Hello and welcome to our wonderful forum. I am not aware of anyone havint
this perticular cancer; however we have an individual on line who has liver
cancer and hopefully you will hear from her. Meanwhile, I have gone into
the land of cyber and researched for you. Even though this is a difficult
case, there is hope; as there are trials in place, there are vrious other
treatments that exclude reserection and so on. All this you will read in
what I am sending you. The most important thing is to maintain hope and
that fight to live....that is part of the winners circle. Know that we are
here for you, a great group of people who know how to listen, permit you to
vent and yes someday laugh with us. Your friend, lillian
http://www.ercpdoc.com/patient/treatment/index.htmlhttp://www.graylab.ac.uk/cancernet/101195.html#18_LOCALIZEDUNRESECTABLEADULT
PRIMARYLIVERCANCER
http://www.livercancer.com/
Curley has been studying a system that combines this hepatic arterial
infusion technique with hepatic venous isolation and extracorporeal
chemofiltration. A chemotherapy drug is infused into the liver through the
hepatic artery; the blood coming out of the liver is then captured and
filtered to remove the drug (figure). Thus the liver and tumor get a high
dose of the drug, but the rest of the body does not. The infusion and the
filtering are done through catheters in the neck and groin.
In trials, this system allowed delivery of doses of doxorubicin of 120
mg/m2, twice what can normally be tolerated by patients. Seven of ten
patients had a reduction in tumor volume of at least 25%; in two patients,
Curley was able to resect a tumor that had previously been unresectable. Now
he is awaiting Food and Drug Administration approval to add mitomycin C and
cisplatin to the doxorubicin to try to increase the effectiveness of the
treatment even more. Both these agents have shown activity against
hepatocellular cancers, and the three-drug combination has shown promise in
hepatic arterial infusion studies.
Curley is also planning a clinical study of a drug-delivery medium called
matrix collagen gel. This compound, when mixed with a chemotherapy drug like
cisplatin, encapsulates the drug; the drug then does not disperse into other
tissues when it is injected into the tumor. "Again, we get higher doses of
the chemotherapy drug in the tumor but reduce the dose of drug that goes to
the rest of the body," Curley said. Tumor kill is enhanced, while side
effects are minimized. Pilot studies of this technique were done at M. D.
Anderson; although measuring patient response was not a primary focus of
these studies, Curley noted that in all 20 patients the size of tumor was
reduced at least 50%, and in nine the reduction was at least 90%.
Researchers are also trying other drugs that attack the tumors in different
ways. Curley has begun studying some experimental compounds that, rather
than being directly toxic to the hepatocellular cancer cells themselves, may
cause the normal liver cells (hepatocytes) to excrete substances that slow
or retard the growth of the cancer cells. These compounds have had promising
results in clinical trials in Europe, producing anticancer responses. Curley
will study the interaction of the compounds with normal hepatocytes and with
hepatocellular cancer cells in the laboratory to determine whether they
indeed produce an effect and, if so, how they can be used to treat cancer
patients.
Cryotherapy Takes Up Where Surgery Leaves Off
Roh, with Bruno D. Fornage, M.D., of the Department of Diagnostic Radiology,
has helped a number of patients with liver tumors--including metastases from
colorectal cancers, hepatomas, and sarcomas--by using cryosurgery. "I cut
out what I can and freeze the remainder of the tumor," he said. This
technique, which was developed in Boston and Pittsburgh in the late 1980s,
involves inserting into the tumor a thin probe that fills with liquid
nitrogen, freezing the surrounding tissue. The freezing (at least 10 minutes
at -30°ree;C) destroys the tumor tissue, which is then slowly absorbed by
the body over time. The probe insertion and freezing process are monitored
precisely by ultrasound.
"It's quite well tolerated," Roh said. Since September 1993, he has
performed cryosurgery on about 35 patients. "This treatment is exciting
because it increases the number of patients who can be treated with
potentially curative therapy," Roh said. Initial data suggest survival rates
as good as those for patients who undergo surgical resection.
Radio-Frequency Current Destroys Tumors
In the laboratory, Curley is studying another technique called bipolar radio
frequency ablation (BRFA). "It's the opposite of cryosurgery," he explained.
