Efficacy and safety of endoscopic ultrasonography-guided interventional treatment for refractory malignant left-sided liver tumors: a case series of 26 patients
Tian-An Jiang, Zhuang Deng, Guo Tian, Qi-Yu Zhao, Wei-Lin Wang, Tian-An Jiang, Zhuang Deng, Guo Tian, Qi-Yu Zhao, Wei-Lin Wang
Abstract
This study aimed to compare the efficacy and safety of EUS-guided ethanol injection and 125I seed brachytherapy for malignant left-sided liver tumors which were difficult for trans-abdominal intervention. The study protocol was registered at Clinicaltrials.gov (NCT02816944). Twenty-six patients were consecutively and prospectively hospitalized for EUS-guided interventional treatment of refractory malignant left-sided liver tumors between June 2014 and June 2016. Liver masses were detected using EUS in 25 of 26 (96.2%) patients. EUS-guided interventional treatment was completed uneventfully in 23 of 26 (88.5%) patients using anhydrous ethanol injection (n = 10) or iodine-125 seed implantation (n = 13). Six months later, complete response was achieved in 15 of 23 (65.2%) patients and partial response in 8 of 23 (34.8%) patients. Patients with tumor residual have second-look EUS-guided interventional treatment (n = 5), radiotherapy (n = 2) or surgical resection (n = 1). Complete response was achieved after repeated interventional treatment in 3 of 5 patients who underwent second EUS-guided intervention; 2 patients required additional surgical resection but one succeed. No significant complications occurred. Therefore EUS-guided 125I seed brachytherapy is an effective and safe treatment modality for radical operation or promising palliative control of malignant left-sided liver tumors refractory to trans-abdominal intervention.
Figures
References
- Fowler K. J., Saad N. E. & Linehan D. Imaging approach to hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Surgical oncology clinics of North America 24, 19–40, doi: 10.1016/j.soc.2014.09.002 (2015).
- Pichlmayr R., Weimann A., Tusch G. & Schlitt H. J. Indications and Role of Liver Transplantation for Malignant Tumors. The oncologist 2, 164–170 (1997).
- Khan K., Wale A., Brown G. & Chau I. Colorectal cancer with liver metastases: neoadjuvant chemotherapy, surgical resection first or palliation alone? World journal of gastroenterology 20, 12391–12406, doi: 10.3748/wjg.v20.i35.12391 (2014).
- Wang H. M. et al.. Analysis of facial bone wall dimensions and sagittal root position in the maxillary esthetic zone: a retrospective study using cone beam computed tomography. The International journal of oral & maxillofacial implants 29, 1123–1129, doi: 10.11607/jomi.3348 (2014).
- Takayasu K. et al.. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 131, 461–469, doi: 10.1053/j.gastro.2006.05.021 (2006).
- Horiguchi Y. et al.. Treatment of choice for unresectable small liver cancer: percutaneous ethanol injection therapy or transarterial chemoembolization therapy. Cancer chemotherapy and pharmacology 33 Suppl, S111–S114 (1994).
- Hoang N. H., Murad H. Y., Ratnayaka S. H., Chen C. & Khismatullin D. B. Synergistic ablation of liver tissue and liver cancer cells with high-intensity focused ultrasound and ethanol. Ultrasound in medicine & biology 40, 1869–1881, doi: 10.1016/j.ultrasmedbio.2014.02.026 (2014).
- Weis S., Franke A., Mossner J., Jakobsen J. C. & Schoppmeyer K. Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma. The Cochrane database of systematic reviews, CD003046, doi: 10.1002/14651858.CD003046.pub3 (2013).
- Chen K. et al.. Adjuvant iodine-125 brachytherapy for hepatocellular carcinoma after complete hepatectomy: a randomized controlled trial. PloS one 8, e57397, doi: 10.1371/journal.pone.0057397 (2013).
- Wang J. D. et al.. Optimal treatment opportunity for mTHPC-mediated photodynamic therapy of liver cancer. Lasers in medical science 28, 1541–1548, doi: 10.1007/s10103-012-1248-3 (2013).
- Holt B. & Varadarajulu S. Endoscopic ultrasound-guided fine needle aspiration or fine needle biopsy: the beauty is in the eye of the beholder. Endoscopy 46, 1046–1048 (2014).
- Nakaji S., Hirata N., Kobayashi M., Shiratori T. & Sanagawa M. Endoscopic ultrasonography-guided ethanol injection as a treatment for ruptured hepatocellular carcinoma in the left hepatic lobe. Endoscopy 47 Suppl 1, E558–E560, doi: 10.1055/s-0034-1393394 (2015).
