97 times higher risk of death than patients without (p=0.131). The results of our work confirmed that in our center, even surgically treated, clearly resectable pancreatic head tumors still have a high occurrence of positive surgical margins (R1 resection) and that tumors with R1 resection had statistically significantly reduced survival compared to R0 resection. A trend for shorter overall survival was found after tumor resection depending on the increasing interface between the tumor and the SMV/PV wall, but this result was not statistically significant.
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Affiliation(s)
- V Prochazka
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Hlavsa
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Kunovsky
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Farkasova
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Potrusil
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - T Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - A Litavcova
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Mazanec
- Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Dolina
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Ostrizkova
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Eid
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - P Kovalcikova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - T Pavlik
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Z Kala
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Abstract
INTRODUCTION Clinical study evaluating the impact of intraoperative radiofrequency ablation in pancreatic cancer. METHODS Patients with histologically proved pancreatic cancer were included. Two groups were defined. In the RFA group (n=24) intraoperative RFA of the pancreatic tumour was performed. In the control group (n=24) only the bypass procedure was indicated (gastroenteric and hepaticojejunal anastomosis). No patient received neoadjuvant chemotherapy. Three-month morbidity and mortality, overall survival, quality of life, pain relief and radiological response were studied. RESULTS Overall three-month morbidity and mortality were 41.7% and 8.3%, respectively. RFA related morbidity and mortality reached 16.6% and 8.3%, respectively. The overall median survival time was 9.9 and 8.3 months in the RFA group and in the control group, respectively. The survival difference was not of statistical significance (p=0.758). QoL improvement after RFA was not proved. There was no statistically significant analgesic effect of RFA. Postoperative CT scan assessed as per RECIST criteria displayed progressive disease, stable disease, partial response and complete response in 41.6%, 45.8%, 8.3% and 0% cases, respectively. CONCLUSION Intraoperative RFA of locally advanced and metastatic pancreatic cancer is a feasible palliative method. A survival benefit of this method remains doubtful, even though some positive results have been achieved in patients with localized, well-differentiated tumours. Although RFA was not associated with any impairment of the quality of life, no convincing evidence of a positive impact thereof on QoL was shown, either, during the three-month postoperative period. Pain relief was not achieved during the first 3 months after RFA.
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Poredska K, Kunovsky L, Prochazka V, Dolina J, Chovancova M, Vlazny J, Andrasina T, Eid M, Jabandziev P, Kysela P, Kala Z. Triple malignancy (NET, GIST and pheochromocytoma) as a first manifestation of neurofibromatosis type-1 in an adult patient. Diagn Pathol 2019; 14:77. [PMID: 31301733 PMCID: PMC6626625 DOI: 10.1186/s13000-019-0848-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neurofibromatosis type-1 (NF1), also called von Recklinghausen disease, is a rare genetic disease which can lead to the development of benign or even malignant tumors. NF1 is mostly diagnosed in children or early adolescents who present with clinical symptoms. A curative therapy is still missing and the management of NF1 is based on careful surveillance. Concerning tumors which affect the gastrointestinal tract in patients with NF1, the most common is a gastrointestinal stromal tumor (GIST). CASE PRESENTATION We present a case of a 58-year-old adult patient with dyspeptic symptoms who was incidentally diagnosed with triple malignancy (pheochromocytoma, multiple GISTs of small intestine and an ampullary NET) as a first manifestation of NF1. The patient underwent surgical treatment (adrenalectomy and pancreaticoduodenectomy) with no complications and after 2 years remains in oncological remission. CONCLUSION NF1 is a rare genetic disease which can cause various benign or malignant tumors. The coincidence of GIST and NET is almost pathognomonic for NF1 and should raise a suspicion of this rare disorder in clinical practice.
