34 research outputs found

    Efficacy of radioembolization according to tumor morphology and portal vein thrombosis in intermediate–advanced hepatocellular carcinoma

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    Purpose: We analyzed overall survival (OS) following radioembolization according to macroscopic growth pattern (nodular vs infiltrative) and vascular invasion in intermediate-advanced hepatocellular carcinoma (HCC). Methods: Between September 2005 and November 2013, 104 patients (50.0% portal vein thrombosis [PVT], 29.8% infiltrative morphology) were treated. Results: Median OS differed significantly between patients with segmental and lobar or main PVT (p = 0.031), but was 17 months in both those with patent vessels and segmental PVT. Median OS did not differ for infiltrative and nodular HCC. Median OS was prolonged in patients with a treatment response at 3 months (p = 0.023). Prior TACE was also a significant predictor of improved OS. Conclusion: A further indication for radioembolization might be infiltrative HCC, since OS was similar to nodular types

    Notulae to the Italian alien vascular flora: 14

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    In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, and status changes for Italy or for Italian administrative regions. Nomenclatural and distribution updates, published elsewhere, and corrections are provided as Suppl. materia

    Notulae to the Italian alien vascular flora: 14

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    In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, and status changes for Italy or for Italian administrative regions. Nomenclatural and distribution updates, published elsewhere, and corrections are provided as Suppl. material

    Indications and results of locoregional therapy for the treatment of hepatocellular carcinoma

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    La chemioembolizzazione (TACE) è uno dei trattamenti locoregionali più largamente utilizzati nel trattamento dell’epatocarcinoma (HCC). A tutt’oggi però rimangono irrisolte alcune importanti controversie sul suo impiego. Nella presente tesi sono stati analizzati alcuni dei principali oggetti di dibattito quali (1) indicazione al trattamento, (2) trattamenti multipli e schema di ritrattamento e (3) trattamento dei pazienti candidabili a trapianto di fegato. A tal fine sono stati riportati tre studi che hanno analizzato gli argomenti sopradescritti. La TACE viene comunemente eseguita nei pazienti al di fuori delle raccomandazioni delle linee guida tra cui i pazienti con nodulo singolo, i pazienti con trombosi portale e con performance status (PS) compromesso. Dallo studio 1 è emerso che la TACE può essere considerata una valida opzione terapeutica nei pazienti con HCC singolo non candidabili a trattamenti curativi, che la trombosi portale non neoplastica ed una lieve compromissione del performance status (PS-1) verosimilmente legata alla cirrosi non hanno impatto sulla sopravvivenza post-trattamento. Multipli trattamenti di chemioembolizzazione vengono frequentemente eseguiti ma non esiste a tutt’oggi un numero ottimale di ritrattamenti TACE. Dallo studio 2 è emerso che il trattamento TACE eseguito “on demand” può essere efficacemente ripetuto nei pazienti che non abbiano scompenso funzionale e non siano candidabili a trattamenti curativi anche se solo una piccola percentuale di pazienti selezionati può essere sottoposto a più cicli di trattamento. La TACE è frequentemente impiegata nei pazienti in lista per trapianto di fegato ma non c’è evidenza dell’efficacia di trattamenti ripetuti in questi pazienti. Dallo studio 3 è emerso che il numero di TACE non è significativamente associato né alla necrosi tumorale, né alla recidiva né alla sopravvivenza post-trapianto. Un tempo d’attesa prima del trapianto ≤6 mesi è invece risultato essere fattore predittivo indipendente di recidiva riflettendo la possibile maggiore aggressività tumorale in questa classe di pazienti.Transarterial chemoembolization (TACE) is largely used in the treatment of patients with HCC. Many unanswered questions relating to TACE are however still challenging. In the present thesis some controversies surrounding TACE were evaluated including (1) patient selection, (2) multiple TACE and schedules for repeat sessions and (3) TACE as neo-adjuvant treatment in patients awaiting liver transplantation. For the aim of the thesis three studies were reported. TACE is frequently performed outside the current treatment guidelines including a considerable percentage of patients with single nodule, patients with portal vein thrombosis and impaired performance status (PS). Study 1 showed that TACE is a valid treatment option for patients with single nodule of HCC not eligible for curative treatments and that bland portal vein thrombosis and a mild impairment of performance statue (PS-1) likely due to cirrhosis have no impact on survival. Multiple TACE are usually performed in the routine clinical practice but the optimal number of repeated TACE to be performed before switching to another or no treatment is still to be definitely established. Study 2 supported the policy of repeating TACE “on demand” in patients with preserved liver function and not eligible to percutaneous treatments or surgery even if only a limited proportion of patients can be submitted to more TACE cycles. TACE is a common treatment for patients awaiting liver transplant (LT) but no studies evaluating the impact of multiple TACE in those patients are available. Study 3 showed no impact of multiple TACE cycles on tumor necrosis, recurrence or overall survival. On the contrary, patients with a waiting time ≤6 months to LT had increased risk of recurrence after LT probably because the tumor biology in those patients had not enough time to be exposed

