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Objective To analyze the risk factors that affect the early recurrence (recurrence occurring within 3 months after surgical resection) of hepatocellular carcinoma (HCC), and to discuss the risk factors influencing the survival after hepatectomy. Methods The clinical data of 257 HCC patients, who were admitted to authors' hospital during the period from January 1, 2007 to March 31, 2014 to receive cTACE within 3 months after surgical resection of hepatocellular carcinoma, were retrospectively analyzed. According to DSA findings (lipiodol CT scan was performed in part of patients with undetermined diagnosis), the patients were divided into recurrence group and non-recurrence group. By using univariate analysis and multiple logistic regression analysis, the correlation of the clinical and pathological data with the early recurrence was analyzed. The patients were followed up, the survival time was recorded. The relationship between patient's clinical data and postoperative survival was evaluated. Results ① Of the 257 patients, early recurrence was detected in 150 patients (58. 4％, recurrence group) and no recurrence was observed in 107 patients (41. 6％, non-recurrence group). ②The presence of satellite nodules and the integrity of tumor encapsulation were two independent factors associated with the postoperative residual lesions. ③The maximum diameter of the tumor, Edmondson grade and the vascular cancer thrombus were the independent risk factors affecting survival. ④The median survival time of patients in recurrence group was markedly shortened than that of patients in non-recurrence group (39 months vs. 93 months). Conclusion The early recurrence (within 3 months after resection) of hepatocellular carcinoma is associated with the presence of satellite nodules and the integrity of tumor encapsulation. The survival of patients after hepatectomy is related to the maximum diameter of the tumor, Edmondson grade and the vascular cancer thrombus. The median survival time in patients having early recurrence is significantly shortened than that in patients having no early recurrence. (J Intervent Radiol, 2018, 27: 215-222)
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Objective To explore the effectiveness,safety and influencing factors of arterial infusion of oxaliplatin for the treatment of colorectal l1iver metastases after surgery.Methods Totally 68 colorectal liver metastases after surgery patients pathologically confirmed received at least two course of arterial infusion of oxaliplatin combined with TACE.According to postoperative intravenous chemotherapy,the patients were divided into group A (no chemotherapy) and group B (chemotherapy).Survival time of patients were followed up.According to the efficacy of solid tumor evaluation criteria the objective effect was evaluated,the adverse reactions were compared between two groups.Cox regression analysis was performed to assess the possible factors influencing survival time.Results The median overall survival (OS) of all the 68 patients was 18 months,with complete remission 16 cases,partial remission 26 cases,stable diseasse 21 cases,stable diseasse 5 cases,the response rate (RR) was 61.76％ (42/68).The median progression-free survival (PFS) was 10 months.The RR,OS and PFS had no statistical difference (all P＞0.05).The variables that eventually entered the Cox regression model were tumor differentiation (P=0.003,hazard ratio 2.202).Conclusion Arterial infusion of oxaliplatin and TACE is effective in treating colorectal liver metastases after surgery,with high objective response rate.
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Malignant hepatopancreatobiliary tumors are highly malignant and have poor prognosis. 125I seed implantation combined with other minimally invasive therapies for radical treatment of early liver cancer has achieved a good clinical effect in preventing early recurrence after liver cancer surgery. It is also used in the treatment of advanced liver cancer and portal vein tumor thrombosis. 125I seed has achieved a good local control rate in the treatment of tumors with a lack of blood supply, such as intrahepatic cholangiocellular carcinoma and metastatic liver cancer. 125I seed combined with biliary stenting can significantly relieve the symptoms of malignant biliary obstruction and extend the time to restenosis. Comprehensive interventional treatment based on 125I seed can significantly improve quality of life and extend survival time in patients with pancreatic cancer. Therefore, 125I seed implantation is safe and convenient in clinical practice and holds promise for clinical application.
