Abstract:

This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease.

References

1.     Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394-424.

https://doi.org/10.3322/caac.21492

2.     Llovet JM, Br? C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Seminars in liver disease. 1999; 19(3): 329-338.

3.     Vishnevsky VA, Ayvazyan KA, Ikramov RZ, et al. Sovremennye printsipy lecheniya gepatotsellyulyarnogo raka. Annaly khirurgicheskoy gepatologii 2020; 25(2): 15-26 [In Russ].

https://doi.org/10.16931/1995-5464.2020215-26

4.     Mizuguchi T, Kawamoto M, Meguro M, et al. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014; 44(1): 1-10.

https://doi.org/10.1007/s00595-013-0534-4

5.     European Association for the Study of the Liver. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018; 69(1): 182-236.

https://doi.org/10.1016/j.jhep.2018.03.019

6.     Kamiyama T, Orimo T, Wakayama K, et al. Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification. World J Surg Oncol. 2017; 15(1): 156.

https://doi.org/10.1186/s12957-017-1229-x

7.     Kim H, Ahn SW, Hong SK, et al. Korean Liver Cancer Association. Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma. Br J Surg. 2017; 104(8): 1045-1052.

https://doi.org/10.1002/bjs.10541

8.     Samuel M, Chow PK, Chan Shih-Yen E, et al. Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev. 2009; 1: CD001199.

https://doi.org/10.1002/14651858.CD001199.pub2

9.     Tremosini S, Reig M, de Lope CR, et al. Treatment of early hepatocellular carcinoma: Towards personalized therapy. Dig Liver Dis. 2010; 42(3): 242-8.

https://doi.org/10.1016/S1590-8658(10)60512-9

10.   Bolondi L, Burroughs A, Dufour JF, et al Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis. 2012; 32(4): 348-59.

https://doi.org/10.1055/s-0032-1329906

11.   Kudo M, Arizumi T, Ueshima K, et al. Subclassification of BCLC B Stage Hepatocellular Carcinoma and Treatment Strategies: Proposal of Modified Bolondi's Subclassification (Kinki Criteria). Dig Dis. 2015; 33(6): 751-8.

https://doi.org/10.1159/000439290

12.   Wada H, Eguchi H, Noda T, et al. Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma. Surgery. 2016; 160(5): 1227-1235.

https://doi.org/10.1016/j.surg.2016.05.023

13.   Wang W, Yang LY, Huang GW, et al. Genomic analysis reveals RhoC as a potential marker in hepatocellular carcinoma with poor prognosis. Br J Cancer. 2004; 90(12): 2349-55.

https://doi.org/10.1038/sj.bjc.6601749

14.   Yang LY, Wang W, Peng JX, et al. Differentially expressed genes between solitary large hepatocellular carcinoma and nodular hepatocellular carcinoma. World J Gastroenterol. 2004; 10(24): 3569-73.

https://doi.org/10.3748/wjg.v10.i24.3569

15.   Chen J, Lai L, Lin Q, et al. Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study. Oncotarget. 2017; 8(1): 408-417.

https://doi.org/10.18632/oncotarget.13427

16.   Pirtskhalava TL, Granov DA, Maystrenko DN. Kombinirovannaya rezektsiya pecheni i nizhnei poloi veny pri gepatotsellyulyarnom rake. Annaly khirurgicheskoy gepatologii. 2016; 21(2): 52-55 [In Russ].

https://doi.org/10.16931/1995-5464.2016252-55

17.   Granov AM, Tarazov PG, Granov DA, et al. Uspeshnoe kombinirovannoe lechenie patsienta s retsidiviruyushchei gepatotsellyulyarnoi kartsinomoi. Vestnik khirurgii imeni II Grekova. 2015; 174(2): 98-100 [In Russ].

18.   Granov DA, Polehin AS, Tarazov PG, et al. Khimioehmbolizatsiya pechenochnykh arterii u bol'nykh gepatotsellyulyarnym rakom na fone tsirroza pered transplantatsiei pecheni: prognosticheskoe znachenie kontsentratsii al'fafetoproteina. Russian Journal of Transplantology and Artificial Organs. 2020; 22(4): 52-57 [In Russ].

https://doi.org/10.15825/1995-1191-2020-4-52-57

Abstract:

Introduction: the review is devoted to clinical results of the use of radiological and endovascular interventionsin intrahepatic cholangiocarcinoma: chemoinfusion, chemo- and radioembolization of the hepatic artery, preoperative embolization of right branch of portal vein.

Aim: was to evaluate and compare the effectiveness of methods of intravascular therapy for intrahepatic cholangiocarcinoma.

Materials and methods: article presents an analysis of 50 scientific literature sources in leading domestic and foreign scientific journals.

Results: it was found that intra-arterial treatment methods have approximately the same clinical efficacy. Chemoinfusion is a technically simple and effective method of treatment, prospects of which are associated with the creation of new chemotherapy drugs and therapeutic regimens. Chemoembolization is most effective for hypervascular cholangiocarcinoma. The question of its use in a neoadjuvant mode requires study, even in resectable cases, it helps to reduce the biological activity of the tumor. Radioembolization (RE) effectively slows down the growth of cholangiocarcinoma and is well tolerated by patients, but long-term results are little bit worse to those of infusion and embolization. The procedure seems to be technically difficult and requires expensive logistics. When solving these problems, ER can become one of the most important methods of treating cholangiocarcinoma, especially when the tumor is resistant to other methods of therapy.

Preoperative portal vein embolization is routinely used in clinical practice. However, operations performed after this procedure account for only 3-6% of all liver resections. The wider application of this technically simple and safe technique seems logical.

Conclusions: in the treatment of cholangiocarcinoma, a combined approach should be used with the use of surgical, X-ray endovascular and other methods of anticancer therapy: this makes it possible to expand possibilities of treating patients and achieve improved long-term results.

References

1.     Datta J, Narayan RR, Kemeny NE, D’Angelica MI. Role of hepatic artery infusion chemotherapy in treatment of initially unresectable colorectal liver metastases (review). JAMA Surg. 2019; 154(8): 768-776.

https://doi.org/10.1001/jamasurg.2019.1694

2.     Rutkin IO, Granov DA, Polysalov VN, et al. Combination of cytoreductive surgery and implantation of intra-arterial infusion systems in the treatment of unresectable liver tumors. Voprosy Onkologii. 2007; 53(2): 206-209 [In Russ].

3.     Generalov MI, Balakhnin PV, Tsurkan VA, et al. Diagnosis and treatment of toxic complications of regional chemotherapy through percutaneously implanted systems. Diagnosticheskaja i Intervencionnaya Radiologiya. 2007; 1(3): 46-51 [In Russ].

4.     Imamine R, Shibata T, Shinozuka K, Togashi K. Complications in hepatic arterial infusion chemotherapy: retrospective comparison of catheter tip placement in the right/left hepatic artery vs. the gastroduodenal artery. Surg. Today. 2017; 47(7): 851-858.

5.     Kozlov AV, Tarazov PG, Polikarpov AA, Polysalov VN. Possibility of regional chemotherapy in patients with cancer of the liver and biliary ducts complicated by obstructive jaundice. Rossijskij Onkologicheskij Zhurnal. 2004; 1: 11-15 [In Russ].

