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Feng W, Guo Y, Lu S, Yin Y, Xue T, Li Z. Transarterial chemoembolization combined with percutaneous ethanol injection for the treatment of hepatocellular carcinoma at high-risk areas. J Cancer Res Ther 2025; 21:395-400. [PMID: 40317144 DOI: 10.4103/jcrt.jcrt_2226_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 01/07/2025] [Indexed: 05/07/2025]
Abstract
PURPOSE To analyze the efficacy and safety of the combination of transarterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) at high-risk areas. MATERIALS AND METHODS Data from cases involving TACE combined with PEI for HCC treatment in high-risk regions were analyzed from January 2016 to December 2023 at three medical centers. High-risk areas were defined as those less than 10 mm from the diaphragm, gallbladder, gastrointestinal tract, or secondary branches of the portal vein or bile duct. The guidance modalities for PEI were computed tomograph (CT) and cone beam computed tomograph (CBCT). Each lesion received only one session of TACE combined with PEI. Treatment efficacy was assessed by complete ablation rate of target lesions at the 2-month follow-up. Factors affecting the efficacy were determined by binary logistic regression analysis. The difference in efficacy between CT-guided and CBCT-guided PEI was analyzed by Chi-square test. RESULTS About 62 patients with 67 target lesions were included in the analysis. The overall complete ablation rate lesion-based was 80.6% (54/67). Lesion diameter was significantly associated with the probability of achieving complete ablation (OR = 6.89, 95% CI: 1.57-30.234, P = 0.011). There was no significant difference in the complete ablation rates between CT- and CBCT-guided approaches (83.3% vs. 80%, P = 0.867). No severe complications occurred during treatment or follow-up. CONCLUSION The combination of TACE with a single PEI proves to be a safe and effective treatment for HCC in high-risk areas. There was no difference between CBCT-guided and CT-guided outcomes.
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Affiliation(s)
- Wencong Feng
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yapan Guo
- Department of Interventional Radiology, Suzhou Xiangcheng people's Hospital, Suzhou, Jiangsu, China
| | - Shitao Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yu Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tongqin Xue
- Department of Interventional Radiology, Huaian Hospital of Huaian City, Huaian, Jiangsu, China
| | - Zhi Li
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Kalath H, Vishwakarma R, Banjan B, Ramakrishnan K, Koshy AJ, Raju R, Rehman N, Revikumar A. In-silico studies on evaluating the liver-protective effectiveness of a polyherbal formulation in preventing hepatocellular carcinoma progression. In Silico Pharmacol 2024; 12:109. [PMID: 39569037 PMCID: PMC11574239 DOI: 10.1007/s40203-024-00285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 11/01/2024] [Indexed: 11/22/2024] Open
Abstract
Liv-52, an herbal formulation consisting of seven distinct plants and Mandur Bhasma, is recognized for its hepatoprotective, anti-inflammatory, and antioxidant properties. To investigate the pharmacological potential of each phytochemical from these plants, we conducted ADMET analysis, molecular docking, and molecular dynamic simulations to identify potent molecules capable of inhibiting the interaction between Alpha-fetoprotein (AFP) and Cysteine aspartyl protease 3 (Caspase-3/CASP3). In our study, we have used molecular docking of all the compounds against AFP and filtered them on the basis of ADME properties. Among the compounds analyzed, (-) Syringaresinol from Solanum nigrum, exhibited good binding interactions with AFP, the highest binding free energy, and maintained stability throughout the simulation along with favorable drug likeness properties based on ADME and Toxicity analysis. These findings have strongly indicated that (-) Syringaresinol is a potential inhibitor of AFP, providing a promising therapeutic avenue for hepatocellular carcinoma (HCC) treatment by inhibiting the interaction between AFP and CASP3, thereby reinstating normal CASP3 activity. Further in vitro studies are imperative to validate the therapeutic efficacy of (-) Syringaresinol as an AFP inhibitor, potentially impeding the progression of HCC. Supplementary Information The online version contains supplementary material available at 10.1007/s40203-024-00285-2.
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Affiliation(s)
- Haritha Kalath
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Riya Vishwakarma
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Bhavya Banjan
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Krishnapriya Ramakrishnan
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Abel John Koshy
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Rajesh Raju
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Niyas Rehman
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
| | - Amjesh Revikumar
- Centre for Integrative Omics Data Science (CIODS), Yenepoya (Deemed to be University), Mangalore, 575018 Karnataka India
- Kerala Genome Data Centre, Kerala Development and Innovation Strategic Council, Vazhuthacaud, Thiruvananthapuram, 695014 Kerala India
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Choi SJ, Lee S, Choi H, Ko MJ, Kim D, Kim DH. Development of injectable colloidal solution forming an in situ hydrogel for tumor ablation. Biomater Sci 2024; 12:4483-4492. [PMID: 39073039 PMCID: PMC11334955 DOI: 10.1039/d4bm00598h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Ablation cancer therapy using percutaneous intra-tumoral injection of ethanol is a promising method for targeted and effective locoregional cancer therapy. Magnetic gelatin microsphere (MGM) colloidal ethanol solution is developed as a potential injectable tumor ablation agent. The MGM was fabricated by electrostatic interactions among gelatin, acrylic acid, and acrylic acid-coated iron oxide nanoparticles. The fabricated MGM was dispersed in ethanol solution to form injectable MGM colloidal ethanol solution. The MGM colloidal ethanol solution can be easily infused and undergo in situ gelation via solvent exchange from ethanol to water in an artificial tissue. Furthermore, the MGM colloidal ethanol solution allowed doxorubicin (Dox) chemo-agent loading and its sustained release upon the formation of a drug depot by in situ gelation in artificial tissues. Our in vitro study demonstrated that locally delivered ethanol and Dox with MGM colloidal ethanol solution promoted the anti-cancer therapeutic efficacy with a significantly suppressed cancer cell recovery rate. Overall, our developed injectable MGM colloidal ethanol solution that can be transformed to a hydrogel drug depot at the injection site holds clinical potential for a new class of chemo-ablation agents.
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Affiliation(s)
- Seong Jin Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Korea
| | - Sanghee Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Hyunjun Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Min Jun Ko
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Donghwan Kim
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, University of Illinois, Chicago, IL 60607, USA
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Lu H, Zheng C, Liang B, Xia X, Fan H. Efficacy and safety analysis of TACE + PEI + lenvatinib compared with TACE + lenvatinib for the treatment of hepatocellular carcinoma with PVTT: a retrospective study. Front Oncol 2024; 14:1280837. [PMID: 38298738 PMCID: PMC10827889 DOI: 10.3389/fonc.2024.1280837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Objective The aim of this study was to investigate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with percutaneous ethanol injection (PEI) and lenvatinib in HCC patients with PVTT (Vp2-3), thus providing a safe and effective treatment strategy for advanced HCC patients. Materials and methods Clinical data of 227 patients with unresectable HCC and PVTT treated at the Union Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into two groups according to their treatment methods: TACE+PEI+lenvatinib group (N=103) and TACE+lenvatinib group (N=124). Results The proportion of patients with disappearance, shrinkage, or no change of PVTT after treatment was significantly higher in the TACE+PEI+lenvatinib group compared to the TACE+lenvatinib group, with statistical significance (P<0.001). The TACE+PEI+lenvatinib group had higher objective response rate (ORR) (50.5% vs. 25.8%, P<0.001) and disease control rate (DCR) (87.4% vs. 74.2%, P=0.013) than the TACE+lenvatinib group. The median progression-free survival (mPFS) of the TACE+PEI+lenvatinib group was longer than that of the TACE+lenvatinib group (8.1 months vs. 6.5 months, P<0.001). Consistently, the median overall survival (mOS) of the TACE+PEI+lenvatinib group was longer than that of the TACE+lenvatinib group (17.1 months vs. 13.9 months, P<0.001). Conclusion Among HCC patients with PVTT (Vp2-3), TACE+PEI+lenvatinib is more effective comparing to TACE+lenvatinib in prolonging PFS and OS. The control of PVTT in the TACE+PEI+lenvatinib group was significantly more satisfactory than that in the TACE+lenvatinib group. TACE+PEI+lenvatinib is a safe and effective treatment strategy for HCC patients with PVTT (Vp2-3).
