Viszeralmedizin最新文献

Precision Medicine and Non-Colorectal Cancer Liver Metastases: Fiction or Reality? 精准医疗与非结直肠癌肝转移:虚构还是真实?

Viszeralmedizin

Pub Date : 2015-12-01 DOI: 10.1159/000442485

E. Liakopoulou, A. Knuth

Background: Non-colorectal liver metastases (nCRLM) constitute a variety of heterogeneous diseases and a considerable therapeutic challenge. Management is based on the primary tumor and the clinical course. In the era of precision medicine (PM) we know that cancer is heterogeneous within the tumor and across different sites. Methods: We give an overview of the path to PM through ‘omics' beyond genomics. We refer to the experience gained to date from models such as colorectal cancer and we discuss the opportunity offered by PM for the management of nCRLM. Results: In order to best characterize and track tumor biological behaviors as well as to understand mechanisms of response to therapy and survival we suggest the application of novel clinical trial designs, a dynamic approach with serial monitoring involving evaluation of primary and metastatic sites. Quality and standardization of tissue acquisition and biobanking is a precondition for the reliability of this approach. Conclusion: The application of PM is increasingly becoming a reality. Elucidating the mysteries of tumors in complex settings can only be achieved with the approach PM offers. nCRLM may serve as a model for the application of PM principles and techniques in understanding individual diseases and also cancer as an entity and therapeutic challenge.

背景:非结直肠肝转移(nCRLM)是一种异质性疾病，是一种相当大的治疗挑战。治疗是基于原发肿瘤和临床病程。在精准医学(PM)时代，我们知道癌症在肿瘤内部和不同部位具有异质性。方法:我们通过基因组学之外的“组学”概述了PM的路径。我们参考了迄今为止从结直肠癌等模型中获得的经验，并讨论了PM为nCRLM管理提供的机会。结果:为了更好地描述和跟踪肿瘤的生物学行为，以及了解对治疗的反应和生存的机制，我们建议应用新的临床试验设计，一种动态的方法，包括对原发和转移部位的评估。组织采集和生物库的质量和标准化是该方法可靠性的先决条件。结论:项目管理的应用日益成为现实。在复杂环境中阐明肿瘤的奥秘只能通过PM提供的方法来实现。nCRLM可以作为应用PM原理和技术来理解个体疾病和癌症作为一个实体和治疗挑战的模型。

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引用次数: 1

Current Medical Treatment of Patients with Non-Colorectal Liver Metastases: Primary Tumor Breast Cancer. 目前非结直肠癌肝转移患者的医学治疗:原发性肿瘤乳腺癌。

Viszeralmedizin

Pub Date : 2015-12-01 Epub Date: 2015-12-03 DOI: 10.1159/000441961

Cornelia Liedtke, Hans-Christian Kolberg

Background: (Metastatic) breast cancer is a heterogeneous entity in which every disease subtype requires an individualized systemic treatment approach.

Methods: We reviewed the currently available data regarding systemic therapy of breast cancer and present a review of historical and current treatment approaches, with the publications cited covering a time span from 1896 to the last ASCO 2015.

Results: Systemic therapy of metastatic breast cancer may include chemotherapy, endocrine therapy, and targeted therapies (e.g. antibody-based approaches). Based on the patient's breast cancer subtype, these agents may be employed alone or in combination. Therefore, characterization of the phenotype of the disease is necessary and may include biopsy of the metastatic site. Novel therapeutic approaches include immunologic therapies as well as PARP, PI3K and CDK 4/6 inhibitors, which are currently under investigation in clinical trials.

Conclusion: Systemic therapy of metastatic breast cancer requires complex and individualized treatment approaches that are best offered in an interdisciplinary setting.

