Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-four patients suffering from various kinds of tumors, including metastasis, were treated by selective embolization with both spherical and cylindrical poly(2-hydroxyethyl methacrylate) [poly(HEMA)] particles and topical chemotherapy. Treatment of a patient with carcinoid metastases in the liver is discussed. Immediately after embolization, 5-fluorouracil, and later, doxorubicin and Lipiodol, were selectively infused into the tumorous tissue for approximately 1 week. Patient received four cycles of this infusion. Chemoembolization proceeded against the background of anticoagulant therapy using small doses of heparin or its low-molecular-weight analogue, dalteparin. This was followed by transcutaneous transhepatic portography and embolization. Finally, the tumor-feeding artery and portal vein were sealed by a hydrogel. After 1.5 months, the affected liver lobe was resected. Although 4 years from the beginning of treatment, the patient is still alive. Embolization with poly(HEMA) hydrogel particles in conjunction with an anticancer drug infusion via catheter is recommended as an efficient method of tumor treatment. The therapeutic effect has been shown to be a function of ischemia and slow local infusion of drug into the tumor, and systemic drug levels can be kept low.
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PMID:Targeted chemoembolization of tumors with poly(2-hydroxyethyl methacrylate) particles. 1082 17

Chemoembolization has become the preferred treatment for patients with inoperable, hypervascular hepatic malignancies in the Far East, but controversial elsewhere. In vivo microscopy in addition to other experimental procedures are used in this presentation to better understand the mechanisms involved in chemoembolization. In chemoembolization Lipiodol acts as a contrast material, a vehicle for chemotherapy and an embolic agent. Although not optimal, Lipiodol injected into the hepatic artery, traverses the peribiliary plexus to the portal veins resulting in a dual embolization. Chemoembolization creates ischemia, slows arterial flow and increases the contact time between the infusate and the neoplasms, increasing the tumor cell kill. However, the vascular occlusion also produces infarction and fibrosis compounding the already existing cirrhosis frequently associated with hepatocellular carcinoma. Lipiodol/ethanol (3:1) injected into the segmental or lobar hepatic artery supplying the neoplasm also gains access to the associated portal venous branches causing focal ablation. This preoperative approach is easier to perform than direct portal vein occlusion, with less parenchymal damage and comparable hypertrophy of the remnant liver frequently necessary for adequate hepatic function following resection. Polymer-drug conjugates, e.g. PG-TXL, have considerable potential for intra-arterial delivery especially with the dramatic increase in concentration of the drug in the tumor and its efficacy. Using in vivo microscopy especially with green fluorescent protein (GFP) gene as an efficient and non-toxic tumor cell marker, the events leading to hepatic metastases can be documented which will serve to better evaluate these varied techniques of chemoembolization.
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PMID:Hepatic chemoembolization: clinical and experimental correlation. 1092 54

Hepatic artery embolization (HAE) has been utilized for treatment of advanced hepatic carcinoid metastases, with promising symptom palliation and tumor control. Our institution employs transcatheter HAE using Lipiodol/Gelfoam for treatment of carcinoid hepatic metastases, and this report presents our experience with twenty-four patients, examining symptom control, quality-of-life, octreotide dependence, and tumor progression. Twenty-four (11 male, 13 female, mean age = 59.4 +/- 2.5 yr) patients with carcinoid and unresectable hepatic metastases, confirmed by urinary 5-hydroxyindole acetic acid (5-HIAA) measurement and biopsy, were treated with Lipiodol/Gelfoam HAE from 1993-2001. Median follow-up was 35.0 months. Before HAE, 14 patients (58.3%) had malignant carcinoid syndrome, with symptoms quantified using our previously reported Carcinoid Symptom Severity Score, and 13 patients (54.2%) required octreotide for symptom palliation. Following treatment, symptom severity, octreotide dose, and tumor response were measured. Asymptomatic patients did not develop symptoms or require following treatment. Hepatic metastases remained stable (n = 4) or decreased (n = 19) in 23 patients (95.8%). Mean pretreatment Symptom Severity Scores (3.8 +/- 0.2), decreased to 1.4 +/- 0.1 post-treatment (P < 0.00001), with 64.3% of patients becoming asymptomatic. Mean pretreatment octreotide dosages (679.6 +/- 73.0 microg/d), decreased to 262.9 +/- 92.7 microg/d (P = 0.0024) post-treatment, with 46.2% of patients discontinuing octreotide. There were no treatment-related serious complications or deaths. This study demonstrates that Lipiodol/Gelfoam HAE produces excellent control of malignant carcinoid syndrome, allowing patients to decrease or eliminate use of octreotide, while controlling hepatic tumor burden.
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PMID:Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors. 1239 54

