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

In the EASL and AASLD guidelines, hepatic resection (HR) is considered the first option for patients in stage 0 (very early HCC). This statement was not based on randomized controlled trials (RCTs) versus other therapies, but on the oncological assumption that HR is the better procedure for obtaining complete tumor ablation including a safety margin. Subsequently, three RCTs compared percutaneous radiofrequency ablation (RFA) versus HR in patients with early HCC. All failed to demonstrate better survival in favor of HR, even though the larger size of the early stage needs a larger area of necrosis. A recent study focused on stage 0 demonstrated a sustained local complete response after RFA comparable with that of HR. All these trials established that RFA is less invasive and associated with lower complication rates and lower costs. These data suggest that RFA can be considered the first option for operable patients with very early HCC. Other options (HR, PEI, selective TAE/TACE) can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible.
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PMID:Single HCC smaller than 2 cm: surgery or ablation: interventional oncologist's perspective. 1989 Jun

Percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) was introduced in Japan in 1999. It has been established as a main local treatment method worldwide including Japan. On comparing outcomes between resection and RFA, they were comparable when cases were limited to those with 3 or fewer tumors 3 cm or smaller in many reports, based on which RFA has become the main treatment for small HCCs. The 5-year survival rate following RFA was as high as 57% in patients registered in the Liver Cancer Study Group of Japan, 73% when cases were limited to liver damage A (Child-Pugh A), and 83.8 and 76.3% in liver damage A (Child-Pugh A) cases with a single 2-cm or smaller and 2- to 5-cm liver tumor, respectively, showing outcomes equivalent to those of resection. The outcomes at our facility were also favorable: the 5-year survival rates of Child-Pugh A liver function HCC cases with 3 or fewer tumors 3 cm or smaller following RFA and resection were 84 and 78%, respectively. Various complications and limitations of RFA have previously been reported, but the advances of physicians' skills and development of various techniques have reduced complications and expanded the indications for RAF. TACE-combined, artificial pleural effusion- and ascites-combined, and contrast-enhanced ultrasonography-guided RFAs are good examples. Adjuvant therapy, such as interferon and molecular targeted therapies following curative therapy, is expected to further improve survival after RFA.
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PMID:Radiofrequency ablation for hepatocellular carcinoma: updated review in 2010. 2061 93

Of 15,681 patients with hepatocellular carcinoma (HCC), 30% underwent transcatheter arterial chemoembolization with lipiodol (Lip-TACE) including infusion chemotherapy with lipiodol (Lip-TAI) for the initial treatment, and 58% underwent it for recurrent HCC according to the latest biannual report of the Liver Cancer Study Group of Japan (LCSGJ). Superselective Lip-TACE is considered to be indispensable to maximize the therapeutic effect (TE) and to minimize injury to the non-cancerous liver. The local recurrence rate of a single session Lip-TACE for HCC <or=5 cm in diameter ranged from 33 to 38% at 3 years. A pathologic study using resected specimens of 26 HCCs treated by Lip-TACE showed that the mean necrosis rates and frequency of complete necrosis in three groups, small (<or=3 cm, n = 6 HCCs), medium (3.1-5 cm, n = 10), and large size (>or=5.1 cm, n = 10) were 95, 87.1%; 68.4, 66.7%; 30, 0%, respectively. Namely, the smaller the tumor size, the higher the TE. However, Lip-TAI showed no correlation between TEs and tumor size. A comparative study between the pathologically proven necrosis rate on the maximum cut surface of the lesion and radiologic necrosis estimated by CT showed a significantly good correlation when the lipiodol-retained area was presumed necrotic, but a poor correlation when it was presumed a viable one. No correlation was seen between the pathologic necrosis rate and the decreased rate of the lesion treated by Lip-TACE assessed by WHO criteria. The modified version of the assessment criteria of the TE of treatment for liver cancer was proposed by the LCSGJ in 2009, using a 4-grade treatment effect with two factors of tumor necrosis and tumor regression.
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PMID:Chemoembolization for unresectable hepatocellular carcinoma in Japan. 2061 96