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Affiliation(s)
- Karolina Poredska
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Vladimir Prochazka
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Dolina
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslava Chovancova
- Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jakub Vlazny
- Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Eid
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Jabandziev
- Department of Pediatrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Kysela
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdenek Kala
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Juracek J, Andrasina T, Cechova B, Vesela P, Zavadil J, Machackova T, Sana J, Vecera M, Gablo N, Svoboda M, Goldberg N, Slaby O. Abstract 521: Dynamic measurements of circulating microRNAs reflect different biological effects of radiofrequency ablation and transarterial chemoembolisation in liver cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The majority of primary or metastatic liver tumors are unresectable (because of tumor size, location, poor performance status or multifocality), therefore other therapeutic modalities as radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are applied. RFA is a localized thermal treatment technique designed to produce tumor destruction by heating tumor tissue, while TACE combines cytotoxic effect of particle based tumor ischemia and locoregional chemotherapy. Both methods cause characteristic changes in liver tissue (inflammation, hypoxia, elevated temperature, tissue destruction) accompanied by targeted systemic secretion of microRNA into the bloodstream. Since RFA and TACE differ in the dynamics with which they affects the tumor tissue, we aimed to investigate whether the expression level of circulating microRNAs related to hypoxia (miR-21 and miR-210), liver injury (miR-122) and epithelial-mesenchymal transition (miR-200a) could reflect such changes.
Material and methods: This study consisted of 14 patients diagnosed with primary hepatocellular carcinoma (HCC) (median age 73; TACE) and 20 patients diagnosed with liver metastases of colorectal cancer (median age 63; 17 patients - RFA, 3 patients - TACE). RFA was performed using the rf/mw generator (AngioDynamics). For TACE drug eluting beads (Biocompatibles Ltd.) loaded with irinotecan for mCRC patients and doxorubicin for HCC patients were used. The concentrations of miRNA were determined for all patients in series of blood plasma from 4 time points (before intervention, immediately after intervention, 24 hours after intervention, 1 week after intervention) using miRNA-specific TaqMan assays and qRT-PCR method.
Results: In RFA cases we observed significant increase of investigated miRNA concentrations immediately after intervention (miR-122, FC = 15, P = 0.0002; miR-200a, FC = 1.9, P = 0.015). In TACE we observed delayed increase in circulating miRNA concentrations at time point 24 hours after intervention (miR-21, FC = 10.4, P < 0.0001; miR-210, FC = 9.0, P = 0.03; miR-122, FC = 27, P = 0.0004; miR-200a, FC = 4.0, P = 0.0098). In both methods, the initial increase was followed by a steady decline of miRNA levels. Identified dynamic changes in circulating miRNA levels were in accordance with the nature of RFA and TACE biologic effects. In selected cases, we observed specific dynamic miRNA patterns to be linked to the course of the disease (e.g. necessity of additional intervention).
Conclusions: Our preliminary data indicates potential usage of circulating miRNAs for monitoring of the systemic effects of RFA and TACE therapy and their ability to reflect efficacy of intervention procedures. This work was supported by Ministry of Health of the Czech Republic, grant nr. 15-33158A, 15-34553A, 15-31627A, 16-31314A, and 15-34678A.
Citation Format: Jaroslav Juracek, Tomas Andrasina, Barbora Cechova, Petra Vesela, Jan Zavadil, Tana Machackova, Jiri Sana, Marek Vecera, Natalia Gablo, Marek Svoboda, Nahum Goldberg, Ondrej Slaby. Dynamic measurements of circulating microRNAs reflect different biological effects of radiofrequency ablation and transarterial chemoembolisation in liver cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 521.
