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Query: UMLS:C0345904 (liver cancer)
 15,188 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

EASL/AASLD guidelines clearly define indications for liver surgery for HCC: patients with single HCC and completely preserved liver function without portal hypertension. These guidelines exclude from operation many patients that could benefit from radical resection and that are daily scheduled for hepatectomy in surgical centers. Patients with large tumors or with portal vein thrombosis cannot be transplanted or treated by interstitial treatments. In selected cases liver resection may obtain good long-term outcomes, significantly better than non-curative therapies. In cases of multinodular HCC, liver transplantation is the treatment of choice within Milan criteria; patients beyond these limits can benefit from liver resection, especially if only two nodules are diagnosed: even if they have a worse prognosis, survival results after liver surgery are better than those reported after TACE or conservative treatments. EASL/AASLD guidelines excluded from operating patients with portal hypertension but data about this topic are not conclusive and further studies are necessary. Selected patients with mild portal hypertension could probably be scheduled for liver resection and, considering the shortage of donors, listing for transplantation could be avoided. In conclusion, guidelines for HCC treatment should consider good results of liver resection for advanced HCC, and indications for hepatectomy should be expanded in order not to exclude from radical therapy patients that could benefit from it.
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PMID:Liver resection for HCC with cirrhosis: surgical perspectives out of EASL/AASLD guidelines. 1768 43

With the current practice of surveillance programs in high-risk patients, early stage hepatocellular carcinoma HCC is commonly diagnosed. This poses great challenge to clinicians, in terms of prognostic estimation, patient stratification to various treatment modalities and patient management during long-term follow-up. This review focuses on the current trends in the management of HCC, with special attention to tumor staging, treatment algorithm, and outcome of various treatment modalities. According to the American Association for the Study of Liver Diseases AASLD practice guideline, Barcelona Clinic Liver Cancer BCLC staging system has fulfilled the criteria that HCC patients can be stratified into different prognostic subgroups, to which optimal treatments can be offered. Under this management scheme, curative treatments hepatic resection, liver transplantation, and percutaneous ablation would be reserved to the subgroup of patients with relatively good prognosis. For patients with advanced malignancy localized to the liver, local ablation or transarterial chemoembolization TACE may offer effective symptomatic palliation, and prolongation of patients' survival. For patients with distant metastases, no effective therapy can be offered, and symptomatic palliative care is the best option. Until now, favorable survival outcomes have been reported following hepatic resection, liver transplantation, and local ablation for HCC. Although the therapeutic effect of TACE is less pronounced than curative treatments, randomized controlled studies have proven its survival benefit for HCC patients. A comprehensive treatment algorithm involving these treatment modalities is mandatory to ensure optimal care of patients with HCC.
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PMID:Current treatment strategy for hepatocellular carcinoma. 1776 55

Percutaneous chemical ablation is an established image-guided therapy for liver cancer that is relatively simple to perform and requires no specialized equipment. Chemical ablation has been used extensively for hepatocellular carcinoma (HCC), and has achieved outcomes comparable to surgical resection for small, solitary HCC. More recent experience with chemical ablation has combined it with TACE or thermal ablation as part of a multimodality approach to liver cancer.
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PMID:Chemical ablation of liver cancer. 1798 Mar 19

FaO rat hepatoma cells show increased levels of the epidermal growth factor receptor (EGFR) ligands, when compared with adult normal hepatocytes, and higher activity of the TNF-alpha converting enzyme (TACE/ADAM17), which is required for EGFR ligand proteolysis and activation. In this work we have analysed the consequences of inhibiting the EGFR in FaO rat hepatoma cells, focusing the attention on autocrine growth and protection from apoptosis. Results have indicated that FaO cells show overactivation of the EGFR pathway, which induces basal growth (in the absence of serum) and protection from pro-apoptotic agents, such as doxorubicin, generating drug resistance. Treatment of cells with the combination of doxorubicin and the tyrphostin 4-(3-chloroanilino)-6,7-dimethoxyquinazoline (AG1478, a potent and specific inhibitor of EGFR tyrosine kinase) potently inhibits autocrine growth and induces apoptosis. The apoptotic effect correlates with high expression and activation of the pro-apoptotic Bax and decreased transcript and protein levels of the anti-apoptotic Mcl-1 and Bcl-x(L). Furthermore, the combination of AG1478 and doxorubicin induces reactive oxygen species (ROS) production and glutathione depletion in FaO cells, coincident with up-regulation of the NADPH oxidase NOX4 and down-regulation of the gamma-glutamylcysteine synthetase (gamma-GCS), a key regulatory enzyme of the glutathione synthesis. Incubation of cells with glutathione ethyl ester attenuates the apoptosis induced by the combination of doxorubicin and AG1478, which indicates that glutathione depletion is required for an efficient cell death. In conclusion, targeting EGFR combined with other conventional pro-apoptotic drugs should potentially be effective in antineoplastic therapy towards liver cancer.
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PMID:Inhibition of the EGF receptor blocks autocrine growth and increases the cytotoxic effects of doxorubicin in rat hepatoma cells: role of reactive oxygen species production and glutathione depletion. 1837 37