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangwen Xia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hongjie Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Pfahl M, Gallaher HM. Successful minimally invasive simple hepatic cyst ablation via ethanol sclerotherapy in a cat. JFMS Open Rep 2023; 9:20551169231215273. [PMID: 38115861 PMCID: PMC10729625 DOI: 10.1177/20551169231215273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Case summary A 12-year-old neutered male domestic shorthair cat was evaluated at the Michigan State University Veterinary Medical Center (MSU-VMC) for an abdominal cyst that was initially noted on ultrasound 1 year prior by the referring veterinarian. The cystic mass was causing clinical signs, including vomiting, diarrhea, hyporexia and abdominal pain. Cyst drainage had originally been performed every few months, but by referral, the required frequency of drainage had increased to every 2 weeks for a total of eight drainage events; therefore, a more definitive curative option was sought. CT evaluation revealed a large simple hepatic cyst - largest diameter 7.2 cm - likely associated with the right medial liver lobe. Minimally invasive ethanol sclerotherapy was performed. A locking-loop catheter was placed percutaneously and transhepatically into the cyst using ultrasound guidance. The cyst was drained, and contrast injected under fluoroscopic guidance to ensure no communication between the cyst and liver. Sclerotherapy was performed using a volume of 99.5% ethanol calculated from the volume of cyst fluid removed. The patient was discharged on the same day and had complete resolution of clinical signs. At a 6-month follow-up, the cyst had decreased in volume by an estimated 95%. The patient remains asymptomatic more than 1 year postoperatively. Relevance and novel information To our knowledge, this is the first report of a feline hepatic cyst treated via percutaneous transhepatic ethanol ablation. Minimally invasive simple hepatic cyst ablation is a viable treatment option in cats that could avoid the need for a more invasive surgical intervention.
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Affiliation(s)
- Madison Pfahl
- Veterinary Medical Center, Michigan State University, East Lansing, MI, USA
| | - Hayley M Gallaher
- Veterinary Medical Center, Michigan State University, East Lansing, MI, USA
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Cui H, Qi Y, Guo C, Tang N. The effect of PM 2.5 exposure on the mortality of patients with hepatocellular carcinoma in Tianjin, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28039-1. [PMID: 37273052 DOI: 10.1007/s11356-023-28039-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
Several studies have shown the effects of PM2.5 exposure on respiratory and cardiovascular systems. However, there is no cohort study evidence of adverse effects of PM2.5 exposure on survival in patients with hepatocellular carcinoma (HCC) in China. This study is aimed at evaluating this association. This cohort study included 1440 HCC patients treated at the Third Central Clinical College of Tianjin Medical University from September 2013 to December 2018. We collected patient information, including demographic data, medical history, lifestyle characteristics, and disease characteristics. Based on PM2.5 concentrations measured at monitoring stations, the inverse distance weighted (IDW) method was used to assess the individuals' exposure during their survival period. Survival status was analysed by the Kaplan-Meier method. Restricted cubic splines and Cox proportional hazards models were used to estimate the relationship between PM2.5 and mortality, and potential confounders were adjusted for. The mortality rate of HCC patients exposed to PM2.5 ≥ 58.56 μg/m3 was significantly higher than that of HCC patients living in environments with PM2.5 < 58.56 μg/m3 (79.0% vs 50.7%, P < 0.001). The restricted cubic spline model showed a linear relationship between the PM2.5 concentration and mortality risk (P overall-association < 0.0001 and P nonlinear-association = 0.3568). Cox regression analysis showed that after adjusting for confounding factors, for every 10-μg/m3 increase in atmospheric PM2.5, the risk of death for HCC patients increased by 44% [hazard ratio (HR) = 1.44, 95% confidence interval (CI) 1.34, 1.56; P < 0.001]. Compared with patients exposed to PM2.5 <58.56 μg/m3, those exposed to PM2.5 ≥ 58.56 μg/m3 had a 1.55-fold increased risk of death. Stratified analysis results showed that the effects of PM2.5 on HCC mortality were more significant in patients aged ≥60 years or patients living in central urban areas. We found that exposure to elevated PM2.5 after HCC diagnosis may affect survival, with a higher concentration corresponding to a greater effect.
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Affiliation(s)
- Hao Cui
- The Third Central Clinical College of Tianjin Medical University, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170, China
| | - Ye Qi
- The Third Central Clinical College of Tianjin Medical University, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170, China
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No. 22 Meteorological Station Road, Heping District, Tianjin, 300070, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China
| | - Chunyue Guo
- The Third Central Clinical College of Tianjin Medical University, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170, China
| | - Naijun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No. 22 Meteorological Station Road, Heping District, Tianjin, 300070, China.
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China.
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Goodwin B, Lou J, Butchy M, Wilson T, Atabek U, Spitz F, Hong Y. Hepatocellular-Cholangiocarcinoma Collision Tumors: An Update of Current Management Practices. Am Surg 2023; 89:2685-2692. [PMID: 36031932 DOI: 10.1177/00031348221124323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary hepatic collision tumor, with an incidence ranging from 0.4 to 14.2%. Given the diagnostic challenges and lack of randomized trials, standardized treatment has yet to be established. We aim to review the literature to summarize the diagnosis, molecular characteristics, current treatment modalities, and challenges for cHCC-CC. A literature review was performed using PubMed. We included studies investigating and describing cHCC-CC, focusing on surgical, medical, and radiologic treatments. Overall prognosis is poor, with a 5-year survival rate under 30%. Minor or major hepatectomy with R0 resection is the only curative treatment; however, recurrence is likely (as high as 50% within 5 years). The role of liver transplantation is also highly debated given the biliary nature of these tumors, with cHCC-CC as a relative contraindication for liver transplantation. Although gemcitabine-based treatments had higher progression-free survival over sorafenib, there is no standard chemotherapy regimen. Treatment with gemcitabine and platinum demonstrates improved disease control rates compared to gemcitabine in conjunction with 5-fluorouracil (78.4% verse 38.5% respectively). Additionally, platinum-containing chemotherapy regimens exhibit a higher overall response rate than non-platinum regimens (21.4% verse 7.0% respectively). These molecular-directed therapies have prolonged survival for HCC, but further investigation needs to be done to assess their utility in patients with cHCC-CC. cHCC-CC is a rare and complex subset of primary hepatic neoplasms with a dismal prognosis and unstandardized treatment options. Further trials need to be performed to investigate systemic chemotherapy and immunotherapy options for patients with unresectable disease.
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Affiliation(s)
- Brandon Goodwin
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | | | | - Traeden Wilson
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Young Hong
- Cooper University Hospital, Camden, NJ, USA
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Liu M, Li XJ, Zhang XE, Kuang M, Xie XY, Huang GL. Long-term outcomes of combined radiofrequency ablation and multipronged ethanol ablation for the treatment of unfavorable hepatocellular carcinoma. Diagn Interv Radiol 2023; 29:342-349. [PMID: 36987999 PMCID: PMC10679715 DOI: 10.4274/dir.2022.22832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the local efficacy, safety, and long-term outcomes of combined radiofrequency ablation (RFA) and multipronged ethanol ablation (EA) in the treatment of unfavorable hepatocellular carcinoma (HCC) and to determine the prognostic factors for survival. METHODS Between August 2009 and December 2017, 98 patients with 110 unfavorable HCC nodules who underwent combined RFA and multipronged EA were retrospectively enrolled in the study. Unfavorable HCC was defined as a medium (3.1-5.0 cm) or large (5.1-7.0 cm) HCC nodule, a tumor located at a high-risk site, or a perivascular tumor. The treatment response, overall survival (OS), and recurrence-free survival (RFS) were analyzed. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the prognostic factors. RESULTS Complete ablation was obtained in 80.9% (89/110) of the tumors after initial treatment. Major complications were observed in 3 (3.1%) patients. The cumulative incidence of local tumor progression (LTP) was 23.5% at five years, and no variable was found to be an independent predictive factor for LTP. The five-year OS and RFS rates were 41.9% and 34.0%, respectively. Multivariate analysis showed that the serum alpha-fetoprotein level, tumor size, presence of residual tumor after ablation, and extrahepatic metastases were significant prognostic factors for OS (P = 0.023, P = 0.030, P = 0.001, and P = 0.010, respectively). Tumor type and the number of tumors were predictive factors for RFS (P = 0.029 and P = 0.001, respectively). A perivascular tumor was not an independent predictive factor for OS or RFS. CONCLUSION Combined RFA and multipronged EA is a safe and effective treatment for unfavorable HCC, especially for perivascular tumors.
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Affiliation(s)
- Ming Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Xiao-Ju Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Xiao-Er Zhang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
| | - Guang-Liang Huang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute for Diagnostic and Interventional Ultrasound, Guangzhou, China
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Liu B, Tan Y, Shen H, Wang L, Huang G, Huang T, Long H, Xie X, Xie X. Treatment outcomes after radiofrequency ablation in patients with non-B non-C hepatocellular carcinoma within Milan criteria: comparison with HBV-related hepatocellular carcinoma. Int J Hyperthermia 2023; 40:2244207. [PMID: 37580046 DOI: 10.1080/02656736.2023.2244207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE This study aims to evaluate the treatment outcomes of radiofrequency ablation (RFA) for patients with non-B non-C hepatocellular carcinoma (HCC) (NBNC-HCC) within Milan criteria, as well as to compare them with those of patients with hepatitis B virus (HBV)-related HCC (HBV-HCC). METHODS From January 2007 to February 2020, 303 patients with primary HCC who underwent RFA were retrospectively reviewed, including 259 patients with HBV-HCC (HBV-HCC group) and 44 patients with NBNC-HCC (NBNC-HCC group). The clinical characteristics and treatment survivals were evaluated and compared. Moreover, the propensity score matching was used to reduce selection bias. RESULTS A significantly lower proportion of cirrhosis was observed in the NBNC-HCC group (p = .048). Before propensity score matching, local tumor progression, disease-free survival, and overall survival after RFA showed no significant differences between the two groups (all p > .05). After matching, the overall survival rates in the NBNC-HCC group were significantly better than those in the HBV-HCC group (p = .042). Moreover, for patients with NBNC-HCC, tumor size (hazard ratio = 8.749, 95% confidence interval, 1.599-47.849; p = .012) was the only independent predictor of local tumor progression. CONCLUSIONS Patients with NBNC-HCC within the Milan criteria after RFA had better long-term survival than patients with HBV-HCC, although larger, prospective and multicenter trials are required to validate these results.
