Hepatic tumor load

In principle, SIRT is based on the general vascular accessibility of the liver and the hepatic tumor load. Therefore, detailed knowledge of the hepatic vascular anatomy and the specific tumor supply is mandatory. It is particularly necessary to identify the accessory right arteries and a potential middle hepatic artery to assess the entire supply. 

The carcinogenic response of medaka, guppies and trout to the PAHs, BaP and DMBA indicates that these, and probably other fish species, are capable of incorporating PAHs and metabolizing them to intermediates that initiate hepatic tumor formation. Studies have also shown that a complex mixture of PAHs and other compounds can induce hepatocarcinomas in a rainbow trout carcinogenesis assay using contaminant-loaded sediment extracts116. 

Wong et al. [57] described 19 patients with unresectable chemotherapy-refractive hepatic metastatic disease of various origins treated with SIR-Spheres. The median absorbed dose for the tumor was 76 Gy. PET was used to monitor patients at 3-month intervals. By PET criteria, 15 of patients (79%) showed response to therapy, whereas four (21%) showed no response. The authors concluded that there is a significant reduction of hepatic metastatic load as evaluated by PET after radioembolization. 

The majority of primary and secondary malignant hepatic tumors are not suitable for surgical resection, which makes systemic chemotherapy treatments and/or local ablative therapies important components of intention-to-treat concepts or palliation. Tumor load and type of response determine the efficacy of these therapies. 

E. Therapeutic response According to the product label, studies have shown that Rofewn-A can normalize serum transaminases, improve Uver histology, and reduce viral load in patients with chronic hepatitis C virus (HCV) infection. Other studies have shown that Roferon-A can produce clinically meaningful tumor regression or disease stabilization in patients with hairy-cell leukemia or in patients with AIDS-related Kaposi s sarcoma. In Ph-positive CML, Roferon-A supplemented with intermittent chemotherapy has been shown to prolong overall survival and to delay disease progression compared to patients treated with chemotherapy alone. In addition Roferon-A has been shown to produce sustained complete cytogenetic responses in a small subset of patients with CML in chronic phase. 

Recent development of a new PVA hydrogel bead has enabled accurate doxorubicin loadings to be achieved, with subsequent slow first order release. This novel drug-delivery system has been recently evaluated for intraarterial treatment of hepatic lesions [22], Doxorubicin-eluting beads (DC Bead for loading by the physician and PRECISION Bead preloaded with doxorubicin. Biocompatibles UK Ltd, Surrey, UK), are designed for intraarterial infusion and selective tumor targeting [14],... 

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