Gokula Kumar Appalanaido, Muhamad Zabidi Ahmad, Syadwa Abdul Shukor, Alex Khoo Cheen Hoe, Manisekar K Subramaniam, Ang Soo Fan, Mohd Zahri Abdul Aziz
{"title":"病理完全反应与免疫治疗和近距离治疗15转移性肝病变在一个病人。","authors":"Gokula Kumar Appalanaido, Muhamad Zabidi Ahmad, Syadwa Abdul Shukor, Alex Khoo Cheen Hoe, Manisekar K Subramaniam, Ang Soo Fan, Mohd Zahri Abdul Aziz","doi":"10.2217/hep-2021-0014","DOIUrl":null,"url":null,"abstract":"<p><strong>Materials & methods: </strong>High dose rate interstitial brachytherapy (HDR-IBT) treatment plan for 15 metastatic liver lesions in a patient with pancreatic cancer was retrieved and analyzed for liver dose parameters and diaphragm dose. Serial <sup>18</sup>F-FDG PET-CT scans were reviewed for disease response assessment and left liver lobe volume. Serial laboratory records were analyzed for liver parameters.</p><p><strong>Results: </strong>Left liver lobe volume increased from 241 cm<sup>3</sup> pre-HDR-IBT to estimated 600 cm<sup>3</sup> after seven sessions of HDR-IBT. Metabolic complete response (CR) and subsequently pathological CR was confirmed in the right hepatotectomy specimen for all the 15 PET-CT avid lesions treated with HDR-IBT. Maximum diaphragm dose in a single fraction was 82 Gy. The liver parameters were stable and patient did not develop radiation induced liver disease.</p><p><strong>Discussion: </strong>This is the largest reported series of HDR-IBT to liver lesions in a single patient. This first ever reported combined treatment of immunotherapy (IT) and HDR-IBT had likely rendered this patient disease free both at local the liver and systemically. Metabolic CR by PET-CT can be seen as early as 46 days after HDR-IBT. Diaphragm can tolerate very high doses of radiation and repeated treatment.</p><p><strong>Conclusion: </strong>In this patient HDR-IBT for multiple liver lesions with IT is well tolerated. PET-CT can be used for response assessment of HDR-IBT liver. Synergistic effect of IT with HDR-IBT and it's role as bridging for liver resection has clinical potential and should be further studied in prospective trials.</p>","PeriodicalId":44854,"journal":{"name":"Hepatic Oncology","volume":"9 3","pages":"HEP44"},"PeriodicalIF":1.2000,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/73/hep-09-44.PMC9517960.pdf","citationCount":"0","resultStr":"{\"title\":\"Pathological complete response with immunotherapy and brachytherapy to 15 metastatic liver lesions in a single patient.\",\"authors\":\"Gokula Kumar Appalanaido, Muhamad Zabidi Ahmad, Syadwa Abdul Shukor, Alex Khoo Cheen Hoe, Manisekar K Subramaniam, Ang Soo Fan, Mohd Zahri Abdul Aziz\",\"doi\":\"10.2217/hep-2021-0014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Materials & methods: </strong>High dose rate interstitial brachytherapy (HDR-IBT) treatment plan for 15 metastatic liver lesions in a patient with pancreatic cancer was retrieved and analyzed for liver dose parameters and diaphragm dose. Serial <sup>18</sup>F-FDG PET-CT scans were reviewed for disease response assessment and left liver lobe volume. Serial laboratory records were analyzed for liver parameters.</p><p><strong>Results: </strong>Left liver lobe volume increased from 241 cm<sup>3</sup> pre-HDR-IBT to estimated 600 cm<sup>3</sup> after seven sessions of HDR-IBT. Metabolic complete response (CR) and subsequently pathological CR was confirmed in the right hepatotectomy specimen for all the 15 PET-CT avid lesions treated with HDR-IBT. Maximum diaphragm dose in a single fraction was 82 Gy. The liver parameters were stable and patient did not develop radiation induced liver disease.</p><p><strong>Discussion: </strong>This is the largest reported series of HDR-IBT to liver lesions in a single patient. This first ever reported combined treatment of immunotherapy (IT) and HDR-IBT had likely rendered this patient disease free both at local the liver and systemically. Metabolic CR by PET-CT can be seen as early as 46 days after HDR-IBT. Diaphragm can tolerate very high doses of radiation and repeated treatment.