Procedure aims to battle cancers that spread to liver

[00:00:00] 主持人安珀·史密斯: 锡拉丘兹上州医科大学, 纽约邀请您成为“知情患者”，收听播客，介绍来自纽约中部唯一学术医疗中心的专家. 我是主持人，安柏·史密斯. For people with colorectal or bile duct cancer that has spread to the liver, a new treatment option may improve survival and life expectancy. Dr. Mashaal迪尔 is here to tell us about hepatic artery infusion therapy. 他是上州大学的外科副教授兼肝胆胰外科主任. 欢迎来到“见多识广的病人”节目. 迪尔.

[00:00:38] Mashaal迪尔医学博士: 谢谢你们邀请我.

[00:00:40] 主持人安珀·史密斯: 首先，结直肠癌和胆管癌通常会扩散到肝脏吗?

[00:00:46] Mashaal迪尔医学博士: 是的, 结直肠癌, they typically arise in the colon and rectum part, 哪个与肝脏相连, 通过一个叫做门静脉的大静脉. So liver becomes the next step for many of these cancers. 总的来说, 50%的结直肠癌患者在其一生中会将疾病扩散到肝脏.

与这种疗法特别相关的胆管癌是从肝脏开始的. The medical term we use for these are intrahepatic. That means the ones which are arising within the liver. Those are the ones which are treated by this type of treatment.

[00:01:32] 主持人安珀·史密斯: 传统的治疗方法是怎样的当你的结肠直肠癌或胆管癌已经扩散到肝脏? 在过去，它是如何被治疗的?

[00:01:42] Mashaal迪尔医学博士: 对于结直肠癌，除了化疗，手术一直是治疗的前沿. There are other treatment options for some of the patients as well. For example, radiation or injection of radioactive particles into the liver. 肝动脉化疗已经有一段时间了，但不是在我们的机构.

类似的, for the bile duct cancers arising within the liver, it's a combination of surgery with chemotherapy. 和 for patients who are not candidates for surgery, 它通常是单独的化疗, in conjunction with radiation for some patients.

[00:02:26] 主持人安珀·史密斯: So tell us about what is hepatic artery infusion therapy? 它是如何工作的??

[00:02:31] Mashaal迪尔医学博士: One of the unique things for these colorectal liver metastases, as well as the bile duct cancers arising in the liver, is that they derive their blood supply from the hepatic artery, 哪个是肝动脉. 和 liver in itself has two blood supplies, the artery and the vein. 这种疗法的原理是将高剂量的化疗药物直接输送到动脉中, 在某种程度上可能比静脉注射同样的化疗有效400倍.

[00:03:12] 主持人安珀·史密斯: So that it goes just to the liver, as opposed to the whole body?

[00:03:17] Mashaal迪尔医学博士: 是的. 是的. 和 95% of this chemotherapy is cleared by the liver within 10 minutes, and a very small amount of the chemo goes into the circulation. 所以很多都是局部有效的而且对病人来说副作用很小, so that's the main strength of this treatment.

[00:03:41] 主持人安珀·史密斯: 很高兴知道这个. 现在, 这个手术有什么风险, because to get this to be done you have to insert a pump, 正确的?

[00:03:52] Mashaal迪尔医学博士: 这是真的. 这是真的. 传统上，这一直是这种疗法的缺点之一，你必须经历一个过程，在皮肤下植入一个泵，把导管放在肝动脉里. But more and more data suggests that it really prolongs life, and patients do bounce back quickly from the procedure itself.

和 over the last few years we are also doing this procedure robotic. We haven't started doing it robotic here at 推荐最近最火的赌博软件, but that's something I trained in and I have written about it in the past. 然而, 我们的项目一开始就向病人开放，让他们随时可以使用.

[00:04:39] 主持人安珀·史密斯: How long does the infusion therapy last once the pump is implanted?

[00:04:45] Mashaal迪尔医学博士: It really depends on what the intent of the treatment is. 在某种程度上, if we are doing the treatment for -- it can be done in two ways, 我应该澄清一下，这是针对那些我们无法移除他们疾病的病人, 哪些疾病是可切除的. 这就是我们要用的术语. 对于这些病人, either it can be for as long as they can tolerate, 或者肿瘤可以切除, we can take them to surgery down the road and stop treatment at that time, or if some side effects of the treatment start showing up.

所以每个病人的情况都不一样, 他们如何忍受, at what point do they develop any side effects, and if their disease becomes amenable to surgery down the road.

[00:05:36] 主持人安珀·史密斯: 如果一切顺利，在化疗结束时泵会被移除吗?

[00:05:44] Mashaal迪尔医学博士: 这个问题问得好. 泵是可以拆卸的. The procedure to remove the pump is 实际上 much simpler, where you just make an incision and remove the pump. 我们把导管留在动脉里，它不会造成任何威胁或副作用. 但也有其他药物可以放入这个泵保持它打开, 这些药物可以每三个月左右更换一次，让病人的生活更轻松.