Neuroendocrine tumors, particularly those of gastrointestinal tract origin, have a predisposition for metastasizing to the liver, causing parenchymal substitution and paraneoplastic syndrome. Lipiodol embolization combined with anticancer drugs is a recent tool in regional therapy. It has been proven that chemoembolization reduces tumor bulk and hormone levels, and that it palliates the symptoms of many patients with liver-dominant neuroendocrine metastases. Beginning in December 1988, ten patients with unresectable and chemotherapy-refractory liver metastatic neuroendocrine tumors were treated with chemoembolization based on a mixture of lipiodol, mitomycin, cisplatin, epirubicin, followed by gelfoam powder and contrast media. Toxicity encountered included: upper right quadrant pain requiring narcotics, elevation of lactate dehydrogenase, alkaline phosphatase, and transaminases. One patient had liver abscess and persistent fever for 2 weeks. We obtained two complete remissions lasting 12 and 34 months and 5 partial remissions. The median survival was 22 months. Four patients had urinary elevation of 5-hydroxyindolacetic acid (5-HIAA). They showed more than a 75% decrease in urinary secretion after treatment. In a patient with transplanted liver we noticed a partial response lasting 7 months. We conclude that chemoembolization will improve the clinical condition of a significant percentage of patients with liver metastases, that future therapy of carcinoid tumors will be based on specific tumor biology and that treatment will be customized for each individual patient combining the use of cytoreductive procedures including radiofrequency ablation, laser treatment and chemoembolization.
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PMID:Intra-arterial hepatic chemoembolization in liver metastases from neuroendocrine tumors: a phase II study. 1533 Mar 28

The importance and methodology of contemporary patient dosimetry in well-established radionuclide therapies are reviewed. The different protocols used for radioiodine treatment of thyrotoxicosis are discussed. Special attention is paid to patient dosimetry in the largest safe dose approach for curative radioiodine therapy of thyroid remnants and metastases in the post-surgical treatment of differentiated thyroid cancer. Nowadays, meta-[131I]iodobenzylguanidine (131I-MIBG) therapy for neuroblastoma relies on bone marrow dose levels. Issues related to whole-body and tumour dosimetry in this type of radionuclide therapy, where, traditionally, dosimetry has played an important role, are discussed. A relatively large number of patients are treated with radiolabelled Lipiodol for hepatocellular carcinoma. Administered activities are restricted to 2.22 GBq (60 mCi) when using 131I-lipiodol because of the radioprotection measures to be taken. These radiation protection issues can be avoided by using 188Re labelled Lipiodol allowing further dose escalation. The follow-up of these patients also necessitates whole-body dosimetry. It is concluded that for treatment of malignant diseases reliable patient dosimetry is now a keystone of high quality radionuclide therapy. Where dosimetry of present medical applications focuses generally on the critical organs, in the near future accurate 3-dimensional tumour dosimetry also will become feasible by the introduction of the combined SPECT-CT and PET-CT imaging systems in the dosimetric methodology. This will allow treatment protocols based on tumour dose prescriptions as performed in external beam radiotherapy.
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PMID:Patient dosimetry in radionuclide therapy: the whys and the wherefores. 1594 79

When radio-iodine was first used in the treatment of metastasized thyroid carcinoma in 1943, its success in terms of tumour response, quality of life improvement and survival was considered a 'miracle', as in those days metastatic cancer was generally fatal. Inspired by this, many efforts have been made to apply radioisotope therapy to other tumours. Radionuclide therapy uses radioactive isotopes labelled with specific targeting agents that aim to deliver the irradiation of the isotope to the tumour, while sparing normal tissues. Its unique modality allows to systemically target radiosensitive tumours throughout the body. Another important principle is its so-called 'cross-fire' action, whereby, owing to the larger reach of the radiation in relation to the cell diameter, a tumour cell receives lethal hits also from isotopes in the neighbourhood that are not directly associated with this cell. The treatment is therefore less hampered by inhomogeneous distribution and metabolism than for example chemo- or immunotherapy. The European Association of Nuclear Medicine has issued guidelines on so-called 'established' therapies (www.eanm.org), i.e. hyperthyroidism, thyroid carcinoma, refractory synovitis, bone metastases, mIBG therapy, 32P therapy and Lipiodol therapy. Newer therapies include radio-peptide therapy, radio-immunotherapy of lymphoma and microsphere therapy for liver cancer. The aim of a recently held workshop at the ECCO13 conference 2005 and this review is to inform the oncology community about these new developing therapies.
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PMID:Clinical applications of newer radionuclide therapies. 1656 89

