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T Livraghi

Publications and source records attributed to T Livraghi.

86 records · Page 5Linked to original sources
PubMedDate not supplied

Intralesional ethanol in the treatment of unresectable liver cancer.

Percutaneous ethanol injection (PEI) under ultrasonography guidance has been widely tried in not advanced hepatocellular carcinoma (HCC). Ten years after the introduction of PEI, some conclusions of its indications can be drawn. In our series, 210 cirrhotic patients were treated; 141 with multisession PEI in an outpatient clinic, 57 with "single session" PEI under general anesthesia, and 12 with both. The 1-, 3-, and 5-year survival rates (by Kaplan-Meier method) were 953%, 65%, and 41% for Child class A patients with single HCC < or = 5 cm, and 88%, 47%, and 33% for patients with multiple HCC up to five lesions < or = 5 cm. In these patients the local recurrence rate was 15% and the new lesion rate at the 5-year follow-up was 74%. One death due to hemorrhage from esophageal varices in a Child class C patient treated by single session PEI occurred. The large number of cirrhotic patients demand for effective, safe, repeatable, low-cost treatment that can be offered at many centers. PEI meets all these requirements. PEI is proposed as the treatment of choice for the mentioned patients, excluding candidates for liver transplantation and surgical resection according to the predictive adverse factors currently in use. "Single session" technique widened the indications of traditional PEI to larger lesions.

Aged↗
PubMedDate not supplied

Percutaneous ethanol injection therapy of hepatoma.

Percutaneous ethanol injection (PEI) under ultrasound guidance is a new therapeutic possibility for patients with small hepatocellular carcinoma (HCC). In our series, 35 patients with a total of 50 tumors were treated (tumor size 0.8-5.0 cm). No significant complications occurred after 502 sessions of ethanol injection. Thirty patients presented complete remission, as no evidence of residual HCC was revealed during the follow-up (mean 16 months). Five patients with lesions larger than 3.5 cm presented only partial remission. The survival curves at 1, 2, and 3 years (Kaplan Meier method) were 100%, 100%, and 80%, respectively. In comparison with the survival curves of untreated and surgically treated patients, PEI seems to be the better treatment for operable HCC smaller than 3 cm, and for lesions smaller than 5 cm in patients with high surgical risk.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Morphological and biochemical effects of intrahepatic alcohol injection in the rabbit.

The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1-2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1-30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side-effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose-related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose-related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.

Animals↗
PubMedDate not supplied

Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough.

Six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor.

Antineoplastic Agents↗
PubMedDate not supplied

[Interstitial percutaneous therapies in primary and secondary liver tumors].

Multiple percutaneous interstitial systems to induce intrahepatic tumor necrosis are classifiable in two major groups: those using chemical agents (ethanol and acetic acid) and those adopting thermal effects (hot saline, radiofrequency, laser and microwave). Indication, technique and results of percutaneous ethanol injection (PEI) are considered. In the case of single hepatocellular carcinoma (HCC), < 5 cm and associated with cirrhosis Child class A long-term results of PEI are comparable with those of best surgical series with 5-years survival which range from 47 to 51%. No mortality and recurrence rates similar to those of surgical cases make PEI as an alternative to surgical resection although the difficulties in comparing retrospectively the different experiences do not enable definitive conclusions. In the case of liver metastases from colorectal cancer or endocrine tumors, which seem more sensitive to locoregional therapies, complete response rates are not adequate yet being 86%, 26%, 11% and 0% respectively in the case of < 2 cm, 2-3 cm, 3-4 cm and > 4 cm lesions and moreover no definitive data are available about long-term prognosis. Waiting for further validation about the encouraging data obtained with the other interstitial methods and in particular with radiofrequency (RF) and laser interstitial photocoagulation (FLI), PEI is a valid alternative to surgery for selected HCC patients and is a good palliation in cases with not resectable liver metastases which are anyway suitable for locoregional treatments.

Acetic Acid↗
PubMedDate not supplied

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis.

BACKGROUND/AIMS: In this study we discuss and evaluate the use of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in cirrhosis. METHODOLOGY: Percutaneous ethanol injection was performed under ultrasound guidance, with multiple sessions at an outpatient department or with "single-session" technique under general anesthesia, according to the size and number of the lesions. RESULTS: In our patients with Child A (293), B (149), or C (20) cirrhosis and single hepatocellular carcinoma 5 cm or smaller, the 1-, 3- and 5-year survival rates were 98, 79 and 47%, 93, 63 and 29%, and 64, 12 and 0%, respectively. In our 108 patients with larger hepatocellular carcinoma, 1- and 3-year survival rates were: 72 and 57% in single, encapsulated tumors, 73 and 42% in single infiltrating or multiple encapsulated tumors, and 46 and 0% in symptomatic or with advanced portal thrombosis tumors. CONCLUSIONS: Percutaneous ethanol injection proved to be a safe, effective, repeatable, easy and low-cost therapy for hepatocellular carcinoma. Survival after percutaneous ethanol injection was comparable to that after surgical resection, probably because of a balancing between greater complete ablation rate of surgery versus absence of early mortality and liver damage of percutaneous ethanol injection. On the basis of the percutaneous ethanol injection rationale, other ablation techniques were proposed using radiofrequency, laser or acetic acid. Their initial results are promising.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

[Percutaneous alcoholization of the small hepatocarcinoma].