6.     Konstantinidis IT, Do RKG, Gultekin GH, et al. Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potentional role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials. Ann. Surg. Oncol. 2014; 21(8): 2675-2683.

https://doi.org/10.1245/s10434-014-3649-y

7.     Konstantinidis IT, Koerkamp BG, Do RKG, et al. Unresectable intrahepatic cholangiocarcinoma: systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone. Cancer. 2016; 122(5): 758-765.

https://doi.org/10.1002/cncr.29824

8.     Sinn M, Nicolaou A, Gebauer B, et al. Hepatic arterial infusion with oxaliplatin and 5-FU/folinic acid for advanced biliary tract cancer: a phase II study. Dig. Dis. Sci. 2013; 58(8): 2399-2405.

https://doi.org/10.1007/s10620-013-2624-y

9.     Wang X, Hu J, Caj G, et al. Phase II study of hepatic arterial infusion chemotherapy with oxaliplatin and 5-fluorouracil for advanced perihilar cholangiocarcinoma. Radiology. 2017; 283(2): 580-589.

https://doi.org/10.1148/radiol.2016160572

10.   Thiels CA, D’Angelica MI. Hepatic artery infusion pumps (review). J. Surg. Oncol. 2020; 122(1): 70-77.

https://doi.org/10.1002/jso.25913

11.   Savic LJ, Chapiro J, Geschwind J-FH. Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects (review). Hepatobiliary Surg. Nutr. 2017; 6(1): 7-21.

https://doi.org/10.21037/hbsn.2016.11.02

12.   Lewis AL, Hall B. Toward a better understanding of the mechanism of action for intra-arterial delivery of irinotecan from DC Bead (DEBIRI). Future Oncology. 2019; 15(17): 2053-2068.

https://doi.org/10.2217/fon-2019-0071

13.   Faramazzalian A, Armitage KB, Kapoor B, Kalva SP. Medical management of tumor lysis syndrome, postprocedural pain, and venous thromboembolism following interventional radiology procedures. Semin. Intervent. Radiol. 2015; 32(2): 209-216.

https://doi.org/10.1055/s-0035-1549379

14.   Matsui Y, Figi A, Horikawa M, et al. Arteriopathy after transarterial chemo-lipiodolization for hepatocellular carcinoma. Diagn. Interv. Imag. 2017; 98(12): 827-835.

https://doi.org/10.3748/wjg.v25.i31.4360

15.   Newgard BJ, Getrajdman GI, Erinjeri JP, et al. Incidence and consequence of nontarget embolization following bland hepatic arterial embolization. Cardiovasc. Intervent. Radiol. 2019; 42(8): 1135-1141.

https://doi.org/10.1007/s00270-019-02229-2

16.   Dolgushin BI, Virshke ER, Kosyrev VJ, et al. Transarterial chemoembolization in the treatment of inoperable patients with nodular cholangiocarcinoma. Annaly Khirurgicheskoy Gepatologii. 2015; 20(3): 24-30 [In Russ].

https://doi.org/10.16931/1995-5464.2015324-30

17.   Park S-Y, Kim JH, Yoon H-J, et al. Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma. Clin. Radiol. 2011; 66(4): 322-328.

https://doi.org/10.1016/j.crad.2010.11.002

18.   Gusani NJ, Balaa FK, Steel JL, et al. Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter arterial chemoembolization (TACE): a single-institution experience. J. Gastrointest. Surg. 2008; 12(1): 129-137.

https://doi.org/10.1007/s11605-007-0312-y

19.   Burger I, Hong K, Schulik R, et al. Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution. J. Vasc. Interv. Radiol. 2005; 16(3): 353-361.

https://doi.org/10.1097/01.RVI.0000143768.60751.7

20.   Kiefer MV, Albert M, McNally M, et al. Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study. Cancer. 2011; 117(7): 1498-1505.

https://doi.org/10.1002/cncr.25625

21.   Vogl TJ, Naguib NN, Nour-Eldin NE, et al. Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: results and prognostic factors governing treatment success. Int. J. Cancer. 2012; 31(3): 733-740.

https://doi.org/10.1002/ijc.26407

22.   Popov VV, Polikarpov AA, Alentiev SA, et al. Possibilities of regional chemotherapy in the treatment of unresectable cholangiocarcinoma. Klinicheskaja Patofisiologija. 2016; 3-1(22): 21-24 [In Russ].

https://doi.org/10.1111/liv.12364

23.   Li J, Wang Q, Lei Z, et al. Adjuvant transarterial chemoembolization following liver resection for intrahepatic cholangiocarcinoma based on survival risk stratification. Oncologist. 2015; 26(6): 640-647.

https://doi.org/10.1634/theoncologist.2014-0470

24.   Lu Z, Liu S, Yi Y, et al. Serum gamma-glutamyl transferase levels affect the prognosis in patients with intrahepatic cholangiocarcinoma who receive postoperative adjuvant transcatheter arterial chemoembolization: a propensity score matching study. Int. J. Surg. 2017; 37: 24-28.

https://doi.org/10.1016/j.ijsu.2016.10.015

25.   Wu ZF, Zhang HB, Yang N, et al. Postoperative adjuvant transcatheter arterial chemoembolization improves survival of intrahepatic cholangiocarcinoma patients with poor prognostic factors: results of a large monocentric series. Eur. J. Surg. Oncol. 2012; 38(7): 602-610.

https://doi.org/10.1016/j.ejso.2012.02.185

26.   Park HM, Yun SP, Lee EC, et al. Outcomes for patients with recurrent intrahepatic cholangiocarcinoma after surgery. Ann. Surg. Oncol. 2016; 23(13): 4392-4400.

https://doi.org/10.1245/s10434-016-5454-2

27.   Ge Y, Jeong S, Luo G-J, et al. Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: development of a prognostic nomogram. Hepatobiliary Pancreat. Dis. Int. 2020; 19(2): 138-146.

https://doi.org/10.1016/j.hbpd.2020.02.005

28.   Aliberti C, Benea G, Tilli M, Fiorentini G. Chemoembolization (TACE) of unresectable intrahepatic cholangiocarcinoma with slow-release doxorubicin-eluting beads: preliminary results. Cardiovasc. Intervent. Radiol. 2008; 31(5): 883-888.

https://doi.org/10.1007/s00270-008-9336-2

29.   Aliberti C, Carandina R, Sarti D, et al. Chemoembolization with drug-eluting microspheres loaded with doxorubicin for the treatment of cholangiocarcinoma. Anticancer Res. 2017; 37(4): 1859-1863.

https://doi.org/10.21873/anticanres.11522

30.   Kuhlman JB, Euringer W, Spangenberg HC, et al. Treatment of unresectable cholangiocarcinoma: conventional transarterial chemoembolization compared with drug eluting bead-transarterial chemoembolization and systemic chemotherapy. Eur. J. Gastroenterol. Hepatol. 2012; 24(4): 437-443.

https://doi.org/10.1097/MEG.0b013e3283502241

31.   Schiffman SC, Metzger T, Dubel G, et al. Precision hepatic arterial irinotecan therapy in the treatment of unresectable cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann. Surg. Oncol. 2011; 18(2): 431-438.

https://doi.org/10.1245/s10434-010-1333-4

32.   Ray CE, Edwards A, Smith MT, et al. Meta-analysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma. J. Vasc. Interv. Radiol. 2013; 24(8): 1218-1226.

https://doi.org/10.1016/j.jvir.2013.03.019

33.   Radosa CG, Radosa JC, Grosche-Schlee S, et al. Holmium-166 radioembolization in hepatocellular carcinoma: feasibility and safety of a new treatment option in clinical practice. Cardiovasc. Intervent. Radiol. 2019; 42(3): 405-412.

https://doi.org/10.1007/s00270-018-2133-7

34.   Gangi A, Shah J, Hatfield N, et al. Intrahepatic cholangiocarcinoma treated with transarterial yttrium-90 glass microsphere radioembolization: Results of a single institution retrospective study. J. Vasc. Interv. Radiol. 2018; 29(8): 1101-1108.

https://doi.org/10.1016/j.jvir.2018.04.001

35.   Reimer P, Virarkar MK, Binnenhei M, et al. Prognostic factors in overall survival of patients with unresectable intrahepatic cholangiocarcinoma treated by means of yttrium-90 radioembolization: results in therapy-na?ve patients. Cardiovasc. Intervent. Radiol. 2018; 41(5): 744-752.

https://doi.org/10.1007/s00270-017-1871-2

36.   Al-Adra DP, Gill RS, Axford SJ, et al. Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. Eur. J. Surg. Oncol. 2015; 41(1): 120-127.

https://doi.org/10.1016/j.ejso.2014.09.007

37.   Zhen Y, Liu B, Chang Z, et al. A pooled analysis of transarterial radioembolization with ittrium-90 microspheres for the treatment of unresectable intrahepatic cholangiocarcinoma. Onco Targets Ther. 2019; 12: 4489-4498.