    Ongoing challenges in the diagnosis of hepatocellular carcinoma

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    In 2001, the European Association for the Study of the Liver (EASL) endorsed the possibility of achieving a non-invasive diagnosis of Hepatocellular Carcinoma (HCC) for the first time. Since then, various refinements of the criteria and techniques capable of achieving this diagnosis and the role of plasma and tissue oncomarkers have been reported in the literature and have been accepted to different extents in various geographical areas. Such tools can also potentially imply prognostic significance. The present article critically discusses some of the most relevant and debated challenges which have emerged in this field, including the role of contrast-enhanced ultrasound, and of hepatocyte-specific magnetic resonance contrast agents, the pitfall of transient hepatic attenuation differences, the reliability of biopsy and the status of biomarkers

    Liver fat quantification: when do we need it?

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    In recent years the most rapidly emerging disease in general hepatology is the Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD). This a new definition, which was suggested to replace and extend what was previously known as Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). The new proposal of MAFLD was set forward because the criterion for diagnosing NAFLD/NASH requires absence of any other chronic liver condition (e. g. viral hepatitis, immune-related cholestatic liver disease, etc) and absence of any over threshold intake of alcohol

    Comparison of International Guidelines for Noninvasive Diagnosis of Hepatocellular Carcinoma

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    none6The aim of this review is to present the similarities and differences between the latest guidelines for noninvasive diagnosis of hepatocelullar carcinoma (HCC) of American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Japanese Society of Hepatology. All the four guidelines defined a typical HCC vascular pattern as the homogeneous hyperenhancement (wash-in) in the arterial phase followed by wash-out in the venous or late phase. The AASLD and EASL guidelines accept only four-phase computed tomography and dynamic contrast magnetic resonance imaging (MRI) for HCC diagnosis, whereas the APASL and Japanese guidelines also accept contrast-enhanced ultrasound (CEUS). Regarding CEUS, the APASL guidelines accept the use of Levovist or Sonazoid as contrast agents, whereas the Japanese guidelines accept only the use of Sonazoid. The AASLD and EASL guidelines recommend using only extracellular contrast agents such as gadolinium for MRI, whereas the APASL guidelines also included the use of super paramagnetic iron oxid-MRI, and the Japanese guidelines recommended the use of gadolinium-ethoxybenzyl-diethylentriamine pentaacetic acid-MRI. The AASLD and EASL guidelines propos a diagnostic algorithm starting from the tumor size, whereas the APASL and Japanese guidelines recommend an algorithm starting from arterial tumor vascularity (hyper- or hypovascular in the arterial phase). In conclusion, important differences exist among the Western and Eastern guidelines for noninvasive HCC diagnosis.noneSimona Bota;Fabio Piscaglia;Sara Marinelli;Anna Pecorelli;Eleonora Terzi;Luigi BolondiSimona Bota;Fabio Piscaglia;Sara Marinelli;Anna Pecorelli;Eleonora Terzi;Luigi Bolond
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