Radioembolization has thus developed as an alternative to TACE, as an option in patients who are poor candidates for TACE

This could be due to hyperpolarization of the mitochondrial membrane caused by mitochondrial ATP accumulation in these metabolically inactive, growth-retarded cells, which may also have diminished ATP turnover. In addition, there was a remarkable increase in AFU observed in hyperoxia-exposed H2S-treated cells compared to untreated hyperoxia cells. In conclusion, we show that H2S preserves and restores normal alveolar development and attenuates PHT in an experimental, oxygen-induced model of impaired alveolar development mimicking BPD. H2S may offer new therapeutic options for lung diseases characterized by alveolar damage and PHT and warrants further investigation. Approximately 650,000 persons die each year from hepatocellular carcinoma, of whom at least two-thirds live in the Asia-Pacific region. Consistent with the experience in most Western countries,,20% of patients within Asia-Pacific clinical practice are diagnosed at a sufficiently early stage to benefit from potentially curative therapies. The remainder suffers from locally advanced or systemic HCC and mortality from HCC continues to approximate its incidence. Radioembolization with yttrium-90 radiolabelled microspheres significantly regresses locoregional HCC, but does not address systemic disease. Conversely, while sorafenib has been shown to be an effective systemic therapy and confers a survival advantage, tumor regression is minimal and an objective tumor response is observed in,5% of patients by Response Evaluation Criteria In Solid Tumors. The addition of a proven systemic therapy to therapy that reliably regresses locoregional tumor could thereby confer an additional survival benefit. The theoretical benefit of combined radiotherapy and sorafenib is supported by several preclinical studies. Radiation exposure is thought to induce the compensatory activations of multiple intracellular signaling pathway mediators, such as PI3K, MAPK, JNK and NF-kB as well as the up-regulation of vascular endothelial growth factor. It has been hypothesized that sorafenib-mediated inhibition of the Raf/MAPK and VEGF receptor pathways might enhance the efficacy of radiation. Although the data are limited, in-vivo studies have shown that sorafenib alters the radiation response in a schedule-dependent manner. Sorafenib administered after radiation therapy is associated with a greater delay in tumor growth than sorafenib pre-treatment. The efficacy and safety of three-dimensional conformal radiation therapy in augmenting the local response to sorafenib has been reported. However, these studies are limited by the total irradiation dose that can be safely tolerated in patients with a higher tumor burden given the sensitivity of the normal parenchyma to radiation. 90Y-microspheres are well tolerated by patients with noncirrhotic livers and in those with cirrhotic livers without ascites and in whom total bilirubin is,2.0 mg/dL. Radioembolization may also be used in HCC patients with portal vein thrombosis, a situation that precludes trans-arterial chemoembolization.

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