https://doi.org/10.2147/OTT.S.202875

38.   Rayar M, Sulpice L, Edeline J, et al. Intra-arterial yttrium-90 radioembolization combined with systemic chemotherapy is a promising method for downstaging unresectable huge intrahepatic cholangiocarcinoma to surgical treatment. Ann. Surg. Oncol. 2015; 22(9): 3102-3108.

https://doi.org/10.1245/s10434-014-4365-3

39.   Bargellini I, Mosconi C, Pizzi G, et al. Yttrium-90 radioembolization in unresectable intrahepatic cholangiocarcinoma: Results of a multicenter retrospective study. Cardiovasc. Intervent. Radiol. 2020; 43(9): 1305-1314.

https://doi.org/10.1007/s00270-020-02569-4

40.   Edeline J, Touchefeu Y, Guiu B, et al. Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: A phase 2 clinical trial. JAMA Oncol. 2019; 6(1): 51-59.

https://doi.org/10.1001/jamaoncol.2019.3702

41.   White J, Carolan-Rees G, Dale M, et al. Yttrium-90 transarterial radioembolization for chemotherapy-refractory intrahepatic cholangiocarcinoma: a prospective, observational study. J. Vasc. Interv. Radiol. 2019; 30(8): 1185-1192.

https://doi.org/10.1016/j.jvir.2019.03.018

42.   Buettner S, Braat AJAT, Margonis GA, et al. Yttrium-90 radioembolization in intrahepatic cholangiocarcinoma: a multicenter retrospective analysis. J. Vasc. Interv. Radiol. 2020; 31(7): 1035-1043.

https://doi.org/10.1016/j.jvir.2020.02.008

43.   Akinwande O, Shah V, Mills A, et al. Chemoembolization versus radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma in a single institution: image-based efficacy and comparative toxicity. Hepatic Oncology. 2017; 4(3): 75-81.

https://doi.org/10.2217/hep-2017-0005

44.   Currie BM, Soulen MC. Decision making: intra-arterial therapies for cholangiocarcinoma – TACE and TARE. Semin. Intervent. Radiol. 2017; 34(2): 92-100.

https://doi.org/10.1055/s-0037-1602591

45.   Hyder O, Marsh JW, Salem R, et al. Intra-arterial therapy for advanced intrahepatic cholangiocarcinoma: a multi-institutional analysis. Ann. Surg. Oncol. 2013; 20(12): 3779-3786.

https://doi.org/10.1245/s10434-013-3127-y

46.   Boehm LM, Jayakrishnan TT, Miura JT, et al. Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma. J. Surg. Oncol. 2015; 111(2): 213-220.

https://doi.org/10.1002/jso.23781

47.   Yang L, Shan J, Shan L, et al. Trans-arterial embolisation therapies for unresectable intrahepatic cholangiocarcinoma: a systematic review. J. Gastrointest. Oncol. 2015; 6(5): 570-588.

https://doi.org/10.3978/j.issn.2078-6891.2015.055

48.   Wright GP, Perkins S, Jones H, et al. Surgical resection does not improve survival in multifocal intrahepatic cholangiocarcinoma: a comparison of surgical resection with intra-arterial therapies. Ann. Surg. Oncol. 2018; 25(1): 83-90.

https://doi.org/10.1245/s10434-017-6110-1

49.   Ebata T, Yokoyama Y, Igami T, et al. Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations. Dig. Surg. 2012; 29(1): 23-29.

https://doi.org/10.1159/000335718

50.   Higuchi R, Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. J. Hep. Bil. Pancr.Sci. 2014; 21(86): 542-549.

https://doi.org/10.1002/jhbp.77

Abstract:

Introduction: treatment of gastric cancer (GC) remains an urgent problem in oncology. One of the unsolved problems in treatment of gastric cancer remains the treatment of patients with liver metastases. With the development of interventional radiology, it became possible to treat gastric cancer patients with liver metastases.

Aim: was to improve results of treatment of gastric cancer patients with liver metastases by using of trans-arterial chemoembolization (TACE).

Material and methods: we analyzed results of 60 patients for the period 2008-2020, who suffered for metastatic liver disease, previously they received combined treatment for stomach cancer at various times. The average age of patients was 58,1 ± 5,8 years. When planning TACE, all patients had a general condition above 80% according to Karnovsky, according to ECOG 1-2. All TACE patients with liver metastatic foci were treated with Lipiodol 6-8ml + Doxorubicin 25mg/m². The interval between TACE cycles was 1,5-2 months. Each patient received 5-6 TACE courses.

Results: immediate results showed the effectiveness of treatment after 2 courses of TACE in 49 (81,7%) patients: partial regression was noted in 36 (60%) patients, and significant regression of the process was noted in 13 (21,6%) patients, stabilization of the process was noted in 11(18,3%) patients. With dynamic follow-up 37 (61,7%) patients lived 6 months, 24 (40%) patients lived 12 months, 11 (18,3%) patients lived 18 months, 8 (13,3%) patients lived 24 months, only 3 (5,0%) patients lived 36 months. The median survival rate was 15,5 ± 1,2 months.

Conclusions: immediate and long-term results of the study, carrying out TACE in patients with metastases of gastric cancer to the liver was effective in 50% of patients. Currently, to improve the survival rate and quality of life of patients with metastases of gastric cancer, the technique of trans-arterial chemoembolization can be considered as an effective, low-toxic method of treatment and it can be the method of choice.

References

1.     Mastoraki A, Benetou C, Mastoraki S, et al. The role of surgery in the therapeutic approach of gastric cancer liver metastases. Indian J. Gastroenterol. 2016; 35(5): 331-336.

https://doi.org/10.1007/s12664-016-0683-7

2.     Kaidarova DR. Indicators of the Oncological Service of the Republic of Kazakhstan for 2019 (statistical and analytical materials), Almaty, 2020, -137 [In Russ].

3.     Kaprin AD, Starinskiy VV, Petrova GV. Malignant neoplasms in Russia in 2016 (morbidity and mortality). - M.: FGBU «MNIOI after named P.A. Herzen» of the Ministry of Health of Russia, 2018. - 250 [In Russ].

4.     Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol. 2020; 12: 1758835920904803.

https://doi.org/10.1177/1758835920904803.

5.     Granov AM, et al. Interventional radiology in oncology (ways of development and technology) - SPb.: - Foliant. - 2007. - 88-97 [In Russ].

6.     Gantsev ShKh, Arybzhanov DT, Kulakeev OK. A method of chemotherapy for gastric cancer metastases in the liver. Patent of the Russian Federation No. 2364397 dated 20.08.2009. Bul. 23 [In Russ].

7.     Chen H, Gao S, Yang XZ, et al. Comparison of Safety and Efficacy of Different Models of Target Vessel Regional Chemotherapy for Gastric Cancer with Liver Metastases. Chemotherapy. 2016; 61(2): 99-107.

https://doi.org/10.1159/000440945

8.     Chen H, Zhang J, Cao G, et al. Target hepatic artery regional chemotherapy and bevacizumab perfusion in liver metastatic colorectal cancer after failure of first-line or second-line systemic chemotherapy. Anticancer Drugs. 2016; 27(2): 118-26.

https://doi.org/10.1097/CAD.0000000000000290

9.     Sawatsubashi T, Nakatsuka H, Nihei K, Takano T. A Case of Metachronous Multiple Liver Metastases of AFP and PIVKA-Producing Gastric Cancer, Responding to Transcatheter Arterial Chemoembolization. Gan To Kagaku Ryoho. 2020; 47(2): 319-321.