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Objective To discuss the effect and safety of modified XELOX regimen for the treatment of colorectal cancer with he-patic metastases.Methods A retrospective analysis on the clinical data in 18 patients with colorectal cancer with hepatic metastases was performed in our hospital.The diagnosis in all patients was confirmed by biopsy and colonoscopy,and the primary lesion was not resected but with at least 2 courses treatment with modified XELOX regimen (intravenous infusion of oxaliplatin changed into ar-terial perfusion and 1-hour slow perfusion with indwelling catheter).The intrahepatic metastases were detected by CT and/or MRI and the primary focus was examined by enteroscopy every 2 months.A follow-up on survival time was performed and the objective response was evaluated in accordance with RECIST criteria.SPSS 1 9.0 was used for an analysis by Kaplan-Meier method.Results (1)Curative effect was evaluated in all 18 patients and TACE has been used for 1 1 5 times.The median OS was 14.0 months with 95% CI (9.6,18.4),and the median PFS was 8.0 months with 95% CI (5.2,10.8)including CR in 2,PR in 7,SD in 4 and PD in 5.The efficiency rate (RP)was 50.0% and the clinical benefit rate (CBR)was 72.2%;(2)The post-treatment adverse reactions mainly included fever,nausea,emesis,pain,impaired liver function,myelosuppression and peripheral sensory neuropathy,most of which were at Level Ⅰ-Ⅱ without treatment-related death.Fever with different degrees occurred in all patients,and nausea and emesis in 13.Pain and abnormal liver function occurred within 3-5 days after TACE with less than Level 2.Conclusion Modified XELOX regimen is practically effective in treating colorectal cancer with hepatic metastases.With a high objective response rate,it can improve patients'living quality and increase excision rate with tolerable adverse reactions.
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Objective To assess the effect of ultrasound-guided percutaneous 125I seed implantation for the treatment of osteolytic metastases. Methods From February 2011 to December 2013, a total of 18 patients with advanced cancer complicated by osteolytic metastases received ultrasound-guided percutaneous implantation of 125I seeds. According to visual analog score (VAS) the pain was estimated before and 3 days as well as one month after the treatment. One month after the treatment follow-up CT scan was performed in all patients to check the tumor size and the distribution of 125I seeds, and the therapy was repeated if necessary. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Results A total of 33 times of procedure were carried out in the 18 patients. Three days after the treatment, local pain was obviously relieved in all cases. Compared with preoperative VAS, the postoperative VAS was significantly improved (P=0.000). The pain was well controlled even one month after the treatment (P=0.000). One month after the last treatment the complete remission (CR) rate was 0% (n=0), partial remission (PR) rate 61.1% (n=11), stable disease (SD) 33.3% (n=6) and progress disease (PD) 5.6% (n=1), and local control rate (CR+PR) was 61.1%. No severe brachytheray-related complications occurred. Conclusion Ultrasound-guided percutaneous 125I seed implantation brachytherapy is technically simple and repeatable, it can safely and effectively guide the performance of percutaneous 125I seed implantation for the treatment of osteolytic metastases. Even in the circumstance of not using TPS, this technique can also obtain satisfactory local control rate and significant pain relief.
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The authors report one case of primary hepatic neuroendocrine carcinoma associated with multiple liver metastases. A patient was a 41-year-old female. In 2010, B-ultrasound examination revealed that there were multiple space-occupying lesions in the liver, and hepatic hemangiomas was considered to be the diagnosis. Then, the patient was followed up regularly. In Aug. 2013, B-ultrasound examination indicated that the hepatic lesions were significantly enlarged. Multi-detector CT scanning and MRI examination were performed, and still the diagnosis of multiple hepatic hemangiomas was suggested. On CT and MRI the lesion presented as a well-circumscribed hypervascular tumor with “fast-in and slow-out” enhancement pattern. On MRI, the lesion was characterized by multiple nodules. Needle biopsy was carried out, and the pathological and immunohistochemical diagnosis was metastatic neuroendocrine tumor. Systemic examination did not find the primary lesion. Therefore, primary hepatic neuroendocrine carcinoma associated with intra- hepatic metastases was diagnosed. The patient was treated with transcatheter arterial chemoembolization. The drugs used were 100 mg Oxaliplatin+one bottle of gelatin sponge particles(300-500μm)+10 ml iodized oil, and micro-pump infusion of 100 mg oxaliplatin(99 mg/h) through catheter was also employed. Clinically, primary hepatic neuroendocrine carcinoma is extremely rare. In combination with the medical literatures, the authors attempt to make a preliminary discussion on the clinical characteristics, differential diagnosis, treatment and prognosis of primary hepatic neuroendocrine carcinoma.