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Affiliation(s)
- Baoxian Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang Tan
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Shen
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Wang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tongyi Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyi Long
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wang J, Wu R, Sun JY, Lei F, Tan H, Lu X. An overview: Management of patients with advanced hepatocellular carcinoma. Biosci Trends 2022; 16:405-425. [PMID: 36476621 DOI: 10.5582/bst.2022.01109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) has constituted a significant health burden worldwide, and patients with advanced HCC, which is stage C as defined by the Barcelona Clinic Liver Cancer staging system, have a poor overall survival of 6-8 months. Studies have indicated the significant survival benefit of treatment based on sorafenib, lenvatinib, or atezolizumab-bevacizumab with reliable safety. In addition, the combination of two or more molecularly targeted therapies (first- plus second-line) has become a hot topic recently and is now being extensively investigated in patients with advanced HCC. In addition, a few biomarkers have been investigated and found to predict drug susceptibility and prognosis, which provides an opportunity to evaluate the clinical benefits of current therapies. In addition, many therapies other than tyrosine kinase inhibitors that might have additional survival benefits when combined with other therapeutic modalities, including immunotherapy, transarterial chemoembolization, radiofrequency ablation, hepatectomy, and chemotherapy, have also been examined. This review provides an overview on the current understanding of disease management and summarizes current challenges with and future perspectives on advanced HCC.
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Affiliation(s)
- Jincheng Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.,Graduate School of Biomedical Science and Engineering, Hokkaido University, Sapporo, Japan
| | - Rui Wu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin-Yu Sun
- The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feifei Lei
- Department of Infectious Diseases, Liver Disease Laboratory, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Huabing Tan
- Department of Infectious Diseases, Liver Disease Laboratory, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiaojie Lu
- Department of General Surgery, Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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11
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Subramanian S, Mallia MB, Shinto AS, Mathew AS. Clinical Management of Liver Cancer in India and Other Developing Nations: A Focus on Radiation Based Strategies. Oncol Ther 2021; 9:273-295. [PMID: 34046873 PMCID: PMC8593115 DOI: 10.1007/s40487-021-00154-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global killer with preponderance in Asian and African countries. It poses a challenge for successful management in less affluent or developing nations like India, with large populations and limited infrastructures. This review aims to assess the available options and future directions for management of HCC applicable to such countries. While summarizing current and emerging clinical strategies for detection, staging and therapy of the disease, it highlights radioisotope- and radioactivity-based strategies as part of an overall program. Using the widely accepted Barcelona Clinic Liver Cancer (BCLC) staging system as a base, it evaluates the applicability of different therapeutic approaches and their synergistic combination(s) in the context of a patient-specific dynamic results-based strategy. It distills the conclusions of multiple HCC management-focused consensus recommendations to provide a picture of clinical strategies, especially radiation-related approaches. Additionally, it discusses the logistical and economic feasibility of these approaches in the context of the limitations of the burdened public health infrastructure in India (and like nations) and highlights possible strategies both at the clinical level and in terms of an administrative health policy on HCC to provide the maximum possible benefit to the widest swathe of the affected population.
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Affiliation(s)
- Suresh Subramanian
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India.
| | - Madhava B Mallia
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India
| | - Ajit S Shinto
- Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
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12
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Nakagomi R, Tateishi R, Mikami S, Wake T, Kinoshita MN, Nakatsuka T, Minami T, Sato M, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Shiina S, Koike K. Infectious complications related to radiofrequency ablation of liver tumors: The role of antibiotics. PLoS One 2021; 16:e0259641. [PMID: 34797828 PMCID: PMC8604344 DOI: 10.1371/journal.pone.0259641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Prophylactic administration of antibiotics within 24 hours of surgery is recommended to reduce the risk of infection. We conducted a prospective study to compare the efficacy of single administration of antibiotics with a historical control of continuous administration of antibiotics for radiofrequency ablation (RFA) of malignant liver tumors. Methods Between February 1, 1999 and November 30, 2010, a total of 6,763 RFA treatments were performed in 2,355 patients, using a protocol with continuous administration of prophylactic antibiotics. On December 1, 2010, we began using a revised protocol with a single administration of prophylactic antibiotics, while continuing to use the old continuous administration protocol for patients who declined the new protocol. Interim analysis was performed to assess the safety of the single administration protocol. Thereafter, from April 1, 2012, all patients were treated using the new protocol. Risk factors for infectious complications of RFA were assessed using logistic regression. Results From December 2010 to March 2012, 766 RFA treatments were performed in 663 patients using the new antibiotic protocol. Infectious complications were observed following 4 of these treatments (0.52%). As the upper limit of the confidence interval (CI) resulting from a one-sided binomial test was exactly the prespecified limit of 1.0%, from April 2012 onwards, we treated all patients using the new protocol with single administration of prophylactic antibiotics. A total of 3,547 RFA treatments were performed using the single administration protocol. Univariable logistic regression indicated that prior transcatheter arterial chemoembolization (TACE) and maximal tumor diameter were significant risk factors for infectious complications (P = 0.04 and P < 0.001, respectively). Multivariable analysis indicated that the adjusted hazard ratio of single vs. continuous administration of antibiotics was 1.20 (95% CI: 0.53–2.75; P = 0.66). Conclusions The rate of infectious complications related to RFA was acceptably low. Single administration of prophylactic antibiotics did not significantly increase the rate of infectious complications related to RFA, compared with a more intensive antibiotic protocol.
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Affiliation(s)
- Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Shintaro Mikami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taijiro Wake
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Xu Y, Guo Q, Wei L. The Emerging Influences of Alpha-Fetoprotein in the Tumorigenesis and Progression of Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13205096. [PMID: 34680245 PMCID: PMC8534193 DOI: 10.3390/cancers13205096] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, and its mortality rate is the third-highest, after lung cancer and colorectal cancer. Currently, systematic targeted therapies for HCC mainly include multiple kinase inhibitors and immunotherapy. However, these drugs carry a black-box warning about the potential for inducing severe toxicity, and they do not significantly prolong the survival period of patients due to the highly heterogeneous characteristics of HCC etiology. In order to improve the prediction, effective treatment and prognosis of HCC, the tools and different biomarkers in clinical practices are recommended. Alpha-fetoprotein (AFP) is the earliest and the most widely used serum marker in the detection of HCC. Interestingly, serum AFP and cytoplasmic AFP show different, even opposite, roles in the cancer progression of HCC. This review focuses on biological characteristics, regulatory mechanisms for gene expression, emerging influences of AFP in HCC and its possible implications in HCC-targeted therapy.
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Affiliation(s)
| | | | - Libin Wei
- Correspondence: ; Tel./Fax: +86-25-83271055
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14
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Yacoub JH, Hsu CC, Fishbein TM, Mauro D, Moon A, He AR, Bashir MR, Burke LMB. Therapies for hepatocellular carcinoma: overview, clinical indications, and comparative outcome evaluation-part one: curative intention. Abdom Radiol (NY) 2021; 46:3528-3539. [PMID: 33835223 DOI: 10.1007/s00261-021-03069-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) offers unique management challenges as it commonly occurs in the setting of underlying chronic liver disease. The management of HCC is directed primarily by the clinical stage. The most commonly used staging system is the Barcelona-Clinic Liver Cancer system, which considers tumor burden based on imaging, liver function and the patient's performance status. Early-stage HCC can be managed with therapies of curative intent including surgical resection, liver transplantation, and ablative therapies. This manuscript reviews the various treatment options for HCC with a curative intent, such as locablative therapy types, surgical resection, and transplant. Indications, contraindications and outcomes of the various treatment options are reviewed. Multiple concepts relating to liver transplant are discussed including Milan criteria, OPTN policy, MELD exception points, downstaging to transplant and bridging to transplant.