10.   Liu SF, Lu CR, Cheng HD, et al. Comparison of Therapeutic Efficacy between Gastrectomy with Transarterial Chemoembolization Plus Systemic Chemotherapy and Systemic Chemotherapy Alone in Gastric Cancer with Synchronous Liver Metastasis. Chin Med J. 2015; 128(16): 2194-201.

https://doi.org/10.4103/0366-6999.162497

11.   Xu H, Min X, Ren Y, et al. Comparative Study of Drug-eluting Beads versus Conventional Transarterial Chemoembolization for Treating Peculiar Anatomical Sites of Gastric Cancer Liver Metastasis. Med Sci Monit. 2020; 26: 922988.

https://doi.org/10.12659/MSM.922988

Abstract:

Cervical cancer (CC) is one of the most common oncological disease in the world. There are lots of methods to treat it. Often we use radiation therapy (RT), chemotherapy (CT), surgical treatment. However, when on one hand we have successes, on the other hand we have a number of unsolved problems. To solve them, we study the method of chemoembolization of uterine arteries (CUA). This treatment option is being studied as one of promising methods in the complex or combined radiation treatment of primary and recurrent cervical cancer. This allows, with minimal trauma and relapse rate, to stop bleeding and reduce the size of the tumor. In this article a number of literature sources about using embolization or chemoembolization and results of treatment with CUA has been analyzed.

References

1.     Kaprin AD, Starinskij W, Petrova GV. The state of cancer care for the population of Russia in 2018. - M.: MNIOI im. P.A. Gertsena - filial FGBU «NMITS radiologii» Minzdrava Rossii, 2019; 236 [In Russ].

2.     Lindsey AT, Ahmedin J, Rebecca L. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; (68): 394-424.

3.     Ashrafyan LA, Antonova IB, Aleshikova Ol et al. Surgical stage as one of the main components in the complex treatment of cervical cancer stage IIb-IIIb. Russian journal o f oncology. 2007; (3): 21-25 [In Russ].

4.     Benedetti-Panici P, Greggy S, Colombo A et al. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locallyadvanced squamous cell cervical cancer: results from the Italian multicenter randomizedstudy. J Clin Oncol. 2002; (20): 179-188.

5.     Benedetti-Panici PL, Zullo MA, Muzii Let. al. The role of neoadjuvant chemotherapy followed by radical surgery in the treatment of locally advanced cervical cancer. EurJ Gynecol Oncol. 2003; 24 (6): 467-470.

6.     Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A et al. A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carbo-platin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Ann Oncol. 2003; 14 (8): 1278-1284.

7.     Sananes C, Giaroli A, Soderini A et al. Neoadjuvant chemotherapy followed by radical hysterectomy and post­operative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: long-term follow-up of a pilot study. Eur J Gynaecol Oncol. 1998; 19 (40): 368-373.

8.     Pavlov AS, Kostromina KN. Cervical cancer (radiation therapy). Meditsina. 1983; 160 [In Russ].

9.     Suvorova JuV. The role of angiography and arterial embolization in malignant tumors of the uterus and bladder complicated by bleeding. Avtoref. dis. kand. med. nauk. 1998; 24 [In Russ].

10.   Oliver J Jr, Lance J. Selective embolization to control massive hemorrhage following pelvic surgery. Am J Obstet Gyn. 1979; (135): 431-432.

11.   Ravina JH, Merland JJ, Herbreteau D. et al. Preoperative embolization of uterine fibroma. Pres Med. 1994; (23): 1540.

12.   Chen C, Wang W, Zhou H et al. Pharmacokinetic comparison between systemic and local chemotherapy by carboplatin in dogs. Department of Obstetrics and Gynecology, Nanfang Hospital, Guangdong Province, PR China. Reprod Sci. 2009; Nov.

13.   Kosenko IA, Matylevich OP, Dudarev VS et al. The effectiveness of complex treatment of locally advanced cervical cancer using uterine artery chemoembolization. Oncological journal named P.A. Gertsena. 2012; (10): 15-19 [In Russ].

14.   Sabekiya IM, Stolyarova IV, Vinokurov VM. Role of endovascular interventions in combined treatment of patients with locally advanced cervical cancer. Oncology issues. 2004; (5): 590-594 [In Russ].

15.   Kobayashi K, Furukawa A, Takahashi M, Murata K. Neoadjuvant intra-arterial chemotherapy for locally advanced uterine cervical cancer: clinical efficacy and fac­tors influencing response. Cardiovasc Intervent Radiol. 2003; 26 (3): 234-241.

16.   Komov DV, Roshhin EM, Kuchinskij GA et al. Results of the first phase of clinical studies of the doxorubicin-estrone complex in patients with malignant neoplasms of the liver during chemoembolization with lipiodol. Bulletin of the ONTs AMS of Russia. 1997; (4): 34-37 [In Russ].

17.   Huang K, Zhou Q, Wang R et al. Doxorubicin-eluting beads versus conventional transarterial chemoembolization for the treatment of hepatocellular carcinoma. J Gastroenterol Hepatol. 2014; 29 (5): 920-925.

18.   Lichinitser MR, Gutorov SL. A new approach to chemotherapeutic treatment of cancer. Jornal Oncology.ru (internetsource). 2011; 13 [In Russ].

https://rosoncoweb.ru/librarv/chemotherapy/001.pdf

19.   Dmitriev VN, Golivets TP, Sukhoterin IV et al. Chemotherapy of tumors of the female reproductive system: definitions and methodological aspects. Scientific statements of BSU, Medicine Pharmacy. 2011; 22(177): 234-244 [In Russ].

20.   Thigpen J, Blessing H, Homesley et al. Phase III trial of doxorubicin +/- cisplatin in advanced or recurrent endometrial carcinoma: a Gynaecologic Oncology group study. Proceedings of ASCO. 1993; 12: 261.

21.   Arybzhanov DT, Bajnazarova AA, Kulakeev OK. Embolization of uterine arteries in the treatment of patients with cervical cancer. Medical Bulletin of Bashkortostan. 2009; (2): 39-41 [In Russ].

22.   Suvorova JuV, Tarazov PG, Zharinov GM. Arterial embolization in chronic bleeding in patients with uterine cancer. Oncology issues. 1996; 42 (4): 59-61 [In Russ].

23.   Suvorova JuV, Tarazov PG. Arterial embolization in uterine and bladder tumors complicated by bleeding. Palliative medicine and rehabilitation. 199; (2): 79-80 [In Russ].

24.   Tarazov PG, Suvorova JuV, Neklasova NY Arterial embolization in malignant tumors of the uterus complicated by bleeding. Obstetrics and gynecology. 1996; (3): 39 [In Russ].

25.   Kedrova AG, Lebedev DP, Shablovskij OR et al. Modern chemoembolization of the pelvic vessels as a stage in the treatment of malignant tumors of the body and cervix. Clinical practice. 2016; (2) [In Russ].

26.   Shakhov EB, Kanishheva NV, Ermolaeva AM et al. The first experience of using selective chemoembolization of the uterine arteries in patients with cervical cancer. Oncology. Medical Almanac Journal. 2016; (2): 124-126 [In Russ].

27.   Nalgieva FK, Shanazarov NA. The problem of treatment of complicated cervical cancer at the present stage. Basic research. 2011; 1 (11): 221 -226 [In Russ].

28.   Bajnazarova AA, Yakubova MB, Kulakeev OK et al. Embolization of uterine arteries in the treatment of patients with cervical cancer. Oncology. Medical Bulletin of Bashkortostan. 2009. (2): 39-41 [In Russ].

29.   Bajnazarova AA, Yakubova MB, Kulakeev OK et al. Embolization of uterine arteries in the treatment of patients with cervical cancer. Oncology. Tyumen Medical Journal. 2010; (3-4): 37-39 [In Russ].

30.   Kosenko IA, ZHavrid EA, Matylevich OP et al. Immediate results of surgical intervention after neoadjuvant polychemotherapy with selective chemoembolization. Tumors of the female reproductive system. 2009; (3-4): 121-124 [In Russ].

31.   Bokhman YV. Oncology guide. 2002; 544 [In Russ].

32.   Stolyarova IV, Vinokurov VL. Modern possibilities of chemoradiation therapy in the treatment of advanced uterine cancer. VII Ross, onkol. kongress 25-27 noyabrya 2003: Congress materials. 2003; 198 [In Russ].

33.   Tian ZZ, Li S, Wang Y et al. Investigation of uterine arterial chemoembolization and uterine arterial infusion chemotherapy for advanced cervical cancer before radical radiotherapy: a long-term follow-up study. Arch Gynecol Obstet. 2014; 290 (1): 155-162.