背景:(转移性)乳腺癌是一种异质性实体，每种疾病亚型都需要个体化的全身治疗方法。方法:我们回顾了目前关于乳腺癌全身治疗的可用数据，并对历史和当前的治疗方法进行了回顾，所引用的出版物涵盖了从1896年到上届ASCO 2015年的时间跨度。结果:转移性乳腺癌的全身治疗可能包括化疗、内分泌治疗和靶向治疗(如基于抗体的方法)。根据患者的乳腺癌亚型，这些药物可单独或联合使用。因此，表征疾病的表型是必要的，可能包括转移部位的活检。新的治疗方法包括免疫疗法以及PARP、PI3K和cdk4 /6抑制剂，目前正在临床试验中进行研究。结论:转移性乳腺癌的全身治疗需要复杂和个性化的治疗方法，最好在跨学科的环境中提供。

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引用次数: 2

Treatment of Non-Colorectal Liver Metastases 非结直肠肝转移的治疗

Viszeralmedizin

Pub Date : 2015-12-01 DOI: 10.1159/000442900

A. Frilling, M. Ebert

from hepatic resection, particularly when surgery is combined with systemic treatment. In contrast, patients with hepatic metastases from lung or neck and head cancers only derive marginal benefit from liver resection. For Yttrium-90 SIRT, promising results are reported for breast cancer, ocular and cutaneous melanoma, renal cell carcinoma, and pancreatic cancer. Results of chemotherapy refer in most instances globally to patients in metastasised stages lacking specification of the treatment effect on liver metastases. Patient selection is the Achilles’ heel of outcomes, and uniform selection criteria for treatment for each of these primaries are yet to be elucidated [5]. In order to move away from anecdotal reports towards more evidence-driven strategies, registries for non-con ventional liver metastases and standardised reporting should be encouraged. Collection of biosamples along the patient journey may facilitate identification of novel molecular-based biomarkers predictive for prognosis and response to treatment. The aim of this issue of Viszeralmedizin is to give the readership an overview on present management strategies for liver metastases originating from non-colorectal, non-neuroendocrine primaries. As the role of personalised medicine in oncology is steadily evolving, we hypothesise that in the future a one-for-one, in con trast to the present one-for-all, treatment concept will have a beneficial impact on the outcome of treatment of patients with nonconventional liver secondaries. The treatment of liver metastases is generally considered as a palliative approach. A large body of literature refers to experience gained in colorectal liver metastases encompassing a panel of treat ment options including surgery, chemotherapy, and various interventional locoregional procedures, either as an isolated measure or embedded within a multimodal treatment pathway. Surgery re mains the cornerstone in this setting with an overall 5-year survival of 60–70% as a benchmark [1]. Comparable results are attainable in the treatment of patients with neuroendocrine liver metastases. However, only a small proportion of these patients are suitable candidates for hepatic resection, the effectiveness of which is hin dered by high recurrence rates [2]. There is limited robust data referring explicitly to the management of non-colorectal, non-neuroendocrine liver metastases. Most of the reports refer to smaller, retrospective case series with poorly defined inclusion criteria, het erogeneous patient cohorts and tumour stages, scarce information on treatment carried out during the patient journey, and poor quality of treatment outcome reporting. In two recent systematic reviews on liver resection for non-colorectal, non-neuroendocrine liver metastases and Yttrium-90 selective internal radiation therapy (SIRT) in the same patient population, respectively, the primary tumour site was identified as the most important predictor of out come [3, 4]. Patients with live

从肝脏切除，特别是当手术与全身治疗相结合。相比之下，肺癌或头颈癌的肝转移患者仅从肝切除术中获得边际效益。据报道，钇-90 SIRT治疗乳腺癌、眼部和皮肤黑色素瘤、肾细胞癌和胰腺癌有很好的结果。化疗结果在全球大多数情况下是指转移期患者，缺乏对肝转移治疗效果的说明。患者选择是影响预后的致命弱点，对于每一种原发性疾病，统一的治疗选择标准尚未阐明[10]。为了从轶事报告转向更多的循证策略，应该鼓励非传统肝转移的登记和标准化报告。沿着患者旅程收集生物样本可能有助于识别新的基于分子的生物标志物，预测预后和对治疗的反应。这一期Viszeralmedizin的目的是给读者一个概述，目前的管理策略源自非结直肠，非神经内分泌原发性肝转移。随着个性化医疗在肿瘤学中的作用稳步发展，我们假设在未来，与目前的一对一治疗相比，一对一的治疗理念将对非传统肝脏继发性疾病患者的治疗结果产生有益的影响。肝转移的治疗通常被认为是一种姑息治疗方法。大量文献引用了结直肠肝转移的治疗经验，包括手术、化疗和各种局部介入手术等治疗方案，这些治疗方案可以作为孤立的措施，也可以作为多模式治疗途径的一部分。手术仍然是这种情况下的基础，总体5年生存率为60-70%。在神经内分泌性肝转移患者的治疗中也可获得类似的结果。然而，这些患者中只有一小部分适合进行肝切除术，其有效性受到高复发率的影响[10]。关于非结直肠、非神经内分泌性肝转移的治疗，目前尚无可靠的数据。大多数报告涉及较小的回顾性病例系列，纳入标准定义不清，患者队列和肿瘤分期不均匀，患者旅程中进行的治疗信息缺乏，治疗结果报告质量差。在最近的两篇系统综述中，分别对同一患者群体中非结直肠、非神经内分泌肝转移的肝脏切除和钇-90选择性内放疗(SIRT)进行了研究，发现原发肿瘤部位是预后最重要的预测因素[3,4]。睾丸、卵巢和肾细胞癌、肉瘤的肝转移患者，或乳腺癌的肝转移患者，似乎可以获得生存优势