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Affiliation(s)
- Joseph H Yacoub
- Department of Radiology, Medstar Georgetown University Hospital, Georgetown University, 3800 Reservoir Rd, NW, Suite CG201, Washington DC, 20007, USA.
| | - Christine C Hsu
- Medstar Georgetown Transplant Institute, Georgetown University, Washington DC, USA
| | - Thomas M Fishbein
- Medstar Georgetown Transplant Institute, Georgetown University, Washington DC, USA
| | - David Mauro
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27514, USA
| | - Andrew Moon
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27514, USA
| | - Aiwu R He
- Department of Medicine, Georgetown University, Washington DC, USA
| | - Mustafa R Bashir
- Department of Radiology and Medicine (Gastroenterology), Duke University School of Medicine, Durham, NC, 27710, USA
- Center for Advanced Magnetic Resonance Development, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lauren M B Burke
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27514, USA
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15
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Chen L, Liu ZX, Bi QC, Zhao J, Liang QR, Tang Q. Ultrasound-Guided Percutaneous Ethanol-Paclitaxel Combined Therapy for Rabbit VX2 Liver Tumors. J Hepatocell Carcinoma 2021; 8:263-270. [PMID: 33907696 PMCID: PMC8068506 DOI: 10.2147/jhc.s301083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background It is difficult to achieve whole tumor ablation using percutaneous ethanol ablation therapy (PEAT) due to the limited diffusion of ethanol. Purpose To determine whether chemotherapy can be an adjuvant therapy to benefit PEAT, we investigated ultrasound-guided percutaneous ethanol-paclitaxel combined therapy (PEPCT) of VX2 carcinoma, a rabbit liver cancer model. Materials and Methods A six-arm study was designed to quantify the correlation between paclitaxel (PTX) dose and tumor necrosis or cell proliferation, including sham group (2 mL saline, n=6), incremented dose of PTX (0, 12.5, 25, 37.5 mg) in 2.0 mL ethanol (n=6) and a conventional PEAT group (n=6) as comparison. The test was followed by contrast-enhanced ultrasonic (CEUS) before 7-day sacrifice, tumor harvest, and sectioning. Tumor necrosis ratio was radiologically and histologically quantified; modified proliferation index (m-PI) was proposed to quantify the PTX's pharmacological effects. A linear regression model was set to correlate the PTX dose with tumor necrosis ratio or cell proliferation index. The difference of radiological, histological necrosis ratio (HNR) and modified PI in six groups was analyzed via Kruskal-Wallis H-test, Welch analysis of variance and one-way ANOVA. Results Incremental increases of PTX (0, 12.5, 25, 37.5 mg) correlated with greater fraction of tumor necrosis (R2 = 0.946, P<0.001 for radiological necrosis ratio [RNR], R2 = 0.843, P<0.001 forHNR), indicating that one week after procedure PTX's anti-proliferation and ethanol's dehydration co-induced severe tumor necrosis. Correlation analysis further testified a significant association between PTX dose and m-PI (R2 = 0.860, P<0.001). Conclusion These results suggest a clear role for PTX-induced cytotoxicity and support the use of chemotherapeutic drugs in ablation therapy.
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Affiliation(s)
- Li Chen
- Department of Ultrasonic Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhi-Xing Liu
- Department of Ultrasonic Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qiu-Chen Bi
- Institute for Advanced Study, Nanchang University, Nanchang, People's Republic of China
| | - Jun Zhao
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Qing-Rong Liang
- Institute for Advanced Study, Nanchang University, Nanchang, People's Republic of China
| | - Qun Tang
- Institute for Advanced Study, Nanchang University, Nanchang, People's Republic of China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, People's Republic of China.,Jiangxi Province Key Laboratory of Laboratory Animal, Nanchang, People's Republic of China
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16
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Kamarajah SK, Bundred JR, Littler P, Reeves H, Manas DM, White SA. Treatment strategies for early stage hepatocellular carcinoma: a systematic review and network meta-analysis of randomised clinical trials. HPB (Oxford) 2021; 23:495-505. [PMID: 33309569 DOI: 10.1016/j.hpb.2020.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several treatment strategies for early stage hepatocellular cancers (HCC) have been evaluated in randomised controlled trials (RCTs). This network meta-analysis (NMA) aimed to explore the relative effectiveness of these different approaches on their impact on overall (OS) and recurrence-free survival (RFS). METHODS A systematic review was conducted to identify RCT's reported up to 23rd January 2020. Indirect comparisons of all regimens were simultaneously compared using random-effects NMA. RESULTS Twenty-eight RCT's, involving 3,618 patients, reporting 13 different treatment strategies for early stage HCC were identified. Median follow-up, reported in 22 studies, ranged from 12-93 months. In this NMA, RFA in combination with iodine-125 was ranked first for both RFS (HR: 0.50, 95% CI: 0.19-1.31) and OS (HR: 0.41, 95% CI: 0.19-0.94). In subgroup with solitary HCC, lack of studies reporting RFS precluded reliable analysis. However, RFA in combination with iodine-125 was associated with markedly better OS (HR: 0.21, 95% CI: 0.05-0.93). CONCLUSION This NMA identified RFA in combination with iodine-125 as a treatment delivering better RFS and OS, in patients with early stage HCC, especially for those with solitary HCC. This technique warrants further evaluation in both Asia and Western regions.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, Tyne and Wear, UK; Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK.
| | - James R Bundred
- Leeds Teaching Hospitals NHS Trust Research and Innovation Department, Leeds, UK
| | - Peter Littler
- Department of Interventional Radiology, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Reeves
- Newcastle University Centre for Cancer, Newcastle University Medical School, Newcastle upon Tyne, UK; Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Derek M Manas
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
| | - Steven A White
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, Tyne and Wear, UK
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17
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Meng ZW, Cai XR, Lin CZ, Chen YL, Liu S. The Islanding effect - a special method of percutaneous peritumor ethanol injection for hepatocellular carcinoma: 15-year follow-up outcome. Medicine (Baltimore) 2021; 100:e24365. [PMID: 33546073 PMCID: PMC7837841 DOI: 10.1097/md.0000000000024365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/19/2020] [Indexed: 12/28/2022] Open
Abstract
Percutaneous ethanol injection is a well-known ablation therapy for hepatocellular carcinoma and is well-tolerated, inexpensive, and effective with few adverse events. In this study, another type of ethanol injection was introduced in the present study.Sixty two patients with hepatocellular carcinoma received 133 percutaneous peritumor ethanol injection treatments and the 15-year follow-up outcomes were analyzed through a collected database.The technical efficiency was 89.5% (119/133 treatments) after the first percutaneous peritumor ethanol injection procedure. However, after the second repeated percutaneous peritumor ethanol injection procedure, technical efficiency increased to 98.5% (131/133 treatments). The 1 year, 3 years, 5 years, 10 years, and 15 years rates of tumor recurrence were 12.9%, 50.0%, 59.7%, 74.2%, and 74.2%, respectively. Multivariate analysis demonstrated that diabetes, Child-Pugh class B, and tumor size greater than 2 cm were significantly related to tumor recurrence. The 1 year, 3 years, 5 years, 10 years, and 15 years rates of overall survival were 98.4%, 83.6%, 61.3%, 19.4%, and 0%, respectively. Multivariate analysis demonstrated that Child-Pugh class B, tumor size greater than 2 cm, and multiple tumors were significantly related to overall survival.Compared with other ablation methods (including peritumor ethanol injection), percutaneous peritumor ethanol injection can avoid tumor ruptures, reduce tumor proliferation and metastasis, and is suitable for the treatment of small tumors. In addition, when combined with other treatment methods, percutaneous peritumor ethanol injection can form a tumor metastatic isolation zone in advance and improve the comprehensive treatment effect.
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18
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Hamid S, Alvares da Silva MR, Burak KW, Chen T, Drenth JP, Esmat G, Gaspar R, LaBrecque D, Lee A, Macedo G, McMahon B, Ning Q, Reau N, Sonderup M, van Leeuwen DJ, Armstrong D, Yurdaydin C. WGO Guidance for the Care of Patients With COVID-19 and Liver Disease. J Clin Gastroenterol 2021; 55:1-11. [PMID: 33230011 PMCID: PMC7713641 DOI: 10.1097/mcg.0000000000001459] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
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Affiliation(s)
- Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Kelly W. Burak
- Department of Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands
| | - Gamal Esmat
- Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Douglas LaBrecque
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alice Lee
- Hepatitis Program, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
| | - Mark Sonderup
- Department of Medicine, Division of Hepatology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dirk J. van Leeuwen
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Armstrong
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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Cardarelli-Leite L, Hadjivassiliou A, Klass D, Chung J, Ho SGF, Lim HJ, Kim PTW, Mujoomdar A, Liu DM. Current locoregional therapies and treatment strategies in hepatocellular carcinoma. ACTA ACUST UNITED AC 2020; 27:S144-S151. [PMID: 33343208 DOI: 10.3747/co.27.7171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Locoregional therapies (lrts) play an important role in the treatment of hepatocellular carcinoma (hcc), with the aim of increasing overall survival while preserving liver function. Various forms of lrt are available, and choosing the best one depends on technical aspects, liver morphology, tumour biology, and the patient's symptoms. The purpose of the present review article is to provide an overview of the current evidence relating to the use of percutaneous ablation, transarterial chemoembolization, and transarterial radioembolization for the curative or palliative treatment of hcc. Special situations are also reviewed, including the combined use of systemic therapy and lrt, indications and techniques for bridging to transplant and downstaging, and the use of lrt to treat patients with hcc and macrovascular invasion.