34.   Yu L, Tan GS, Xiang XH et al. Comparison of uterine artery chemoembolization and internal iliac arterial infusion chemotherapy for the combining treatment for women with locally advanced cervical cancer. Ai Zheng. 2009; 28 (4): 402-407.

35.   Song J, Chen W, Zhu X et al. Short-term efficacy, safety, and cost-effectiveness of transarterial chemoembolization with drug-eluting beads versus synchronous radiochemotherapy for cervical cancer. Int J Gynaecol Obstet. 2019; 147 (1): 29-35.

36.   Babaeva NA, Antonova IB, Aleshikova Ol et al. The role of selective chemoembolization of the uterine arteries in the complex treatment of locally advanced cervical cancer. Doctor.Ru. 2018. 146 (2): 20-25 [In Russ].

Abstract:

Aim: was to estimate efficacy of methods of permanent or temporary blocking of blood flow through the gastroduodenal artery (GDA) during arterial chemoinfusion/chemoembolization of hepatic and pancreatic malignancies.

Materials and methods: for the period of 5 years (2015-2019), GDA embolization with coils was performed in 90 patients. Of them, 39 patients with liver tumors underwent occlusion of proximal GDA. GDA embolization distally to pancreatic branches (commonly on the level of gastroepiploic artery) was done in 51 patients with pancreatic head adenocarcinoma. Alternatively, in 12 patients with liver and 23 patients with pancreatic cancer, hand compression of GDA was used.

Results: technical success was 98% (88/90 patients). During embolization, coil migration into the hepatic artery developed in two patients with liver tumors: in one case stenting of the common hepatic artery was performed, the other case was asymptomatic and the presence of coil did not complicate the following arterial therapy. There were no other complications. Patients received multiple repeated courses of arterial chemotherapy.

Conclusion: methods of blocking of GDA blood flow are relatively safe, effective, simple and inexpensive. Both, embolization and hand compression, help to prevent non-target chemoinfusion and embolization.

References

1.     Generalov Ml, Balakhnin PV, Tsurkan VA, et al. Percutaneously implanted «port-catheter» systems for long-lasting regional chemotherapy in patients with metastatic liver disease. Diagnosticheskaja i Intervenzionnaya Radiologiya. 2007; 1(4): 51-59 [In Russ].

2.     Arybzhanov DT, Gantsev SH, Kulakeev OK, et al. Results of endovascular methods of treatment in liver tumors in South Kazakhstan. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(1): 15-19 [In Russ].

3.     Popov AA, Skupchenko AV, Polarush NF. Colorectal liver metastases after chemoembolization with microspheres: comparison of the different criteria for tumor response assessment. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2014; 8(1): 37-46 [In Russ].

4.     Dolgushin Bl, Virshke ER, KosyrevVJ. Interventional radiological technologies in treatment of intermediate stage HCC (BCLC B). Onkologicheskiy Zhurnal. 2018. 1(1): 60-62 [In Russ].

5.     Kozlov AV, Granov DA, Tarazov PG et al. Intra-arterial chemotherapy in patients with unresectable pancreatic cancer. Annaly Khirurgicheskoy Gepatologii. 2019; 24(3): 73-86 [In Russ].

6.     Pavlovskij AV, Stacenko AA, Popov SA et al. The first experience of selective intra-arterial injection of albuminbound paclitaxel (Abraxane) in patients with pancreatic adenocarcinoma. Diagnosticheskaya i Intervenionnaya Radiologiya. 2019; 13(1): 59-64 [In Russ].

7.     Bagdasarov W, Bagdasarova EA, Chernookov Al et al. Endovascular arterial embolization in duodenal bleeding - alternative to surgical treatment. Khirurgiya. 2016; (2): 45-50 [In Russ].

8.     Musinov IM, Chikin AE, Ganin AS, Kachesov EYu. Transcatheter arterial embolization in treatment of gastroduodenal ulcers with bleeding. Vestnik Khirugii. 2018; 177(6): 27-30 [In Russ].

9.     Tibilov AM, BaymatovMS. Endovascular intervention in the treatment of recurrent gastroduodenal hemorrhage. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(3): 45-48 [In Russ].

10.   Tarazov PG, Granov DA, Polikarpov AA et al. Endovascular control of arterial bleeding after major surgery in pancreatic cancer. Vestnik Khirugii. 2012; 171(1): 24-30 [In Russ].

11.   Chuang VP, Wallace S, Stroehlen J et al. Hepatic artery infusion chemotherapy: gastroduodenal complications. American Journal o f Roentgenology. 1981; 137(2): 347-350.

12.   Granmayeh M, Wallace S, Schwarten D. Transcatheter occlusion of the gastroduodenal artery. Radiology. 1979; 131(1): 59-62.

13.   Kuribayashi S, Phillips D, Harrington DP et al. Therapeutic embolization of the gastroduodenal artery in hepatic artery infusion chemotherapy. American Journal of Roentgenology. 1981; 137(6): 1169-1172.

14.   Kuyumcu G, Latich I, Hardman RLet al. Gastroduodenal embolization: indications, technical pearls, and outcomes. Journal o f Clinical Medicine. 2018; 7(5): pii E101.

http://doi.org/10.3390/icm7050101

15.   Desai GS, Pande PM. Gastroduodenal artery: Singe key for many locks (review). Journal of Hepatobiliary and Pancreatic Surgery. 2019; 26(7): 281-291.

16.   Tarazov PG, Polikarpov AA, Ivanova AA. Arterial radioembilzation of liver malignancies with glass yttrium-90 microspheres: first experience. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2014; 8(4): 59-66 [In Russ].

17.   Tarazov PG, Ryzhkov VK. Gastroduodenal artery embolization during endovascular interventions in cirrhosis and tumors of the liver. Vestnik Khirugii. 1988; 140(1): 83- 85 [In Russ].

18.   Lopez-Benitez R, Hallscheidt P, Kratochwil C et al. Protective embolization of the gastroduodenal artery with a one HydroCoil technique in radioembolization procedures. Cardiovascular and Interventional Radiology. 2013; 36(1): 105-110.

19.   Enriquez J, Javadi S, Murthy R et al. Gastroduodenal artery recanalization after transcatheter fibered coil embolization for prevention of hepatoenteric flow: incidence and predisposing technical factors in 142 patients. Acta Radiologica. 2013; 54(7): 790-794.

20.   Kubota H, Nimura X Hayakawa N, Shionoya S. Hepatic transcatheter arterial embolization with gastroduodenal artery blocking by finger compression. Radiology. 1989; 170(2): 562-563.

21.   Tarazov PG, Pavlovskij AV, Granov DA. Oily chemoembolization of pancreatic head adenocarcinoma. Cardiovascular Interventional Radiology. 2001; 24(6): 424-426.

22.   Karimov Shi, Borovskiy SP, Khakimov MSh, Adylkhodzhaev AA. Regional chemotherapy in the treatment of unresectable pancreatic tumors. Annaly Khirurgicheskoy Gepatologii. 2010; 15(3): 105-109 [In Russ].

23.   Khayrutdinov ER, Tsurkan VA, Arablinskiy AV, Gromov DG. First experience in using transradial arterial approach in selective chemoembolization of malignant pancreatic tumor. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2017; 11(4): 81-85 [In Russ].

Abstract:

Aim: was to analyze the first experiment and estimate the tolerability of intra-arterial use of the Abraxane in oil chemoembolization in patients with pancreatic adenocarcinoma.

Material and methods: for the period January 2018 - August 2018 г on the basis of the FSCU RIS RHT named after academician A.M. Granov, 19 patients with histologically verified ductal adenocarcinoma of the pancreas received treatment: intra-arterial oil chemoembolization with the use of the Abraxane.

Results: in 14 (73.6%) patients appeared mild pain syndrome that was not accompanied by marked laboratory changes, against the background of standard conservative prophylaxy. In 5 (26.4%) cases, patients had clinical and laboratory signs of postembolization syndrome, which was regarded as adverse events of grade 3 antitumor therapy, manifested by clinical and laboratory signs of mild acute pancreatitis, treated in all cases conservatively

The treatment of the postembolization syndrome lasted up to 7 days, until complete laboratory markers normalization, consisting in reducing the activity of blood amylase and urinary diastase to normal values. In all cases, postembolization syndrome was stopped conservatively In described 5 (26.4%) patients, adverse events of intra-arterial oil chemoembolization were regarded as mild postembolization pancreatitis. After treatment, a decrease in the tumor marker CA 19-9 was observed in 9 (90%) patients.

