Safety of Lobar Hepatic Arterial Embolization in Metastatic Uveal Melanoma Patients with Underlying Gilbert's Disease
David C. Feldstein, MD; Robert D. Adamo, MD; Carin F. Gonsalves, MD, FSIR; David J. Eschelman, MS, FSIR; Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA; and Takami Sato, MD, PhD
❖ Uveal melanoma is the most common primary intraocular malignant tumor in adults.
❖ Up to half of all patients develop systemic metastases, with liver involvement in >90% of patients.1
❖ Various liver-directed, locoregional therapies (i.e. chemoembolization, immunoembolization, radioembolization, and ablation) have played a significant role in prolonging the lives of patients with metastatic uveal melanoma.2
❖ Elevated bilirubin levels are typically considered a relative contraindication for lobar hepatic arterial embolization treatment, given mainly the increased risk of precipitating hepatic failure.
❖ Gilbert's syndrome, also known as benign unconjugated hyperbilirubinemia, is a hereditary disorder of bilirubin conjugation. Gilbert’s syndrome leads to elevated levels of serum bilirubin, that do not truly reflect cholestasis or liver failure and therefore should not exclude patients from targeted embolization therapy.3
Poster presented at: World Conference on Interventional Oncology in Boston MA.
Ryan M. Weight, Shingo Sato, Masahiro Ohara, Mizue Terai, Michael Mastrangelo, Marlana Orloff, Benjamin Goldschmidt, John Viator, and Takami Sato
Circulating tumor cells (CTCs) have been shown to be a prognostic marker in breast cancer1. We hypothesize that circulating melanoma cell (CMC) detection could be utilized in the management of uveal melanoma, including early intervention. Prior methodologies for circulating uveal melanoma cell (CUMC) detection have been fraught with poor sensitivity, limiting their clinical utility2. Development of an improved method is necessary to establish the clinical utility of CUMC monitoring. Photoacoustics, also referred to as laser-induced ultrasound, is a novel platform for the detection and capture of CMCs. Photoacoustics uses short duration pulsed light to create ultrasonic acoustic waves in an optically absorbing medium, in this case melanin within melanoma3. As light is absorbed by irradiated chromophores, the optical energy gets converted into kinetic thermal energy trapped within the chromophore and subsequent thermal expansion ensues. Transient thermoelastic expansion of the absorbent cell results in the propagation of ultrasonic acoustic waves which can be detected and analyzed using a piezoelectric response mechanism. In addition, detected CMCs can be isolated by a two-phase flow cell separation technique4. Due to the low cost and melanoma specific capabilities of photoacoustics, we evaluated this technology for the purpose of CUMC detection.
Methods: Cells from uveal melanoma cell line UM002B, established at Thomas Jefferson, were titrated to various cell concentrations and analyzed in a neutral density solution utilizing the photoacoustic method. Uveal melanoma cells of differing concentrations were spiked into isolated healthy donor peripheral blood mononuclear cells (PBMCs) and healthy whole blood samples. PBMC isolates were analyzed for CUMCs.
Results: CUMCs were successfully quantified by the photoacoustic method including single cell detection. Recovery rates of cultured cells in a neutral density solution approached 25%. Recovery rates for CUMCs in whole blood averaged 10% of expected cell yield (56/540 cells detected) with a higher detection rate at lower cell concentrations. Photoacoustics offers a viable method for the detection of CUMCs with an accuracy that meets or exceeds previously reported CUMC yields. Studies analyzing CUMCs from patients with metastatic disease are ongoing.
Metabolic Patterns in Cancer Cells and Tumor Micro-environment in Diffuse Large B¬Cell Lymphoma: Tumor–Stromal Metabolic Coupling
Mahasweta Gooptu, MD; Alina E. Dulau Florea, MD; Benjamin E. Leiby, PhD; Barbara Pro, MD; John David Sprandio, Jr. MD; Diana Whitaker-Menezes, PhD; Paolo Cotzia, MD; Guldeep Uppal, MD; Jaime Caro, MD; Jerald Z. Gong, MD; and Ubaldo E. Martinez-Outshoorn, MD
It has previously been suggested that the tumor microenvironment in diffuse large B-cell lymphoma (DLBCL) has prognostic significance. Furthermore, gene expression profiling in DLBCL patients has identified separate subsets with glycolytic and mitochondrial (oxidative phosphorylative) metabolic signatures.
Glycolytic metabolism forms the basis for FDG PET scans, widely used in staging and response assessment in DLBCL. While many assume that the tumor as a whole is primarily glycolytic, the metabolic patterns of cancer cells (C) and surrounding cancer-associated stromal cells (CAS) remain relatively unknown. We investigated the in situ metabolic patterns of C and CAS cells as well as tumor-associated macrophages (TAM) in DLBCL.
Hee-Soon Juon, PhD; Frederic Kim, MS; Seon Yoon Chung, MSN; and Sunmin Lee, ScD
To report the prevalence of Health Related Quality of Life (HRQOL) in foreign-born Asian Americans (AA) and to compare this with the general AA from 2010 BRFSS data.
To examine the influential factors associated with HRQOL-4 including English proficiency, perceived racial discrimination, smoking, alcohol use, and sociodemographics.
Quality of life (QOL) represents individuals’ subjective perception of multidimensional aspects of life including physical, psychological, social and spiritual aspects.
HRQOL represents the physical and mental health domain of QOL.
Centers for Disease Control and Prevention (CDC) has been measuring HRQOL to capture people’s overall perceptions about their health; HRQOL has become an important component of health surveillance (U.S. DHHS, 2000).
While acculturation and racial discrimination have been negatively associated to the number of chronic health conditions and well-being of AA, their influence on HRQOL has not been studied.
Public surveillance study has typically considered Asian Americans as a single group and little is known about how HRQOL and health-related risk factors vary among foreign-born Asian Americans including Chinese-, Korean-, and Vietnamese- Americans.
Poster presented at APHA in Chicago Illinois.