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Affiliation(s)
| | - A Hadjivassiliou
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - D Klass
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - J Chung
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - S G F Ho
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - H J Lim
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - P T W Kim
- Department of Surgery, University of British Columbia, Vancouver, BC
| | - A Mujoomdar
- Department of Medical Imaging, Western University, London, ON
| | - D M Liu
- Department of Radiology, University of British Columbia, Vancouver, BC
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20
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Chen Z, Xie H, Hu M, Huang T, Hu Y, Sang N, Zhao Y. Recent progress in treatment of hepatocellular carcinoma. Am J Cancer Res 2020; 10:2993-3036. [PMID: 33042631 PMCID: PMC7539784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. In the past decade, there have been improvements in non-drug therapies and drug therapies for HCC treatment. Non-drug therapies include hepatic resection, liver transplantation, transarterial chemoembolization (TACE) and ablation. The former two surgical treatments are beneficial for patients with early and mid-stage HCC. As the first choice for non-surgical treatment, different TACE methods has been developed and widely used in combination therapy. Ablation has become an important alternative therapy for the treatment of small HCC or cases of unresectable surgery. Meanwhile, the drugs including small molecule targeted drugs like sorafenib and lenvatinib, monoclonal antibodies such as nivolumab are mainly used for the systematic treatment of advanced HCC. Besides strategies described above are recommended as first-line therapies due to their significant increase in mean overall survival, there are also potential drugs in clinical trials or under preclinical development. In addition, a number of potential preclinical surgical or adjuvant therapies are being studied, such as oncolytic virus, mesenchymal stem cells, biological clock, gut microbiome composition and peptide vaccine, all of which have shown different degrees of inhibition on HCC. With some potential anti-HCC drugs being reported, many promising therapeutic targets in related taxonomic signaling pathways including cell cycle, epigenetics, tyrosine kinase and so on that affect the progression of HCC have also been found. Together, the rational application of existing therapies and drugs as well as the new strategies will bring a bright future for the global cure of HCC in the coming decades.
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Affiliation(s)
- Zhiqian Chen
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Hao Xie
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Mingming Hu
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Tianyi Huang
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Yanan Hu
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
| | - Na Sang
- Cancer Center, West China Hospital, West China Medical School, and Collaborative Innovation Center for Biotherapy, Sichuan UniversityChengdu 610041, China
| | - Yinglan Zhao
- West China School of Pharmacy, Sichuan UniversityChengdu 610041, China
- Cancer Center, West China Hospital, West China Medical School, and Collaborative Innovation Center for Biotherapy, Sichuan UniversityChengdu 610041, China
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21
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Satiya J, Schwartz I, Tabibian JH, Kumar V, Girotra M. Ablative therapies for hepatic and biliary tumors: endohepatology coming of age. Transl Gastroenterol Hepatol 2020; 5:15. [PMID: 32258519 PMCID: PMC7063520 DOI: 10.21037/tgh.2019.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Ablative therapies refer to minimally invasive procedures performed to destroy abnormal tissue that may arise with many conditions, and can be achieved clinically using chemical, thermal, and other techniques. In this review article, we explore the different ablative therapies used in the management of hepatic and biliary malignancies, namely hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), with a particular focus on radiofrequency ablation (RFA) and photodynamic therapy (PDT) techniques.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, West Palm Beach, FL, USA
| | - Ingrid Schwartz
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - James H. Tabibian
- Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Vivek Kumar
- Gastroenterology and Hepatology, UPMC Susquehanna, Williamsport, PA, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Hatanaka T, Kakizaki S, Nagashima T, Namikawa M, Tojima H, Shimada Y, Takizawa D, Naganuma A, Arai H, Sato K, Harimoto N, Shirabe K, Uraoka T. Analyses of objective response rate, progression-free survival, and adverse events in hepatocellular carcinoma patients treated with lenvatinib: A multicenter retrospective study. Hepatol Res 2020; 50:382-395. [PMID: 31760660 DOI: 10.1111/hepr.13460] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/20/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to investigate the predictive factors of objective response rate (ORR) and progression-free survival (PFS), and the correlation of albumin-bilirubin (ALBI) grade with decreased appetite and fatigue in hepatocellular carcinoma patients treated with lenvatinib. METHODS From March 2018 to December 2018, a total of 94 patients was included in this retrospective multicenter study. RESULTS The median age of all patients was 73 years (interquartile range 66-79.3 years), and approximately 78% patients were men. The ALBI grade was 1, 2, and 3 in 27 (28.7%), 64 (68.1%), and three patients (3.2%), respectively. The Barcelona Clinic Liver Cancer stage was early, intermediate, and advanced in one (1.1%), 22 (23.4%), and 71 patients (75.5%), respectively. Best radiological response was determined to complete response, partial response, stable disease, and progressive disease in 0 (0.0%), 24 (30.4%), 38 (48.1%), and 17 patients (21.5%), respectively, giving the ORR of 30.4%. The 3-, 6-, and 12-month PFS was calculated to be 78.7% (95% CI 70.3-87.1%), 46.7% (95% CI 36.1-57.3%), and 17.4% (95% CI 6.6-28.2%). Multivariate analysis showed that the Barcelona Clinic Liver Cancer intermediate stage was shown to be the only significant factor affecting the ORR (odds ratio 3.78, 95% CI 1.14-12.5, P = 0.030) and PFS (hazard ratio 0.49, 95% CI 0.26-0.94, P = 0.030). The incidence of all grades of decreased appetite and fatigue was significantly less in patients with ALBI grade 1 compared with ALBI grade 2 + 3. CONCLUSIONS The Barcelona Clinic Liver Cancer intermediate stage was the predictive factor affecting the ORR and PFS, and ALBI grade was a good predictive factor affecting the incidence of fatigue and decreased appetite.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Tamon Nagashima
- Department of Gastroenterology, National Hospital Organization Shibukawa Medical Center
| | | | - Hiroki Tojima
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | | | | | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Norifumi Harimoto
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
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Baidoo SA, Sarkodie EK, Boakye-Yiadom KO, Kesse S. Nanomedicinal delivery systems for intelligent treatment of hepatocellular carcinoma. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Oncul S, Karakaya G, Dilsiz Aytemir M, Ercan A. A kojic acid derivative promotes intrinsic apoptotic pathway of hepatocellular carcinoma cells without incurring drug resistance. Chem Biol Drug Des 2019; 94:2084-2093. [PMID: 31495064 DOI: 10.1111/cbdd.13615] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/09/2019] [Accepted: 08/03/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Selin Oncul
- Department of Biochemistry Faculty of Pharmacy Hacettepe University Ankara Turkey
| | - Gulsah Karakaya
- Department of Pharmaceutical Chemistry Faculty of Pharmacy Hacettepe University Ankara Turkey
| | - Mutlu Dilsiz Aytemir
- Department of Pharmaceutical Chemistry Faculty of Pharmacy Hacettepe University Ankara Turkey
| | - Ayse Ercan
- Department of Biochemistry Faculty of Pharmacy Hacettepe University Ankara Turkey
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25
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Chen Z, Jian Z, Wu X, Wang J, Peng J, Lao X. Clinical conditions and treatment requirements for long-term survival among hepatitis B-related hepatocellular carcinoma initially treated with chemoembolization. Cancer Med 2019; 8:5097-5107. [PMID: 31313476 PMCID: PMC6718579 DOI: 10.1002/cam4.2380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Transarterial chemoembolization (TACE) is recommended to treat intermediate/advanced stage of hepatocellular carcinoma (HCC). However, the overall survival among initially TACE-treated patients varies significantly. The clinical characterization of long-term survival following TACE remains uncertain. We sought to identify clinical parameters and treatment requirements for long-term survival among patients with hepatitis B-related HCC who were initially treated with TACE. MATERIALS AND METHODS The included patients with HCC were admitted to our cancer center between December 2009 and May 2015. Patients who survived for >3 years were compared with those who died within 3 years. The clinical and laboratory findings that were associated with the survival were also analyzed. RESULTS One in six (17.9%) patients with HCC in this cohort survived for > 3 years after TACE. Body mass index (BMI) ≥ 23kg/m2 , aspartate aminotransferase levels ≤ 40 U/L, an activated partial thromboplastin time ≤ 34 seconds, α-fetoprotein (AFP) levels ≤ 25 ng/mL, antiviral therapy, tumor size ≤ 8 cm, solitary nodule, and the absence of vascular invasion were independently favorably associated with a 3-year survival. An absence of vascular invasion was the only independent factor associated with 3-year survival in patients who received resection and/or ablation after TACE. CONCLUSION In this cohort, a 3-year survival was associated with BMI, antivirus treatment, tumor status, hepatic function, and AFP level. Distant metastasis did not negatively impact the long-term survival among patients with hepatitis B-related HCC initially treated with TACE. Vascular invasion was the single impediment to long-term survival in patients who received add-on resection and/or ablation after TACE.
