Transarterial chemotherapy embolization combined with high intensity focused ultrasound for treating elderly patients with primary liver cancer / 重庆医学

Objective To evaluate clinical therapeutic efficacy of transarterial chemotherapy embolization (TACE) combined with high intensity focused ultrasound (HIFU ) compared with single TACE for treating elder patients ( ≥ 60 years old) with pri-mary liver cancer .Methods Clinical data of 72 elderly patients with primary liver cancer in the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed .They were divided into TACE combined with HIFU group (combina-tion group :n= 36) and TACE group (TACE group :n= 36) according to the treatment .Compared tumor shrunk ,the change of AFP value and liver function ,median survival time ,1 year ,2 years ,3 year survival rates in two groups .Results The degree of tumor shrunk in combination group were more significant than that of TACE group (P< 0 .05) ,meanwhile ,AFP value decreased more in combination group (P< 0 .05) .Median survival time in combination and TACE group ,the 1 year ,2 years ,3 year survival rates were (32 .0 ± 6 .9) months ,83 .1% ,57 .3% ,42 .6% and (21 .0 ± 6 .3) months ,62 .9% ,41 .4% ,22 .3% respectively ,as compared with the TACE group ,the combination group had a higher survival rate (P< 0 .05) .There were no severe complications in both groups .Con-clusion The treatment of TACE combined with HIFU is effective and safe for treating elder patients with primary liver cancer and can make more clinical benefits compared with single TACE .

Differences in the patterns and outcomes of enhanced viral replication between hepatitis C virus and hepatitis B virus in patients with hepatocellular carcinoma during transarterial chemolipiodolization / 대한간학회지

BACKGROUND/AIMS: Enhanced replication of hepatitis C virus (HCV) is well described in the setting of moderate to severe immunosuppression. The aims of this retrospective study were to determine the incidence of enhanced HCV replication in hepatocellular carcinoma (HCC) patients undergoing transarterial chemolipiodolization (TACL) and to identify the factors associated with enhanced replication of HCV. The clinical pattern of enhanced HCV replication was compared with hepatitis B virus (HBV) reactivation during TACL. METHODS: This study enrolled 49 anti-HCV-seropositive patients who were diagnosed with HCC between January 2005 and December 2010 and who underwent TACL using epirubicin and/or cisplatin with consecutive HCV RNA copies checked. For comparison, 46 hepatitis B surface antigen1-positive patients with HCC who were treated with TACL were also enrolled. The frequency, associated factors, and clinical outcomes of enhanced HCV replication were analyzed and compared with those of HBV reactivation during TACL. RESULTS: Enhanced replication of HCV occurred in 13 (26.5%) of the 49 anti-HCV-seropositive patients during TACL. Of these 13 patients, 4 developed hepatitis, but none of the subjects developed decompensation due to the hepatitis. No significant clinical factors for enhanced HCV replication during TACL were found. Compared with HBV reactivation, the frequency of hepatitis attributed to enhanced HCV replication was significantly lower than that for HBV reactivation (8.2% vs. 23.9%, P=0.036). CONCLUSIONS: TACL can enhance HCV replication; however, the likelihood of hepatitis and decompensation stemming from enhanced HCV replication was lower than that for HBV reactivation in patients undergoing TACL.

Clinical observation of transarterial infusion chemotherapeutics in treatment of advanced pancreatic carcinoma / 中国基层医药

Objective To investigate the efficacy and toxicity of infusion of chemotherapeutics through artery to treat advanced pancreatic carcinoma. Methods 46 patients with advanced pancreatic carcinoma were divided into experiment group ( n = 24) and control group ( n = 22). The way of administration of experiment group and control group were through artery or through vein respectively. Results Objective remission rate was 45.83% (11/24) clinical benefit rate was 58.33% (14/24) .median survival time was 16 months(from6 ～23months) in infusion-through-artery group, while those in infusion-through-vein group were18. 18% (4/22) ,27. 27% (6/22) ,7 months (from 3 -18months) respectively. All had significant diferences between two groups (P ＜ 0.05). Conclusion To treat patients with advanced pancreatic carcinoma,transarterial infusion chemotherapeutics was more effective,the toxicity was endurable.

Hepatic Failure Caused by Reactivation of YMDD Mutants Occurring during Preemptive Lamivudine Therapy

Reactivation of hepatitis B virus (HBV) replication is a frequent phenomenon in patients receiving immunosuppressants or chemotherapy. It was recently reported that regional therapy, such as transarterial chemotherapy (TAC) or radiotherapy, can also induce HBV reactivation in patients with hepatocellular carcinoma (HCC), and this can be prevented by preemptive lamivudine treatment. We report an unusual case of fatal hepatitis caused by reactivation of the tyrosine-methionine-aspartate-aspartate (YMDD) lamivudine-resistant strain in a 51-year-old male patient with HCC who was receiving preemptive lamivudine therapy. This patient received combined helical tomotherapy and TAC for the treatment of HCC with pulmonary metastasis. HBV reactivation and hepatitis exacerbation occurred after 2 months of therapy, but preemptive antiviral therapy was continued. Laboratory tests showed that the serum HBV DNA level had increased by more than 10,000-fold and a severe elevation of the aminotransferase level to 1,060 U/L. Although adefovir was added to lamivudine immediately after detecting the YMDD mutants, the patient eventually died of hepatic failure. Our experience suggests that for preemptive therapy, the use of potent antiviral drugs with a low risk of drug resistance as well as close viral monitoring are important for chronic HBV carriers undergoing intensive anticancer therapy.