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ABSTRACT: To assess the survival of patients with hepatic uveal melanoma metastases undergoing sequential transarterial hepatic chemoperfusion.
61 patients (mean age, 60.3 ± 13.8 y) underwent a total of 249 hepatic chemoperfusion procedures (mean: 4 chemoperfusion procedures; range, 1-7 chemoperfusion procedures; standard deviation, 2.3 chemoperfusion procedures). All patients started with melphalan. In the case of progressive disease, melphalan was replaced by a different chemoperfusion agent. 38 patients were treated with melphalan only, 23 patients were treated with a combination of melphalan and other drugs. The median overall survival time was calculated for the overall population and several sub-groups. Differences in the survival rate between the sub-groups were assessed for statistical significance. The complication rate was assessed.
The median overall survival of the entire population was 10 months. The patients in the subgroups with a maximum number of 9 hepatic metastases as well as the patients in the subgroup without extrahepatic metastases at the beginning of therapy survived significantly longer than patients with more than 9 metastases/extrahepatic metastases (p = 0.019, p = 0.008). One patient (0.4%) died from liver failure after initial infusion of melphalan.
Intraarterial sequential hepatic chemoperfusion offers a minimally invasive treatment in patients with hepatic uveal melanoma metastases with good survival times and an acceptable major complication rate.
RöFo - Fortschritte auf dem Gebiet der R 12/2011; 183(12):1151-60. · 2.76 Impact Factor
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ABSTRACT: Primary and secondary hypervascularized liver tumors may be treated with transarterial chemoembolization (TACE). The purpose of this study was to experimentally quantify the effect of different chemoembolization materials on the PET activity concentration in PET/CT.
Different concentrations of lipiodol, tungsten, tantalum, and a different number of platinum coils embedded in a carrier substance were placed in a liver phantom. An insert filled with only the carrier substance served as the negative control. The liver phantom was placed in a body phantom. The liver phantom was filled with 63.3 KBq [18-F]-Fluor-2-deoxy-D-glucose (FDG)/ml water, the body phantom was filled with 19.7 KBq FDG/ml water. PET/CT was performed and PET attenuation correction was performed based on the CT data. We defined: Activity concentration over embolization material (kBq/ml) approximately measured activity concentration; activity concentration over negative control (kBq/ml) approximately real activity concentration. An overestimation of the activity concentration was quantified by the following ratio: Activity concentration overestimation = activity concentration over embolization material (kBq/ml)/activity concentration over negative control (kBq/ml).
All chemoembolization materials led to an overestimation of the PET activity concentration when using CT information for PET attenuation correction. The extent of overestimation is dependent on the concentration and the density of the chemoembolizing agent. PET activity overestimation was 11-151% with lipiodol, 34-1827% with tungsten, 16-1205% with tantalum, and 4-29% with platinum coils.
Conventional chemoembolization materials cause an overestimation of the PET activity concentration in CT-based attenuation-corrected PET/CT images. This is of importance for the clinical routine since activity concentration quantification may not be used in the presence of chemoembolizing agents for imaging follow-up. If an increased FDG uptake is detected after transarterial chemoembolization, non-attenuation-corrected PET images must be assessed in addition to the attenuation-corrected images in order to differentiate artificially increased tracer uptake from a true increase in activity concentration of the tracer. The use of non-attenuating chemoembolizing materials (e.g. drug-eluting beads) for TACE may serve as an alternative to avoid embolization-associated PET artifacts.
RöFo - Fortschritte auf dem Gebiet der R 12/2007; 179(11):1159-65. · 2.76 Impact Factor
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Georgios C Sotiropoulos,
M Malago,
E P Molmenti,
A Radtke,
E I Brokalaki,
S Nadalin,
H Lang,
A Frilling,
H A Baba,
H Kühl, R Verhagen,
C E Broelsch
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ABSTRACT: To study the disease course of patients with hepatocellular carcinoma (HCC) showing complete tumor necrosis in their liver explants after undergoing bridging treatments followed by liver transplantation (LTx).
We evaluated data corresponding to 10 patients with liver cirrhosis undergoing bridging treatments for HCC prior to LTx. In all cases there was complete tumor necrosis in the explanted livers.
There were 8 men and 2 women. Percutaneous radiofrequency ablation (RFA) was performed under computed tomographic guidance in 4 patients. The remaining 6 patients underwent transarterial chemoembolization (TACE). Five of them received one session of TACE, while the remaining one received a series of 4 sessions prior to LTx. Six patients had solitary nodules with a median diameter of 3.5 cm (range 2.5-4.2 cm). Four of them underwent RFA. Segmental tumor chemoembolization was performed in 2 patients. The remaining 4 patients had 2 tumors each with a median total diameter of 4.4cm (range 4.2-6.0 cm) prior to TACE. They underwent bilobar hepatic chemoembolization, which under staged the tumors prior to live donor liver transplantation (LDLTx). Six patients underwent deceased donor orthotopic liver transplantation. LDLTx was performed in 4 patients. Median waiting time to LTx was 53 days. All patients are alive without recurrence after a median follow-up of 19 months.
Achievement of 100% tumor necrosis by means of bridging treatments followed by LTx for HCC is characterized by a very low recurrence rate and should receive further consideration and study.
European journal of medical research 01/2006; 10(12):539-42. · 1.13 Impact Factor
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ABSTRACT: Asymptomatic arteriovenous fistulae and pseudoaneurysms are common after renal biopsy. We present a patient with a single kidney and symptomatic pseudoaneurysm of the renal artery with concomitant arteriovenous fistula as a rare complication following surgical embolectomy. The patient developed renal insufficiency because of a significant degree of vascular steal caused by the fistula. Dialysis was performed for more than 6 months until the fistula was diagnosed. The fistula and the pseudoaneurysm were successfully treated by superselective arterial embolization with metallic coils. Renal function improved within the next 2 weeks and no further dialysis was necessary.
Nephron 09/2000; 85(4):351-3. · 13.26 Impact Factor
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Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 01/1995; · 1.29 Impact Factor