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Affiliation(s)
- Zhen‐Xin Chen
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Zhi‐Wei Jian
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Xi‐Wen Wu
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Jun‐Cheng Wang
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Jing‐Yuan Peng
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Xiang‐Ming Lao
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
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Precision Locoregional Therapies for Hepatocellular Carcinoma: Percutaneous Ablation and Radiotherapy. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-21540-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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27
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Liu B, Long J, Wang W, Huang T, Xie X, Chen S, Huang G, Jiang C, Ye J, Long H, Xie X, Kuang M. Predictive factors of treatment outcomes after percutaneous ablation of hepatocellular carcinoma in the caudate lobe: a retrospective study. BMC Cancer 2019; 19:699. [PMID: 31311502 PMCID: PMC6636011 DOI: 10.1186/s12885-019-5881-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 06/25/2019] [Indexed: 02/08/2023] Open
Abstract
Background Hepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult. The aim of this study is to summarize the experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and to investigate the predictive factors of the treatment outcomes. Methods From August 2006 to June 2017, 73 patients (63 males and 10 females; mean age, 54.9 ± 11.6 years; age range, 25–79 years) with 73 caudate lobe HCCs (mean size, 2.6 ± 1.1 cm; size range, 1.0–5.0 cm) were treated with percutaneous ablation, including 33 patients with radiofrequency ablation (RFA), 23 patients with ethanol ablation (EA), and 17 patients with combination of RFA and EA. The treatment outcome and survival after ablation for caudate lobe HCC were assessed and the predictive factors were calculated by univariate and multivariate analyses. Results A total of 72 patients achieved complete ablation after the first or second session of ablation. The treatment effectiveness was 98.6% (72/73). During the follow-up, 16 tumors developed local tumor progression (LTP) and a total of 61 patients (61/73, 83.6%) were detected distant recurrence (DR). According to univariate and multivariate analyses, tumor size > 2 cm (hazard ratio[HR] = 3.667; 95% confidence interval[CI], 1.043–12.889; P = 0.043) was a significant prognostic factor of LTP after ablation for HCC in the caudate lobe, while tumor number (HR = 2.245; 95%CI, 1.168–4.317; P = 0.015) was a significant prognostic factor of DR. The mean overall survival time after ablation was 28.7 ± 2.8 months, without independent predictive factors detected. Four patients (4/73, 5.5%) were detected treatment-related major complications, without independent predictive factor detected. Conclusion Ultrasound-guided percutaneous ablation is a feasible treatment for a selected case with HCC in the caudate lobe. Tumor size > 2 cm increases the risk of LTP and intrahepatic tumor number is associated with DR after ablation.
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Affiliation(s)
- Baoxian Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jianting Long
- Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wei Wang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Tongyi Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaohua Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shuling Chen
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chunlin Jiang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jieyi Ye
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Haiyi Long
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Ming Kuang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China. .,Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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28
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Lee CH, Hsieh SY, Huang WH, Wang IK, Yen TH. Association between Ambient Particulate Matter 2.5 Exposure and Mortality in Patients with Hepatocellular Carcinoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:2490. [PMID: 31336910 PMCID: PMC6678370 DOI: 10.3390/ijerph16142490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/26/2019] [Accepted: 07/06/2019] [Indexed: 12/11/2022]
Abstract
Air pollution is a severe public health problem in Taiwan. Moreover, Taiwan is an endemic area for hepatocellular carcinoma (HCC). This study examined the effect of particulate matter 2.5 (PM2.5) exposure on mortality in this population. A total of 1003 patients with HCC treated at Chang Gung Memorial Hospital between 2000 and 2009 were included in this study. At the end of the analysis, 288 (28.7%) patients had died. Patients with HCC living in environments with PM2.5 concentrations of ≥36 µg/m3 had a higher mortality rate than patients living in environments with PM2.5 concentrations of <36 µg/m3 (36.8% versus 27.5%, p = 0.034). The multivariate Cox regression analysis confirmed that PM2.5 ≥ 36 µg/m3 was a significant risk factor for mortality (1.584 (1.162-2.160), p = 0.004). A nonlinear relationship was observed between the odds ratio and PM2.5. The odds ratio was 1.137 (1.015-1.264) for each increment of 5 µg/m3 in PM2.5 or 1.292 (1.030-1.598) for each increment of 10 µg/m3 in PM2.5. Therefore, patients with HCC exposed to ambient PM2.5 concentrations of ≥36 µg/m3 had a 1.584-fold higher risk of death than those exposed to PM2.5 concentrations of <36 µg/m3. Further studies are warranted.
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Affiliation(s)
- Chern-Horng Lee
- Division of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Hung Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung 404, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
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Wake T, Tateishi R, Nakagomi R, Fujiwara N, Kinoshita MN, Nakatsuka T, Sato M, Minami T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Tanaka Y, Shiina S, Koike K. Ischemic complications after percutaneous radiofrequency ablation of liver tumors: Liver volume loss and recovery. Hepatol Res 2019; 49:453-461. [PMID: 30570810 DOI: 10.1111/hepr.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/06/2018] [Accepted: 12/15/2018] [Indexed: 02/08/2023]
Abstract
AIM The liver regrows after acute liver injury and liver resection. However, it is not clear whether the liver regenerates in advanced cirrhosis. This study aimed to evaluate the clinical course of, and liver volume change after, ischemic liver complications caused by radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS We enrolled 35 patients with ischemic complications after RFA. Ischemic complications were defined as rapid elevation of aspartate aminotransferase (AST) to over 500 U/L, with typical radiological findings. Patient characteristics and the ischemic liver volume were investigated. Long-term liver volume changes at 3-8 months after ischemic complications were also assessed in 32 patients. We also assessed the overall survival rate after ischemic complications. RESULTS The median value of peak AST was 798 U/L (range, 531-4096 U/L). The median ischemic liver volume relative to the functional liver volume before RFA was 13% (range, 3.1-46.5%). There was a strong correlation between the peak AST value and the ischemic liver volume (r = 0.84, P < 0.001). The liver volume recovered to some extent in 18 of 32 (56%) patients after ischemic complications. The survival rate after ischemic complications was 45.7% at 5 years and correlated with the functional liver volume after ischemic complications (P = 0.02). CONCLUSIONS Ischemic complications after RFA can lead to massive liver parenchymal loss. Although the liver volume recovered to some extent in the majority of our patients, ischemic liver complications after RFA should be avoided to improve the overall survival rate.
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Affiliation(s)
- Taijiro Wake
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuo Tanaka
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Lee DH, Lee JM. Recent Advances in the Image-Guided Tumor Ablation of Liver Malignancies: Radiofrequency Ablation with Multiple Electrodes, Real-Time Multimodality Fusion Imaging, and New Energy Sources. Korean J Radiol 2018; 19:545-559. [PMID: 29962861 PMCID: PMC6005950 DOI: 10.3348/kjr.2018.19.4.545] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/27/2018] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) has emerged as an effective loco-regional treatment modality for malignant hepatic tumors. Indeed, studies have demonstrated that RFA of early stage hepatocellular carcinomas can provide comparable overall survival to surgical resection. However, the incidence of local tumor progression (LTP) after RFA is significantly higher than that of surgical resection. Thus, to overcome this limitation, multiple electrode radiofrequency (RF) systems that use a multi-channel RF generator have been developed, and they demonstrate better efficiency in creating larger ablation zones than that using the conventional RFA with a single electrode. Furthermore, RFA with multiple electrodes can allow the “no-touch” ablation technique which may also help to reduce LTP. Another technique that would be helpful in this regard is multi-modality-ultrasound fusion imaging, which helps to not only more accurately determine the target lesion by enabling the RFA of small, poorly visible or invisible tumors, but also improve the monitoring of procedures and determine the appropriateness of the ablation margin. In addition, new energy sources, including microwave and cryoablation, have been introduced in imaging-guided tumor ablation. In this review, these recently introduced ablation techniques and the results of the most current animal and clinical studies are discussed.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
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Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol 2018; 2018:4756147. [PMID: 29974040 PMCID: PMC6008833 DOI: 10.1155/2018/4756147] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/03/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023] Open
Abstract
Image-guided percutaneous ablation is considered best in the treatment of early-stage hepatocellular carcinoma (HCC). Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. Ethanol injection used to be the standard in ablation. However, radiofrequency ablation has recently been the most prevailing ablation method for HCC. Many investigators have reported that radiofrequency ablation is superior to ethanol injection, from the viewpoints of treatment response, local tumor curativity, and overall survival. New-generation microwave ablation can create a larger ablation volume in a shorter time period. Further comparison studies are, however, mandatory between radiofrequency ablation and microwave ablation, especially in terms of complications and long-term survival. Irreversible electroporation, which is a non-thermal ablation method that delivers short electric pulses to induce cell death due to apoptosis, requires further studies, especially in terms of long-term outcomes. It is considerably difficult to compare outcomes in ablation with those in surgical resection. However, radiofrequency ablation seems to be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis. Furthermore, radiofrequency ablation may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. Various innovations would further improve outcomes in ablation. Training programs may be effective in providing an excellent opportunity to understand basic concepts and learn cardinal skills for successful ablation. Sophisticated ablation would be more than an adequate alternative of surgery for small- and possibly middle-sized HCC.
