To analyze the results of treatment of patients with primary liver cancer for the period from 2004 to 2019. Materials and methods: The treatment results were analyzed 174 patients with primary liver cancer using liver resection, local destruction methods, transarterial chemoembolization, targeted therapy, and a combination of these methods. Results: When performing liver resection, the median survival was 34 month. When performing local methods of destruction of a liver tumor, life expectancy increased from 23 before 31 months. The use of local destruction methods, transarterial chemoembolization made it possible to increase the resectability of patients. Conclusion:The use of various methods of treatment of patients with primary liver cancer can increase the overall life expectancy of patients. The use of local destruction methods for tumor reccurences in previously operated patients and / or somatically burdened patients reduces the number of surgical and anesthetic complications, reduces the hospital stay of patients.
Цель. Повышение эффективности лечения больных первичным и метастатическим раком печени. Материал и методы. Микроволновая абляция выполнена 29 больным: 13 пациентам с гепатоцеллюлярным раком стадии 0-А по Барселонской классификации и ТNM, 16 пациентам с колоректальным раком и метастатическим поражением печени I стадии по Gennari. В лечении применяли микроволновую абляцию опухолей печени аппаратом AveCure MWG881 (MedWaves). Процедуру выполняли чрескожно чреспеченочно (25), под контролем УЗИ, в 4 наблюдениях-интраоперационно в сочетании с резекцией печени. Контроль эффективности воздействия осуществляли при УЗИ и КТ. Результаты. Летальных исходов не было. В 1 наблюдении развилось умеренное кровотечение из места входа игольчатого катетера, которое остановилось самостоятельно. Остаточная полость, не потребовавшая дополнительных оперативных вмешательств, сформировалась в 1 наблюдении. Внутрипеченочная гематома отмечена у 1 больного. Ожог кожи выявлен в 2 наблюдениях. Средняя продолжительность пребывания в стационаре составила 7 дней. Местных рецидивов после абляции не было. Однолетняя выживаемость составила 78,5%, двухлетняя-63,3%. Заключение. Применение микроволновой абляции у пациентов с первичным и вторичным раком печени и сопутствующим циррозом сопровождается увеличением однолетней и двухлетней выживаемости. Чрескожное применение микроволновой абляции уменьшает риск осложнений оперативного вмешательства у соматически отягощенных больных за счет миниинвазивности и малой травматичности.
Background: Surgical resection is the standard treatment for colorectal liver metastases(CRLM). The use of ablation in combination with resection allows more patients to benefit from cure .We report the outcomes & recurrence rates of ablation & resection vs liver resection alone for CRLM. Methods: We analysed prospectively maintained data base of 133 consecutive patients from 2012-2016 who underwent surgical treatment for CRLM.107patients underwent resection alone & 26 had resection & ablation. Results: Baseline variables like age,BMI,preoperative ALT, Bilirubin,INR,CEA &size of largest lesion on imaging were similar in both groups.The mean operative time244 mins was higher in ablation&resection vs.178 mins in resection only (P<0.01). The mean intra-operative blood loss was similar in both groups P=0.17. The mean number of lesions on histology, the largest lesion on histology and the distance from resection margin on histology were similar(3.8 vs 2.1 P=0.002, 33 vs 38 mm P= 0.418 and 20.5 vs 6.1 mm P= 0.54).In ablation & resection group 38% patients had R1 resection as compared to 22% in resection group.1 year liver and multiorgan recurrence rates were 46%and 15% in ablation &resection group as compared to 19.6% and 12.11%. The overall recurrence rate in ablation & resection group was 34.6% vs 56.1% in resection. Conclusion: There is higher recurrence rate in ablation & resection group compared to resection only group reflecting advanced disease in the group but we believe ablation till has a role in curative treatment.
Introduction: mFOLFOX6þantiEGFR antibody is a standard-of-care in the 1st line chemotherapy of metastatic colorectal cancer. Two molecular targeted drugs, i.e. cetuximab (Cet) and panitumumab (Pani), are the choices of antiEGFR antibody, but the proper use of these drugs are not clarified yet. Cet, IgG subclass1 antibody, is demonstrated to have ADCC activity and other immune, inflammatory functions. Differences of the activities of these two antibodies could be analyzed from this standpoint using the kinetic evaluations of neutrophil-to-lymphocyte ratio (NLR), which is the indicator of cancer-related immune and inflammatory activities. Methods: 50 pts with RAS wild metastatic colorectal cancer were enrolled and treated with mFOLFOX6þantiEGFR antibody (25 pts with Cet, 25 pts with Pani). NLR was measured at the points of pre-treatment (preT), early-tumor-shrinkage (ETS) and gression of disease (PD). The associations of NLR and clinical outcomes were evalua ing by Spearman's rank correlation coefficient, and two-sample Mann-Whitney U were performed with several variants between Cet and Pani pts. Results: The median follow-up time for censored cases was 28 months (m) (IQR, 14-52). Progression free survival (PFS) and overall survival (OS) were 10.9m (95% C.I;7.9-12.6) and 30.0m (95% CI; 20.4-41.2), respectively. PFS and OS of Cet and Pani pts were not different significantly different [PFS: 12.0m (95% CI; 7.2-16.2) vs 9.5m (95% CI; 7.8-12.1), p ¼ 0.23; OS: 30.0m (95% CI; 21-49.9) vs 33.1m (95% CI; 13-41.9), p ¼ 0.202]. NLR at preT and PD were significantly correlated with OS, -0.291(p ¼ 0.0422) and -0.347 (p ¼ 0.0413), respectively. Correlation of PFS with NLR at ETS and with the difference of NLR between preT and ETS, were -0.415 (p ¼ 0.0391) and -0.355 (p ¼ 0.0816) in Cet pts, whereas there were no significant trends of correlation in Pani pts, 0.272 (p ¼ 0.209) and 0.598 (p ¼ 0.002), respectively. Conclusion: Our results suggest that NLR kinetics could reflect the treatment outcomes and kinetic analysis would lead to the stratification of clinical use of Cet and Pani. Cet, rather than Pani, might have more immune and inflammatory associations in the 1st line chemotherapy of RAS wild metastatic colorectal cancer. Clinical trial information: UMIN000031535.
Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.
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