At the next stage, all patients with localized forms of the tumor underwent surgical treatment in the volume of pylorus-preserving pancreatoduodenal resection (n = 13) from 7 to 15 days after intra- arterial oil chemoembolization.

Conclusion: the procedure of oil chemoembolization with Abraxane can be considered as safe if dosages of the oil radiopaque drug Lipiodol are adeqate. There was a tendency to a decrease in the level of the tumor marker CA 19-9 in the blood of patients after the procedure. 

References

1.      Davydov MI, Aksel' EM. Statistics of malignant tumors in Russia and the CIS countries in 2012. Izdatel'skaya gruppa RONTs. 2014; 4: 226 [In Russ].

2.      Siegel R.L., Jemal А. Cancer statistics. CA. Cancer J Clin. 2018; 68: 7-30.

3.      Kaprin AD, Starinsky VV, Petrova GV. Statistics of malignant tumors in Russia 2016 (morbidity and mortality) M.: MNIOI im. PA. Gertsena filial FGBU «NMITs radiologii» Minzdrava Rossii. 2018; 250 p [In Russ].

4.      Alexakis N. Current standards of surgery for pancreatic cancer. Br J Surg. 2004; (11) 91: 1410-27.

5.      Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010; 4(12): 239-43.

6.      Yang ZYYuan JQ, Di MY Zheng DY Chen JZ, Ding H, Wu XY, Huang YF, Mao C, Tang J.L. Gemcitabine plus erlotinib for advanced pancreatic cancer: a systematic review with meta-analysis. PLoS One. 2013;8(3):e57528. doi: 10.1371/journal.pone.0057528. Epub 2013 Mar 5.

7.      Hidalgo M. Pancreatic cancer. N Engl j med. 2010; 362: 1605-17.

8.      Burris H.A. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J ClinOncol. 1997; 2403-13.

9.      Popova AS, Pokataev I A, Tyulyandin S.A. Combined chemotherapy regimens for pancreatic cancer. Zhurnal Meditsinskii sovet, Izdatel'stvo «GRUPPA REMEDIUM». 6: 62-70 [In Russ].

10.    Pokataev I A, Bazin I S, Popova A S, Podluzhnyi D V. Efficacy and safety of induction chemotherapy according to the FOLFIRINOX scheme with borderline resectable and unresectable pancreatic cancer. Nauchno-prakticheskii zhurnal po onkologii «Zlokachestvennye opukholi». 2018; 8(1): 38-47[ In Russ].

11.    Conroy T, Desseigne F, Ychou M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 19(364): 1817-25.

12.    Stocken DD. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005; 8(92): 1372-81.

13.    Desai N, Trieu V, Yao Z. Increased antitumor activity, intratumor paclitaxel concentrations, and endothelial cell transport of cremophor-free, albumin-bound paclitaxel, ABI-007, compared with cremophor-based paclitaxel. Clin Cancer Res. 2006; 1(4): 1317-24.

14.    Dranitsaris G, Yu B, Wang L. Abraxane versus Taxol for patients with advanced breast cancer: A prospective time and motion analysis from a Chinese health care perspective. J Oncol Pharm Pract. 2016; 2: 205-11

15.    Giordano G, Pancione M, Olivieri N. Nano albumin bound-paclitaxel in pancreatic cancer: Current evidences and future directions. World J Gastroenterol. 2017; 23(32): 5875-5886.

16.    Ottaiano A. Nab-Paclitaxel and Gemcitabine in Advanced Pancreatic Cancer: The One-year Experience of the National Cancer Institute of Naples. Anticancer Res. 2017; 4(37): 1975-1978.

17.    Von Hoff DD. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. ClinOncol. 2011; 29(34): 454854.

18.    Granov DA, Polikarpov AA, Pavlovskij AV, Moiseenko VE, Popov SA. Evaluation of the safety of intra-arterial chemotherapy with gemcitabine and oxaliplatin in the combined treatment of pancreatic head adenocarcinoma. Annaly khirurgicheskoy gepatologii. 2017; 22 (2): 54-59 [InRuss].

19.    Granov DA., Pavlovskij AV, Suvorova JuV, Gulo AS, Popov SA, Shapoval SV, Tlostanova MS. Neoadjuvant intra-arterial oil chemoembolization and adjuvant regional chemoinfusion in combined treatment of pancreatic cancer. Voprosioncologii. 2008; 54(4): 501-503.

Abstract:

Pancreatic cancer (PC) is one of the most aggressive malignant neoplasms, results of treatment of which remain extremely unsatisfactory, in view of the low (20%) possibility of tumor resectability A relatively new method of treatment of pancreatic cancer, which showed in practice an increase in tumor resectability in patients with borderline resectable forms of the disease and an increase ir survival mediana of inoperable patients is transartorial chemoembolization (TACE).of pancreatic arteries.

Authors first used transradial vascular access for TACE of a malignant pancreatic tumor.

As the first stage of the intervention - performed redistribution embolization of the right gastroomental artery distally to branches feeding the tumor, with two pushable coils Azur (Terumo) sized 4x60 mm and 5x60 mm in order to prevent embolization of non-target vessels and achieve total embolization of the tumor.

The second stage - performed chemoembolization with lipiodol - 5 ml and gemcitabine - 1000 mg, as a result - accumulation of chemotherapy in the head of the pancreas.

The duration of the procedure and the radiation dose in the patient were 52 minutes, respectively and 0.57 mSv and were comparable to those for similar interventions through transfemoral access. At the same time, all the main advantages of access through the radial artery remained, including: a higher level of psychological and functional comfort for the patient, its early activation and a minimal risk of vascular complications. The patient's discharge was made on the 10th day after the intervention. 

References

1.    Kubyshkin V.A., Vishnevskiy V.A. Rak podzheludochnoi zhelezy [Pancreatic cancer]. Moscow. 2003: 375 [In Russ].

2.     Nitecki S.S., Sarr M.G., Colby T.V. et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann. of Surg. 1995; 221(1):59-66

3.     Ishikawa O., Ohigashi H., Imaoka S. et al. Is the longterm survival rate improved by preoperative irradiation prior to Whipple’s procedure for adenocarcinoma of the pancreatic head? Arch. Surg. 1994; 129(10):1075-1080.

4.     Pavlovskiy A.V. Maslyanaya khimioembolizatsiya arteriy podzheludochnoi zhelezy pri mestnorasprostranennom rake. [Oily chemoembolization of pancreatic arteries in patients with locally advanced cancer]. Prakticheskaya onkologiya. 2004; 5(2):108-114 [In Russ].

5.     A.A., Tarazov P.G., Ivanova A.A., Alejnikova O.V. Diagnostika I lechenie toksicheskih oslozhnenij regionarnoj himioterapii, provodimoj cherez chreskozhno implantiruemye sistemy. [Diagnostics and treatment of toxic complications of regional chemotherapy through port-system] Diagnosticheskaya i intervencionnaya radiologiya. 2007; 1 (3): 46-51. [In Russ].

6.     Chandrasekar B., Doucet S., Bilodeau L. et al. Complications of cardiac catheterization in the current era: a single-center experience. Catheter Cardiovasc. Interv. 2001; 52(3):289-295.

7.     Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005; 65(2): 196-202.

8.     Tavris D.R., Gallauresi B.A., Lin B. et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9):459-464.

9.     Mclvor J., Rhymer J.C. 245 transaxillary arteriograms in arteriopathic patients: success rate and complications. Gin. Radiol. 1992; 45: 390-394.

10.   Jolly S.S., Yusuf S., Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775):1409-1420.

11.   Kanei Y, Kwan T.,  NakraN.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011.

12.   Caputo R.P., Tremmel J.A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011.

Abstract:

Purpose: South Kazakhstan Regional Cancer Clinic presents the immediate results of hepatic artery chemotherapy infusion and chemoembolization in patients with hepatic tumors. 