[00:06:19] 主持人安珀·史密斯: This is 推荐最近最火的赌博软件's "The Informed Patient" podcast. 我是主持人，安柏·史密斯. 我正在和外科医生Mashaal迪尔谈话, who's the section chief of hepatobiliary and pancreatic surgery at 推荐最近最火的赌博软件, 我们正在讨论一种新的肝动脉输注泵，它可以帮助一些已经扩散到肝脏的癌症患者.

现在, who would be a candidate for hepatic artery infusion, and is there anything that would disqualify someone?

[00:06:46] Mashaal迪尔医学博士: 我们使用这种疗法治疗的两种特殊疾病是结肠直肠肝转移. 所以一般来说，推荐给那些不能切除的病人. 这意味着无法切除的疾病，通常会累及两侧肝脏. 和, such patients also should not have disease outside the liver as well, 例如, 他们的肺或骨头, because we are delivering this therapy to one organ only.

对于不可切除的胆管癌也是一样，肝内胆管醇，就像我们之前讨论过的. 这些是发生在肝脏小胆管内的胆管癌. So, unresectable disease is one clear-cut indication, but in some patients where we resect the disease, 但它们的肝脏有很多损伤, 泵仍然可以植入，以防止复发或治疗复发，如果他们发展一个在道路上.

[00:07:51] 主持人安珀·史密斯: How soon do you know whether the therapy is working?

[00:07:57] Mashaal迪尔医学博士: This is similar to as we do for most patients who undergo chemotherapy. Usually we check a scan after two to three months of treatment. 如果患者血液肿瘤标志物升高, 哪些在胆管癌和结肠癌患者中升高, we can also check those in their blood levels. 但通常我们会在治疗后的两到三个月进行扫描检查.

[00:08:24] 主持人安珀·史密斯: 到目前为止, 肝动脉输注与传统化疗相比效果如何?

[00:08:32] Mashaal迪尔医学博士: Over the last few years, there have been several studies. 最近的数据表明, 实际上, 如果我们同时使用, 而不是一种对抗另一种, 它可以提高效率.

和 in patients who have unresectable disease, if we add this therapy to their chemotherapy regimen, 这实际上可以使它们的存活率翻倍. 这取决于你的意图. 对于无法切除的病人, 如果它被加入化疗, over 30 to 40 percent of those patients can become resectable down the road. 所以数据非常, 非常令人鼓舞, especially when we combine this with modern chemotherapy regimens.

[00:09:20] 主持人安珀·史密斯: 听起来确实很鼓舞人心. There are other types of cancer that travel to the liver. Would an infusion pump work for those cancers too?

[00:09:31] Mashaal迪尔医学博士: 在一般情况下, this therapy is not recommended for those types of cancers, 只是因为传播的方式不同, 他们在不同的时间进步, and it's a more systemic disease when we think of those types of cancers. 我想说肝内胆管和结肠肝转移是肝动脉输注化疗的两个主要适应症.

[00:10:04] 主持人安珀·史密斯: 我知道你最近发表了一篇关于原发性肝癌全球趋势的论文. 你能分享一下其中的亮点吗?

[00:10:12] Mashaal迪尔医学博士: 谢谢你提出来.

所以我认为有趣的是传统上原发性肝癌的发病率一直在增加, 但当我们研究全球癌症观测数据库时，我们看到的是，这些数字开始趋于平稳.

我认为其中一些可能与在流行地区接种疫苗有关, 例如, 乙型肝炎等等. 但我认为这些情况在未来可能会改变，我们看到肥胖和其他疾病会影响肝脏健康. 它们可能会影响未来的数据, 但到目前为止，与2012年和2020年相比, 基于数据库, 这些数字似乎正在趋于稳定, 总的来说，哪个是好消息.

[00:11:02] 主持人安珀·史密斯: Which regions are historically endemic for liver cancer?

[00:11:06] Mashaal迪尔医学博士: The eastern region, including China, would be one. But then there are certain parts of Africa and the different regions. WHO (World Health Organization) divides world into six major regions. 所以我想说有几个流行地区，但东亚一直是主要流行地区之一.

[00:11:34] 主持人安珀·史密斯: 嗯，这是令人鼓舞的. 如果发生率下降，我想这就是正确的方向.

[00:11:39] Mashaal迪尔医学博士: 是的.

[00:11:40] 主持人安珀·史密斯: 好吧,博士. 迪尔, thank you so much for making time for this interview. 我很感激.

[00:11:45] Mashaal迪尔医学博士: 谢谢你邀请我.

[00:11:47] 主持人安珀·史密斯: 我的客人是博士. Mashaal迪尔, 他是上州立大学的外科副教授兼肝胆胰外科主任. "The Informed Patient" is a podcast covering health, 科学与医学, brought to you by 锡拉丘兹上州医科大学, 纽约, 由吉姆·豪制作. Find our archive of previous episodes at nhfilmexpo.com/informed. If you enjoyed this episode, please tell a friend to listen too. 和 you can rate and review "The Informed Patient" podcast on Spotify, 苹果, YouTube, 或者无论你收看什么节目. This is your host, Amber Smith, thanking you for listening.