Biomedical subjects

R Lencioni

Publications and source records attributed to R Lencioni.

93 records · Page 6Linked to original sources

PubMedDate not supplied

[Combined treatment of hepatocarcinoma with chemoembolization and alcohol administration. Long-term results].

We investigated the long-term outcome of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). A series of 86 patients with biopsy-proved HCC were treated at our Institution January, 1991, to June, 1996. All patients had a single primary tumor bigger than 3 cm, occurring solitary or associated with no more than 2 daughter nodules. Forty-eight patients were in Child class A and 38 patients were in Child class B. The diameter of the lesions ranged 3 to 8 cm (mean: 5.3 cm). The treatment schedule included a single TACE performed via a segmental approach by injecting an emulsion of 20-70 mg adriblastin or farmorubicin and 5-20 ml Lipiodol followed by gelatin sponge particles. Four weeks later, CT and MR follow-up studies were performed and PEI was subsequently started. PEI included 4-16 treatment sessions (mean: 6.8 sessions) performed under US guidance. The total amount of alcohol administered ranged 16 to 215 ml (mean: 69 ml). All patients were followed after therapy with clinical examinations. laboratory tests, and US, CT, and MR studies performed at regular time intervals. The follow-up period ranged 4 to 65 months (mean: 27.8 months; median: 26 months). No major treatment-related complication occurred. The therapeutic response, as assessed with imaging studies performed after the end of treatment, was complete tumor necrosis in 71 of 86 patients (82%) and partial tumor necrosis in the remaining 15. Overall survival rates by the Kaplan-Meier method were 92% at 1 year, 83% at 2 years, 69% at 3 years, 58% at 4 years, and 47% at 5 years. The survival of Child A patients (75% at 3 years and 59% at 5 years) was significantly longer (p < .01) than that of Child B patients (61% at 3 years and 35% at 5 years). During the follow-up, a recurrence of the treated tumors was observed in 5 patients, and new HCCs appeared in 46 patients. The 1-, 2-, 3-, 4-, and 5-year recurrence rates by the Kaplan-Meier method were 14%, 35%, 56%, 69%, and 82%, respectively. The long-term results of combined treatment with TACE and PEI confirm the effectiveness of this therapeutic approach in patients with large uninodular HCC.

Aged↗

PubMedDate not supplied

[Diagnostic imaging and interventional therapy in hepatocarcinoma. Multicenter study of 290 cases].

We report the results of a multicenter study on the diagnosis and interventional therapy of hepatocellular carcinoma (HCC). The first aim--diagnosis--was to evaluate the sensitivity of 4 imaging techniques, namely ultrasonography (US), Computed Tomography (CT), digital arteriography (DSA) and Lipiodol CT (LCT), in HCC detection. The accuracy of these techniques was also investigated in tumor staging, which is important for treatment planning. Two hundred ninety patients underwent this imaging protocol. The patients were classified by tumor spread into three groups, namely group 1 (single HCCs < 5 cm), group 2 (multifocal HCCs with max. 3 nodules or tumor volume < 80 cc), group 3 (multifocal HCCs with more than 3 nodules and/or tumor volume > 80 cc). US and CT diagnosed more cases as group 1 and fewer cases as group 3 than DSA and LCT; the latter two techniques gave a similar classification. With LCT as the gold standard, US and CT understaged 27.9% and 26.5% of cases, respectively. Even though LCT is known to have 53% sensitivity, it is currently the most sensitive preoperative investigation and therefore the best tool for treatment planning. In surgical patients, however, intraoperative US, with its nearly 100% sensitivity, is suggested. The second aim--treatment--consisted in assessing the therapeutic efficacy of intraarterial chemoembolization (CEAT) versus percutaneous ethanol injection (PEI) in non advanced HCC and of CEAT versus no treatment (NT) in advanced HCC. Treatment efficacy was evaluated with the following randomized protocols: PEI versus CEAT in group 1, PEI versus CEAT in group 2 and CEAT versus NT in group 3. The data were analyzed relative to 215 patients for 6 to 30 months. The Kaplan-Meier method was used to calculate survival rates, which were, at 24 and 30 months, 72% and 72% for PEI and 72% and 52% for CEAT in group 1, 52% and 28% for PEI and 70% and 50% for CEAT in group 2 and finally 30% and 20% for NT and 45% and 30% for CEAT in group 3. In group 1, PEI appeared markedly superior to CEAT. In group 2, the difference between PEI and CEAT was not statistically significant; the results in this group indicate that CEAT should be considered when three nodules are present because of PEI invasiveness in these cases. In group 3, CEAT results were definitely better in the first two years, but there was no difference with NT patients at the end of the third year. Therefore, CEAT is indicated in advanced HCC because it improves the survival rate in the first 24 months. After this period, the survival time is not modified by treatment.

Antineoplastic Agents, Hormonal↗

PubMedDate not supplied

[Percutaneous alcohol administration for hepatocarcinoma: long-term results].

We investigated the long-term outcome of percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). A series of 184 HCC patients received PEI as the sole anticancer treatment over an 8-year period, December, 1987, to December, 1995. Ninety-four patients had a single tumor < or = 3 cm, 50 patients had a single lesion of 3.1-5 cm, and 40 patients had multiple nodules (up to four) < or = 3 cm each. All patients had liver cirrhosis, classified as Child-Pugh class A in 127 cases and as Child-Pugh class B in 57 cases. The treatment schedule included, for each lesion, 6-14 therapeutic sessions performed once or twice weekly. The total amount of alcohol administered ranged 10 to 110 ml (mean: 36 ml). All patients were followed after therapy with clinical examinations, laboratory tests, and imaging studies performed at regular time intervals. The follow-up period ranged 2 to 94 months (mean: 23.6 months). Overall survival rates by the Kaplan-Meier method were 67% at 3 years, 41% at 5 years, and 19% at 7 years. The survival rates of patients with single lesion < or = 3 cm (78% at 3 years, 54% at 5 years, and 28% at 7 years, respectively) were significantly higher (p < .01) than those of the patients with a single lesion of 3.1-5 cm (61% at 3 years, 32% at 5 years, and 16% at 7 years) or multiple lesions (51% at 3 years, 21% at 5 years, and 0% at 7 years). The survival of Child-Pugh A patients (79% at 3 years, 53% at 5 years, and 32% at 7 years) was significantly longer (p < .01) than that of Child-Pugh B patients (50% at 3 years, 28% at 5 years, and 8% at 7 years). A selected group of 70 patients with Child-Pugh A cirrhosis and a single lesion < or = 3 cm had a 3-, 5-, and 7-year survival of 89%, 63% and 42%, respectively. During the follow-up, new lesions appeared in 93 patients. The recurrence rates by the Kaplan-Meier method were 15% at 1 year, 34% at 2 years, 51% at 3 years, 67% at 4 years, 78% at 5 years, 88% at 6 years, and 94% at 7 years. The analysis of the survival curves of the treated patients confirms the effectiveness of PEI in the treatment of HCC. This therapeutic approach is particularly indicated for patients with a single lesion 3 cm or less in greatest diameter, as in these cases the long-term results of PEI are comparable to those reported in the best surgical series published in the literature.

Adult↗