Short-term effectiveness of radiochemoembolization for selected hepatic metastases with a combination protocol
AIM： To introduce the combination method of radio- chemoembolization for the treatment of selected he- patic metastases. METHODS： Twenty patients with biopsy proven hepat- ic metastases were selected from those who underwent transarterial radiochemoembolization, a novel combina- tion protocol, betwe...
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| Published in: | World journal of gastroenterology : WJG Vol. 18; no. 37; pp. 5249 - 5259 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Baishideng Publishing Group Co., Limited
07-10-2012
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | AIM： To introduce the combination method of radio- chemoembolization for the treatment of selected he- patic metastases. METHODS： Twenty patients with biopsy proven hepat- ic metastases were selected from those who underwent transarterial radiochemoembolization, a novel combina- tion protocol, between .lanuary 2009 and July 2010. Patients had different sources of liver metastasis. The treatment included transarterial administration of three chemotherapeutic drugs （mitomycin, doxorubicin and cisplatin）, followed by embolization with large （50-150 μm） radioisotope particles of chromic 32R Multiphasic computer tomography or computer tomography stud- ies, with and without contrast medium injections, were performed for all patients for a short-term period before and after the treatment sessions. The short-term effec- tiveness of this procedure was evaluated by modified response evaluation criteria in solid tumors （mRECIST）, which also takes necrosis into account. The subjective percentage of necrosis was also assessed. The re- sponse evaluation methods were based on the changes in size, number, and the enhancement patterns of the lesions between the pre- and post-treatment imaging studies. RESULTS： Patients had liver metastasis from colorectal carcinomas, breast cancer, lung cancer and carcinoid tumors. The response rate based on the mRECIST criteria was 5% for complete response, 60% for par- tial response, 10% for stable disease, and 25% for progressive disease. Regarding the subjective necrosis percentage, 5% of patients had complete response, 50% had partial response, 25% had stable disease, and 20% had progressive disease. Based on traditional RECIST criteria, 3 patients （15%） had partial response, 13 patients （65%） had stable disease, and 4 patients （20%） had disease progression. In most patients, colorectal carcinoma was the source of metastasis （13 patients）. Based on the mRECIST criteria, 8 out of these 13 patients had partial responses, while one remained stable, and 5 showed progressive disease. We also had 5 cases of breast cancer metastasis which mostly remained stable （4 cases）, with only one partial response after the procedure. Six patients had bilobar involvement; three of them received two courses of radiochemoembolization. The follow up imaging study of these patients was performed after the second ses- sion. In the studied patients there was no evidence of extrahepatic occurrence, including pulmonary radioac- tive deposition, which was proven by Bremsstrahlung scintigraphy performed after the treatment sessions. For the short-term follow-ups for the 2 mo after the therapy, no treatment related death was reported. The mostly common side effect was post-embolization syndrome, presented as vomiting, abdominal pain, and fever. Nineteen （95%） patients experienced this syndrome in different severities. Two patient had asci- tes （with pleural effusion in one patient） not related to hepatic failure. Moreover, no cases of acute liver failure, hepatic infarction, hepatic abscess, biliary necrosis, tu- mor rupture, surgical cholecystitis, or non-targeted gut embolization were reported. Systemic toxicities such as alopecia, marrow suppression, renal toxicity, or cardiac failure did not occur in our study group. CONCLUSION： Radiochemoembolization is safe and effective for selected hepatic metastases in a short- term follow-up. Further studies are required to show the long-term effects and possible complications of this approach. |
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| Bibliography: | Hepatic metastasis; Radiochemoemboliza-tion; Phosphorus radioisotopes; Treatment; Outcome 14-1219/R AIM： To introduce the combination method of radio- chemoembolization for the treatment of selected he- patic metastases. METHODS： Twenty patients with biopsy proven hepat- ic metastases were selected from those who underwent transarterial radiochemoembolization, a novel combina- tion protocol, between .lanuary 2009 and July 2010. Patients had different sources of liver metastasis. The treatment included transarterial administration of three chemotherapeutic drugs （mitomycin, doxorubicin and cisplatin）, followed by embolization with large （50-150 μm） radioisotope particles of chromic 32R Multiphasic computer tomography or computer tomography stud- ies, with and without contrast medium injections, were performed for all patients for a short-term period before and after the treatment sessions. The short-term effec- tiveness of this procedure was evaluated by modified response evaluation criteria in solid tumors （mRECIST）, which also takes necrosis into account. The subjective percentage of necrosis was also assessed. The re- sponse evaluation methods were based on the changes in size, number, and the enhancement patterns of the lesions between the pre- and post-treatment imaging studies. RESULTS： Patients had liver metastasis from colorectal carcinomas, breast cancer, lung cancer and carcinoid tumors. The response rate based on the mRECIST criteria was 5% for complete response, 60% for par- tial response, 10% for stable disease, and 25% for progressive disease. Regarding the subjective necrosis percentage, 5% of patients had complete response, 50% had partial response, 25% had stable disease, and 20% had progressive disease. Based on traditional RECIST criteria, 3 patients （15%） had partial response, 13 patients （65%） had stable disease, and 4 patients （20%） had disease progression. In most patients, colorectal carcinoma was the source of metastasis （13 patients）. Based on the mRECIST criteria, 8 out of these 13 patients had partial responses, while one remained stable, and 5 showed progressive disease. We also had 5 cases of breast cancer metastasis which mostly remained stable （4 cases）, with only one partial response after the procedure. Six patients had bilobar involvement; three of them received two courses of radiochemoembolization. The follow up imaging study of these patients was performed after the second ses- sion. In the studied patients there was no evidence of extrahepatic occurrence, including pulmonary radioac- tive deposition, which was proven by Bremsstrahlung scintigraphy performed after the treatment sessions. For the short-term follow-ups for the 2 mo after the therapy, no treatment related death was reported. The mostly common side effect was post-embolization syndrome, presented as vomiting, abdominal pain, and fever. Nineteen （95%） patients experienced this syndrome in different severities. Two patient had asci- tes （with pleural effusion in one patient） not related to hepatic failure. Moreover, no cases of acute liver failure, hepatic infarction, hepatic abscess, biliary necrosis, tu- mor rupture, surgical cholecystitis, or non-targeted gut embolization were reported. Systemic toxicities such as alopecia, marrow suppression, renal toxicity, or cardiac failure did not occur in our study group. CONCLUSION： Radiochemoembolization is safe and effective for selected hepatic metastases in a short- term follow-up. Further studies are required to show the long-term effects and possible complications of this approach. Author contributions: Akhlaghpoor S designed the study, performed the procedures, and supervised the team; Aziz-Ahari A searched the literature, analyzed the data and drafted the manuscript; Amoui M planned the nuclear medicine aspects of the study; and Sheybani S, Tolooee S and Poorbeigi H designed and produced the radioisotope particles. Correspondence to: Dr. Shahram Akhlaghpoor, MD, Department of Computed Tomography, Noor Medical Imaging Center, Sina Hospital, Tehran Medical University, Tehran 15667-86553, Iran. akhlaghpoor@nmri-ir.com Telephone: +98-21-88086783 Fax: +98-21-88086782 |
| ISSN: | 1007-9327 2219-2840 |
| DOI: | 10.3748/wjg.v18.i37.5249 |