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Affiliation(s)
- Jaroslav Juracek
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | | | - Barbora Cechova
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Petra Vesela
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Jan Zavadil
- 2University Hospital Brno, Brno, Czech Republic
| | - Tana Machackova
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Jiri Sana
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Marek Vecera
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Natalia Gablo
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
| | - Marek Svoboda
- 3Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Nahum Goldberg
- 4Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Ondrej Slaby
- 1CEITEC - Central European Institute of Technology, Brno, Czech Republic
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Smajerova M, Petrasova H, Little J, Ovesna P, Andrasina T, Valek V, Nemcova E, Miklosova B. Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis. World J Gastroenterol 2016; 22:8605-8614. [PMID: 27784973 PMCID: PMC5064042 DOI: 10.3748/wjg.v22.i38.8605] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/26/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether contrast-enhanced ultrasonography (CEUS) as the first-line method is more cost-effective in evaluating incidentally discovered focal liver lesions (FLLs) than is computed tomography (CT) and magnetic resonance imaging (MRI). METHODS Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The results were compared. RESULTS The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar (USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD (4%) and that between MRI and CEUS was 308352 USD (406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent (P < 0.001). CONCLUSION While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more cost-effective in comparison to MRI.
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Mauri G, Michelozzi C, Melchiorre F, Poretti D, Pedicini V, Salvetti M, Criado E, Falcò Fages J, De Gregorio MÁ, Laborda A, Sonfienza LM, Cornalba G, Monfardini L, Panek J, Andrasina T, Gimenez M. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 2016; 26:4057-4063. [DOI: 10.1007/s00330-016-4278-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/23/2015] [Accepted: 02/08/2016] [Indexed: 01/20/2023]
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Felsoci M, Nehyba S, Andrasina T, Nemec P. Ruptured aneurysm of non-coronary sinus of valsalva as a rare cause of chest pain. Eur Heart J 2014; 35:2123. [PMID: 24810387 DOI: 10.1093/eurheartj/ehu184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marian Felsoci
- Division of Non-invasive Cardiology, Department of Cardiology and Internal Medicine, University Hospital Brno, Jihlavska 20, 62500 Brno, Brno, Czech Republic International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Svatopluk Nehyba
- Division of Non-invasive Cardiology, Department of Cardiology and Internal Medicine, University Hospital Brno, Jihlavska 20, 62500 Brno, Brno, Czech Republic
| | - Tomas Andrasina
- Department of Radiology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Petr Nemec
- International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic Centre for Cardiovascular and Transplant Surgery, Brno, Czech Republic
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Procházka V, Kala Z, Svoboda T, Masek M, Andrasina T. [Delayed diagnosis of diaphragmatic rupture--case reports]. Rozhl Chir 2012; 91:110-114. [PMID: 22746093] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- V Procházka
- Chirurgicki klinika FN Brno Bohunice a LF MU Brno.
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Hlavsa J, Procházka V, Kala Z, Man M, Andrasina T, Cíhalová M, Válek V, Crha M, Svobodová I, Urbanová L. [Radiofrequency ablation of pancreatic neuroendocrine tumor]. Klin Onkol 2011; 24:209-215. [PMID: 21717790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUNDS Pancreatic neuroendocrine tumors (PNETs) include a broad range of neoplasms spanning from relatively benign to malignant. Radical resection has been advocated as the only curative method. Debulking (R2) resection can be indicated for locally unresectable PNETs. Debulking surgery improves the quality of life and prolongs overall survival. The disadvantages of this approach include bleeding, pancreatic fistula and tumor spread. No alternative method that would eliminate these complications has been published yet. Considering the encouraging results of the studies describing radiofrequency ablation (RFA) of locally advanced pancreatic cancer, a question arises, whether it might be possible to use RFA as a R2 resection alternative in PNETs. CASE A 73-year-old gentleman had been admitted due to abdominal pain and hyperglycaemic syndrome. Contrast-enhanced CT showed a tumor of pancreatic head invading portal vein (PV) and superior mesenteric vein (VMS). A surgery was indicated on the basis of EUS-guided FNAB that verified a PNET of uncertain biological behaviour. The surgery confirmed a locally advanced tumor of pancreatic head invading the PV and SMV. Due to the polymorbidity, radical pancreatoduodenectomy with SMV resection was not indicated. Because of the presence of symptoms, RFA of the PNET using ValleyLab generator with cooltip cluster electrode, was performed. Postoperative course was uneventful. Final immunohistochemical examination verified a well-differentiated grade 1 PNET. The patient was regularly monitored during a three-year follow-up. The quality of life was evaluated using standardized EORT QLQ-30 questionnaire. Pain was assessed by a ten-point visual analogue scale (VAS). Ablated area was evaluated annually by contrast-enhanced CT. Postoperatively, abdominal pain ceased (pain decrease from 2 to 0 on VAS). Insulin dose was reduced from 46 IU (international units) to 20 IU of Humulin-R per day. CT verified tumor regression according to RECIST (response evaluation criteria in solid tumors). During the three-year follow-up, no local progression or tumor dissemination was observed. CONCLUSION We present the first case report of a patient with locally advanced symptomatic pancreatic neuroendocrine tumor successfully treated by intraoperative radiofrequency ablation. More clinical studies are needed to evaluate the clinical relevance of this cytoreductive method in the PNET indication.
