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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hepatic metastases of pancreatobiliary cancer have a dismal patient prognosis of approximately 1 year after diagnosis. There have been a few reports in the literature on aggressive treatment of these patients with the intention of cure. For hepatic metastases from biliary cancer, hepatic resection has been performed in a small number of patients, resulting in a median survival time of less than 12 months. In our series of 7 patients, median survival time was 9 months. For hepatic metastases of gallbladder carcinoma, long-term (> 3-year) survivors have been reported. In our series of 16 patients, median survival time was 8 months, but one patient is still alive after more than 5 years. For simultaneous hepatic metastases of pancreas cancer. Howard et al and Takada et al have reported the results of aggressive surgical resection in 10 and 11 consecutive patients, respectively. The median survival times in their series were 11 and 6 months after hepatic resection and pancreaticoduodenectomy, respectively. These results cannot justify aggressive resection for patients with hepatic metastases of pancreatic cancer. In most series previously reported, the treatment for hepatic metastases from pancreatobiliary malignancies was systemic and regional chemotherapy, especially hepatic arterial infusion chemotherapy. However, there is no evidence suggesting a beneficial effect of cancer chemotherapy on prognosis. Therefore new therapeutic modalities should be developed to improve the outcome of the treatment of hepatic metastases of pancreatobiliary cancer.
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PMID:[The treatments of hepatic metastasis from pancreato-biliary cancer]. 1457 58

Accurate staging of pancreatico-biliary cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. The complex regional anatomy of the pancreatico-biliary system makes histologic diagnosis of malignancy at this region difficult. The ability to position the endoscopic ultrasound transducer at endoscopy in direct proximity to the pancreas and the bile duct, combined with the use of fine-needle aspiration, enables accurate preoperative staging of cancer, especially cancer too small to be characterized by CT or MRI. Endoscopic ultrasonography (EUS) identifies patients unlikely to be cured by surgery due to vascular invasion or regional nodal metastasis, thereby limiting procedure-related morbidity and mortality. This article focuses on the utility and recent advances of EUS in the evaluation of pancreatico-biliary cancer.
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PMID:The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. 1599 54

Cholangiocarcinoma is one of the most aggressive malignancies. Patients with advanced or metastatic disease have a particularly dismal prognosis. The role of chemotherapy remains a matter of debate. A number of recent trials have shown that capecitabine in combination with other agents seems to be active as first-line treatment in advanced biliary cancer. Clinical data regarding the activity of capecitabine in pretreated patients are limited. In this report we describe a patient with previously treated, metastatic cholangiocarcinoma who developed stabilization of the disease for 7 months following chemotherapy with capecitabine. The patient had previously received 2 lines of chemotherapy. Capecitabine was tolerated fairly well without serious adverse events. We consider this observation to be important given the absence of active, non-surgical treatments in unresectable tumors.
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PMID:Capecitabine in pretreated metastatic cholangiocarcinoma. A case report and review of the literature. 1760 Aug 85

A 77-year-old woman underwent pancreatoduodenectomy with the diagnosis of biliary tract cancer. Postoperative immunohistochemical study showed endocrine cell carcinoma originating in the common bile duct. Systemic infusion of gemcitabine was started as adjuvant chemotherapy, however, 6 months after the operation, multiple liver and lymph node metastases were revealed by computed tomography. Then hepatic artery infusion with CPT-11 (40 mg/body) and CDDP (20 mg/body) were repeated every two weeks. Tumor markers normalized, and the size of both lymph nodes and liver tumors was remarkably decreased after 5 months. Endocrine cell carcinoma of the bile duct generally has a poor prognosis. This method could be a therapeutic option for recurrent endocrine cell carcinoma of the bile duct.
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PMID:[A case of recurrent endocrine cell carcinoma of the common bile duct successfully treated by hepatic artery infusion with CPT-11 and CDDP]. 1946 Nov 86

Accurate staging of pancreatico-biliary cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. The complex regional anatomy of the pancreatico-biliary system makes histologic diagnosis of malignancy at this region difficult. The ability to position the endoscopic ultrasound transducer at endoscopy in direct proximity to the pancreas and the bile duct, combined with the use of fine-needle aspiration, enables accurate preoperative staging of cancer, especially cancer too small to be characterized by CT or MRI. Endoscopic ultrasonography (EUS) identifies patients unlikely to be cured by surgery due to vascular invasion or regional nodal metastasis, thereby limiting procedure-related morbidity and mortality. This article focuses on the utility and recent advances of EUS in the evaluation of pancreatico-biliary cancer.
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PMID:The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. 2036 85

(18)F-Labeled fluorodeoxyglucose positron-emission tomography (FDG-PET), a rapidly evolving functional imaging modality, has recently been shown to be useful in the diagnosis and staging of various malignant tumors due to focal uptake of FDG-labeled glucose in malignant cell populations. However, the role of FDG-PET in the diagnosis and staging of biliary tract cancer is still controversial and has not yet been fully evaluated. The aim of this study was to determine the clinical importance of FDG-PET in the preoperative evaluation of biliary tract cancer and retrospectively clarify the characteristics of false-negative and false-positive cases. We retrospectively analyzed data for 73 consecutive patients diagnosed with cancer of the biliary tract and were admitted to the Department of Hepato-Biliary-Pancreatic Surgery at Kobe University Hospital for treatment, from January 2007 to August 2009. Since the sensitivity, specificity and positive predictive value (PPV) of FDG-PET in the diagnosis of bile duct carcinoma are usually relatively high, FDG-PET is considered to be a useful tool in diagnosing biliary tract cancer. FDG-PET also seems to be useful in clinical decision-making, regarding treatment strategy, including surgery. Our results showed that FDG-PET is highly sensitive in delineating the primary focus of biliary cancer and is a useful tool in preoperative examination. A disadvantage of FDG-PET is its inability to indicate small metastases and false-positive findings of inflamed gallbladder and bile duct lesions.
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PMID:Feasibility of (18)F-fluorodeoxyglucose positron-emission tomography for preoperative evaluation of biliary tract cancer. 2315 88