Hepatocellular carcinoma (HCC) is a malignant tumor which is becoming more prevalent worldwide. Patients at high risk of developing HCC, namely hepatitis B- and C-related liver cirrhosis patients, should be entered into surveillance programs, which should be performed using both ultrasonography and 3 tumor markers (AFP, PIVKA-II, AFP-L3). The surveillance interval needs to be shortened for patients at higher risk of HCC. Therefore, super-high-risk patients should be screened at 3- to 4-month intervals based on their risk of developing HCC. Sonazoid-enhanced US is extremely useful to characterize hepatic tumors when compared with multidetector-row computed tomography (MDCT). Moreover, Sonazoid-enhanced US with defect reperfusion imaging is a breakthrough approach in the treatment of HCC. This technique will markedly change the therapeutic strategy for liver cancer. Furthermore, diagnostic capability using the new imaging technique Gd-EOB-DTPA MRI is promising. A reduced uptake (low intensity) in the hepatobiliary phase of Gd-EOB-DTPA MRI strongly suggests HCC (including early-stage HCC) or a high-grade dysplastic nodule with high malignant potential. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective for advanced HCC with vascular invasion; however, no randomized study exists to prove its efficacy. Further controlled study is necessary to establish this treatment option as a standard of care in a treatment algorithm for HCC. In contrast, sorafenib was established as the first choice of treatment as a standard of care in advanced HCC patients with preserved liver function and vascular invasion/extrahepatic spread. Furthermore, global clinical trials are now ongoing using sorafenib as an adjuvant setting after resection, ablation or TACE. Efficacy of combined use of sorafenib with TACE or intra-arterial infusion chemotherapy is not clear. In order to clarify this issue a randomized clinical trial for intermediate and advanced HCC comparing sorafenib alone versus sorafenib combined with maintenance TACE/intra-arterial infusion chemotherapy and/or intra-arterial infusion chemotherapy is scheduled to be initiated in Japan in 2009. If positive results are obtained by these trials, its impact on treatment strategy for HCC will be drastically changed.
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PMID:Hepatocellular carcinoma 2009 and beyond: from the surveillance to molecular targeted therapy. 1909 66

New advances in the treatment of HCC have emerged in recent years. The implementation of surveillance programmes has led to better diagnosis of HCC at early stages. Liver resection and liver transplantation remain the only potentially curative treatment options that can be applied in a limited number of patients resulting in 5-year survival rates as high as 75 - 80 %. Resection is indicated in patients with limited disease and absence of cirrhosis. Liver transplantation is beneficial in patients with cirrhosis and tumour size according to the Milan criteria. Organ donor shortage and the consequently long waiting time limits its applicability. TACE and radiofrequency ablation provide local tumour control in unresectable HCC and are increasingly used in addition to tumour resection. The major drawback of all treatments is the risk for local tumour recurrence or tumour progress during the waiting time for transplantation. The application of sorafenib in the (neo-)adjuvant situation is being tested in clinical trials.
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PMID:[New surgical approaches in the treatment of hepatocellular carcinoma]. 1915 93

New interventional options especially for patients with HCC and BCLC scores B and C give rise to disputes about the optimal therapeutic management. CT-guided brachytherapy complements established interventional techniques like RFA and TACE since it may also be used successfully in tumors much greater than 5 cm in diameter. In addition, unlike thermal ablation, the brachytherapy technique may be applied in tumors located nearby risk structures such as liver hilum or gallbladder and it is independent of cooling effects such as through large blood vessels or strong tumor perfusion. Depending on tumor size, geometry and visibility, MRI or CT guidance may be used. 15 Gy minimal target dose can be applied safely in a single or--in case of very large tumors--a sequential approach targeting different tumor portions. Local recurrence rates will be very low, and the rate of complications is moderate despite the fact that most patients present with underlying cirrhosis and related comorbidities. Preliminary data suggest a positive impact on overall survival. Randomized controlled trials are on their way to assess combination schemes with systemic treatments such as sorafenib.
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PMID:Image-guided interstitial high-dose-rate brachytherapy in hepatocellular carcinoma. 1954 56

Superselective TACE is defined as TACE from the distal portion of the feeding subsegmental hepatic artery to evoke strong ischemic effects on a small area of the liver, thus avoiding damage to liver function. Lipiodol (iodized oil) is semi-fluid, and it can flow into the surrounding portal venules and hepatic sinusoids through peribiliary plexus (PBP) and the drainage route from the hypervascular HCC. Therefore, the reversed flow from the hepatic sinusoids and portal venules to the peripheral portion of the tumor and daughter nodules can be blocked by Lipiodol injected before a particulate embolus (such as gelatin sponge particles). Common complications of superselective TACE are mild local pain and fever and temporary minimal changes of liver function. Reported CR ratio of definitely hypervascular HCC are around 30-60% by superselective TACE with Lipiodol for hypervascular HCC less than 5 cm. According to a nationwide survey by the Liver Cancer Study Group of Japan (LCSGJ), overall 5-year survival rate was 26% in patients with HCCs not indicated for surgery or RFA (PEI), mainly treated by segmental or subsegmental TACE using Lipiodol. Therefore, this TACE technique should be widely introduced as the first line technique for TACE therapy of HCC.
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PMID:Interventional oncology: new options for interstitial treatments and intravascular approaches: superselective TACE using iodized oil for HCC: rationale, technique and outcome. 1988 39


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