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引用次数: 1

Ectopic Spleen Tissue – an Underestimated Differential Diagnosis of a Hypervascularised Liver Tumour 异位脾组织-一个被低估的鉴别诊断的高血管化肝脏肿瘤

Viszeralmedizin

Pub Date : 2015-12-01 DOI: 10.1159/000442115

E. Grambow, M. Weinrich, A. Zimpfer, K. Kloker, E. Klar

Background: Patients with liver cirrhosis have an increased risk of developing hepatocellular carcinoma (HCC). Implantation metastasis following diagnostic biopsy is a well-known complication. Therefore, primary resection of a hypervascularised tumour suspicious for HCC is often performed with curative intent. Case Report: An exophytically growing mass was diagnosed between liver segments III and IVb by means of ultrasound in a 53-year old male patient with decompensated liver cirrhosis. Computed tomography confirmed a 3.5 cm large hypervascularised tumour with given resectability. Intraoperatively, the tumour appeared like a HCC. Thus, an atypical resection was performed. Histopathology revealed ectopic spleen tissue without any signs of malignancy. As enquiries revealed, the patient had undergone splenectomy after a blunt abdominal trauma 9 years prior to admission. Conclusion: In the present patient, hepatic splenosis in a cirrhotic liver was misinterpreted as HCC. In patients with a history of traumatic rupture of the spleen or splenectomy, splenosis has to be considered as a potential differential diagnosis of a hypervascularised tumour. Specific diagnostics should be performed to rule out splenosis.

背景:肝硬化患者发生肝细胞癌(HCC)的风险增加。诊断活检后移植物转移是一种众所周知的并发症。因此，对疑似HCC的高血管化肿瘤进行原发性切除术通常是为了治疗目的。病例报告:在53岁男性失代偿性肝硬化患者中，超声诊断出肝III节和IVb节之间有一个外生性生长的肿块。计算机断层扫描证实一个3.5厘米大的血管增生肿瘤，可切除。术中肿瘤表现为肝细胞癌。因此，进行了非典型切除。组织病理学显示脾脏组织异位，无任何恶性肿瘤征象。调查显示，患者在入院前9年曾因腹部钝性创伤行脾切除术。结论:在本例患者中，肝硬化肝脾肿大被误诊为HCC。在有创伤性脾破裂或脾切除术史的患者中，脾萎缩必须被视为血管增生肿瘤的潜在鉴别诊断。具体的诊断应排除脾萎缩。

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引用次数: 7

How Effective Are Percutaneous Liver-Directed Therapies in Patients with Non-Colorectal Liver Metastases? 经皮肝脏导向疗法对非结肠直肠肝转移患者的疗效如何？

Viszeralmedizin

Pub Date : 2015-12-01 DOI: 10.1159/000440677

Thomas J Vogl, Ahmed Emam, Nagy N Naguib, Katrin Eichler, Stefan Zangos

Background: The purpose of this review is to demonstrate the clinical indications, technical developments, and outcome of liver-directed therapies in interventional oncology of non-colorectal liver metastases.