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Affiliation(s)
- J Hlavsa
- Chirurgická klinika, LF MU a FN Brno-Bohunice.
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Schiffman SC, Metzger T, Dubel G, Andrasina T, Kralj I, Tatum C, McMasters KM, Scoggins CR, Martin RCG. Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann Surg Oncol 2010; 18:431-8. [PMID: 20862554 DOI: 10.1245/s10434-010-1333-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unresectable intrahepatic cholangiocellular carcinoma (ICC) carries a poor prognosis, and there are few chemotherapeutic treatments to prolong survival. The purpose of this study was to assess the efficacy of drug-eluting bead (DEB) therapy by transarterial infusion for unresectable ICC. METHODS A prospective multicenter study of ICC patients who received hepatic arterial DEB therapy. RESULTS Twenty-four patients with unresectable ICC were treated with DEB. Ten patients (41.6%) had recurrent ICC after prior radiofrequency ablation (n = 3) or hepatectomy (n = 7). Twenty patients (80%) had received prior chemotherapy, mostly of gemcitabine (n = 8) or Eloxatin (n = 6). The percent of overall liver involvement was < 25% (n = 8), 26% to 50% (n = 11), and > 50% (n = 4). Ten patients (40%) had sites of extrahepatic disease located at lymph nodes (n = 5), bone (n = 2), peritoneum (n = 1), lung (n = 1), and mouth (n = 1). A total of 42 DEB treatments were administered. Eight were administered in combination with systemic chemotherapy of FOLFOX (n = 4) or Gemzar (n = 4). Twelve patients (48%) received a second treatment, and 4 patients (16%) received a third treatment. The median length of stay was 23 h (23-72 h). Eleven adverse reactions (26.2%) were reported. Of these, 7 (63.6%) were minor (less than grade 3). One patient died from hepatorenal syndrome. The disease of one patient was downstaged to resection. After a median follow-up of 13.6 months, the median overall survival of a multitherapeutic regimen with DEB therapy was significantly greater than chemotherapy alone (17.5 vs. 7.4 months; P = 0.02). CONCLUSIONS Bead therapy is safe and effective in patients with unresectable ICC. There is a marked survival benefit when DEB therapy is used as adjunctive therapy.