The patient was a 63-year-old male. He was admitted to our department due to obstructive jaundice and acute renal failure, and was diagnosed with a lower bile duct cancer. As a result of a stent placement into the bile duct and hemodialysis, jaundice and renal failure improved. As scattered metastases were recognized on the superior surface of both hepatic lobes in intraoperative findings, only a portoenterostomy was performed. After that, 1,000 mg/m(2) of gemcitabine(day 1)and 60 mg/m(2) day of S-1(days 1-7)were administered repeatedly every other week as a course. One year and four months after the start of chemotherapy, radiation therapy of 40 Gy was performed at the site considered to be the remaining primary tumor according to the PET-CT findings. While chemotherapy was continued without change thereafter, the time passed with no visualization of lesions by CT. Two years and five months after the start of chemotherapy, duodenal stenosis and a metastasis in the liver occurred, resulting thereafter in aggravated conditions and death. The entire course lasted two years and eight months. We considered that combined therapy of gemcitabine and S-1 would be a useful option in chemotherapy for biliary tract cancer.
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PMID:[A case of inoperable advanced bile duct cancer treated effectively with combined chemotherapy of gemcitabine and S-1]. 2341 68

The objective of this study was to carry out a meta-analysis of the efficacy of gemcitabine+platinum agent regimens in the treatment of advanced biliary tract cancer (BTC). PubMed and Google Scholar were searched using the following combination of search terms: gemcitabine, oxaliplatin, cholangiocarcinoma, biliary, gallbladder, bile duct. Studies were eligible for inclusion in the meta-analysis if they were randomized trials on the use of gemcitabine plus a platinum agent for the treatment of advanced (unresectable or metastatic cancer) BTC. Outcomes of interest were response rate, overall survival, and progression-free survival. Pooled odds ratios/differences in median survival and 95% confidence intervals (CIs) were determined for each outcome. A total of 47 records were identified in the initial search. Ultimately, three open-label randomized trials (two phase 2 and one phase 3) met the eligibility criteria and were included in the meta-analysis. Two studies compared gemcitabine plus cisplatin with gemcitabine alone, whereas the other study compared gemcitabine plus oxaliplatin with fluorouracil-folinic acid. The total number of patients in the studies ranged from 54 to 410. The overall analyses revealed that all survival outcomes assessed were significantly more favorable for patients treated with gemcitabine plus platinum agents than for patients not treated with this combination. Response rates: odds ratio=2.639, 95% CI=1.210-5.757, Z=2.439, P=0.015; pooled difference in median overall survival=3.822 months, 95% CI=1.798-5.845 months, Z=3.702, P<0.001; pooled difference in median progression-free survival=3.268 months, 95% CI=1.996-4.541 months, Z=5.035, P<0.001. Patients with advanced BTC who are treated with gemcitabine plus platinum agents may experience better survival outcomes compared with patients who are not treated with this combination of chemotherapy.
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PMID:Efficacy of gemcitabine plus platinum agents for biliary tract cancers: a meta-analysis. 2379 94

This case report describes an 83-year-old man with intrahepatic cholangiocarcinoma who was referred by a local hospital. Abdominal computed tomography (CT) showed a large tumor in hepatic segments 4, 5, and 8 involving the right hepatic vein and inferior vena cava, which is normally indicative of an unresectable locally advanced tumor. After systemic chemotherapy with gemcitabine and cisplatin, the observed decrease in the level of tumor marker suggested that the cancer was responding to treatment, while radiological findings showed the main tumor shrunk without the presence of distant metastases. Thus, hepatic left trisectionectomy with bile duct resection was performed after portal vein embolization. Pathological examination revealed negative margins (R0). Eighteen months after surgery, the patient is free of disease and shows no signs of recurrence. An initially unresectable, locally advanced biliary tract cancer may be down sized by chemotherapy, which makes radical resection possible, at least in a proportion of patients. This approach provides longer survival and may have a potential for disease eradication as a new multidisciplinary approach for patients with unresectable locally advanced biliary tract cancer.
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PMID:[A case of curative resection after downsizing chemotherapy in initially unresectable locally advanced intrahepatic cholangiocarcinoma]. 2573 Dec 35

Gallbladder cancer represents a rare but dismal disease. The only curative option is complete surgical resection, though patients often develop recurrent disease. In patients with advanced biliary tract cancer, the combination of cisplatin and gemcitabine showed a benefit in overall survival compared to gemcitabine alone. However, there is no standardized second-line regimen after treatment failure. We report on a young patient with early recurrence of a gallbladder cancer with cutaneous and peritoneal metastases. Upon identification of an ERBB2 gene amplification within the NCT MASTER (Molecularly Aided Stratification for Tumor Eradication Research) exome sequencing program with resulting overexpression of HER2 in the tumors cells, the patient received a targeted therapy with the HER2 antibodies pertuzumab and trastuzumab in combination with nab-paclitaxel, which led to a durable remission for more than one year. This case report underlines the potential of molecularly aided personalized targeted therapy for patients with biliary tract cancer and the need for respective clinical trials.
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PMID:[Durable remission under dual HER2 blockade with Trastuzumab and Pertuzumab in a patient with metastatic gallbladder cancer]. 2717 33


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