Percutaneous ethanol injection (PEI) under ultrasound guidance is a new therapeutic possibility for patients with small hepatocellular carcinoma (HCC). In our series, 51 patients with a total of 72 lesions were treated (tumor size 0.8-5.0 cm). No significant complications occurred after 745 treatments. Forty patients presented complete remission, as no evidence of residual HCC was revealed during the follow-up (mean 18 months). Ten patients with lesions larger than 3.5 cm and one with lesion less than 3 cm presented partial remission (80-90% of necrosis). The cumulative survival rates at 1, 2 and 3 years (Kaplan-Meier method) were 100%, 89% and 58%. The survival rates for patients carrier of single lesion were 100%, 94% and 71% respectively. In comparison with the survival curves of untreated and surgically treated patients, PEI seems to be the better treatment for operable HCC smaller than 3 cm, and for lesions smaller than 5 cm in patients with surgical risk.

Adult↗
PubMedDate not supplied

Primary mediastinal embryonal carcinoma and choriocarcinoma. A case report.

A case of primary malignant germ-cell tumor of the mediastinum is presented. The diagnosis was suggested by a fine needle aspiration biopsy and confirmed by alpha-fetoprotein and human chorionic gonadotropin demonstration in the patient's serum. The cytologic, gross and microscopic findings are described.

Choriocarcinoma↗
PubMedDate not supplied

[Physical and chemical locoregional therapy in liver metastasis].

Close imaging follow-up of patients with known colorectal adenocarcinoma and other cancer can often detect hepatic metastases that are still small and potentially treatable. Unfortunately, many of these patients are poor surgical candidates, or refuse operation. This has stimulated the search for other minimally invasive means of tumor ablation. The first procedure suggested for this type of treatment was percutaneous ultrasound guided ethanol injection. Complete response is often obtained in lesions less than 2-3 cm, but only partial response in greater lesions. Usually a decrease of CEA values is observed, lasting for some months. Clearly, is difficult to establish whether, how much, and in which cases patient survival is lengthened. In the same time, because the procedure has proved safe, simple and cheap, when palliative purpose is requested it is hard to deny treatment to an inoperable patient with not advanced disease. Response in endocrine metastases in higher, because of their hypervascularity. Recently, encouraging results have been obtained inducing coagulation necrosis by means of thermal methods as laser or radiofrequency. In particular, new strategies of the latter obtained very promising results.

Electrocoagulation↗
PubMedDate not supplied

[Single-session alcohol administration for hepatocarcinoma].

We investigated the long-term efficacy and the contraindications of single-session percutaneous ethanol injection (PEI) under general anesthesia in hepatocellular carcinoma (HCC). One hundred patients were treated from October, 1991, to April, 1996: 24 patients had a single capsulated HCC, 4.5 to 10 cm phi (group A); 62 had a single infiltrating tumor or multiple lesions (3 to 6), with 10 cm maximum phi (group B); 14 patients were in an advanced stage because of Child class C or of infiltrating tumors with portal thrombosis, with 14 cm lesion maximum phi (group C). Group A patients were treated because they were not operable or refused surgery. Three to 22 injections were performed (mean: 13) depending on tumor size and ethanol spread. The maximum injected volume of ethanol was 190 ml (mean: 57 ml). The procedure took 20 to 50 minutes (mean: 30 minutes). The mean hospital stay was 3.5 days. Tumor necrosis was complete in 58% of encapsulated tumors and > 70% in infiltrating lesions. The greatest lesion with complete post-PEI necrosis was 8.2 cm phi. A transient and variable increase in transaminase, bilirubin, white cell and D-dimer levels and a decrease in red cell, platelet, hemoglobin, fibrinogen and haptoglobin levels were observed. These changes were due to hepatic cell necrosis, hemolysis and focal thrombosis. One death (bleeding esophageal varices in the Child C patient)(1%) and four major complications (one peritoneal bleeding, one liver decompensation, two chemical segmentectomies with pain)(4%) were observed. 1, 2, 3 year survival rates for groups A, B and C were: 80, 63, 63%; 70, 50, 30% and 58, 14 and 0% respectively. In our experience, PEI was an efficacious procedure. The risk conditions are: superficial lesion site with severe coagulation defects, severe portal and/or pulmonary hypertension, esophageal varices at risk of bleeding, cardiac ischemia, advanced cirrhosis.

Adult↗