Methods: Liver-directed therapies are classified into vascular transarterial techniques such as chemoperfusion (TACP), chemoembolization (TACE), radioembolization (selective internal radiation therapy (SIRT)), and chemosaturation, as well as thermal ablation techniques like microwave ablation (MWA), radiofrequency ablation (RFA), laser-induced thermotherapy (LITT), cryotherapy, and irreversible electroporation (IRE). The authors searched the database PubMed using the following terms: 'image-guided tumor ablation', 'thermal ablation therapies', 'liver metastases of uveal melanoma', 'neuroendocrine carcinoma', 'breast cancer', and 'non-colorectal liver metastases'.

Results: Various combinations of the above-mentioned therapy protocols are possible. In neuroendocrine carcinomas, oligonodular liver metastases are treated successfully via thermal ablation like RFA, LITT, or MWA, and diffuse involvement via TACE or SIRT. Although liver involvement in breast cancer is a systemic disease, non-responding nodular metastases can be controlled via RFA or LITT. In ocular or cutaneous melanoma, thermal ablation is rarely considered as an interventional treatment option, as opposed to TACE, SIRT, or chemosaturation. Rarely liver-directed therapies are used in pancreatic cancer, most likely due to problems such as biliary digestive communications after surgery and the risk of infections. Rare indications for thermal ablation are liver metastases of other primary cancers like non-small cell lung, gastric, and ovarian cancer.

Conclusion: Interventional oncological techniques play a role in patients with liver-dominant metastases.

背景：本综述旨在展示非结肠直肠癌肝转移介入疗法的临床适应症、技术发展和结果：本综述旨在展示非结肠直肠肝转移介入肿瘤学中肝导向疗法的临床适应症、技术发展和结果：肝脏导向疗法分为血管经动脉技术，如化学灌注（TACP）、化疗栓塞（TACE）、放射栓塞（选择性内放射治疗（SIRT））和化学饱和，以及热消融技术，如微波消融（MWA）、射频消融（RFA）、激光诱导热疗（LITT）、冷冻疗法和不可逆电穿孔（IRE）。作者使用以下术语在 PubMed 数据库中进行了搜索：图像引导下的肿瘤消融"、"热消融疗法"、"葡萄膜黑色素瘤肝转移"、"神经内分泌癌"、"乳腺癌 "和 "非结直肠肝转移"：上述治疗方案可以有多种组合。在神经内分泌癌中，少结节性肝转移可通过 RFA、LITT 或 MWA 等热消融术成功治疗，而弥漫性受累则可通过 TACE 或 SIRT 治疗。虽然乳腺癌的肝脏受累是一种全身性疾病，但无反应的结节性转移灶可通过 RFA 或 LITT 得到控制。对于眼部或皮肤黑色素瘤，相对于TACE、SIRT或化疗，热消融很少被考虑作为介入治疗方案。胰腺癌很少使用肝脏导向疗法，这很可能是由于术后胆道消化道沟通等问题以及感染风险所致。热消融的罕见适应症是非小细胞肺癌、胃癌和卵巢癌等其他原发性癌症的肝转移：结论：肿瘤介入技术在肝转移患者中发挥着作用。