</p><p><strong>Conclusion: </strong>In this patient HDR-IBT for multiple liver lesions with IT is well tolerated. PET-CT can be used for response assessment of HDR-IBT liver. Synergistic effect of IT with HDR-IBT and it's role as bridging for liver resection has clinical potential and should be further studied in prospective trials.</p>\",\"PeriodicalId\":44854,\"journal\":{\"name\":\"Hepatic Oncology\",\"volume\":\"9 3\",\"pages\":\"HEP44\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2022-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/73/hep-09-44.PMC9517960.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hepatic Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2217/hep-2021-0014\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatic Oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2217/hep-2021-0014","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/9/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Pathological complete response with immunotherapy and brachytherapy to 15 metastatic liver lesions in a single patient.
Materials & methods: High dose rate interstitial brachytherapy (HDR-IBT) treatment plan for 15 metastatic liver lesions in a patient with pancreatic cancer was retrieved and analyzed for liver dose parameters and diaphragm dose. Serial 18F-FDG PET-CT scans were reviewed for disease response assessment and left liver lobe volume. Serial laboratory records were analyzed for liver parameters.
Results: Left liver lobe volume increased from 241 cm3 pre-HDR-IBT to estimated 600 cm3 after seven sessions of HDR-IBT. Metabolic complete response (CR) and subsequently pathological CR was confirmed in the right hepatotectomy specimen for all the 15 PET-CT avid lesions treated with HDR-IBT. Maximum diaphragm dose in a single fraction was 82 Gy. The liver parameters were stable and patient did not develop radiation induced liver disease.
Discussion: This is the largest reported series of HDR-IBT to liver lesions in a single patient. This first ever reported combined treatment of immunotherapy (IT) and HDR-IBT had likely rendered this patient disease free both at local the liver and systemically. Metabolic CR by PET-CT can be seen as early as 46 days after HDR-IBT. Diaphragm can tolerate very high doses of radiation and repeated treatment.
Conclusion: In this patient HDR-IBT for multiple liver lesions with IT is well tolerated. PET-CT can be used for response assessment of HDR-IBT liver. Synergistic effect of IT with HDR-IBT and it's role as bridging for liver resection has clinical potential and should be further studied in prospective trials.
期刊介绍：
Primary liver cancer is the sixth most common cancer in the world, and the third most common cause of death from malignant disease. Traditionally more common in developing countries, hepatocellular carcinoma is becoming increasingly prevalent in the Western world, primarily due to an increase in hepatitis C virus infection. Emerging risk factors, such as non-alcoholic fatty liver disease and obesity are also of concern for the future. In addition, metastatic tumors of the liver are more common than primary disease. Some studies report hepatic metastases in as many as 40 to 50% of adult patients with extrahepatic primary tumors. Hepatic Oncology publishes original research studies and reviews addressing preventive, diagnostic and therapeutic approaches to all types of cancer of the liver, in both the adult and pediatric populations. The journal also highlights significant advances in basic and translational research, and places them in context for future therapy. Hepatic Oncology provides a forum to report and debate all aspects of cancer of the liver and bile ducts. The journal publishes original research studies, full reviews and commentaries, with all articles subject to independent review by a minimum of three independent experts. Unsolicited article proposals are welcomed and authors are required to comply fully with the journal''s Disclosure & Conflict of Interest Policy as well as major publishing guidelines, including ICMJE and GPP3.
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