- Nakaji S. et al.. Endoscopic ultrasound (EUS)-guided ethanol injection for hepatocellular carcinoma difficult to treat with percutaneous local treatment. Endoscopy 44 Suppl 2 UCTN, E380, doi: 10.1055/s-0032-1309918 (2012).
- Azab M. et al.. Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma. Arab journal of gastroenterology: the official publication of the Pan-Arab Association of Gastroenterology 12, 113–118, doi: 10.1016/j.ajg.2011.07.005 (2011).
- Giorgio A. et al.. Percutaneous radiofrequency ablation of hepatocellular carcinoma compared to percutaneous ethanol injection in treatment of cirrhotic patients: an Italian randomized controlled trial. Anticancer research 31, 2291–2295 (2011).
- Brunello F. et al.. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian journal of gastroenterology 43, 727–735, doi: 10.1080/00365520701885481 (2008).
- Shiina S. et al.. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129, 122–130 (2005).
- Zhang W. et al.. Placement of (1)(2)(5)I seed strands and stents for a type IV Klatskin tumor. World journal of gastroenterology 21, 373–376, doi: 10.3748/wjg.v21.i1.373 (2015).
- Luo J., Yan Z., Liu Q., Qu X. & Wang J. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. Journal of vascular and interventional radiology: JVIR 22, 479–489, doi: 10.1016/j.jvir.2010.11.029 (2011).
- Zhang F. J. et al.. CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma. Chinese medical journal 121, 2410–2414 (2008).
- Nag S., DeHaan M., Scruggs G., Mayr N. & Martin E. W. Long-term follow-up of patients of intrahepatic malignancies treated with iodine-125 brachytherapy. International journal of radiation oncology, biology, physics 64, 736–744, doi: 10.1016/j.ijrobp.2005.08.029 (2006).
- Bang J. Y. & Varadarajulu S. Endoscopic ultrasound-guided management of pancreatic pseudocysts and walled-off necrosis. Clinical endoscopy 47, 429–431, doi: 10.5946/ce.2014.47.5.429 (2014).
- Puspok A. et al.. Endoscopic ultrasound guided therapy of benign and malignant biliary obstruction: a case series. The American journal of gastroenterology 100, 1743–1747, doi: 10.1111/j.1572-0241.2005.41806.x (2005).
- Artifon E. L. et al.. Endoscopic ultrasound-guided choledochoduodenostomy and duodenal stenting in patients with unresectable periampullary cancer: one-step procedure by using linear echoendoscope. Scandinavian journal of gastroenterology 48, 374–379, doi: 10.3109/00365521.2012.763176 (2013).
- Zhang W. Y., Li Z. S. & Jin Z. D. Endoscopic ultrasound-guided ethanol ablation therapy for tumors. World journal of gastroenterology 19, 3397–3403, doi: 10.3748/wjg.v19.i22.3397 (2013).
- Awad S. S. et al.. Preoperative evaluation of hepatic lesions for the staging of hepatocellular and metastatic liver carcinoma using endoscopic ultrasonography. American journal of surgery 184, 601-604; discussion 604–605 (2002).
- Singh P. et al.. Endoscopic ultrasound versus CT scan for detection of the metastases to the liver: results of a prospective comparative study. Journal of clinical gastroenterology 43, 367–373, doi: 10.1097/MCG.0b013e318167b8cc (2009).
- Tonozuka R. et al.. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos). Gastrointestinal endoscopy 81, 1463–1469, doi: 10.1016/j.gie.2015.01.023 (2015).
- Eso Y., Marusawa H., Tsumura T., Okabe Y. & Osaki Y. Endoscopic ultrasonography-guided transgastric drainage of infectious biloma following radiofrequency ablation for hepatocellular carcinoma. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society 24, 390, doi: 10.1111/j.1443-1661.2012.01305.x (2012).
- Silva M. F. et al.. m-RECIST at 1 month and Child A are survival predictors after percutaneous ethanol injection of hepatocellular carcinoma. Annals of hepatology 13, 796–802 (2014).
- Zhuang H. Q., Wang J. J., Liao A. Y., Wang J. D. & Zhao Y. The biological effect of 125I seed continuous low dose rate irradiation in CL187 cells. Journal of experimental & clinical cancer research: CR 28, 12, doi: 10.1186/1756-9966-28-12 (2009).
- Xiang G. A., Chen K. Y., Wang H. N. & Xiao J. F. [Immunological influence of iodine-125 implantation in patients with hepatocellular carcinoma resection]. Nan fang yi ke da xue xue bao = Journal of Southern Medical University 30, 292–294 (2010).
Source: PubMed