Transarterial radioembolization for hepatocellular carcinoma: An update and perspectives

In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma (HCC), both in terms of disease control and tolerability profile. This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound (usually Yttrium90), and exerts its therapeutic effect through the radiation carried by these microspheres. A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications. Radioembolization is a technically complex and expensive technique, which has only recently entered clinical practice and is supported by scant results from phase III clinical trials. Nevertheless, it may represent a valid alternative to transarterial chemoembolization (TACE) in the treatment of intermediate-stage HCC patients, as shown by a comparative retrospective assessment that reported a longer time to progression, but not of overall survival, and a more favorable safety profile for radioembolization. In addition, this treatment has reported a higher percentage of tumor shrinkage, if compared to TACE, for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery. Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib

Complete response for advanced liver cancer during sorafenib therapy: Case Report

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is the fifth most common neoplasia in the world. In the past, treatment of advanced HCC with conventional antineoplastic drugs did not result in satisfactory outcomes: recently, in this patient population the oral multikinase inhibitor sorafenib has been able to induce a statistically significant improvement of overall survival. Similarly to other anti-angiogenic drugs employed in other tumour types, also sorafenib seldom induces the dimensional tumour shrinking usually observed with conventional cytotoxic drugs: data gathered from studies carried out with sorafenib and other competitors under development do not report any complete response in HCV-induced HCC.</p> <p>Case presentation</p> <p>An 84-year old man with a long-lasting history of chronic HCV hepatitis was referred to our Institution for an ultrasonography investigation of a focal hepatic lesion. To better characterize the liver disease and clearly define the diagnosis of the focal hepatic lesion, the patient was hospitalized in our department. Laboratory and instrumental investigations confirmed the clinical picture of HCV-related liver cirrhosis and identified a hepatic lesion of about 6 cm featuring infiltrating HCC with thrombosis of the portal trunk. Due to the advanced stage of the disease, therapy with sorafenib 400 mg bid was started. Right from one month after the treatment was started, a reduction of alpha-fetoprotein level was observed which, by the third month, turned down within the normal limits. In addition the CT scan showed 50% reduction of the neoplastic lesion along with canalization of the portal trunk. At the sixth month the normalization of the alpha-fetoprotein level at the lower limit of normality was confirmed and the MRI showed complete disappearance of the neoplasia. In addition a reduction of a metallo-proteinase serum level was obserdved. At the twelfth month a further MRI confirmed complete response had been maintained. At present the patient is in a follow-up program to evaluate the duration of the complete response.</p> <p>Conclusions</p> <p>This case is worth mentioning since, to the best of our knowledge, it represents the first evidence of complete response to sorafenib in an elderly patient with advanced HCV-related HCC.</p

Knowledge of human papillomavirus infection and its prevention among adolescents and parents in the greater Milan area, Northern Italy

<p>Abstract</p> <p>Background</p> <p>In order to be widely accepted by users, the implementation of a new health intervention requires them to be adequately informed about its clinical importance, benefits and risks. The aim of this study was to provide data on the knowledge of Italian adolescents and parents concerning human papillomavirus (HPV) infection and its prevention in order to allow the development of adequate training programmes.</p> <p>Methods</p> <p>Between 2 May and 15 June 2008, we made a cross-sectional survey of 863 high school students and 2,331 parents of middle and high school students using two anonymously completed questionnaires covering the knowledge of HPV infection and related diseases, and attitudes to vaccinations. The approached schools were a convenience sample of the schools of the greater Milan area, Northern Italy.</p> <p>Results</p> <p>More mothers than fathers were aware that HPV infection could concern their children (58% <it>vs </it>53%; p = 0.004) and were favourable towards vaccinating their children against HPV (68% <it>vs </it>65%; p = 0.03); among the students, more females than males were aware that HPV infection could concern themselves (45% <it>vs </it>26%; p < 0.001) and would undergo vaccination against HPV (68% <it>vs </it>40%; p < 0.001). The parents' propensity to vaccinate their children against HPV was significantly associated with professing the Catholic religion (odds ratio - OR = 0.61, 95% confidence interval - CI 0.46-0.82, being atheist), the gender of the offspring (OR = 1.88, 95% CI 1.53-2.30, having at least one daughter), a propensity to vaccinations in general (OR = 23.1, 95% CI 13.7-38.8), a knowledge that HPV vaccine is aimed at preventing cervical cancer (OR = 2.31, 95% CI 1.69-3.16), and an awareness that HPV could affect their own children (OR = 3.52, 95% CI 2.89-4.29). The students who were aware that HPV infection could affect themselves were more in favour of to HPV vaccination, regardless of whether they were male (OR = 5.73, 95% CI 2.85-11.5) or female (OR = 2.39, 95% CI 1.66-3.46).</p> <p>Conclusions</p> <p>Both students and parents seem to underestimate the likelihood of HPV infection, and this is associated with a lower propensity for vaccination. This is an important indication for future training programmes concerning HPV prevention designed to increase the acceptance of HPV vaccine in families.</p

Comparison between hydrogen and electric vehicles by life cycle assessment: A case study in Tuscany, Italy

The use of hydrogen produced from renewable energy sources is often reported as an attractive strategy to address the issue of urban environmental sustainability in automotive sector, and a potential alternative to fossil fuel-fed vehicles. The project ‘Filiera Idrogeno’ (Hydrogen Chain) has investigated the potential realisation of hydrogen production chains from renewables and its use as automotive fuel in Tuscany Region (Italy). In this context, life cycle assessment was used for evaluating the environmental sustainability of such chains, applied to a fleet of hydrogen vehicles for urban commercial delivery. From the energy supply side, renewable wind and biomass energy sources were considered for hydrogen production either by electrolysis or direct separation from biomass gasification syngas, according to specific simulations. Benchmarking with hydrogen produced by using Italian electricity mix was carried out. From the transport side, vehicles equipped with either fuel cell or internal combustion engine were evaluated. A benchmarking analysis with standard electric vehicles supplied with electricity produced from the same renewable energy sources was also carried out. The results give some indications on the environmental aspects of the different alternatives and on the contribution of the chain phases to the overall impacts

Are district heating systems and renewable energy sources always an environmental win-win solution? A life cycle assessment case study in Tuscany, Italy

Space heating and cooling pose fundamental challenges to the achievement of EU decarbonization targets. A comprehensive review of the recent literature acknowledged that district energy systems contribute substantially to the sustainability of energy in the building sector by improving the efficiency and integration of low energy sources. However, a holistic evaluation of the environmental performance of such systems is advisable during the planning and design stage. In this study, we use life cycle assessment to assess the potential contribution and environmental sustainability of renewable heating and cooling alternatives. The unit of analysis is a residential neighbourhood of 1000 inhabitants (equivalent to 250 apartments), located in Tuscany, Italy, served by a district network that provides heating, cooling and sanitary hot water. A geothermal heat pump and a biomass system are compared to two systems based on natural gas as a fossil fuel: a centrally produced heating and cooling system and a more conventional system with single apartment boilers and airâ\u80\u93air heat pumps for cooling. The cradle-to-grave analysis shows significant global GHG emission savings of about 35% for the biomass system and about 20% for the GHP system compared with the centralised benchmark system, increasing to 46% and 34%, respectively, with respect to the conventional standalone appliances system. However, other environmental impact categories show different levels of performance depending on the scenario, and in some cases their impact is even greater than that of the benchmarking scenarios. The contributions from each life cycle stage â\u80\u93 assembly, operation and end of life â\u80\u93 suggest that an eco-design approach could improve the global performances of each scenario. Recommendations for local planning authorities are drawn accordingly