Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide. A variety of pharmacological strategies has been evaluated in the treatment of HCC: classical chemotherapy, tamoxifen, octreotide, thymostimulin, pravastatin, (131)I-lipiodol as well as transarterial chemoperfusion (TAC) and chemoembolisation (TACE). TACE monotherapy or TACE combined with pravastatin resulted in a survival benefit of selected HCC patients. New strategies such as immunotherapy, antiangiogenic agents or cyclooxygenase inhibitors are under clinical investigation and might play a role in future therapies for HCC. Efficient strategies for the primary prevention of HCC are available and promising concepts in the secondary prevention have been reported.
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PMID:[Systemic treatment for hepatocellular carcinoma]. 1466 10

This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients.
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PMID:Current role of portal vein embolization/hepatic artery chemoembolization. 1506 66

Hepatocellular carcinoma (HCC) is one of the most common cancers and is the leading cause of cancer death in Taiwan. Curative surgery is feasible for only about 30% of patients. Transarterial embolization or chemoembolization (TAE/TACE) has been demonstrated to provide a survival benefit compared with supportive care for HCC patients with adequate liver reserves, tumors confined to the liver, and no evidence of portal vein thrombosis. Percutaneous ethanol injection (PEI) may provide long-term disease control if the extent of liver tumors is limited (3 or less in number and less than 3 cm in diameter). The relative efficacy of TAE/TACE, PEI, and other locoregional treatment modalities, such as radiofrequency ablation or cryosurgery, remains unclear. Radiotherapy has been used mostly as a salvage therapy in combination with other locoregional modalities. Despite the incorporation of 3-dimensional conformal technology, radiation-induced liver injury remains an important problem, especially for patients with hepatitis B-related cirrhosis. Systemic therapy is difficult for HCC because of the underlying cirrhosis and accompanying hypersplenism and peripheral cytopenia. HCC is typically resistant to most cytotoxic agents. Biochemical modulation with high-dose tamoxifen may sensitize HCC cells to doxorubicin-induced apoptosis and improve the clinical response to doxorubicin in patients with advanced HCC. Thalidomide, which inhibits angiogenesis induced by vascular endothelial growth factor and basic fibroblast growth factor, can produce a response in some HCC patients. Future research on drug therapy for HCC will focus on identification of tumor-specific targets.
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PMID:Recent advances in non-surgical treatment for advanced hepatocellular carcinoma. 1531 70

Surgical treatment of hepatocellular carcinoma. The therapy of hepatocellular carcinoma (HCC) has got nowadays an important problem of medicine. The five year survival time has increased in the consequences of the last 25 year medical activities. The development of liver surgery, the introduction of aggressive surgical strategy, the prognosis of the disease and the special indication of the operation have had important factors in bettering of the results. The size and number of the tumor, the tumor-free region of the tissue resected, capsule building, and the venous infiltration are the most important factors influencing the survival time. The repeated resection in case of newly developed HCC has got also a result with 19-20 per cent of five year survival time. In cases of non resectable tumors the a la carte chemotherapy, radiofrequency, TACE for down staging produce an opportunity in 10-20% of tumors being resectable. The new combined surgical-oncologic-intervention strategies involve the two step and repeated interventions, the minimal invasive technique (MIT), the TACE and the a la carte chemotherapy. Liver transplantation can be carried out exclusively in tumors less than 3 cm and in those having no more than 3 metastases.
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PMID:[Surgical treatment of hepatocellular carcinoma]. 1549 19

We devised low-output radiofrequency ablation (RFA)combined with transcatheter arterial chemoembolization using iodized oil mixed with anticancer drugs (TACE) for hepatocellular carcinoma (HCC), to reduce the cooling effect of tumoral arterial blood flow, to prevent intraportal disseminations and intrahepatic metastases by sudden ebullition (bumping), and to obtain an adequate margin of safety. We performed low-output RFA on 10 HCC patients. We performed RFA with a lower output of 90W or less within two weeks after TACE. After the ablation, portal venous-phase CT images showed a low-density margin of 5 mm or larger around the site of iodized-oil accumulation, indicating that the necrotic area completely included the tumor. No intrahepatic metastasis or severe complication occurred. Low-output RFA combined with TACE is a safe, effective therapy for HCC.
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PMID:[Low-output radiofrequency ablation combined with transcatheter arterial oily-chemoembolization for hepatocellular carcinoma]. 1592 Sep 73

The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre- and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 +/- 3.2 months in the TACE group and 4.3 +/- 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre- and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis > or =80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P = 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival.
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PMID:Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. 1597 10