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Objective To investigate the effects of transcatheter arterial chemoembolization (TACE) using low doses of oxaliplatin in elderly patients with hepatocellular carcinoma.Methods A retrospective study was conducted in the Department of Interventional Radiology,Changhai Hospital from September 2009 to September 2011.Fifty-eight patients were divided into two groups according to the doses of oxaliplatin used in TACE as group 1 (40 mg/m2) and group 2 (80 mg/m2).The clinical data were collected and analyzed using SPSS 19.Results When compared with group 2,patiems in group 1 showed less postoperative nausea and vomiting (22.6％ vs.66.7％;x2 =11.43;P ＜0.05),lower pain scores (29.3％ vs.77.8％;x2 =13.73;P ＜ 0.05),and less decrease in leukocyte numbers (7.98 ± 1.04 × 199/L vs.3.98 ±1.66 × 199/L;t =8.27;P ＜ 0.05),and better liver function as measured by ALT [(44.1 ± 23.8) U/L vs.(79.4 ±24.7)U/L;t =-5.54;P ＜0.05].The two groups showed no significant differences at one year and three years on follow up with overall survival rates of 67.7％ vs.63.0％,30.7％ vs.22.2％,respectively,P ＞ 0.05.Conclusion Elderly HCC patients treated with TACE using low doses of oxaliplatin had milder side effects of chemotherapy and better overall survival.
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OBJECTIVE: To observe and discuss the dynamic changes of interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) and their significance in the patients with primary liver cancer after transarterial chemoembolization (TACE) therapy combined with Jinglong Capsule. METHODS: A total of 48 patients with primary liver cancer, who failed to be treated by major surgery, were randomly divided into two groups: Jinlong Capsule group (TACE therapy plus Jinlong Capsule) and control group (TACE therapy alone). There were 24 cases in each group. The levels of peripheral blood IL-2 and slL-2R were measured before the first TACE and 1, 7 and 15 days after the second TACE respectively by using double-antibody sandwich enzyme-linked immunosorbent assay. The data from Jinlong Capsule group were compared with those from the control group. RESULTS: The level of sIL-2R in Jinlong Capsule group was significantly lower than that in the control group (P<0.05), while the level of IL-2 was significantly higher than that in the control group (P<0.05). CONCLUSION: Jinlong Capsule can significantly improve the lymphocyte function of the patients with primary liver cancer after TACE. The levels of IL-2 and sIL-2R can be considered as the valuable parameters for evaluating the effects on primary liver cancer, and Jinlong Capsule is helpful for the patients with primary liver cancer.
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Objective： To study the application of DSA in the diagnosis and treatment of ENT diseases. Methods： The diagnostic and therapeutic roles of DSA in ENT patients admitted from November 1995 to December 1999 were retrospectively studied. Results： Therapeutic vascular embolization using DSA was performed in 9/10 patients with severe epistaxis. The treatment was successful in 8/9 patients with a successful rate of 88.89%; embolization of tumor supplying vessels using DSA as a preoperative measure for reducing operative blood loss in 3 patients with nasopharyngeal fibrohemangioma obtained a total success; diagnosis was clarified in 2 patients using DSA. No patients were with severe complications. Conclusion： DSA is not only a safe and effective measure for diagnosis and therapy, but also effective in differential diagnosis of space occupying lesions. Preoperative selective embolization of tumor supplying arteries can reduce operative blood loss.
