Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma

Abstract

Background

Hepatocellular carcinoma (HCC) is a common cause of worldwide mortality. Transarterial radioembolization (TARE) with yttrium-90 (Y90), a transcatheter intra-arterial procedure performed by interventional radiology, has become widely utilized in managing HCC.

Methods

The following is a focused review of TARE covering its commercially available products, clinical considerations of treatment, salient clinical trial data establishing its utility, and the current and future roles of TARE in the management of HCC.

Results

TARE is indicated for patients with unresectable, intermediate stage HCC. The two available products are glass and resin microspheres. All patients undergoing TARE must be assessed with a history, physical examination, clinical laboratory tests, imaging, and arteriography with macroaggregated albumin. TARE is safe and effective in the treatment of unresectable HCC, as it has a safer toxicity profile than chemoembolization, longer time-to-progression, greater ability to downsize and/or bridge patients to liver transplant, and utility in tumor complicated by portal vein thrombosis. TARE can also serve as an alternative to ablation and chemotherapy.

Conclusion

TARE assumes an integral role in the management of unresectable HCC and has been validated by numerous studies.

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Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from The National Cancer Data Base.

Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from The National Cancer Data Base.

J Urol. 2016 Mar 29;

Authors: Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR

Abstract
PURPOSE: Sex-cord stromal tumors (SCSTs) of the testis comprise < 5% of testicular neoplasms. Consequently, data regarding patterns of care and survival is sparse. Utilizing a large national database, we sought to provide a more definitive analysis of outcomes and management of these malignancies.
MATERIALS & METHODS: Data were obtained from the National Cancer Data Base. Patients diagnosed from 1998 to 2011 with two of the most frequent SCSTs of the testis, Leydig and Sertoli cell, were selected. Overall survival estimates was assessed by Kaplan-Meier.
RESULTS: Of the 79,120 cases of testicular cancer between 1998 and 2011, 315 (0.39%) were primary malignant Leydig or Sertoli tumors. The median age was 43 years for both. Of the 315 patients, 250 (79%) had malignant Leydig tumors and 65 (21%) had malignant Sertoli tumors; majority were stage I (94% and 78%, respectively). Overall survival at 1 and 5 years for stage I Leydig tumors were 98% (95% CI: 96-100) and 91% (95% CI: 85- 96), respectively, and for stage I Sertoli were 93% (95% CI: 83-100) and 77% (95% CI: 62-95, p=0.015). Most patients with stage I tumors received no further treatment following orchiectomy (94% Leydig, 84% Sertoli).
CONCLUSIONS: Five-year survival estimates of stage I Leydig and Sertoli cell tumors are significantly lower when compared to stage I germ cell tumors, with Sertoli cell tumors being significantly worse than Leydig cell. These differences in survival of SCSTs, indicate the importance of large databases to evaluate efficacy of treatment for rare neoplasms.

PMID: 27036305 [PubMed - as supplied by publisher]

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Efficacy of nasal corticosteroid in preventing regrowth after adenoidectomy.

Efficacy of nasal corticosteroid in preventing regrowth after adenoidectomy.

Auris Nasus Larynx. 2016 Mar 29;

Authors: Yildirim YS, Senturk E, Eren SB, Dogan R, Tugrul S, Ozturan O

Abstract
OBJECTIVE: One of the most frequent reasons of nasal obstruction and sleep apnea in pediatrics is adenoid hypertrophy. Remaining adenoid tissue can reoccur following hypertrophied adenoid removal and a second operation may be needed. Nasal corticosteroids are utilized in order to reduce adenoid hypertrophy and eliminate adenoidectomy operation. The purpose of our study is to assess the effect of nasal corticosteroid administration after adenoidectomy on adenoid regrowth and symptom scores.
MATERIAL AND METHOD: Seventy patients who had adenoidectomy were enrolled in our study. Patients were divided into two groups. Group I (35 patients) received Mometasone furoate (40mcg/day per nostril) intranasal spray for 6 months, starting at postoperative week 3 after wound healing. As for Group II (35 patients), they received intranasal saline spray. Patients were followed up for one year. Every patient had flexible nasal endoscopy at postoperative week 3 and one year after the operation. Choana was scored according to its occlusion level by the adenoid tissue. Additionally, nasal obstruction symptoms (nasal congestion, dry mouth, snoring, nasal speaking, apnea and night coughing) were scored.
RESULTS: Remaining adenoid tissue in the nasopharynx was comparable in flexible endoscopic assessment and no significant difference was seen between postoperative week 3 nasal obstruction scores. In the flexible endoscopic assessment completed in the twelfth month of the study, significant reduction was found in Group 1 compared to Group 2 in terms of adenoid size. When patients in both groups were compared, statistically significant reduction was observed in nasal obstruction symptom scores at the twelfth month.
CONCLUSION: This study has demonstrated that the use of steroid nasal spray following adenoidectomy significantly prevents regrowth and reduces nasal obstruction symptoms in the early period.