More data about TACE and pTACE seem necessary to better define the global treatment strategy for HCC. Aim of our analysis was to evaluate the role of TACE, either with lipiodol (traditional) or drug-eluting microspheres in terms of response rate (RR), time to progression (TTP), overall survival (OS) and toxicity in HCC.Patients with HCC undergoing traditional TACE or pTACE (either alone or in combination with other treatment options) were eligibleOne hundred and fifty patients were analyzed. In the global patient population median OS was 46 months for lipiodol TACE and 19 months for pTACE (p < 0.0001), TTP was 30 months versus 16 months for patients receiving TACE or pTACE respectively (p = 0.003). These results were confirmed also among the group of patients who received exclusive TACE or pTACE. Neither RR nor toxicity was different between TACE or pTACE.At multivariate analysis, age, the Okuda stage, type of TACE and number of TACE proved to be independent prognostic factors influencing overall survival.In our experience, lipiodol TACE showed a better OS and TTP over pTACE, without difference in toxicity profile and RR. Among the staging systems analyzed only the Okuda stage seemed able to reliably predict patients outcome.
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PMID:Trans-arterial chemo-embolization (TACE), with either lipiodol (traditional TACE) or drug-eluting microspheres (precision TACE, pTACE) in the treatment of hepatocellular carcinoma: efficacy and safety results from a large mono-institutional analysis. 2115 84

A 56-year-old man was revealed to be HCC with portal vein tumor thrombus. Curative operation was impossible because we recognized many daughter lesions in the liver. Tumor marker was very high. DSM-TACE was conducted as the first line therapy. There was no remarkable side effect. After two-course, the size of HCC was decreased in CT and tumor marker was normalized. Generally speaking, a prognosis of HCC with portal vein tumor thrombus is poor. Hence, DSM-TACE is one of the effective therapies for HCC with portal vein tumor thrombus.
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PMID:[A case report of unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus responding to DSM-TACE (degradable starch microspheres-transcatheter arterial chemoembolization)]. 2122 86

Radioembolization is a form of brachytherapy in which intra-arterially injected (90)Y-loaded microspheres serve as sources for internal radiation purposes. It produces average disease control rates above 80% and is usually very well tolerated. Main complications do not result from the microembolic effect, even in patients with portal vein occlusion, but rather from an excessive irradiation of non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series accounting for nearly 700 patients. When compared to the standard of care for the intermediate and advanced stages (transarterial embolization and sorafenib), radioembolization consistently provides similar survival rates. Two indications seem particularly appealing in the boundaries of these stages for first-line radioembolization. First, the treatment of patients straddling between the intermediate and advanced stages (intermediate patients with bulky or bilobar disease that are considered poor candidates for TACE, and advanced patients with solitary tumors invading a segmental or lobar branch of the portal vein). Second, the treatment of patients that are slightly above the criteria for resection, ablation or transplantation, for which downstaging could open the door for a radical approach. Radioembolization can also be used to treat patients progressing to TACE or sorafenib. With a number of clinical trials underway, the available evidence shows that it adds a significant value to the therapeutic weaponry against HCC of tertiary care centers dealing with this major cancer problem.
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PMID:Radioembolization for hepatocellular carcinoma. 2332 19

A 70-year-old man with type B hepatitis had ruptured HCC in segment 5, and he underwent with TAE at other hospital in June 2007. Then, he was introduced to our hospital in July 2007. Partial hepatectomy( S5) was performed in August 2007 (pT2N0M0, Stage II). Afterward, he underwent TACE therapy twice because of multiple intrahepatic recurrences. Abdominal CT revealed a viable recurrence lesion (S5), and peritoneal dissemination (surface of S3) in June 2009. We carried out partial hepatectomy (S5), and removal of peritoneal dissemination because of good liver function and without any other extra hepatic recurrence in July 2009. Histologically, the intrahepatic lesion( S5) and the S3 surface lesion were diagnosed as moderately differentiated HCC. In July 2010, abdominal CT revealed three lesions of peritoneal dissemination (right subphrenic lesion, hepatic flexure of the colon, neighborhood of left ureter, then the second removal of peritoneal dissemination was performed. In January 2011, he had multiple lung metastatic lesions, and multiple bone metastatic lesions were occurred in March 2011, then his general condition was getting worse. In April 2011, he was dead 46 months after the first TAE therapy for ruptured HCC, or 21 months after the first resection of peritoneal dissemination. Surgical resection of peritoneal dissemination of HCC may improve a survival for patients whose intrahepatic lesion is contorollable.
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PMID:[A long-term survival case after two resections of the peritoneal metastasis from hepatocellular carcinoma]. 2220 15