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Objective:To study the inhibitory effects of an adenovirus(Ad)-based short hairpin RNA(shRNA) expression system on expression of vascular endothelial growth factor receptor(VEGFR) and on growth of colon carcinoma cells in vitro and in vivo.Methods: RNA interference pAd-Easy/VEGFR vector was used to transfect 293 cells via Lipofectamine 2000.The adenoviral vector carrying VEGFR was used to transfect CW2 cells and the transfection efficiency was determined by fluorescent microscope and flow cytometry.The expression of VEGFR was examined by RT-PCR and Western blotting.The cell growth was observed with MTT method and the growth curve was plotted.Nude mouse was transplanted with CW2 cells to establish colon cancer tumor model and the growth of tumor was observed daily.Micro-vessel density(MVD) was detected by immunohistochemistry.Results: The recombinant pAd-Easy carrying shRNA against VEGFR was verified by sequencing.Flow cytometry showed that the transfection efficiency of CW2 cells was 99.7%.RT-PCR and Western blotting showed that the expression of VEGFR in pAd-Easy/VEGFR group was obviously decreased.The growth curve showed that the cell growth in the pAd-Easy/VEGFR group was obviously slowed down.We also found that the tumor growth in the nude mouse model was obviously inhibited and the MVD was also decreased.Conclusion: pAd-Easy/VEGFR-mediated VEGFR shRNA can effectively inhibit the expression of VEGFR in CW2 cells and suppress tumor growth in vivo.
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Objective To study the efficacy of thyroidal arterial embolization in treating hyperthyroidism by using different embolizing materials and the relationship between recurrence rate and the numbers of embolized arteries. Methods 56 cases with hyperthyroidism were divided into group A (25 cases) and group B (31 cases). Patients of group A had their thyroidal arteries embolized with gelfoam particles and stainless coils after arterial infusion of a total dosage of 24 mg of blemycin. Patients of group B had their thyroidal arteries occluded with polyvinyl alcohol (PVA) particles. The effectiveness and general complications of arterial embolization for these two groups were compared and the relationship between recurrence rate of hyperthyroidism after treatment and numbers of embolized thyroidal arteries was studied. Results It showed effectiveness in all patients within 2 3 months. The follow up records showed, the recurrence rate of hyperthyroidism was 28% and 16.1% for group A and group B respectively but without statistical difference. The recurrence rates were 46.7% for those patients with 2 thyroid arteries embolized and 12.2% for those with 3 4 arteries embolized, showing significant difference ( ? 2=7.751, P
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0.05). The diameters of left superior and inferior thyroid arteries ranged from 2.4mm to 6.0mm(3.7?0.9mm) and from 1.0mm to 5.2mm(2.9? 1.0 mm) respectively, showed statistically significant difference ( t=3.7796, P 0.05), but the right inferior thyroid arteries were larger than the left ones ( t=2.3 917, P
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Objective To investigate the complications of thyroid arterial embolization and their prevention and treatment.Methods 61 cases of thyroid disorders received the therapy of thyroid arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache(23 cases), toothache(11 cases), neckache(13 cases), hoarseness(37 cases) were caused by non target arterial embolization with the most serious one of cerebral infarction(1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti coagulant, all others were given anti symptomatics or no special treatment.Conclusions Proper treatment should be ready during thyroid arterial embolization and given in time with occurance of complications.
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Objective To assess the effect of arterial embolization in treating hyperthroidism by colour ultrasonography.Methods Forty two cases of hyperthyroidism were treated with thyroid arteries embolization. A few days before and 1, 3, 6 months after embolization, the echograms of thyroids were observed including the volumes of thyroids and the internal diameters of thyroid arteries were measured with colour ultrasonography respectively. The Vs, Vd, Vm, PI, RI were measured with the Doppler and the quantities of blood flow were calculated. The relationships of changes for all these parameters and T 3, T 4 and TSH were analysed. Results Before artery embolization all thyroids were enlarged with diffusely homogenous or heterogenous low echos and nodules in some patients accompanied by widenings of the thyroid arteries and their branches full of blood supply. The volume of thyroids decreased after artery embolization. 1 3 months later the echo of thyroids enhanced and got coarse with decrease of the thyroid vasculature and narrowing of vessel calibers except a few star or spot like blood streams were sometimes seen within the thyroids and no blood flow signals found in some cases. 3 6 months after embolization, the echo of thyroids decreased gradually or unevenly distribnted. All the parameters of blood flow before and after the treatment showed statistically significant differences( P