{"title":"How Effective Are Percutaneous Liver-Directed Therapies in Patients with Non-Colorectal Liver Metastases?","authors":"Thomas J Vogl, Ahmed Emam, Nagy N Naguib, Katrin Eichler, Stefan Zangos","doi":"10.1159/000440677","DOIUrl":"10.1159/000440677","url":null,"abstract":"Background: The purpose of this review is to demonstrate the clinical indications, technical developments, and outcome of liver-directed therapies in interventional oncology of non-colorectal liver metastases.Methods: Liver-directed therapies are classified into vascular transarterial techniques such as chemoperfusion (TACP), chemoembolization (TACE), radioembolization (selective internal radiation therapy (SIRT)), and chemosaturation, as well as thermal ablation techniques like microwave ablation (MWA), radiofrequency ablation (RFA), laser-induced thermotherapy (LITT), cryotherapy, and irreversible electroporation (IRE). The authors searched the database PubMed using the following terms: 'image-guided tumor ablation', 'thermal ablation therapies', 'liver metastases of uveal melanoma', 'neuroendocrine carcinoma', 'breast cancer', and 'non-colorectal liver metastases'.Results: Various combinations of the above-mentioned therapy protocols are possible. In neuroendocrine carcinomas, oligonodular liver metastases are treated successfully via thermal ablation like RFA, LITT, or MWA, and diffuse involvement via TACE or SIRT. Although liver involvement in breast cancer is a systemic disease, non-responding nodular metastases can be controlled via RFA or LITT. In ocular or cutaneous melanoma, thermal ablation is rarely considered as an interventional treatment option, as opposed to TACE, SIRT, or chemosaturation. Rarely liver-directed therapies are used in pancreatic cancer, most likely due to problems such as biliary digestive communications after surgery and the risk of infections. Rare indications for thermal ablation are liver metastases of other primary cancers like non-small cell lung, gastric, and ovarian cancer.Conclusion: Interventional oncological techniques play a role in patients with liver-dominant metastases.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"406-13"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64913024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Arterial Therapies of Non-Colorectal Liver Metastases. 非结直肠肝转移的动脉疗法

Viszeralmedizin

Pub Date : 2015-12-01 DOI: 10.1159/000441689

Gilbert Puippe, Thomas Pfammatter, Niklaus Schaefer

Background: The unique situation of the liver with arterial and venous blood supply and the dependency of the tumor on the arterial blood flow make this organ an ideal target for intrahepatic catheter-based therapies. Main forms of treatment are classical bland embolization (TAE) cutting the blood flow to the tumors, chemoembolization (TACE) inducing high chemotherapy concentration in tumors, and radioembolization (TARE) without embolizing effect but very high local radiation. These different forms of therapies are used in different centers with different protocols. This overview summarizes the different forms of treatment, their indications and protocols, possible side effects, and available data in patients with non-colorectal liver tumors.

Methods: A research in PubMed was performed. Mainly clinical controlled trials were reviewed. The search terms were 'embolization liver', 'TAE', 'chemoembolization liver', 'TACE', 'radioembolization liver', and 'TARE' as well as 'chemosaturation' and 'TACP' in the indications 'breast cancer', 'neuroendocrine', and 'melanoma'. All reported studies were analyzed for impact and reported according to their clinical relevance.

Results: The main search criteria revealed the following results: 'embolization liver + breast cancer', 122 results, subgroup clinical trials 16; 'chemoembolization liver + breast cancer', 62 results, subgroup clinical trials 11; 'radioembolization liver + breast cancer', 37 results, subgroup clinical trials 3; 'embolization liver + neuroendocrine', 283 results, subgroup clinical trials 20; 'chemoembolization liver + neuroendocrine', 202 results, subgroup clinical trials 9; 'radioembolization liver + neuroendocrine', 64 results, subgroup clinical trials 9; 'embolization liver + melanoma', 79 results, subgroup clinical trials 15; 'chemoembolization liver + melanoma', 60 results, subgroup clinical trials 14; 'radioembolization liver + melanoma', 18 results, subgroup clinical trials 3. The term 'chemosaturation liver' was tested without indication since only few publications exist and provided us with five results and only one clinical trial.

Conclusion: Despite many years of clinical use and documented efficacy on intra-arterial treatments of the liver, there are still only a few prospective multicenter trials with many different protocols. To guarantee the future use of these efficacious therapies, especially in the light of many systemic or surgical therapies in the treatment of non-colorectal liver metastases, further large randomized trials and transparent guidelines need to be established.