"Instead of freezing the tumor, we're heating it." Two needles are placed in
the liver, one on each side of the tumor, and a radio frequency current is
run through the tumor, coagulating it. As for cryosurgery, the dead tumor
tissue is slowly absorbed by the body over time. The potential advantage
over cryosurgery is that the needles used are much smaller than cryosurgery
probes and therefore less traumatic to the liver.
In the United States this research is still in the preclinical stage; Curley
is studying BRFA in pigs. "When it comes to the anatomy of the liver and
blood vessels, pigs are strikingly similar to humans," he said. The
technique has been used in patients in Asia and Europe. "It looks
promising," Curley said, "but these are early studies."
Early Detection and New Research Are Increasing Options
"Promising" means a lot when there are so few good treatment options for
patients with liver cancer. The chances for the patient would be better if
the tumors were detected earlier, when there are more options for therapy.
"We're doing better at early detection by screening patients at higher risk
with blood tests and ultrasound," Curley said. People appropriate for such
screening include those with cirrhosis or chronic hepatitis B or C
infection.
Because the cancer is usually advanced by the time it is diagnosed, any
treatments that even prolong survival could benefit the patient, Curley
said. He feels that multimodality treatments will be the key to success. A
significant number of patients develop recurrences in the liver or other
organs after surgery alone. "We need to combine surgery with other
treatments," he said. "For example, if the tumor is small, we can do surgery
first and follow with chemotherapy. Or, if it is large, we can use
chemotherapy to reduce the size of the tumor and then use surgery or
radiation." Such multidisciplinary strategies are made possible at M. D.
Anderson by the team efforts of 12 to 15 specialists, including Curley, Roh,
and radiologist C. Humberto Carrasco, M.D., who participate in a liver tumor
study group chaired by Patt. The group meets each week to discuss their
patients' treatments and future treatment protocols.
The various lines of attack described here all attempt to remove or dissolve
the tumor. Novel therapies down the road may be able to change the behavior
of the tumor so that it will regress on its own or become more benign.
"That's science fiction now," said Curley, "but as we understand the liver
better, we'll be able to develop other options."
Current Liver Cancer Protocols
CPP/GS 94-001
Current practice of cryosurgery for unresectable hepatic metastases
(Study chairman: Dr. Roh)
DM 89-064
A phase II trial of intravenous 5-fluorouracil and subcutaneous recombinant
interferon-alpha for treatment of fibrolamellar hepatoma and cancer of the
biliary tree (cholangiocarcinoma and gall bladder carcinoma)
(Study chairman: Dr. Patt)
ID 92-024
A phase II trial of hepatic arterial infusion of floxuridine (FUDR),
leucovorin, doxorubicin (Adriamycin), and cisplatin (Platinol) for the
treatment of hepatocellular cancer confined to the liver
(Study chairman: Dr. Patt)
DM 93-137
A case-control study of hepatitis C virus and its interaction with hepatitis
B virus in the development of hepatocellular cancer in Harris County, Texas
(Study chairman: Dr. Patt)
ID 93-024
A two-arm phase II trial of cisplatin (Platinol), recombinant
interferon-alpha, doxorubicin (Adriamycin), and 5-fluorouracil for the
treatment of hepatocellular cancer: arm A by hepatic arterial infusion, arm
B by systemic administration confined to the liver
(Study chairman: Dr. Patt)
-----
REFERRALS. Physicians who have questions or would like to refer a patient
may write Drs. Curley, Roh, or Patt at the Departments of Surgical Oncology
(Curley, Roh) or Gastrointestinal Oncology and Digestive Diseases (Patt),
The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd.,
Houston, TX 77030, or call (713) 794-4957 (Curley), 792-7961 (Roh), or
792-2828 (Patt).
-----
Figure. Delivery system used for hepatic arterial infusion of chemotherapy
with complete hepatic venous isolation and extracorporeal chemofiltration.
(Reprinted with permission from The Cancer Bulletin. Copyright 1994, The
University of Texas M. D. Anderson Cancer Center, Houston, Texas.) Return to
article.
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----- Original Message -----
From: <Keyd@AOL.COM>
To: <mol-cancer@lists.meds.com>
Sent: Sunday, August 01, 1999 3:37 PM
Subject: [MOL] (no subject)
> My husband has recently been diagnosed with cholangiocarcinoma. The
> prognosis is not good. Drs. were not able to do the planned liver
resection.
> I would like to talk with others who are dealing with this. Thanks for
any
> help you can give.
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