Hepatocellular carcinoma (HCC) presents with a high burden of disease in East Asian countries. Intermediate-stage HCC as defined by the Barcelona Clinic Liver Cancer (BCLC) staging system poses a clinical challenge as it includes a heterogeneous population of patients that can vary widely in terms of tumour burden, liver function and disease aetiology. Intermediate HCC patients often have unsatisfactory clinical outcomes with repeated transarterial chemoembolization (TACE, due to non-response of the target tumour or the development of further metastasis indicating progressive disease. In September 2011, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was convened in HK in an attempt to provide a consensus on the practice of TACE. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies. This review summarises the evidence discussed at the meeting and provides expert recommendation regarding the available therapeutic options for unresectable intermediate stage HCC. A key consensus of the Expert Panel was that in order to improve patient outcomes and long-term survival, the possibility of using TACE in combination with targeted agents given systemically should be explored. While the currently available clinical data is promising, the expected completion of several pivotal phase II and III RCTs will provide further evidence in support of the rationale for combination therapy regimens.
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PMID:Consensus recommendations and review by an International Expert Panel on Interventions in Hepatocellular Carcinoma (EPOIHCC). 2333 61

The prognosis of patients suffering from primary hepatocellular carcinoma (HCC) is unfavourable because the tumour usually develops in cirrhosis-affected liver and is typically not diagnosed until an advanced stage of the disease. The 5-year survival rate for HCC patients in Europe does not exceed 9%. On the basis of a clinical case, the present article discusses the strategy of treatment of HCC patients. Patients with advanced HCC, stage C according to the Barcelona Clinic Liver Cancer (BCLC) staging system, typically receive systemic chemotherapy with sorafenib. The standard management in the treatment of intermediate-stage HCC, i.e. BCLC's stage B, is chemoembolization (TACE). However, repeated TACE sessions activate factors involved in the process of angiogenesis such as hypoxia-inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF), which can render the procedure ineffective. Therefore, there are scientific foundations for combining TACE with antiangiogenic agents such as sorafenib. Results of studies conducted to date indicate that the combination of sorafenib with TACE in patients with BCLC's stage B brings tangible therapeutic effects while being safe. The value of this therapeutic strategy is confirmed by the case described below, in which TACE + sorafenib have induced a partial regression of HCC.
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PMID:Effective therapeutic management of hepatocellular carcinoma - on the basis of a clinical case. 2378 57

We report a case of multiple intrahepatic recurrence of hepatocellular carcinoma( HCC) that was successfully treated with transcatheter arterial chemoembolization( TACE) and sorafenib therapy. A 73-year-old man was diagnosed as having multiple intrahepatic recurrence in segment 2 (S2) and segment 7 (S7) of the liver on abdominal computed tomography (CT) scans 4 years after he underwent liver resection. He was treated with 5 cycles of TACE. Two years and 6 months after the initial TACE, we found that the patient had become refractory to TACE, and therefore, we initiated sorafenib therapy. The response to treatment was stable disease (SD) for 9 months, but the patient's tumor marker levels increased and the tumor gradually increased. Therefore, he underwent additional TACE for the intrahepatic lesions. The patient is still alive with recurrences 4 years and 8 months after the initial recurrence.
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PMID:[A case of a patient with hepatocellular carcinoma who achieved long-term survival after repeated transcatheter arterial chemoembolization and sorafenib therapy]. 2439 31


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