Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. / Eficacia y seguridad de la radioembolización con 90Y en el tratamiento de metástasis hepáticas de tumores neuroendocrinos. Seguimiento a largo plazo y repercusión en la supervivencia.

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.

Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver.

OBJECTIVE: Hepatocellular carcinoma (HCC) ablation by radiofrequency (RFA) is a novel technique with a great variety of methods whose efficacy and predictive factors have not been completely studied. Some of the main predictive factors in this type of treatment are analyzed in the present study. PATIENTS AND METHODS: Ninety-three patients with hepatocellular carcinoma over cirrhosis, and with no indication for surgical resection were treated by RFA. Two different types of electrodes were used for RFA (refrigerated-"Cool-Tip" and perfusion with saline solution, the approach was percutaneous, by laparoscopy or laparotomy. RESULTS: Overall survival at 1, 2 and 3 years was 88, 81, and 76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively. For tumors less than 3 cm, FDS at 1,2 and 3 years was 74, 44 and 30%, while for more than 3 cm in size FDS was 55, 12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36 and 22%, and for more than one nodule it decreased to 50, 17 and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly, the method employed for RFA has a main influence in FDS, with 0% at 3 years for perfusion electrodes and 26% for cool-tip electrodes at the same period. CONCLUSIONS: In this series, overall survival at three years was relatively high; however, tumoral size, number of nodules and RFS method were independent variables associated with disease-free survival.

Factores de respuesta tumoral tras ablación mediante radiofrecuencia del carcinoma hepatocelular sobre cirrosis / Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver

Objetivo: la ablación por radiofrecuencia del hepatocarcinoma(ARF) es una técnica de reciente adquisición, cuya eficacia yfactores predictivos no han sido suficientemente evaluados. Elpresente estudio fue diseñado para este análisis.Pacientes y métodos: se han tratado 93 pacientes con hepatocarcinomasobre hígado cirrótico sin criterios de resección nide trasplante hepático. El tratamiento se realizó mediante abordajepercutáneo, laparoscópico o mediante laparotomía con dos tiposde electrodos de radiofrecuencia, electrodo refrigerado y deperfusión respectivamente.Resultados: la supervivencia global a los 1, 2 y 3 años fue del88, 81 y 76%, con una supervivencia-libre de enfermedad (SLE)de 66, 31 y 17% respectivamente. El análisis multivariante demostrótres variables predictivas independientes: tamaño tumoral( 3 cm; SLE a 1,2 y 3 años de 74, 44 y 30%,frente a 55, 12 y 0%; HR= 2,02; IC 95% 1,10-3,70; p = 0,02),número de nódulos (uno frente a más de uno; SLE a 1,2 y 3 añosde 70, 36 y 22, frente a 50, 17 y 0%; HR= 1,92 IC 95% 0,95-3,93; p = 0,07) y tipo de electrodo (refrigerado frente a perfusión;SLE 80, 43 y 26% a 1, 2 y 3 años frente a 49, 12 y 0%;HR = 2,06; IC 95% 1,12-3,79; p = 0,02).Conclusiones: a pesar de que la ARF proporciona una supervivenciaglobal aceptable, la SLE es notablemente inferior. El tamañodel tumor, el número de nódulos y el tipo de electrodo deARF fueron variables independientes asociadas a la SLE

Objective: hepatocellular carcinoma (HCC) ablation by radiofrequency(RFA) is a novel technique with a great variety ofmethods whose efficacy and predictive factors have not beencompletely studied. Some of the main predictive factors in thistype of treatment are analyzed in the present study.Patients and methods: ninety-three patients with hepatocellularcarcinoma over cirrhosis, and with no indication for surgicalresection were treated by RFA. Two different types of electrodeswere used for RFA (refrigerated-“Cool-Tip” and perfusion withsaline solution, the approach was percutaneous, by laparoscopyor laparotomy.Results: overall survival at 1, 2 and 3 years was 88, 81, and76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively.For tumors less than 3 cm, FDS at 1,2 and 3 years was74, 44 and 30%, while for more than 3 cm in size FDS was 55,12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36and 22%, and for more than one nodule it decreased to 50, 17and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly,the method employed for RFA has a main influence in FDS, with0% at 3 years for perfusion electrodes and 26% for cool-tip electrodesat the same period.Conclusions: in this series, overall survival at three years wasrelatively high; however, tumoral size, number of nodules andRFS method were independent variables associated with diseasefreesurvival

Leiomiosarcoma de la vena renal izquierda / Leiomyosarcoma of the left renal vein

Introducción. El leiomiosarcoma representa el 2 por ciento de los tumores de origen vascular. Se trata de una tumoración rara que suele afectar a pacientes de edad media, con una distribución parecida en ambos sexos. Caso clínico. Mujer de 63 años que acudió a urgencias por un dolor lumbar irradiado a la fosa renal izquierda. La ecografía abdominal reveló una masa sólida de 10 cm anterior al riñón izquierdo, cuya dependencia era difícil de establecer. La tomografía axial computarizada confirmó una masa de 12 cm, posiblemente relacionada con un sarcoma retroperitoneal. Se detectó una hidronefrosis del riñón izquierdo que obligó a la colocación de una nefrostomía percutánea. El resultado de la punción mediante aspiración con aguja fina fue compatible con leiomiosarcoma. En la cirugía se halló una tumoración de 15 cm sobre la aorta y el hilio renal izquierdo. Se realizó una disección de la tumoración y una ligadura de la arteria y la vena renal izquierda, con una nefrectomía que incluía la tumoración. El resultado definitivo de la anatomía patológica fue leiomiosarcoma dependiente de la vena renal. Conclusión. A pesar de su rareza, el leiomiosarcoma es el tumor maligno más frecuente en el territorio de la vena cava inferior. El diagnóstico se basa en la clínica y en las pruebas de imagen. Desde el punto de vista terapéutico, la cirugía es de elección. Debe ser completa, con unos márgenes de seguridad de 1 cm. El tratamiento con el que se consiguen supervivencias más prolongadas combina quimioterapia preoperatoria seguida de cirugía radical y quimioterapia posoperatoria. Desde el punto de vista evolutivo, su pronóstico es malo. La localización es el principal factor pronóstico; es peor cuanto más proximales se encuentran situados (AU)