with details of the nature of the infringement. We will investigate the claim and if justified, we will take the appropriate steps. Download date: 04. Jul. 2022 ORIGINAL RESEARCH • VASCULAR AND INTERVENTIONAL RADIOLOGYH epatocellular carcinoma (HCC) is the most prevalent primary liver tumor, accounting for 8% of cancer-related deaths (1). Prognosis depends on tumor extension, the degree of liver dysfunction, and the patient's performance status. The European Society for the Study of the Liver endorsed the Barcelona Clinic Liver Cancer (BCLC) classification because it links these three major determinants to dynamic treatment guidelines (2). Very early (a single tumor 2 cm) and early HCC (single tumor or up to three nodules, with none of them 3 cm) is amenable to curative surgical or ablative treatment. For patients with intermediate-stage (BCLC B) unresectable HCC and preserved liver function, transarterial chemoembolization (TACE) is the standard treatment (2,3). For the advanced BCLC stage C-characterized by vascular invasion, extrahepatic spread, or tumor-induced symptoms-systemic treatment is the standard of care.Conventional TACE is a level I evidence treatment for intermediate HCC. The major drawback of TACE is the high variability of the procedure: Miscellaneous Background: Transarterial chemoembolization (TACE) is the recommended treatment for intermediate hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer guidelines. Prospective uncontrolled studies suggest that yttrium 90 ( 90 Y) transarterial radioembolization (TARE) is a safe and effective alternative. Purpose: To compare the efficacy and safety of TARE with TACE for unresectable HCC. Materials and Methods: In this single-center prospective randomized controlled trial (TRACE), 90 Y glass TARE was compared with doxorubicin drug-eluting bead (DEB) TACE in participants with intermediate-stage HCC, extended to Eastern Cooperative Oncology Group performance status 1 and those with early-stage HCC not eligible for surgery or thermoablation. Participants were recruited between September 2011 and March 2018. The primary end point was time to overall tumor progression (TTP) (Kaplan-Meier analysis) in the intention-to-treat (ITT) and per-protocol (PP) groups.Results: At interim analysis, 38 participants (median age, 67 years; IQR, 63-72 years; 33 men) were randomized to the TARE arm and 34 (median age, 68 years; IQR, 61-71 years; 30 men) to the DEB-TACE arm (ITT group). Median TTP was 17.1 months in the TARE arm versus 9.5 months in the DEB-TACE arm (ITT group hazard ratio [HR], 0.36; 95% CI: 0.18, 0.70; P = .002) (PP group, 32 and 34 participants, respectively, in each arm; HR, 0.29; 95% CI: 0.14, 0.60; P , .001). Median overall survival was 30.2 months after TARE and 15.6 months after DEB-TACE (ITT group HR, 0.48; 95% CI: 0.28, 0.82; P = .006). Serious adverse events grade 3 or higher (13 of 33 participants [39%] vs 19 of 36 [53%] after TARE and DEB-TACE, respectively; P = .47) and 30-day mortality (0 of 33 participants [0%] vs thr...
Hepatocellular carcinoma (HCC) is a frequent cancer with a high mortality. For early stage cancer there are potentially curative treatments including local ablation, resection and liver transplantation. However, for more advanced stage disease, there is no optimal treatment available. Even in the case of a "curative" treatment, recurrence or development of a new cancer in the precancerous liver is common. Thus, there is an urgent need for novel and effective (adjuvant) therapies to treat HCC and to prevent recurrence after local treatment in patients with HCC. The unique immune response in the liver favors tolerance, which remains a genuine challenge for conventional immunotherapy in patients with HCC. However, even in this "immunotolerant" organ, spontaneous immune responses against tumor antigens have been detected, although they are insufficient to achieve significant tumor death. Local ablation therapy leads to immunogenic tumor cell death by inducing the release of massive amounts of antigens, which enhances spontaneous immune response. New immune therapies such as dendritic cell vaccination and immune checkpoint inhibition are under investigation. Immunotherapy for cancer has made huge progress in the last few years and clinical trials examining the use of immunotherapy to treat hepatocellular carcinoma have shown some success. In this review, we discuss the current status of and offer some perspectives on immunotherapy for hepatocellular carcinoma, which could change disease progression in the near future.
BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients. CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement. CONCLUSION EH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.
Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with the use of large caliber lumen-apposing metal stents (LAMS). Therefore, some experts suggest percutaneous drainage (PCD) to facilitate endoscopic management with LAMS. The aim of this study is to determine the impact of PCD on WON resolution in patients undergoing LAMS drainage. Methods: A retrospective cohort study was performed for patients who underwent Endoscopic Ultrasound (EUS)-guided LAMS drainage of WON from 4/2014 to 10/2019. Demographic and procedural information and patient clinical outcomes were recorded. Cross-sectional imaging was reviewed by two abdominal radiologists blinded to patient outcome to independently determine size and percentage of solid necrosis within the WON. Wilcoxon rank sum test and Fisher's exact tests were used to compare continuous and categorical variables, respectively. A 2-sided p-value <0.05 was regarded as statistically significant. Results: A total of 62 patients underwent LAMS drainage for WON >10cm during the study period, of whom 54 (87%) did not undergo PCD. Baseline characteristics were similar between both groups including size, rate of paracolic gutter extension, percentage of solid necrosis, and presence of disconnected pancreatic duct (Table 1). Both groups were noted to contain a median of 60% solid necrosis (pZ0.66). Although no statistical procedural differences were noted between the groups (Table 2), use of a multigateway technique was more common in those without PCD (30% vs 0%; pZ0.21). Patients with PCD had no observed improvement in time to WON resolution (103 vs 78 days; pZ0.63) and did not reduce the number of endoscopic necrosectomy procedures (3.5 vs 1.0; pZ0.12) compared to those without PCD. Conclusions: In this cohort study, the majority of patients with large WON were successfully managed endoscopically with LAMS drainage and necrosectomy without the need for additional percutaneous drainage. Further studies are needed to clarify the role of percutaneous drainage in the setting of LAMS placement for WON.
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