27 mei 2012: Dr. Vogl heeft weer een nieuwe studie gepubliceerd van herhaalde TACE plus RFA - LITT behandelingen van levertumoren, ontstaan vanuit darmkanker. Het is wel jammer dat dr. Vogl geen gerandomiseerde studies doet met een controlegroep ernaast. Hij selecteert zelf zijn patiënten en vergelijkt die niet met een controlegroep. Zelfs niet met historische gegevens. De waarde van zo'n studie is dan heel veel minder want er is geen vergelijking mogelijk.

Hier het abstract van de studie als vervolg op studie resultaten die onderaan staan. Het volledige studie rapport is tegen betaling in te zien als u hier klikt.

Repeated TACE offers adequate downsizing of CRC liver metastases to allow further treatment with LITT. The combined treatment illustrates substantial survival rates and high local tumour control with statistically significant differences between the three protocols used

Br J Cancer. 2012 Mar 27;106(7):1274-9. doi: 10.1038/bjc.2012.69. Epub 2012 Mar 1.

Repeated transarterial chemoembolisation using different chemotherapeutic drug combinations followed by MR-guided laser-induced thermotherapy in patients with liver metastases of colorectal carcinoma.

Source

Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. T.Vogl@em.uni-frankfurt.de

Abstract

BACKGROUND:

To evaluate a treatment protocol with repeated transarterial-chemoembolisation (TACE) downsizing before MR-guided laser-induced interstitial thermotherapy (LITT) using different chemotherapeutic combinations in patients with unresectable colorectal cancer (CRC) liver metastases.

METHODS:

Two hundred and twenty-four patients were included in the current study. Transarterial-chemoembolisation (mean 3.4 sessions per patient) was performed as a downsizing treatment to meet the LITT requirements (number5, diameter <5 cm). The intra-arterial protocol consisted of either Irinotecan and Mitomycin (n=77), Gemcitabine and Mitomycin (n=49) or Mitomycin alone (n=98) in addition to Lipiodol and Embocept in all patients. Post TACE, all patients underwent LITT (mean 2.2 sessions per patient).

RESULTS:

Overall, TACE resulted in a mean reduction in diameter of the target lesions of 21.4%. The median time to progression was 8 months, calculated from the start of therapy and the median local tumour control rate was 7.5 months, calculated as of therapy completion. Median survival of patients calculated from the beginning of TACE was 23 months (range 4-110 months), in patients treated with Irinotecan and Mitomycin the median was 22.5 months, Gemcitabine and Mitomycin 23 months and Mitomycin only 24 months with a statistically significant difference between the groups (P<0.01).

CONCLUSION:

Repeated TACE offers adequate downsizing of CRC liver metastases to allow further treatment with LITT. The combined treatment illustrates substantial survival rates and high local tumour control with statistically significant differences between the three protocols used. Further randomised trials addressing the current study results are required.

PMID:
22382689
[PubMed - indexed for MEDLINE]

31 december 2008: Bron Medscape

Chemo embolisatie in de vorm van TACE , LITT en RFA of combinaties daarvan als palliatieve behandeling verlengt het leven van darmkankerpatienten met uitzaaiingen in de lever significant. Dit bljkt uit de resultaten van een studie die dr. Vogl in januari zal publiceren. Dr. Vogl heeft in deze studie de gegevens gebruikt van 463 darmkankerpatienten met leveruitzaaiingen en die in principe niet meer curatief konden worden behandeld. De resutlaten:

Van de 463 patienten, hadden 68 patienten (14.7%) een gedeeltelijke remissie, 223 patienten (48.2%) hadden stabiele ziekte en 172 patienten (37.1%) toonden progressie van de ziekte. Na chemo embolisatie, was de 1 jaars-overleving 62%, en 2-jaars overleving was 28%. Mediane overleving was 38 maanden na datum van diagnose van levermetastases en 14 maanden vanaf het moment dat voor de eerste keer chemo embolisatie werd toegepast.

Chemoembolization May Be Useful for Palliative Treatment of Liver Metastases From Colorectal Cancer

 

Laurie Barclay, MD

Medscape Medical News 2008. © 2008 Medscape

 

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December 24, 2008 — Chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with colorectal cancer, according to the results of a study reported in the January 2009 issue of Radiology.

"In addition to systemic chemotherapy, current therapies of unresectable liver lesions include hepatic arterial infusion of chemotherapeutic drugs, transarterial chemoembolization, radiofrequency ablation, cryotherapy, laser-induced thermotherapy (LITT), and yttrium-90 radioembolization," write Thomas J. Vogl, MD, from the University Hospital Frankfurt, Johann Wolfgang Goethe-University in Frankfurt am Main, Germany. "Chemoembolization is defined as a selective administration of chemotherapy usually combined with embolization of the vascular supply to the tumor. This treatment results in selective ischemic and chemotherapeutic effects on liver metastases."

The goal of this study was to evaluate local tumor control and survival associated with transarterial chemoembolization using different drug combinations for palliative treatment of liver metastases in patients with colorectal cancer.

The study sample consisted of 463 patients with unresectable liver metastases from colorectal cancer that had not responded to systemic chemotherapy. Mean age was 62.5 years (range, 34.7 - 88.1 years); 67.4% had at least 5 metastases, 14.3% had 3 or 4 metastases, 10.4% had 2 metastases, and 8% had 1 metastasis.

At 4-week intervals, patients were repeatedly treated with chemoembolization, for a total of 2441 chemoembolization procedures (mean, 5.3 sessions per patient) with use of lipiodol and starch microspheres for vessel occlusion. The local chemotherapy protocol consisted of mitomycin C alone (n = 243), mitomycin C with gemcitabine (n = 153), or mitomycin C with irinotecan (n = 67).

Magnetic resonance imaging was used to assess tumor response, and the Response Evaluation Criteria in Solid Tumors were used to calculate change in tumor size and to determine response. The Kaplan-Meier method was used to calculate survival rates from first diagnosis and from first chemoembolization session, and follow-up imaging continued until patient death.

Of the 463 patients, 68 patients (14.7%) had partial response, 223 patients (48.2%) had stable disease, and 172 patients (37.1%) had progressive disease. After chemoembolization, 1-year survival was 62%, and 2-year survival was 28%. Median survival was 38 months from date of diagnosis of liver metastases and 14 months from the start of chemoembolization. Outcomes with the 3 treatment protocols did not differ statistically significantly.

Limitations of this study include nonrandomized study design and limited differences in the symptomatic and palliative indications for chemoembolization.

"Chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with colorectal cancer, with similar results among three chemoembolization protocols," the study authors write. "Repeated studies have therefore shown that it might be possible to prolong survival in the treatment of metastatic colorectal cancer in the liver by means of regional chemotherapy."

The study authors have disclosed no relevant financial relationships.

Radiology. 2009;250:281-289.


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