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Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation 被引量:1
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作者 Sophia Schmitz Georg Lurje +5 位作者 Florian Ulmer Anne Andert Philipp Bruners maximilian schulze-hagen Ulf Neumann Wenzel Schoening 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2019年第3期228-236,共9页
Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma(HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points(exceptional M... Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma(HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points(exceptional MELD, ex MELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional(neoadjuvant) treatment(LRT) is used. For patients unlikely to timely receive an organ via primary allocation,“extended critera donor(ECD) organs” are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary. Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42(84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients(82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses. Results: One-and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached( P = 0.487). LRT had no impact on overall survival( P = 0.629). Median waiting time was shorter if no LRT was performed(4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival( P = 0.663). Conclusions: Patients with an expected waiting time to transplantation of > 6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option. 展开更多
关键词 HEPATOCELLULAR carcinoma LIVER TRANSPLANTATION Therapeutic EMBOLIZATION LIVER NEOPLASMS ORGAN TRANSPLANTATION
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Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization?
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作者 Markus Zimmermann maximilian schulze-hagen +4 位作者 Federico Pedersoli Peter Isfort Alexander Heinzel Christiane Kuhl Philipp Bruners 《World Journal of Radiology》 CAS 2019年第7期102-109,共8页
BACKGROUND The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery(RHA) originating from the superior mesenteric artery(SMA) and a left hepatic artery(L... BACKGROUND The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery(RHA) originating from the superior mesenteric artery(SMA) and a left hepatic artery(LHA) originating from the left gastric artery(LGA). These anatomical variants could potentially increase the risk for non-target embolization during Y90-Radioembolization due to the close proximity between hepatic and enteric vessel branches.AIM To evaluate the safety of Yttrium-90radioembolization(90Y-RE) with resin microspheres in patients with a variant hepatic arterial anatomy.METHODS In this retrospective single-center observational study, 11 patients who underwent RE with 90Y-resin microspheres via a LHA originating from the LGA,and 13 patients via a RHA originating from the SMA were included. Patient and treatment data were reviewed regarding clinical and imaging evidence of nontarget embolization of 90Y-resin microspheres to the GI tract. Positioning of the tip of the microcatheter in relationship to the last hepatoenteric side branch was retrospectively analyzed using angiographic images, cone-beam CT and preinterventional CT-angiograms.RESULTS None of the 24 patients developed clinical symptoms indicating a potential nontarget embolization to the GI tract within the first month after 90Y-RE. On thepostinterventional 90Y-bremsstrahlung images and/or 90Y-positron emission tomographies, no evidence of extrahepatic 90Y-activity in the GI tract was noted in any of the patients. The mean distance between the tip of the microcatheter and the last enteric side branch during delivery of the 90Y microspheres was 3.2 cm(range: 1.9-5 cm) in patients with an aberrant LHA originating from a LGA. This was substantially shorter than the mean distance of 5.2 cm(range: 2.9-7.7 cm) in patients with an aberrant right hepatic originating from the SMA.CONCLUSION90Y-RE via aberrant hepatic arteries appears to be safe;at least with positioning of the microcatheter tip no less than 1.9 cm distal to the last hepatoenteric side branch vessel. 展开更多
关键词 RADIOEMBOLIZATION YTTRIUM 90 ABERRANT HEPATIC ARTERIES HEPATIC arterial variants Safety
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