Efficacy and safety of metronomic chemotherapy for patients with advanced primary hepatocellular carcinoma with major portal vein tumor thrombosis / 대한간학회지

BACKGROUND/AIMS: Low-dose metronomic chemotherapy involves the frequent administration of comparatively low doses of cytotoxic agents with no extended breaks, and it may be as efficient as and less toxic than the conventional maximum tolerated dose therapy. This study evaluated the feasibility and therapeutic efficacy of metronomic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) with major portal vein thrombosis (PVT). METHODS: Thirty consecutive HCC patients with major PVT with or without extrahepatic metastasis were prospectively allocated to metronomic chemotherapy consisting of epirubicin being infused through the correct hepatic artery at a dose of 30 mg/body surface area (BSA) every 4 weeks, and cisplatin (15 mg/BSA) and 5-fluorouracil (50 mg/BSA) every week for 3 weeks, with intervening 1 week breaks. The treatment response was assessed using response evaluation criteria in solid tumors (RECIST). RESULTS: In total, 116 cycles of metronomic chemotherapy were administered to the 30 patients, with a median of 3 cycles given to individual patients (range, 1-15 cycles). Six patients (20.0%) achieved a partial response and six patients (20.0%) had stable disease. The median time to disease progression and overall survival were 63 days (range, 26-631 days) and 162 days (95% confidence interval; range, 62-262 days), respectively. Overall survival was significantly associated with baseline alpha-fetoprotein level (P=0.001) and tumor response (P=0.005). The baseline alpha-fetoprotein level was significantly associated with the disease control rate (P=0.007). Adverse events were tolerable and managed successfully with conservative treatment. CONCLUSIONS: Metronomic chemotherapy may be a safe and useful palliative treatment in HCC patients with major PVT.

Successful Treatment of an Iatrogenic Giant Femoral Artery Pseudoaneurysm With Percutaneous Thrombin Injection

A femoral artery pseudoaneurysm (FAP) is one of the most troublesome complications following invasive procedures related to the femoral arterial access. Post-procedure FAP rarely occurs; however, its occurrence tends to increase with the more frequently antiplatelet agents, anticoagulants, and larger-sized catheter used for interventional procedures. Traditionally, surgical repair has been considered as the standard treatment modality for FAP; however, less invasive methods currently exist such as blind manual or ultrasound-guided compression repair (UGCR) as well as percutaneous thrombin injection, both of which have replaced the need for surgery. We report a case of a giant pseudoaneurysm in a femoral artery, which had developed as a complication of stenting in a patient with carotid artery stenosis and ischemic heart disease, and was subsequently successfully treated using percutaneous thrombin injection.

Three Cases of Endoscopic Hemostasis of Gastric Ulcer Bleeding from an Exposed Blood Vessel with Using Histoacryl (N-Butyl-2-Cyanoacrylate) / 대한소화기내시경학회지

Upper gastrointestinal bleeding is a primary and emergency complication of peptic ulcer. Injection of Histoacryl (N-butyl-2-cyanoacrylate) is an effective endoscopic hemostasis procedure to treat peptic ulcer bleeding. However, Histoacryl injection is not a widely used method because of its various and sometimes severe complications. Therefore, the use of Histocaryl should be considered as a second line treatment modality to achieve therapeutic endoscopic hemostasis when the conventional treatment modalities fail or the patient has a high risk of needing operative therapy. Three patients, who had gastric ulcer bleeding from an exposed blood vessel, were each treated by an injection of Histoacryl diluted with Lipiodol at a dilution ratio of 1:1. All 3 procedures were successfully accomplished without any complications.