Material and methods: hepatic artery chemoembolization and chemotherapy infusion was performed in 70 patients (47 males, 67,1%) with hepatic tumors since 2004-2008. There were all in all 42 cases (60%) of primary hepatic carcinoma, and in 28 patients (40%) the procedure was done for liver metastatic malignancies. Hepatic artery chemotherapy infusion (HACI) was performed in 50 cases, including 32 patients (45,7%) with primary hepatic carcinoma, and 18 patients (25,7%) with metastatic foci. Hepatic artery chemoembolization (HACE) performed in 20 patients, including 10 patients (17,1%) with primary hepatic carcinoma, and 8 cases (11,4%) of metastatic malignancies. 

Results: significant regression of primary cancer foci and uneventful 3 years follow-up were seen in 2 patients (4,76%), partial regression of the lesion - in 6 (14,3%) of cases, tumor stabilization - in 16 (38%), and tumor progression were found in 8 (19%) of patients. 12 months survival with tumor stabilization was 33,3% (14 patients), 18 months survival - 7,14% (3 patients). Post-procedure mortality in terms of 4 to 8 months made up as high as 30,9% (13 patients). HACE procedure resulted with tumor regression in 8 of 10 patients; the effect sustained for 3-5 months already. For the present moment, 2nd and 3d HACE session is scheduled for this group of patients.

Conclusions: HACI is shown to be effective in treatment of primary and to improve the quality of life in 45,2% of cases. Thus, wide use of the method could be recommended in such a complicated category of patients. HACE procedure results are also hopeful, tumor stabilization starting after the first session.

References

1.      Давыдов М.И., Гранов А.М., Таразов П.Г., Гранов    Д.А.    и    др.    Интервенционная радиология в онкологии (пути развития и технологии). С-Пб: Фолиант. 2007.

2.      Гранов Д.А.,  Таразов П.Г.  Рентгеноэндоваскулярные вмешательства в лечении злокачественных опухолей печени. С-Пб: Фолиант. 2002.

3.      Таразов П.Г. Артериальная химиоинфузия в лечении нерезектабельных злокачественных опухолей печени (обзор литературы).Вопр. онкол. 2000; 46 (5): 521-528.   

4.      Таразов П.Г. Роль методов интервенционной радиологии в лечении больных с метастазами колоректального рака в печень. Практическая онкология. 2005; 6 (2): 119-126.

5.      Bierman H.R., Miller E.R., Byron R.L. et al.Intra-arterial catheterization  of viscera in man. Amer.J. Roentgenol. 1951; 66 (4): 555-568.

6.      Chiba Т., Tokuuye K., Matsuzaki Y. et al. Proton beam therapy for hepatocellular carcinoma: A retrospective review of 162 patients. Clin. Cane. Res. 2005; 11 (10): 3799-3805.

            7.      Gianturco C., Anderson J.H., Wallace S. Mechanical devices for arterial occlusion. Amer.J. Roentgenol. 1975; 124 (3):428-435

Abstract:

Aim: a case report of a 5-year experience of regional (arterial chemoembolization) treatment of a patient with isolated liver metastases of skin melanoma.

Materials and Methods: in 1994, the patient performed excision of melanoma in the right scapular region. Patient didn't undergo another treatment. During examination in 2006 metastasis in the liver was revealed. Patient recieved five rounds of chemotherapy Aranoza, Temodal, Kanglite. Metastatic tumer, sized 16,5 х14,5 х18,5 cm, occupied right liver lobe with deformation of it. After gaining this data - patient received 2 courses of liver chemoembolization in 2008.

Results: during the 5 years follow-up - progression of tumor lesion is not noticed.

Conclusion: the optimal transarterial chemoembolization creates possibilities for an efficient delivery of drugs and tumor embolization particles in the affected organ, particularly in the liver. In addition to surgery (with resectable formations) and systemic chemotherapy, above capabilities regional transarterial therapy can provide long term as new palliative treatment of patients with metastatic melanoma.

References

1.     Davydov M.I., Axel E.M. Mortality in Russia and the CIS countries from cancer in 2009 [Mortality of population in Russian Federation and CIS from malignant neoplasms in 2009]. Vestnik RCRC im. N.N. Blokhin RAMS. 2011; 22(3) 1: 57 [In Russ].

2.     Tuomaala S., Eskelin S., Tarkkanen A., Kivela T. Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest. Ophthalmol. Vis Sci 43: 3399-3408, 2002.

3.     Becker J.C., Terheyden P., Kampgen E., Wagner S., Neumann C., Schadendorf D., Steinmann A., Wittenberg G., Lieb W., BrockerE.B. Treatment of disseminated ocular melanoma with sequential fotemustine, interferon alpha, and inter-leukin 2. Br. J. Cancer 2002;87: 8400-845.

4.     Bedikian A.Y, Legha S.S., Mavligit G., Carrasco C.H., Khorana S., Pager C., Papadopoulos N., Benjamin R.S. Treatment of uveal melanoma metastatic to the liver. Cancer 76: 1665-1670, 1995.

5.     Aubin J.M., Rekman J., Vandenbroucke-Menu F., Lapointe R., Fairfull-Smith R.J., Mimeault R., Balaa F.K., Martel G. Systematic review and meta-analysis of liver resection for metastatic melanoma. Br. J. Surg. 2013 Aug;100(9):1138-47. doi: 10.1002/bjs.9189. Epub 2013 Jun 17.

6.     Ramia J.M., Garcfa-Bracamonte B., de la Plaza R., Ortiz P., Garcfa-Parreno J., Vanaclocha F. Surgical treatment of melanoma liver metastases. Cir. Esp. 2013 Jan;91 (1 ):4-8. doi: 10.1016/j.ciresp.2012.10.002. Epub 2012 Dec 6.

7.     Gragoudas E.S., Egan K.M., Seddon J.M., Glynn R.J., Walsh S.M., Finn S.M., Munzenrider J.E., Spar M.D. Survival of patients with metastases from uveal melanoma. Ophthalmology. 1991 ; 98:383-389.

8.     Agarwala S.S., Eggermont A.M., O'Day S., Zager J.S. Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options. Cancer. 2013 Dec 2. doi: 10.1002/cncr.28480.

9.     Pyrhonen S. The treatment of metastatic uveal melanoma. Eur. J. Cancer 34(Suppl 3): S27-30, 1998.

10.   Mavligit G.M., Charnsangavej C., Carrasco C.H., Patt YZ., Benjamin R.S., Wallace S. Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge. JAMA. 1988; 260:974 -976.

11.   Stuart K. Chemoembolization in the management of liver tumors. Oncologist. 2003;8 : 425-437.

12.   Ahrar J., Gupta S., Ensor J., Ahrar K., Madoff D.C., Wallace M.J., Murthy R., Tam A., Hwu P, Bedikian A.Y Response, survival, and prognostic factors after hepatic arterial chemoembolization in patients with liver metastases from cutaneous melanoma. Cancer Invest. 2011 Jan;29(1 ):49-55. doi: 10.3109/07357907.2010.535052.

13.   Brown R.E., Gibler K.M., Metzger T., Trofimov I., Krebs H., Romero F.D., Scoggins C.R., McMasters K.M., Martin R.C. 2nd. Imaged guided transarterial chemoembolization with drug-eluting beads loaded with doxorubicin (DEBDOX) for hepatic metastases from melanoma: early outcomes from a multi-institutional registry. Am. Surg. 2011 Jan;77(1):93-8.

14.   Sharma K.V., Gould J.E., Harbour J.W., Linette G.P., Pilgram T.K., Dayani PN., Brown D.B. Hepatic arterial chemoembolization for management of metastatic melanoma. AJR Am. J. Roentgenol. 2008 Jan; 190(1): 99-104.

15.   Patel K., Sullivan K., Berd D., Mastrangelo M.J., Shields C.L., Shields J.A., Sato T. Chemoembolization of hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res 15(4): 297-304, 2005. 

16.   Vogl T., Eicheler K., Zangos S., Herzog C., Hammerstingl R., Balzer J., Gholami A. Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival. J. Cancer Res. Clin. Oncol. 133: 177-184, 2007.

