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.

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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. 

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