Tumor liver metastases

Fig. 14.1. Treatment algorithm for patients with neuroendocrine tumor liver metastases...

Most patients with neuroendocrine tumor liver metastasis have extensive bilobar involvement. As only one lobe is treated during each embolization session, most patients require a minimum of two treatment sessions in order to treat the entire liver, depending on the hepatic arterial anatomy. An interval of 4 to 6 weeks is recommended between treatment sessions to allow for liver function recovery. 

Shaheen RM, Davis DW, Liu W, et al. Antiangiogenic therapy targeting the tyrosine kinase receptor for vascular endothelial growth factor receptor inhibits the growth of colon cancer liver metastasis and induces tumor and endothelial cell apoptosis. Cancer Res 1999 59(21) 5412-5416. 

B16 melanoma, Walker sarcoma, and M5076 forming liver metastasis have been used in the preclinical evaluation of HPMA copolymer-adriamydn conjugates [36]. Other tumors useful for secondary screening are MS-2 sarcoma, NMU-1 murine lung adenocarcinoma, and murine adenocarcinoma Colon 26. These have been used by Zunino et al. [147] to determine the activity of poly (carboxylic acid) immobilized anthracyclines. Mice inoculated intramuscularly with Lewis lung carcinoma have been used by Pratesi et al. [215] to assess the effect of a poly-L-aspartic acid/doxorubicin conjugate. 

One of the obvious advantages of orthotopic models is that targeting processes involved in local invasion (e.g., angiogenesis) can be undertaken at a clinically relevant site (36). Since the early studies showing orthotopic transplantation of colon tumors and metastasis to the liver (39), tumor xenografts have been grown orthotopically in mice. However, despite the clinical relevance of orthotopic models, their utilization is hindered by a need for a high level of technical skill, time and cost. Therapeutic efficacy is also more difficult to assess with orthotopic models in contrast to the relative ease of subcutis tumor measurements (36). 

Xanthangelol (50 mg/kg, twice daily) inhibited metastasis to the lung in tumor-removed mice and the increase of lung weight that occurred in tumor-removed mice Table (17) . Next, we examined the effects of xanthoangelol on liver metastasis in mice with intrasplenically implanted LLC. 

Lee CM et al (2002) Novel chondroitin sulfate-binding cationic liposomes loaded with cisplatin efficiently suppress the local growth and liver metastasis of tumor cells in vivo. Cancer Res 62 4282 288... 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

Pellegrini et al. (P2) reported that combining serum TIMP-1 levels with CEA measurements in patients with colorectal cancer was useful to predict prognosis. TIMP-1 levels have been reported to be more than 3-fold elevated in patients with Dukes D (stage IV) colorectal cancer as compared to healthy donors (H7). Similar increased levels of plasma TIMP-1 were found in patients with advanced breast cancer. Holten-Andersen et al. (H7) proposed that plasma measurements of TIMP-1 may be of value in the management of cancer patients. Yukawa et al. (Y9) further reported that the plasma concentration of TIMP-1 was increased in colorectal cancer patients with serosal invasion by tumor and metastasis to lymph node and liver. 

Fig. 14.3.Cholangio-MR showing common bile duct stenosis after liver radioembolization. The patient was a 64-year-old man with non-resectable liver metastasis from a neuroendocrine tumor. He became jaundiced 3 months after receiving radioembolization...

---