Zdravljenje primarnih jetrnih tumorjev z elektrokemoterapijo (ECT)

doktorska disertacija

Mihajlo Djokić (Author), Stojan Potrč (Mentor), Pavel Skok (Thesis defence commission member), Borut Štabuc (Co-mentor)

Abstract

Izhodišče in namen: Incidenca primarnih jetrnih tumorjev v svetu se povečuje. Najpogostejši med njimi (90 %) je hepatocelični karcinom (HCC) in skupaj z intrahepatičnim holangiokarcinom (CHC) predstavlja 98,5 % primarnih jetrnih tumorjev. Ne glede na dejstvo, da je to eden najpogostejših vzrokov smrti zaradi raka v svetu, je manj kot 20 % bolnikov s HCC kandidatov za kurativno zdravljenje – kirurško resekcijo ali presaditev jeter. Samo kurativno zdravljenje omogoča bolnikom možnost za dolgoletno preživetje s petletnim preživetjem do 70 % pri kirurških resekcijah in presaditvi jeter. Ko radikalni/kurativni tretmaji zaradi splošnega stanja telesne zmogljivosti, pridružene okvare jeter ali velikosti in razširjenosti tumorja ne pridejo v poštev, uporabljamo druge metode, kot sta transarterijska kemoembolizacija (TACE) in transarterijska radioembolizacija (TARE), ali lokalne ablativne tehnike, kot so radiofrekvenčna ablacija (RFA), mikrovalovna ablacija (MWA), krioterapija in druge metode za zdravljenje primarnih jetrnih tumorjev, ki podaljšajo preživetje teh bolnikov. Elektrokemoterapija (ECT) omogoča netoplotno ablacijo kožnih in tudi globlje ležečih tumorjev. Na podlagi dobrih rezultatov pri zdravljenju jetrnih zasevkov raka debelega črevesa in danke smo opravili prospektivno raziskavo zdravljenja hepatoceličnega karcinoma z namenom ugotavljanja izvedljivosti, varnosti in učinkovitosti elektrokemoterapije pri primarnih jetrnih tumorjih. Metode: Elektrokemoterapijo z bleomicinom smo izvedli pri 25 bolnikih s hepatoceličnim karcinomom, skupno je bilo tretiranih 33 lezij po predvidenem protokolu. Zdravljenje je bilo izvedeno med odprto laparotomijo pri 24 od 25 bolnikov, pri enem bolniku je bila elektrokemoterapija izvedena perkutano pod kontrolo računalniške tomografije. Ob zaključku spremljanja bolnikov je bila mediana opazovanja 23,5 meseca. Rezultati: Elektrokemoterapija je bila izvedljiva pri vseh 33 hepatoceličnih karcinomih. Pri nobenem bolniku ni prišlo do neželenih stranskih učinkov zdravljenja ali večjih pooperativnih zapletov. Do popolnega odgovora na zdravljenje je po 3 do 6 mesecih prišlo pri 92 % bolnikov in 94 % zdravljenih lezij. Ob zaključku spremljanja, tj. po medianem času spremljanja 23,5 meseca, je pri 31 od 33 lezij prišlo do popolnega odgovora. Zaključki: Elektrokemoterapija primarnih jetrnih tumorjev se je izkazala kot izvedljiv in varen način zdravljenja pri vseh 25 bolnikih. Za dokončno oceno učinkovitosti zdravljenja je potreben daljši interval sledenja bolnikov. Elektrokemoterapija je predvsem primerna pri bolnikih z zmanjšano jetrno funkcijo zaradi jetrne ciroze, pri bolnikih z zmerno do hudo portalno hipertenzijo in/ali pri zdravljenju lezij, pri katerih bi lahko zgolj operacija z velikim tveganjem za zaplete ponudila možnost popolne ozdravitve, saj elektrokemoterapija ponuja možnost popolnega odgovora lezije na zdravljenje.

Keywords

jetra;rak (medicina);novotvorbe;zdravljenje;elektrokemoterapija;kemoterapevtiki;elektroporacija;varnost;izid zdravljenja;radiologija;disertacije;

Data

Language:	Slovenian
Year of publishing:	2019
Typology:	2.08 - Doctoral Dissertation
Organization:	UM - University of Maribor
Publisher:	M. Đokić]
UDC:	616.36-006(043.3)
COBISS:	6764863
Views:	1584
Downloads:	90
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	English
Secondary title:	Treatment of primary liver tumors with electrochemotherapy
Secondary abstract:	Background and objectives: The incidence of primary liver cancer (PLC) is rising across the world. Hepatocellular carcinoma (HCC) is the most common (90%) and it and intrahepatic cholangiocarcinoma represent more than 98.5% of all primary liver tumors. Despite being one of the most common causes of cancer-related death around the world, fewer than 20%of patients with HCC are eligible for curative treatment—that is, surgical resection or liver transplantation. Only curative treatment offers the patient a chance for long-term survival, with 5-year survival rates of 70% for liver resection and liver transplantation. When radical or curative treatment is not indicated due to the patient’s condition, underlying liver disease, or tumor extent, other methods such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and local ablative treatments such as radiofrequency ablation (RFA), microwave ablation (MWA), cryotherapy, and other methods help in longer survival of those patients. Electrochemotherapy provides non-thermal ablation of cutaneous and deep-seated tumors. Based on positive results of the treatment of colorectal liver metastases, we conducted a prospective pilot study on hepatocellular carcinomas with the aim of testing the feasibility, safety, and effectiveness of electrochemotherapy. Patients and methods: Electrochemotherapy with bleomycin was performed on 33 hepatocellular carcinomas in 25 patients using a previously established protocol. The procedure was performed during open laparotomy for 24/25 patients, and percutaneous electrochemotherapy with computed tomography control was performed for one patient. At the end of the observation period, the median follow-up was 23.5 months. Results: Electrochemotherapy was feasible for all 33 lesions, and no treatment-related adverse events or major postoperative complications were observed. The complete response rate at 3 to 6 months was 92% per patient and 94% per treated lesion. At the end of the observation period, after a median follow-up time of 23.5 months, complete response was obtained in 31 out of 33 lesions. Conclusions: Electrochemotherapy of hepatocellular carcinoma proved to be a feasible and safe treatment in all 25 patients. To evaluate the effectiveness of this method, a longer observation period is needed. Electrochemotherapy is predominantly applicable for patients with impaired liver function due to liver cirrhosis, in patients with mild to severe portal hypertension, and/or for lesions where a high-risk operation is needed to achieve curative intent because ECT offers the possibility for complete response of the lesion to treatment.
Secondary keywords:	Hepatocellular carcinoma;Electrochemotherapy;Bleomycin;Electroporation;Safety;Effectiveness;
Type (COBISS):	Dissertation
Thesis comment:	Univ. v Mariboru, Medicinska fak.
Pages:	88 f.
ID:	11009456