Abstract:

Introduction. The RECIST criteria, which are routinely used to assess results of treatment of colorectal liver metastases with the transarterial chemoembolization (TACE), are not based on the identification of the tumor necrosis, and therefore their objectivity is questionable.

Aim: was to develop method of assessment of tumor response, based on tumor necrosis after TACE.

Materials and Methods: own technique of assessment of the tumor responce, based on measurement of computed tomography density of metastatic lesions in native and post-contrast phases, before and after treatment («criteria of N») is offered. Data of 13 patients who have undergone treatment of metastases of a colorectal cancer in a liver by the TACE method with application of microspheres «DC Beads» and irinotekan are analysed. Comparison of results of treatment according to criteria of RECIST and «criteria of N» is carried out.

Results: аccording to RECIST criteria stable disease was achieved in 11(85%) patients, and 2(15%) patients had a partial response. Neither complete response, nor progressive disease was observed. Later, progressive disease occurred in 11 patients. The period from the start of treatment until progression fixation averaged 7-9 months. According to the «N criteria», 4 (31%) patients had a complete response, 6(46%) patients had a partial response: and in 3(23%) patients we detected stable disease. Then progressive disease was monitored in all 13 patients, the period from the start of treatment until the progression fixation averaged 3-6 months. In 4 cases the progression process according to «N criteria» was detected earlier than by RECIST criteria.

Conclusion: The usе of RECIST criteria may underestimate the objective response to treatment, and as a result - the progression of disease later on. The proposed method of tumor response assessment, based on the analysis of tumor necrosis («the N criteria»), proves to be more productive. 

References

1.     Pickren J.W., Tsukada Y., Lane W.W. Liver metastasis. in: Weiss L, Gilbert HA (eds) Analysis of autopsy data. GK Hall, Boston. 1982: 2-18.

2.     Vogl T.J., Zangos S., Balzer J.O., Thalhammer A., Mack M.G. Transarterial chemoembolization of liver metastases: indication, technique, results. Rofo. 2002; 174(6): 675-683.

3.     Pwint T.P., Midgley R., Kerr D.J. Regional hepatic chemotherapies in the treatment of colorectal cancer metastases to the liver. Semin. Oncol. 2010; 37(2): 149-159.

4.     Cohen A.D., Kemeny N.E. An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist. 2003; 8(6): 553-566.

5.     Ji S.H., Park Y.S., Lee J., Lim D.H., Park B.B., Park K.W., Kang J.H., Lee S.H., Park J.O., Kim K., Kim W.S., Jung C., im Y.H. Kang W.K., Park K. Phase ii study of irinotecan, 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer. Jpn. J. Clin. Oncol. 2005; 35(4): 214-217.

6.     Kemeny N., Garay C.A., Gurtler J., Hochster H., Kennedy P., Benson A., Brandt D.S., Polikoff J., Wertheim M., Shumaker G., Hallman D., Burger B., Gupta S. Randomized multicenter phase ii trial of bolus plus infusional fluorouracil/leucovorin compared with fluorouracil/leucovorin plus oxaliplatin as third-line treatment of patients with advanced colorectal cancer. J. Clin.Oncol. 2004; 22(23): 4753-4761. Erratum in: J. Clin. Oncol. 2005; 23(1): 248.

7.     Liapi E., Geschwind J.F. Chemoembolization for primary and metastatic liver cancer. Cancer J. 2010; 16(2): 156-162.

8.     Fiorentini G., Aliberti C., Turrisi G., Del Conte A., Rossi S., Benea G., Giovanis P. intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase ii clinical study. in Vivo. 2007; 21(6): 10851091.

9.     Martin R.C., Joshi J., Robbins K., Tomalty D., Bosnjakovik P., Derner M., Padr R., Rocek M., Scupchenko A., Tatum C. Hepatic intra-arterial injection of drug-eluting bead, irinotecan (DEBiRi) in unresectable colorectal liver metastases refractory to systemic chemotherapy: results of multi-institutional study. Ann. Surg. Oncol. 2011; 18(1): 192-198.

10.   Narayanan G., Barbery K., Suthar R., Guerrero G., Arora G. Transarterial chemoembolization using DEBiRi for treatment of hepatic metastases from colorectal cancer. Anticancer Res. 2013; 33(5): 2077-2083.

11.   Martin R.C., Howard J., Tomalty D., Robbins K., Padr R., Bosnjakovic P.M., Tatum C. Toxicity of irinotecan-eluting beads in the treatment of hepatic malignancies: results of a multi-institutional registry. Cardiovasc Intervent Radiol. 2010; 33(5): 960-966.

Abstract:

Inflammatory breast cancer (BC) is a locally-spread unresectable primary diffuse form of tumor, occurring in 1- 6% of patients with breast cancer, and is one of the most malignant forms of cancer with a poor prognosis and a low survival rate.

The article describes the clinical case of successful experience in the application of repeated chemoembolization and one cycle of radical radiation therapy in patient with metastatic breast cancer (inflammatory form), resistant to conduct systemic chemotherapy (possibility to transfer tumor into operable condition).

Patient underwent three cycles of chemoembolization into right internal thoracic artery, followed by radical radiotherapy The combination of these techniques allowed to reach a complete response to treatment and subsequently perform a radical mastectomy. Postoperative follow-up period is 85 months of remission without specific therapy.

References

1.     Dawood S., Lei X., Dent R. et al. Survival of women inflammatory breast cancer: a lage population-based study. Ann. Oncol. 2014; 25(6): 1143-1151.

2.     Wilke D., Colwell B., Dewar R. Inflammatory breast carcinoma: comparison of survival of those diagnosed clinically, pathologically, or with both features. Am Surg. 1998; 64(5):428-431.

3.     Henderson M.A., Mc Bride C.M. Secondary inflammatory breast cancer: treatment options. South Med J. 1988; 81(12):1512-15177.

4.     Liauw S.L., Benda R.K., Morris C.G, et al, Inflammatory breast carcinoma: Outcomes with trimodality therapy for nonmetastatic disease. Cancer. 200; 100(5): 920-928.

5.     Masljukova E.A., Odincova S.V., Korytova L.I., Polikarpov A.A., Zhabina R.M. Vnutriarterial'naja himioterapija i luchevaja terapija v kombinirovannom lechenii bol'nyh rakom molochnoj zhelezy[Intra-arterial chemotherapy and radiation therapy in combined treatment of patients with breast cancer.]. Vestnik novyh medicinskih tehnologij. Jelektronnoe izdanie. 2015:4:2-10 [In Rus].

6.     Belka C. Biological Basis of Combined Radio and Chemotherapy. Multimodal Concepts for Integration of Cytotoxic Drugs. Ed. Brady L.W. et al., Springer, Heidelberg. 2006;3-17.

7.     Harada H. Combinations of Antimetabolites and Ionizing Radiation. Multimodal Concepts for Integration of Cytotoxic Drugs. Ed. Brady L.W. et al. Springer, Heidelberg. 2006;19-34.

8.     Perez C.A., Fields J.N., Fracasso PM., et. al, Management of locally advanced carcinoma of the breast. Inflammatory carcinoma. Cancer. 1994;74 (Supll 1): 466-76.

9.     Chhikvadze T.B. Mesto luchevogo, lekarstvennogo i hirurgicheskogo jetapov v kompleksnom lechenii otechnyh form raka molochnoj zhelezy [Role of beam, medicinal and surgical stages in complex treatment of inflammatory forms of breast cancer]: dis. kand. med. nauk: M., 2008; 82 [In Russ].

10.   Cristofanilli M., Valero V., Buzdar A.U. et al. Inflammatory breast cancer (IBC): patterns of recurrence and micrometastatic homing. Breast Cancer Res. Treat. 2006;100(Suppl 1):155.

11.   Fisher B, Brown A, Mamounas E. et. al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997; 15(7): 2483-2493.

12.  Granov A.M., Davydov M.I. Intervencionnaja radiologija v onkologii (puti razvitija i tehnologii) [Interventional radiology in oncology (path of development and technology)]. Izdanie vtoroe, dopolnennoe. Spb: Foliant, 2013;560 [In Russ].