背景：肝脏具有动静脉供血的独特情况以及肿瘤对动脉血流的依赖性，使其成为肝内导管疗法的理想靶点。主要的治疗方法有：传统的栓塞疗法（TAE）切断肿瘤血流；化疗栓塞疗法（TACE）在肿瘤内诱导高浓度化疗；放射栓塞疗法（TARE）没有栓塞效果，但局部辐射很强。这些不同形式的疗法在不同的中心采用不同的方案。本文概述了不同的治疗方式、适应症和方案、可能的副作用以及非结肠直肠肝肿瘤患者的现有数据：方法：在 PubMed 上进行了研究。方法：在 PubMed 上进行了研究，主要审查了临床对照试验。搜索关键词为 "栓塞肝脏"、"TAE"、"化疗栓塞肝脏"、"TACE"、"放射性栓塞肝脏"、"TARE "以及适应症为 "乳腺癌"、"神经内分泌 "和 "黑色素瘤 "的 "化疗 "和 "TACP"。对所有报告的研究进行了影响分析，并根据其临床相关性进行了报告：主要搜索标准显示了以下结果：栓塞肝脏 + 乳腺癌"，122 项结果，亚组临床试验 16 项；"化疗栓塞肝脏 + 乳腺癌"，62 项结果，亚组临床试验 11 项；"放射栓塞肝脏 + 乳腺癌"，37 项结果，亚组临床试验 3 项；"栓塞肝脏 + 神经内分泌"，283 项结果，亚组临床试验 20 项；化疗栓塞肝脏 + 神经内分泌"，202 项结果，分组临床试验 9；"放射栓塞肝脏 + 神经内分泌"，64 项结果，分组临床试验 9；"栓塞肝脏 + 黑色素瘤"，79 项结果，分组临床试验 15；"化疗栓塞肝脏 + 黑色素瘤"，60 项结果，分组临床试验 14；"放射栓塞肝脏 + 黑色素瘤"，18 项结果，分组临床试验 3。对 "肝脏化疗 "这一术语进行了测试，但未作任何说明，因为该术语仅有少量出版物，并为我们提供了 5 项结果和 1 项临床试验：结论：尽管肝脏动脉内治疗的临床应用已有多年，且疗效有据可查，但采用多种不同方案的前瞻性多中心试验仍然寥寥无几。为了保证这些疗效显著的疗法在未来的应用，尤其是在治疗非结肠直肠肝转移瘤时有许多全身或外科疗法的情况下，需要进一步建立大型随机试验和透明的指南。

{"title":"Arterial Therapies of Non-Colorectal Liver Metastases.","authors":"Gilbert Puippe, Thomas Pfammatter, Niklaus Schaefer","doi":"10.1159/000441689","DOIUrl":"10.1159/000441689","url":null,"abstract":"Background: The unique situation of the liver with arterial and venous blood supply and the dependency of the tumor on the arterial blood flow make this organ an ideal target for intrahepatic catheter-based therapies. Main forms of treatment are classical bland embolization (TAE) cutting the blood flow to the tumors, chemoembolization (TACE) inducing high chemotherapy concentration in tumors, and radioembolization (TARE) without embolizing effect but very high local radiation. These different forms of therapies are used in different centers with different protocols. This overview summarizes the different forms of treatment, their indications and protocols, possible side effects, and available data in patients with non-colorectal liver tumors.Methods: A research in PubMed was performed. Mainly clinical controlled trials were reviewed. The search terms were 'embolization liver', 'TAE', 'chemoembolization liver', 'TACE', 'radioembolization liver', and 'TARE' as well as 'chemosaturation' and 'TACP' in the indications 'breast cancer', 'neuroendocrine', and 'melanoma'. All reported studies were analyzed for impact and reported according to their clinical relevance.Results: The main search criteria revealed the following results: 'embolization liver + breast cancer', 122 results, subgroup clinical trials 16; 'chemoembolization liver + breast cancer', 62 results, subgroup clinical trials 11; 'radioembolization liver + breast cancer', 37 results, subgroup clinical trials 3; 'embolization liver + neuroendocrine', 283 results, subgroup clinical trials 20; 'chemoembolization liver + neuroendocrine', 202 results, subgroup clinical trials 9; 'radioembolization liver + neuroendocrine', 64 results, subgroup clinical trials 9; 'embolization liver + melanoma', 79 results, subgroup clinical trials 15; 'chemoembolization liver + melanoma', 60 results, subgroup clinical trials 14; 'radioembolization liver + melanoma', 18 results, subgroup clinical trials 3. The term 'chemosaturation liver' was tested without indication since only few publications exist and provided us with five results and only one clinical trial.Conclusion: Despite many years of clinical use and documented efficacy on intra-arterial treatments of the liver, there are still only a few prospective multicenter trials with many different protocols. To guarantee the future use of these efficacious therapies, especially in the light of many systemic or surgical therapies in the treatment of non-colorectal liver metastases, further large randomized trials and transparent guidelines need to be established.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"414-22"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64947752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Liver Resection for Non-Colorectal Liver Metastases – Standards and Extended Indications 非结直肠肝转移的肝切除术-标准和扩展适应症