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Takayasu K, Arii S, Sakamoto M, Matsuyama Y, Kudo M, Kaneko S, Nakashima O, Kadoya M, Izumi N, Takayama T, Ku Y, Kumada T, Kubo S, Kokudo T, Hagiwara Y, Kokudo N. Impact of resection and ablation for single hypovascular hepatocellular carcinoma ≤2 cm analysed with propensity score weighting. Liver Int 2018; 38:484-493. [PMID: 29266722 DOI: 10.1111/liv.13670] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/09/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Small hypovascular hepatocellular carcinoma (HCC) ≤2 cm is biologically less aggressive than hypervascular one, however, the optimal treatment is still undetermined. The efficacy of surgical resection (SR), radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) was evaluated. METHODS The 853 (SR, 176; RFA, 491; PEI, 186) patients were enrolled who met Child-Pugh A/B, single hypovascular HCC ≤2 cm pathologically proven, available tumour differentiation and absence of macrovascular invasion and extrahepatic metastasis. Overall and recurrence-free survivals were compared in original and a propensity score weighted pseudo-population with 732 patients. RESULTS The median follow-up time and tumour size were 2.8 years and 1.47 cm respectively. In original population, multivariate Cox regression showed no significant difference for overall survival among three groups. In pseudo-population, Cox regression also revealed no significant difference for overall survival among them, although SR (HR, 0.56; 95% CI, 0.36-0.86) and RFA (HR, 0.75; 95% CI, 0.57-1.00) groups had significantly lower recurrence than PEI group. The overall survival rates at 3 and 5 years for the SR, RFA and PEI groups were 94%/70%, 90%/75% and 94%/73% respectively. Corresponding recurrence-free survival rates were 64%/54%, 59%/41% 48%/33% respectively. Subgroup analysis revealed no significant survival benefit of SR compared with non-SR. No treatment-related death occurred. CONCLUSIONS For patients with single hypovascular HCC ≤2 cm, no significant difference for overall survival was first identified among 3 treatment groups. The SR or RFA could be recommended, and PEI would be alternative to RFA.
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Affiliation(s)
- Kenichi Takayasu
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Arii
- Department of Hepato-Biliary-Pancreatic Surgery, Hamamatsu Rosai Hospital, Japan Labor Health and Welfare Organization, Hamamatsu, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Sayama, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University School of Medical Science, Kanazawa, Japan
| | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
| | - Masumi Kadoya
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yonson Ku
- Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiro Hagiwara
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
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Zhang RG, Zhang XL, Yang YS. Alcoholization of pyogenichepatic abscess with absolute alcohol in Bama minipigs. Exp Ther Med 2017; 14:4483-4488. [PMID: 29067123 DOI: 10.3892/etm.2017.5022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/26/2017] [Indexed: 11/05/2022] Open
Abstract
Pyogenic hepatic abscess (PHA) is a rare, but potentially serious disease. At present, ultrasound-guided or computed tomography-guided percutaneous needle aspiration or catheter drainage is appropriate as a first-line treatment. However, it is difficult to aspirate or drain pus and to select the appropriate antibiotic therapy if the abscess consists of thick pus and polymicrobial confections, or its pathogenic bacterium is multidrug resistant and cryptogenic. Case studies of alcoholization provide a novel method to manage PHA. However, the efficacy and safety of this treatment should be further evaluated. In the present study, the therapeutic efficacy and complications of alcoholization for PHAs in Bama minipigs were investigated. PHAs were prospectively treated by ultrasound-guided percutaneous instillation of absolute alcohol in the abscess cavity. The criteria for considering a successful intervention were met in all minipigs subsequent to alcoholization twice within 14 days. The procedures were well tolerated in all animals, and there were no alcoholic adverse effects or procedure-associated complications. In conclusion, ultrasound-guided percutaneous alcoholization is a safe and effective procedure to manage PHA. The problems of thick pus aspiration and selection of an appropriate antibiotic observed in other treatments were resolved effectively using alcoholization. This technique may reduce the treatment period and possibly become a novel strategy for the management of PHA.
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Affiliation(s)
- Ru-Gang Zhang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xiu-Li Zhang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yun-Sheng Yang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Lee CH, Hsieh SY, Chang CC, Wang IK, Huang WH, Weng CH, Hsu CW, Yen TH. Hepatocellular carcinoma in hemodialysis patients. Oncotarget 2017; 8:73154-73161. [PMID: 29069858 PMCID: PMC5641201 DOI: 10.18632/oncotarget.17127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/01/2017] [Indexed: 02/06/2023] Open
Abstract
We investigated the rates and predictors of mortality in hepatocellular carcinoma (HCC) patients who were or were not undergoing long-term hemodialysis. The participants in this retrospective observational study were 1298 HCC patients (60.0 ± 12.1 years old, 72% male), of whom 172 were undergoing hemodialysis and 1126 were not. HCC patients on hemodialysis exhibited a higher hepatitis C virus carrier rate (49.4% versus 39.3%, P = 0.012), lower hepatitis B virus carrier rate (37.2% versus 58.3%, P < 0.001) and lower hepatitis B or C virus carrier rate (77.9% versus 89.3%, P < 0.001) than those not on hemodialysis. Serum alkaline phosphatase levels were higher in the hemodialysis than non-hemodialysis group (162.8 ± 141.1 u/l versus 124.6 ± 102.5 u/l, P < 0.001). By the end of the analysis, 32.0% of HCC patients on hemodialysis and 28.0% of those not on hemodialysis had died. Kaplan-Meier analysis confirmed that cumulative survival was poorer in HCC patients on hemodialysis (P = 0.004). In a multivariate Cox regression model, hemodialysis (P < 0.001), older age (P < 0.001) and advanced tumor stages (P < 0.001) were found to be risk factors for mortality. HCC patients on hemodialysis had a 2.036-fold greater chance of death than HCC patients not on hemodialysis. Prospective studies with longer follow-ups and larger samples are warranted.
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Affiliation(s)
- Chern-Horng Lee
- Department of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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35
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Eun HS, Lee BS, Kwon IS, Yun GY, Lee ES, Joo JS, Sung JK, Moon HS, Kang SH, Kim JS, Shin HJ, Kim TK, Chun K, Kim SH. Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma. Dig Dis Sci 2017; 62:2586-2600. [PMID: 28744835 DOI: 10.1007/s10620-017-4688-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inoperable hepatocellular carcinoma (HCC) can be treated with laparoscopic radiofrequency ablation (LRFA), which is generally a more accurate and accessible procedure than percutaneous RFA (PRFA). However, few studies have compared survival outcomes between LRFA and PRFA in patients with HCC. AIMS This study aimed to compare the efficacy of LRFA and PRFA for HCC treatment. METHODS Patients who underwent PRFA or LRFA as an initial treatment modality between April 2005 and April 2016 were enrolled in this study. The overall and recurrence-free survival rates were examined for each patient. Additionally, propensity score matching was performed for both groups. RESULTS The baseline characteristics of patients in the PRFA and LRFA groups showed several minor differences. Multivariate analysis showed that the RFA method was not a critical determinant of recurrence-free or overall survival (p = 0.069 and p = 0.406). Among patients who underwent RFA as the initial treatment modality, there was no significant effect between either RFA procedures on survival. After propensity score matching, univariate analysis showed a significant difference in overall survival between PRFA and LRFA (p = 0.031). Multivariate analysis showed that LRFA is a strong factor that contributed to an improved overall survival in HCC patients (hazard ratio 0.108, p = 0.040). Furthermore, our data showed that LRFA was able to limit multiple intrahepatic recurrences, as well as prevent marginal recurrence. CONCLUSIONS LRFA appears to be superior to PRFA in terms of survival. LRFA may help reduce mortality in HCC patients.
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Affiliation(s)
- Hyuk Soo Eun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Gee Young Yun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jong Seok Joo
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hae Jin Shin
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Tae Kyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
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36
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Symptom Clusters and Impact of Fatigue and Sleep Disturbance on Symptom Experiences of Hepatoma Patients in Taiwan. Cancer Nurs 2017; 40:403-411. [DOI: 10.1097/ncc.0000000000000417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, Tateishi R, Han KH, Chawla YK, Shiina S, Jafri W, Payawal DA, Ohki T, Ogasawara S, Chen PJ, Lesmana CRA, Lesmana LA, Gani RA, Obi S, Dokmeci AK, Sarin SK. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017; 11:317-370. [PMID: 28620797 PMCID: PMC5491694 DOI: 10.1007/s12072-017-9799-9] [Citation(s) in RCA: 1612] [Impact Index Per Article: 201.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.