Hepatocellular carcinoma (HCC) is one of the most common solid cancers worldwide with surgery being considered the treatment of choice. However, it is limited in view of the hepatic dysfunction and high recurrence rates associated with the disease. Liver transplantation offers the advantage of both, eradicating the tumor and treating the underlying liver disease and is the only chance for cure in patients suffering from HCC. Survival is known to reach 70% after 5 years and recurrent tumor can be found in less than 20% provided transplantation is restricted to patients with single tumors < or =5 cm or three nodules <3 cm (Milan criteria). However, donor organs are limited and the time on the transplant waiting list is up to 6 or 12 months in Europe and the United States with up to 30-40% dropouts per year. It has been demonstrated that patients with untreated HCC while on the waiting list longer than 6-10 months do not have any benefit in survival after liver transplantation. Interventional treatment options such as transarterial chemoembolization and percutaneous ablation techniques documented promising results concerning the reduction of dropouts from the waiting list and the potential risk for recurrent tumor. Mortality and morbidity were considerably low when radiological interventions had been considered as bridging therapies for liver transplantation. Percutaneous therapies come along with tumoral seeding of 0.1% to 0.6%. Adjuvant treatment with TACE, PEI, and/ or RFA in T1- and T2-staged HCC resulted in tumor-free survival after transplantation of 95.2% after 4 years and intention-to-treat survival of 94%, 85%, and 79% at 1, 2, and 3 years, respectively. Aggressive ablation therapy with a short transplant waiting time has the potential to optimize the use of liver transplantation for curative intent in selected cirrhotic HCC patients. Especially combined treatments seemed to play a key role in achieving complete tumor necrosis associated with improved disease-free survival after liver transplantation. In conclusion, no evidence based data exist in the literature supporting the efficacy of adjuvant interventional treatment modalities for HCC in patients awaiting liver transplantation. However, it has been shown that adjuvant (multimodal) interventional treatments seem a promising option for safe and effective bridging.
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PMID:Hepatocellular carcinoma: interventional bridging to liver transplantation. 1628 87

HCC in Japan has very different characteristics from that in other Asian countries. Because, among the Japanese HCC patients approximately 80% of the patients are HCV positive and they are aged over 60 years old. On the other hand, in many Asian countries HBVpositive HCC patients are dominant and their age is younger than the Japanese patients. Early diagnosis of HCC is mainly performed by means of imaging diagnostic technique such as abdominal ultrasonography, dynamic CT, dynamic MRI and CT angiography. If small HCC less than 3 cm in diameter is found and liver function is well preserved, local ablation therapy or surgical treatment promises better than 5 years survival (over 60%). While, TAE or TACE is performed in cases of HCC larger than 3 cm in size, if liver failure is not complicated. In advanced HCC cases with multiple tumors, arterial infusion of anticancer drug has been applied. However, its efficacy is not estimated. Chemoprevention is another modality for HCC. Eradication of HCV with an antiviral agent has proven to prevent hepatocarcinogenesis. As for chemoprevention of HCC, some trials are on going in Japan.
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PMID:Clinical aspects of hepatocellular carcinoma in Japan. 1659 85

Despite considerable efforts no ideal treatment exists for HCC. The disease is usually detected late and few patients are candidates for potentially curative treatment options such as surgical resection or liver transplantation. Surgical resection is limited mostly by the impaired liver function in cirrhotic livers, whereas liver transplantation is limited by tumor size, multi-localized disease and, most important, by shortage of donor organs. TACE as a local ablative treatment is able to induce local disease control and to prolong survival and might even achieve survival similar to surgical resection. The high rates of recurrence of HCC after successful control of local tumor spread is the reason to consider that procedure as a non-curative treatment option. PEI and RFA are able to control local tumor growth, but cannot influence tumor recurrence or de novo tumor growth. Systemic therapies need to be investigated in large randomized trials, especially to evaluate the use of somatostain analogues, HMGCoA reductase inhibitors, or other drugs such as rapamycin or inhibitors of vascular endothelial growth factor (VEGF).
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PMID:Hepatocellular carcinoma--rising incidence, changing therapeutic strategies. 1693 43

The transforming growth factor-beta (TGF-beta) regulates hepatocyte growth, inhibiting proliferation and inducing apoptosis. Indeed, escaping from the TGF-beta suppressor actions might be a prerequisite for liver tumour progression. In this work we show that TGF-beta plays a dual role in regulating apoptosis in FaO rat hepatoma cells, since, in addition to its pro-apoptotic effect, TGF-beta also activates survival signals, such as AKT, the epidermal growth factor receptor (EGFR) being required for its activation. TGF-beta induces the expression of the EGFR ligands transforming growth factor-alpha (TGF-alpha) and heparin-binding EGF-like growth factor (HB-EGF) and induces intracellular re-localization of the EGFR. Cells that overcome the apoptotic effects of TGF-beta undergo morphological changes reminiscent of an epithelial-mesenchymal transition (EMT) process. In contrast, TGF-beta does not activate AKT in adult hepatocytes, which correlates with lack of EGFR transactivation and no response to EGFR inhibitors. Although TGF-beta induces TGF-alpha and HB-EGF in adult hepatocytes, these cells show very low expression of TACE/ADAM 17 (TNF-alpha converting enzyme), which is required for EGFR ligand proteolysis and activation. Furthermore, adult hepatocytes do not undergo EMT processes in response to TGF-beta, which might be due, at least in part, to the fact that F-actin re-organization induced by TGF-beta in FaO cells require the EGFR pathway. Finally, results indicate that EGFR transactivation does not block TGF-beta-induced cell cycle arrest in FaO cells, but must be interfering with the pro-apoptotic signalling. In conclusion, TGF-beta is a suppressor factor for adult quiescent hepatocytes, but not for hepatoma cells, where it plays a dual role, both suppressing and promoting carcinogenesis.
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PMID:Differential intracellular signalling induced by TGF-beta in rat adult hepatocytes and hepatoma cells: implications in liver carcinogenesis. 1705 26


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