Locally advanced hepatocellular carcinoma includes the presence of portal tumor thrombosis. The prognosis and treatment options for these patients are limited. Radiation therapy allows portal recanalization and the combination of other treatments such as TACE or even surgery. There are different modalities of radiotherapy including conventional radiotherapy, 3DRT, IMRT or VMAT. SBRT allows high doses of radiation to be delivered to the tumor while limiting the dose to the nearby healthy tissues. This allows high doses of radiation to be delivered to the tumor in a few sessions with low side effects. This study aims to review the role of radiation therapy in hepatocellular carcinoma with portal tumour thrombosis, specifically the role of SBRT.
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide and management of this disease remains challenging in many cases. For patients with Barcelona Clinic Liver Cancer (BCLC) advanced stage (C) disease, systemic therapy with Sorafenib has been the standard of care with median overall survival (OS) rates of less than one year. Patients presenting with portal vein tumour thrombosis (PVT) are considered to have a particularly dismal survival. For select patients, various loco-regional therapies may improve outcomes and even aid in downstaging to surgical resection or liver transplant. We present a case report of an adult male patient with a unilobar HCC with lobar portal vein invasion who underwent transarterial radioembolization (TARE) as a downstaging procedure. The patient had complete radiological response and then underwent a liver transplant. Complete pathological response was confirmed in the liver explant. At time of writing, almost 4 years following diagnosis, this patient was still alive with no evidence of recurrence. Patient selection is key when deciding on the optimal management of HCC and multidisciplinary team (MDT) involvement is encouraged.
We are presenting a clinical case of a 35 year old man that was referred to our outpatient department by his neurology team. He was known to them with myasthenia gravis diagnosed in 2017. The myasthenia gravis was paraneoplastic, associated with a thymoma for which he had required a thymectomy in late 2017. He was on maintenance with an anticholinesterase inhibitor, and immunosuppression with prednisone and azathioprine.
Gastrocutaneous fistula (GCF) are rare but serious post-operative complication, usually as a result of previous surgery to the alimentary tract. The most well described conditions etiologically related to GCFs include breakdown of gastroenteric anastomosis, disruption of gastric suture lines following bariatric surgery, chronic inflammatory disease, failure of gastrostomy tract healing, and others. We report a 47-year-old female who developed a Gastrocutaneous fistula secondary to gastric inflammation and ulceration.
Endoscopy services in South Africa are in trouble. The two main problems are inadequate number of endoscopists and lack of endoscopy units. Endoscopy is a broad field and requires endoscopic professionals. As demands increase with a new wave of flexible endoscopy screening CRC programs, there is great need for expansion in the workforce to provide this diagnostic service . Equally, endoscopy still has to deal with more complex cases and therapeutic cases that will inevitably arise as a result of the increased diagnostic service. This requires extra (surgical) gastroenterologists who are prepared to take risks and accept the subsequent complications that will ensue. For endoscopy among nurses who are well trained there is interest to be trained for nurse endoscopist to deal with the shortage of enough endoscopists. Studies established that nurse endoscopists can safely perform colonoscopies and upper endoscopies. These are interesting, albeit challenging options for South Africa. In an era where safe, yet cost effective, policies run at the forefront of stakeholders' minds, we discuss and suggest how nursing staff can undertake additional roles in the endoscopic suites and how to address this in the near future.
