Viszeralmedizin最新文献

{"title":"Precision Medicine and Non-Colorectal Cancer Liver Metastases: Fiction or Reality?","authors":"E. Liakopoulou, A. Knuth","doi":"10.1159/000442485","DOIUrl":"https://doi.org/10.1159/000442485","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"434 - 439"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64978695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Medical Treatment of Patients with Non-Colorectal Liver Metastases: Primary Tumor Breast Cancer.","authors":"Cornelia Liedtke, Hans-Christian Kolberg","doi":"10.1159/000441961","DOIUrl":"10.1159/000441961","url":null,"abstract":"<p><strong>Background: </strong>(Metastatic) breast cancer is a heterogeneous entity in which every disease subtype requires an individualized systemic treatment approach.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Systemic therapy of metastatic breast cancer requires complex and individualized treatment approaches that are best offered in an interdisciplinary setting.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"424-32"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000441961","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64960370","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}

{"title":"Treatment of Non-Colorectal Liver Metastases","authors":"A. Frilling, M. Ebert","doi":"10.1159/000442900","DOIUrl":"https://doi.org/10.1159/000442900","url":null,"abstract":"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","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"386 - 386"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64992833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ectopic Spleen Tissue – an Underestimated Differential Diagnosis of a Hypervascularised Liver Tumour","authors":"E. Grambow, M. Weinrich, A. Zimpfer, K. Kloker, E. Klar","doi":"10.1159/000442115","DOIUrl":"https://doi.org/10.1159/000442115","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"445 - 447"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64965580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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'.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Interventional oncological techniques play a role in patients with liver-dominant metastases.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","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}

{"title":"Liver Resection for Non-Colorectal Liver Metastases – Standards and Extended Indications","authors":"Ulf Kulik, F. Lehner, H. Bektas, J. Klempnauer","doi":"10.1159/000439419","DOIUrl":"https://doi.org/10.1159/000439419","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"394 - 398"},"PeriodicalIF":0.0,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000439419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64906569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphologic and Functional Imaging of Non-Colorectal Liver Metastases","authors":"P. Heusch, G. Antoch","doi":"10.1159/000441857","DOIUrl":"https://doi.org/10.1159/000441857","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"21 1","pages":"387 - 392"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000441857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64957159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Role for Liver Transplantation in Non-Colorectal Liver Metastases?","authors":"U. Herden, B. Nashan","doi":"10.1159/000441237","DOIUrl":"https://doi.org/10.1159/000441237","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"400 - 404"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000441237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64929927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostics and Early Diagnosis of Esophageal Cancer","authors":"V. Meves, A. Behrens, J. Pohl","doi":"10.1159/000439473","DOIUrl":"https://doi.org/10.1159/000439473","url":null,"abstract":"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.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"315 - 318"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000439473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64907669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}