PMID: 27036360 [PubMed - as supplied by publisher]

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[Multicenter trial for sudden hearing loss therapy - planning and concept].

[Multicenter trial for sudden hearing loss therapy - planning and concept].

HNO. 2016 Apr 1;

Authors: Plontke SK, Girndt M, Meisner C, Probst R, Oerlecke I, Richter M, Steighardt J, Dreier G, Weber A, Baumann I, Plößl S, Löhler J, Laszig R, Werner JA, Rahne T

Abstract
Systemic steroids are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids for primary therapy of ISSHL, without evidence from randomized controlled trials (RCTs). The rationale for the treatment of ISSHL using high dose steroids is only based on retrospective cohort studies.This article describes the planning and initiation of a multicenter, national, randomized, controlled clinical trial entitled Efficacy and safety of high dose glucocorticosteroid treatment for idiopathic sudden sensorineural hearing loss - a three-armed, randomized, triple-blind, multicenter trial (HODOKORT). This clinical trial aims to compare standard dose with two types of high-dose steroids for primary systemic therapy with respect to their efficacy in improving hearing, and thus communication ability, in patients with idiopathic sudden sensorineural hearing loss.This study is funded by the "Clinical Trials with High Patient Relevance" research program in the health research framework of the German Federal Ministry of Education and Research. It is one of two studies by the German Study Center of Clinical Trials of the German Society of Otorhinolaryngology, Head and Neck Surgery (DSZ-HNO). Planning and initiation was done in cooperation with the DSZ-HNO, the Coordination Center of Clinical Trials of the Martin-Luther-University Halle-Wittenberg, and the Study Center of the University Hospital Freiburg.

PMID: 27038034 [PubMed - as supplied by publisher]

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[Diagnosis of auditory processing disorders in children].

[Diagnosis of auditory processing disorders in children].

HNO. 2016 Apr 1;

Authors: Ptok M, Miller S, Kühn D

Abstract
Despite normal hearing thresholds in pure tone audiometry, 0.5-1 % of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. Based on a selective literature search in the PubMed and Scopus databases using the term "auditory processing disorder", several consensus papers are discussed. Numerous studies on APD have revealed partially contradicting results, thus fueling critical discussion regarding validity and reliability-of specific audiometric APD methods and the APD construct in particular. In order to correctly advise parents and, where necessary, treat affected children, otorhinolaryngologists, phoniatrists, and pediatric audiologists must understand the psychometric properties of applied tests and have knowledge of current discussion. Diagnosis is generally a multistep interdisciplinary process.

PMID: 27038033 [PubMed - as supplied by publisher]

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[Medical examination: preparation for ENT specialisation : Part 24].

[Medical examination: preparation for ENT specialisation : Part 24].

HNO. 2016 Apr 1;

Authors: Marek A

PMID: 27038032 [PubMed - as supplied by publisher]

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Differential spatial regulation of BMP molecules is associated with single-suture craniosynostosis.

Differential spatial regulation of BMP molecules is associated with single-suture craniosynostosis.

J Neurosurg Pediatr. 2016 Apr 1;:1-9

Authors: Whitton A, Hyzy SL, Britt C, Williams JK, Boyan BD, Olivares-Navarrete R

Abstract
OBJECTIVE The aim of this study was to examine messenger RNA (mRNA) levels of bone morphogenetic protein (BMP) ligands, receptors, and soluble inhibitors in cells isolated from single-suture synostoses from fused coronal, metopic, sagittal, and lambdoid sutures. METHODS Cells were isolated from bone collected from patients undergoing craniotomies at Children's Healthcare of Atlanta. Real-time polymerase chain reaction was used to examine mRNA levels in cells isolated from fused sutures or patent sutures in comparison with levels in normal bone from the same patient. RESULTS Cells isolated from fused sutures in cases of sagittal and coronal synostosis highly expressed BMP2, while cells isolated from fused metopic or lambdoid synostosis expressed high BMP4. Noggin, a BMP inhibitor, was lower in fused sutures and had high expression in patent sutures. CONCLUSIONS These results suggest that BMPs and inhibitors play a significant role in the regulation of suture fusion as well in the maintenance of patency in the normal suture.

PMID: 27035551 [PubMed - as supplied by publisher]

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