The therapy of adrenocortical carcinoma has not yet been standardized, and a palliative treatment with embolization of hormonally active metastases or adrenocortical tumour, could be a method of choice. We report on a case of adrenocortical carcinoma which was diagnosed as S. Cushing. In the time of diagnosis the tumour was unresectable, and the therapy with mitotane and aminoglutethimide began. When medical treatment was unsuccessful, and side effects aggravated the disease, embolization of the tumour was performed. Superselective angiography of the artery adrenalis mediae sinistrae allowed parfusion of the malignant tissue by emulsion of Streptozotocin (2 g), 5-fluorouracil (17.5 ml) and Lipiodol (15 ccm). There was no adverse reaction after this administration. Plasma cortisol levels were on the same levels three months after this therapy, and improvement of the disease was evident.
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PMID:[Intraarterial perfusion of inoperable adrenocortical carcinoma with emulsion of lipiodol and cytostatics in a patient with Cushing syndrome]. 1797 16

We report a case of inguinal lymphorrhea cured by Lipiodol lymphangiography. The patient was a 80-year-old female who underwent an abdomino-perineal resection with lateral pelvic lymph node dissection and inguinal lymph node extraction for anal canal cancer. Histologically, the tumor was a poorly differentiated adenocarcinoma and considered to be stage IV (a2, n3 (+), P0, H3, M (-), cur C) in the Japanese classification of colorectal cancer. We recognized a lot of lymph node metastases in dissected lateral pelvic lymph node and inguinal lymph node. By hepatic arterial infusion using 5-FU (1250 mg/body weekly), the liver metastases had a complete response after 15 courses. She noticed a left inguinal lymph node swelling and an elevation of serum CEA level (79.5 ng/mL) was observed. There was no evidence of recurrence except left inguinal lymph nodes. She underwent a left inguinal lymph node dissection. Serous discharge from a surgical site persisted despite of conservative therapy such as compression. She received lymphangiography using 8 mL of Lipiodol from left dorsum of foot. We found three lymph ducts heading to left groin and observed a lot of Lipiodol leakage from ducts. We determined not only the site of leakage but we also confirmed a gradual decrease and a complete stop of lypmphorrhea in 7 days after lymphangiography. Slight lymph edema of left lower extremity appeared but gradually relieved. Lymphangiography using Lipiodol helps determine the site of leakage and may be an effective therapeutic modality for treating refractory lymphorrhea.
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PMID:[A case of refractory inguinal lymphorrhea cured by lipiodol lymphangiography]. 1821 32

A clinical pilot study of intracavital chemotherapy with anticancer agents dissolved in lipids for malignant effusion in pleural and peritoneal cavity was performed. Seven patients with pleural or peritoneal metastases were treated with a cocktail of anticancer agents dissolved in Lipiodol individually administered via the intracavitary route. All the patients revealed cytological and physical improvement. Five patients responded completely and two responded partially; four patients were able to be discharged from hospital and no serious side effects were observed. Thus, this therapeutic tactic of using oily anticancer agents appeares to be promising for control of pleural and peritoneal carcinomatoses.
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PMID:Intracavital chemotherapy for peritoneal and pleural carcinomatosis with lipid-formulated anticancer agents. 2160 57

A 58-year-old man presented with a very rare case of pituitary metastasis from hepatocellular carcinoma with active nasal bleeding which was treated by transarterial embolization using ethiodized oil (Lipiodol) and gelatin sponge. After treatment, nasal bleeding ceased and tumor size decreased. The prognosis for patients with pituitary metastases is very poor, so aggressive treatment is recommended to alleviate symptoms. This minimally invasive approach may be a reasonable therapeutic option for pituitary metastases.
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PMID:Transarterial embolization with use of lipiodol and gelatin sponge for active nasal bleeding from hepatocellular carcinoma metastasis in the pituitary gland. 2186 84


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