Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

AIM:To prospectively evaluate the short and long term clinical impact of selective transarterial chemoembolization (TACE) on liver function in patients with hepatocellular carcinoma (HCC).To assess side effects in relation to treatments.To analyze the overall survival and HCC progression free survival probability. METHODS:One hundred and seventeen cirrhotic patients with HCC were enrolled.Baseline liver function included Child-Pugh score and serum levels of alanineaminotransferase (ALT),prothrombin time(PT)and bilirubin.According to Cancer Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC) staging systems,71 patients were eligible for TACE; 32 had previously received treatment for HCC.No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions.While hospitalized, patient sunder went clinical,hematologicand ultrasonographic assessments.One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed"on demand".Liver function tests were checked in all patients every four months.RESULTS:After first TACE,the mean Child-Pugh score increased from a mean baseline 5.62±1.12 to 6.11±1.57 at discharge time (P<0.0001),decreasing after four months to 5.81±0.73 (not significant).ALT,PT and bilirubin significantly (P<0.0001)increased 24 h after TACE and progressively decreased until discharge. After the second TACE,variations in Child-Pugh score,ALT,PT and bilirubin were comparable to that described after the first TACE.No major complications were observed.The mean follow-up was 14.7±6.3 mo (median:16 mo).Only one patient died.No other patient experienced important long term worsening of clinical status.The overall survival probability at twenty-four months was 98.18%with a correspondent HCC progression free survival probability of 69%. CONCLUSION:Selectiv TAC Emayproduce significant,but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score.Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles.Liver function can remain stable in the long-term, with optimal medium term survival.This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.

Endotics system vs colonoscopy for the detection of polyps

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P < 0.0001). No patient required sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P < 0.0001). The sensitivity and specificity of ES for detecting polyps were 93.3% (95% CI: 68-98) and 100% (95% CI: 76.8-100), respectively. PPV was 100% (95% CI: 76.8-100) and NPV was 97.7% (95% CI: 88-99.9). CONCLUSION: The ES allows the visualization of the entire colonic mucosa in most patients, with good sensitivity/specificity for the detection of lesions and without requiring sedation.

Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.