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Affiliation(s)
- Suzanne C Schiffman
- Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
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Bower M, Metzger T, Robbins K, Tomalty D, Válek V, Boudný J, Andrasina T, Tatum C, Martin RCG. Surgical downstaging and neo-adjuvant therapy in metastatic colorectal carcinoma with irinotecan drug-eluting beads: a multi-institutional study. HPB (Oxford) 2010; 12:31-6. [PMID: 20495642 PMCID: PMC2814401 DOI: 10.1111/j.1477-2574.2009.00117.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 07/03/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for potentially resectable metastatic colorectal cancer (MCC) is becoming a more common treatment algorithm. The aim of the present study was to evaluate the efficacy of precision hepatic arterial Irinotecan therapy in unresectable MCC. METHODS An open-label, multi-centre, multi-national single arm study of MCC patients, who received hepatic arterial irinotecan. Primary endpoints were safety, tolerance and metastatic tumour resection. RESULTS Fifty-five patients with metastatic colorectal to the liver underwent a total of 90 hepatic arterial irinotecan treatments. The extent of liver involvement was < 25% in 75% of the patients (n= 41), between 26 and 50% in 15% of the patients (n= 11) and >50% in 10% of the patients (n= 24). The median number of hepatic lesions was four (range 1-20), with a median total size of all target lesions of 9 cm (range 5.5-28 cm) with 50% of patients having bilobar tumour distribution. The median number of irinotecan treatments was two (range 1-5). The median treatment dose was 100 mg (range 100-200) with a median total hepatic treatment of 200 mg (range 200-650). The majority of treatments (86%) were performed as lobar infusion treatments, and 30% of patients were treated with concurrent simultaneous chemotherapy. Eleven (20%) patients demonstrated significant response and downstage of their disease or demonstrated stable disease without extra-hepatic disease progression allowing resection, ablation or resection and ablation. There were no post-operative deaths. Post-operative complications morbidity occurred in 18% of patients, with none of them hepatic related. Non-tumorous liver resected demonstrated no evidence of steatohepatitis from the irinotecan arterial infusion. CONCLUSIONS Hepatic arterial infusion irinotecan drug-eluting beads is safe and effective in pre-surgical therapy and helpful in evaluating the biology of metastatic colorectal cancer to the liver prior to planned hepatic resection.
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Affiliation(s)
- Matthew Bower
- University of Louisville School of Medicine Division of Surgical OncologyLittle Rock, AR
| | - Tiffany Metzger
- University of Louisville School of Medicine Division of Surgical OncologyLittle Rock, AR
| | | | | | - Vlatimil Válek
- Department of Radiology, FN Brno a LF MU BrnoCzech republic
| | - Jean Boudný
- Department of Radiology, FN Brno a LF MU BrnoCzech republic
| | | | - Cliff Tatum
- Norton Healthcare RadiologyLouisville, KY, USA
| | - Robert CG Martin
- University of Louisville School of Medicine Division of Surgical OncologyLittle Rock, AR
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Tucek S, Tomasek J, Halámkova J, Kiss I, Andrasina T, Hemmelová B, Adámková-Krákorová D, Vyzula R. Bile duct malignancies. Klin Onkol 2010; 23:231-241. [PMID: 20806821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bile duct malignancies include intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), gall bladder carcinoma (GC) and carcinoma of Vater's ampulla (ampulloma). Bile duct neoplasms are rare tumours with overall poor prognosis. The overall incidence affects up to 12.5 per 100,000 persons in the Czech Republic. The mortality rate has risen recently to 9.5 per 100,000 persons. The incidence and mortality have been remarkably stable over the past 3 decades. The survival rate of patients with these tumours is poor, usually not exceeding 12 months. The diagnostic process is complex, uneasy and usually late. Most cases are diagnosed when unresectable, and palliative treatment is the main approach of medical care for these tumours. The treatment remains very challenging. New approaches have not brought much improvement in this field. Standards of palliative care are lacking and quality of life assessments are surprisingly not common. From the scarce data it seems, however, that multimodal individually tailored treatment can prolong patients'survival and improve the health-related quality of life. The care in specialized centres offers methods of surgery, interventional radiology, clinical oncology and high quality supportive care. These methods are discussed in the article in greater detail. Improvements in this field can be sought in new diagnostic methods and new procedures in surgery and interventional radiology. Understanding the tumour biology on the molecular level could shift the strategy to a more successful one, resulting in more cured patients. Further improvements in palliative care can be sought by defining new targets and new drug development. The lack of patients with bile duct neoplasms has been the limiting factor for any improvements. A new design of larger randomized international multicentric clinical trials with prompt data sharing could help to overcome this major problem. Defining standards of palliative care is a necessity. Addressing health-related quality of life could help to assess the real benefit of palliative treatment.
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Affiliation(s)
- S Tucek
- Department of Clinical Oncology, Faculty Hospital Brno.
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