Viszeralmedizin

Pub Date : 2015-11-24 DOI: 10.1159/000439419

Ulf Kulik, F. Lehner, H. Bektas, J. Klempnauer

Background: Due to the uncertain benefit of liver resection for non-colorectal liver metastases (NCLM), patient selection for surgery is generally difficult. Therefore, the aim of this article was to propose standard and extended indications for liver resection in this heterogeneous disease collective. Methods: Review of the literature. Results: The myriad of biologically different primary tumor entities as well as the mostly small and retrospective studies investigating the benefit of surgery for NCLM limits the proposal of general recommendations. Only resection of neuroendocrine liver metastases (NELM) appears to offer a clear benefit with a 5- and 10-year overall survival (OS) of 74 and 51%, respectively, in the largest series. Resection of liver metastases from genitourinary primaries might offer reasonable benefit in selected cases - with a 5-year OS of up to 61% for breast cancer and of 38% for renal cell cancer. The long-term outcome following surgery for other entities was remarkably poorer, e.g., gastric cancer, pancreatic cancer, and melanoma reached a 5-year OS of 20-42, 17-25, and about 20%, respectively. Conclusion: Liver resection for NELM can be defined as a standard indication for the resection of NCLM while lesions of genitourinary origin might be defined as an extended indication.

背景:由于非结直肠肝转移(NCLM)的肝切除疗效不确定，患者选择手术通常很困难。因此，本文的目的是提出标准和扩展的适应症肝切除在这种异质疾病集体。方法:查阅文献。结果:生物学上不同的原发肿瘤实体以及调查NCLM手术益处的大多数小型和回顾性研究限制了一般建议的提出。在最大的研究系列中，仅切除神经内分泌肝转移瘤(NELM)似乎提供了明显的益处，5年和10年总生存率(OS)分别为74%和51%。在某些病例中，切除泌尿生殖系统原发性肝转移瘤可能提供合理的益处——乳腺癌的5年总生存率高达61%，肾细胞癌的5年总生存率高达38%。其他肿瘤手术后的长期预后明显较差，如胃癌、胰腺癌和黑色素瘤的5年OS分别为20-42、17-25和20%左右。结论:NELM肝切除可作为NCLM切除的标准指征，而泌尿生殖系统病变可作为NCLM切除的扩展指征。

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引用次数: 4

Morphologic and Functional Imaging of Non-Colorectal Liver Metastases 非结直肠肝转移的形态学和功能影像学

Viszeralmedizin

Pub Date : 2015-11-23 DOI: 10.1159/000441857

P. Heusch, G. Antoch

Liver metastases are the most frequent malignant liver lesions. Besides colorectal carcinoma, gastric carcinoma, pancreatic carcinoma, breast cancer, lung cancer, and neuroendocrine tumors are the most common entities that metastasize to the liver. The morphology of these metastases depends on the primary tumor. For morphologic and functional imaging of non-colorectal liver metastases, multiple imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography coupled with CT or MRI are available. This review summarizes morphologic and functional characteristics of different non-colorectal liver metastases.

肝转移是最常见的肝脏恶性病变。除结直肠癌外，胃癌、胰腺癌、乳腺癌、肺癌和神经内分泌肿瘤是最常见的转移到肝脏的肿瘤。这些转移瘤的形态取决于原发肿瘤。对于非结直肠肝转移的形态学和功能成像，超声、计算机断层扫描(CT)、磁共振成像(MRI)、正电子发射断层扫描联合CT或MRI等多种成像技术是可用的。本文综述了不同类型非结直肠肝转移的形态学和功能特点。

引用次数: 5

Is There a Role for Liver Transplantation in Non-Colorectal Liver Metastases? 肝移植在非结直肠肝转移中有作用吗?

