3 results
18 - Intrahepatic Cholangiocarcinoma
- from PART III - ORGAN-SPECIFIC CANCERS
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- By Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
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- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 213-221
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Summary
EPIDEMIOLOGY
Intrahepatic cholangiocarcinoma (ICC) is primary liver cancer with cholangiocytic molecular and histopathologic characteristics located peripheral to the biliary ductal confluence. Cholangiocarcinomas, in general, represent only 15% of primary liver cancers (1), with ICC composing only about 15% of those. These numbers have contributed to the pervasive perception that ICC is a rare cancer, and compared with cancers that globally impact health care (i.e., colon, breast, lung cancers), indeed it is. However, an accelerated increase in incidence has recently been demonstrated, which, coupled with the very poor prognosis imparted by this cancer, has raised concerns. From 1975 to 2000, the age-adjusted incidence of ICC in the United States has increased from 0.32 per 100,000 to 0.85 per 100,000, or roughly an increase from 800 to 2800 newly diagnosed cases per year (2). More concerning is that this 165% increase in age-adjusted incidence (2, 3) is accelerating, with current estimates showing an annual percentage increase in incidence of 9.11% (2). Prognosis is almost universally poor, with little change in demonstrated survival over the past 25 years despite novel and more aggressive treatments. In 1975, the 1- and 5-year survival rates were 15.8% and 2.6% respectively. Twenty-five years later (2000) and despite significant medical advances in cancer treatment 1-, 2- and 5-year survival rates have essentially remained stable, at 25%, 13% and 3.5% respectively (2, 3). Even for the few patients who are initially deemed resectable, post-operative 1-, 3- and 5-year survival is 58%, 33% and 33%, respectively (4, 5).
16 - Transcatheter Arterial Chemoembolization: Technique and Future Potential
- from PART III - ORGAN-SPECIFIC CANCERS
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- By Eleni Liapi, Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
-
- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 192-201
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Summary
Transcatheter arterial chemoembolization (TACE) is one of the most commonly performed procedures in interventional radiology and over the past 20 years, has significantly contributed to the evolution of this subspecialty (1, 2). TACE exploits the initial observation that most hepatic malignancies receive their blood supply largely by the hepatic artery, and selectively delivers intra-arterially high doses of chemotherapy to the tumor bed, while sparing the surrounding hepatic parenchyma (3, 4). Despite its promising design, TACE has not proved yet to be as effective as in theory. Several variations in the application of the technique, as well as the heterogeneity of chemotherapeutic regimens, are some of the most important challenges toward a thorough investigation of its clinical benefits (5). It is therefore essential for interventional radiologists to standardize the technique in order to maximize its effectiveness and help future advancements. In this chapter, we review the technical and clinical part of the procedure, as well as current results and future potential of TACE.
DEFINITION OF TACE, HISTORICAL BACKGROUND AND UNDERLYING PRINCIPLES OF TUMOR DAMAGE
TACE is defined as the infusion of a mixture of chemotherapeutic agents with or without iodized oil followed by embolization with particles (6). The technique was introduced in 1977 by Yamada, who intra-arterially delivered gelatin-sponge pieces permeated with 10 mg of mitomycin C or 20 mg of doxorubicin (Adriamycin), after super-selecting the tumor feeding artery of unresectable hepatomas (3, 4).
17 - New Concepts in Targeting and Imaging Liver Cancer
- from PART III - ORGAN-SPECIFIC CANCERS
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- By Eleni Liapi, Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
-
- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 202-212
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Summary
Ongoing research in the discipline of image-guided interventional oncology for hepatic malignancies seeks to discover and implement novel and effective therapeutic approaches in order to benefit patients with unresectable liver cancer. Research in this area incorporates advancements in the knowledge of liver cancer biology, new concepts in targeting liver cancer, development of novel drugs, improvement of intra-arterial drug delivery and technological advances of imaging systems.
This chapter is an overview of the most recent knowledge in liver cancer biology, new locoregional therapies for liver cancer and new imaging concepts for monitoring locoregional treatment response.
NEW CONCEPTS IN TARGETING LIVER CANCER
Targeting Angiogenesis
The fundamental role of angiogenesis in tumor progression was first suggested by Folkman et al. in a classic study describing that tumors cannot grow beyond 1 mm or 2 mm without the formation of new blood vessels (1). This complex process facilitates tumor progression and, eventually, tumor metastatic spread (1, 2). Several factors, including tumor hypoxia, growth factors, cytokines, oncogene activation and other mutations interact to stimulate angiogenesis (2, 3). Therefore, targeted inhibition of angiogenesis can be achieved at any of the aforementioned different levels, with treatments including the neutralization of growth factors with monoclonal antibodies (mAbs), the inhibition of downstream signaling from tyrosine kinase receptors and interference with the interaction between proliferating endothelial cells and matrix components.
Hepatocellular carcinoma (HCC) is one of the most vascular solid cancers, associated with a high propensity for vascular invasion.