Viszeralmedizin

Pub Date : 2015-11-23 DOI: 10.1159/000441237

U. Herden, B. Nashan

Due to the high blood flow, especially blood from the intestinal tract via the portal vein, the liver is a preferred organ for metastases. In case of advanced, irresectable liver metastases liver transplantation (LTX) remains an attractive option. However, due to high recurrence rates or a lack of data, up to date, metastases from neuroendocrine tumors (NETs) are the only accepted indication for LTX in non-colorectal liver metastases. In this regard, LTX is only justified in patients in which complete tumor resection (R0 resection) of the NET is achievable. A literature review revealed no clear patient selection criteria but transplantation should definitively achieve an R0 resection with complete freedom of tumor. The available data regarding the outcome following LTX for NETs show a comparable short- and long-term outcome for patients transplanted for other malignancies, e.g. hepatocellular carcinoma, or also benign indications in the high MELD (model for end-stage liver disease) era. Thus, most data prove a better post-transplant outcome and a lower recurrence rate in patients with a good differentiation of the tumor, a low proliferation index (Ki67), and a portal drainage of the NET.

由于血流量大，尤其是肠道经门静脉的血流量大，肝脏是转移的首选器官。在晚期，不可切除的肝转移病例中，肝移植(LTX)仍然是一个有吸引力的选择。然而，由于高复发率或缺乏数据，迄今为止，神经内分泌肿瘤(NETs)转移是唯一接受的非结直肠肝转移的LTX适应症。在这方面，LTX仅适用于可实现NET完全切除(R0切除)的患者。文献回顾显示没有明确的患者选择标准，但移植应该明确实现R0切除，肿瘤完全自由。现有数据显示，对于因其他恶性肿瘤(如肝细胞癌)或在高MELD(终末期肝病模型)时代的良性适应症而接受肝移植的患者，LTX治疗后的短期和长期结果相当。因此，大多数数据证明，肿瘤分化良好、增殖指数低(Ki67)、门静脉网引流的患者移植后预后较好，复发率较低。

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引用次数: 2

Diagnostics and Early Diagnosis of Esophageal Cancer 食管癌的诊断与早期诊断

Viszeralmedizin

Pub Date : 2015-10-01 DOI: 10.1159/000439473

V. Meves, A. Behrens, J. Pohl

In the esophagus two different kinds of primary neoplasias may arise: squamocellular carcinomas (SCC) and esophageal adenocarcinomas (EAC). Although both types of carcinoma are rare diseases, especially the incidence of EAC rose in the last years. The management of esophageal cancer is challenging. There are no specific symptoms of early esophageal cancers. Due to this fact, most of the esophageal cancers are found incidentally, and only 12.5% of esophageal tumors are endoscopically resectable. Gastroscopy is the gold standard for the diagnosis of esophageal cancer. The sensitivity of detecting early-stage carcinoma may be improved by adjunct techniques such as chromoendoscopy, virtual chromoendoscopy, magnification endoscopy, and other advanced endoscopic imaging techniques. The diagnosis of esophageal cancer can be verified with targeted biopsies. Accurate staging information is crucial for establishing appropriate treatment choices for esophageal cancer, while the depth of the tumor determines the feasibility of therapy. In terms of staging, endosonography, abdominal ultrasound, and computed tomography scan of the thorax and abdomen should thus be performed before initiation of therapy.

食道可发生两种不同类型的原发性肿瘤:鳞状细胞癌(SCC)和食道腺癌(EAC)。虽然这两种类型的癌症都是罕见的疾病，特别是EAC的发病率在过去几年中有所上升。食管癌的治疗具有挑战性。早期食管癌没有特定的症状。由于这一事实，大多数食管癌是偶然发现的，只有12.5%的食管癌是可内镜切除的。胃镜检查是食管癌诊断的金标准。通过辅助技术，如色内镜、虚拟色内镜、放大内镜和其他先进的内镜成像技术，可以提高早期癌的检测灵敏度。食管癌的诊断可以通过有针对性的活检来证实。准确的分期信息对于确定适当的食管癌治疗选择至关重要，而肿瘤的深度决定了治疗的可行性。在分期方面，应在治疗开始前进行胸腹超声、腹部超声和计算机断层扫描。

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引用次数: 31