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Affiliation(s)
- Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu-city, Yamanashi, Japan.
- The University of Tokyo, Tokyo, Japan.
| | - Ann-Lii Cheng
- Department of Oncology and Internal Medicine, National Taiwan University Hospital, National Taiwan University Cancer Center and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan
| | - Jeong Min Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jidong Jia
- Beijing Key Laboratory of Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoghesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Wasim Jafri
- Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan
| | | | - Takamasa Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cosmas Rinaldi A Lesmana
- Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Laurentius A Lesmana
- Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rino A Gani
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Shuntaro Obi
- Third Department of Internal Medicine, Teikyo University School of Medicine, Chiba, Japan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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38
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Yoon K, Kwak J, Cho B, Park JH, Yoon SM, Lee SW, Kim JH. Gated Volumetric-Modulated Arc Therapy vs. Tumor-Tracking CyberKnife Radiotherapy as Stereotactic Body Radiotherapy for Hepatocellular Carcinoma: A Dosimetric Comparison Study Focused on the Impact of Respiratory Motion Managements. PLoS One 2016; 11:e0166927. [PMID: 27875568 PMCID: PMC5119818 DOI: 10.1371/journal.pone.0166927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To assess the potential dosimetric benefits associated with the CyberKnife (CK) tumor tracking capability, wherein an extra margin for respiratory tumor motion is not required, when compared to respiratory-gated volumetric-modulated arc therapy (VMAT) for hepatocellular carcinoma (HCC). Methods Twenty-nine HCC patients previously treated with double-arc VMAT were enrolled. In each VMAT plan, the individual internal target volume (ITV) margin around the tumor was determined by measuring its motion over 30–70% of respiratory phases using four-dimensional computed tomography, followed by a 5-mm isotropic margin for the planning target volume (PTV). For each VMAT plan, two CK plans were generated using the original (CKoriginal, ITV included) and modified PTVs (CKmodified, ITV excluded) for comparison. In each case, the CKoriginal and CKmodified plans were compared to the original VMAT plan in terms of the dosimetric parameters including the conformity index (CI), PTV coverage (CO), organs at risk (OAR) doses, and normal liver tissue sparing. Results The original PTVs with median 24 cc (range, 9–65 cc) were significantly reduced to median 12 cc (range, 5–41 cc) in the CKmodified plans. Statistically significant differences in plan qualities were observed between the VMAT and the CK plans: mean CI, 1.05 in VMAT vs. 1.17 in both CK plans (p < 0.001); and mean CO, 93.0% in VMAT vs. 96.6% in CKoriginal and 96.9% in CKmodified (p < 0.001). The average volume of normal liver tissue receiving > 15 Gy was significantly decreased in the CKmodified plan, as compared to that in the VMAT and CKoriginal plans, by 1.75- and 1.61-fold, respectively. Conclusions The tumor tracking capability of the CK system can significantly decrease the volume of normal liver tissue receiving > 15 Gy, while maintaining high precision in target localization, conformity, tumor coverage, and dose sparing of the OAR. Therefore, it can be a valuable SBRT option, particularly for HCC patients with poor liver function.
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Affiliation(s)
- KyoungJun Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: ,
| | - Jin-hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Donadon M, Solbiati L, Dawson L, Barry A, Sapisochin G, Greig PD, Shiina S, Fontana A, Torzilli G. Hepatocellular Carcinoma: The Role of Interventional Oncology. Liver Cancer 2016; 6:34-43. [PMID: 27995086 PMCID: PMC5159721 DOI: 10.1159/000449346] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) remains a major health issue because of its increasing incidence and because of the complexity of its management. In addition to the traditional potentially curative treatments, i.e., liver transplantation and surgical resection, other new and emerging local therapies have been applied with promising results. SUMMARY Radiotherapy (RT) and interstitial treatments, such as radiofrequency ablation (RFA), microwave ablation (MWA), and irreversible electroporation (IRE), have recently opened new and interesting treatment scenarios for HCC and are associated with promising results in selected patients. Herein, we describe the emerging role of interventional oncology for the treatment of HCC and focus on the different Western and Eastern approaches. KEY MESSAGES Modern RT and modern interstitial therapies, such as RFA, MWA, and IRE, should be considered for inclusion in HCC therapy guidelines.
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Luigi Solbiati
- Department of Interventional Radiology, Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Laura Dawson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Aisling Barry
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Gonzalo Sapisochin
- Deparments of General Surgery and Multi Organ Transplantation, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paul D Greig
- Deparments of General Surgery and Multi Organ Transplantation, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Shuichiro Shiina
- Department of Gastroenterology, Junten-do University Graduate School of Medicine, Tokyo, Japan
| | - Andrea Fontana
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
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40
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Ai DL, Li BT, Peng XM, Zhang LZ, Wang JY, Zhao Y, Yang B, Yu Q, Liu CZ, Yang N, Wang HM, Zhou L. Acquired amegakaryocytic thrombocytopenic purpura induced by percutaneous ethanol injection during treatment of hepatocellular carcinoma: A case report. Oncol Lett 2016; 11:798-800. [PMID: 26870287 DOI: 10.3892/ol.2015.3934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/23/2015] [Indexed: 01/31/2023] Open
Abstract
Percutaneous ethanol injection is an important localized treatment method for patients presenting with hepatocellular carcinoma (HCC). Among the advantages of percutaneous ethanol injection are its minimal invasiveness, simplicity, low cost and low risk of complications. However, the increasing popularity of percutaneous ethanol injection has resulted in serious adverse effects attributed to individual variations. The present study describes the case of a patient who exhibited acquired amegakaryocytic thrombocytopenic purpura, caused by percutaneous ethanol injection treatment for HCC. This complication was promptly identified, and platelet transfusion and injection of recombinant human interleukin-11 resulted in a rapid recovery of the patient's platelet count. Attention should be given to this rare complication in patients administered percutaneous ethanol injection treatment for HCC.
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Affiliation(s)
- Ding-Lun Ai
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Bo-Tao Li
- Department of Hematopoietic Stem Cell Transplantation, Affiliated Hospital to the Chinese Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Xiao-Ming Peng
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Lin-Zhi Zhang
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Jing-Yan Wang
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Yun Zhao
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Bin Yang
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Qiang Yu
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Chun-Zi Liu
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Ning Yang
- Department of Clinical Laboratory, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Hua-Ming Wang
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
| | - Lin Zhou
- Department of Interventional Radiology, Beijing 302nd Hospital, Beijing 100039, P.R. China
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41
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Shen ZY, Xia GL, Wu MF, Ji LY, Li YJ. The effects of percutaneous ethanol injection followed by 20-kHz ultrasound and microbubbles on rabbit hepatic tumors. J Cancer Res Clin Oncol 2016; 142:373-378. [PMID: 26306908 DOI: 10.1007/s00432-015-2034-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 08/15/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Low-frequency ultrasound (US) in combination with microbubbles (MBs) is able to inhibit the growth of VX2 rabbit liver tumors. In this study, we investigated the feasibility of using percutaneous ethanol injection (PEI) followed by low-frequency ultrasound and microbubbles (USMB) to inhibit VX2 tumor growth. METHODS Eighteen New Zealand rabbits with hepatic VX2 tumors were divided into three groups: PEI, low-frequency ultrasound and MBs followed by PEI (USMB + PEI), and PEI followed by USMB (PEI + USMB). PEI was performed by ultrasound-guided injection of 95% anhydrous alcohol into internal liver tumors in rabbits twice a week for 2 weeks. The US parameters were 20 kHz, 2 W/cm(2), 40% duty cycle, 5 min, and once every other day for 2 weeks. Magnetic resonance imaging (MRI) was used to observe tumors before and after treatment, to examine changes in the tumors, and to measure the diameters of the tumors. All animals were followed up for 180 days after tumor implantation. Autopsy was performed at the end of the scheduled follow-up or immediately after death. Anatomically observed metastatic sites included the liver, lung, abdomen, and pelvic cavity. The survival time of all rabbits was recorded. RESULTS After 4 weeks of treatment, on MRI, the tumor diameters in the PEI, USMB + PEI, and PEI + USMB groups were 8.33 ± 1.83, 19 ± 2.61, and 4.5 ± 1.22 mm, respectively. There was a significant difference in tumor size indicated by MRI in the three groups. Tumor size was smaller in the PEI + USMB group than in the PEI and USMB + PEI groups, with t = 4.54, p = 0.0062, and t = 16.38, p < .0001, respectively. The PEI + USMB group showed the fewest metastasis sites (χ(2) = 11.7333, p = 0.0194) and the longest survival period (χ(2) = 7.448, p = 0.0241). CONCLUSION Percutaneous ethanol injection followed by low-frequency ultrasound and microbubbles can be effective in inhibiting rabbit liver tumors and prolonging survival time.
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Affiliation(s)
- Zhi Yong Shen
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, No. 30, North Tong-yang Road, Nantong, 226361, Jiangsu, China.
| | - Gan Lin Xia
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, No. 30, North Tong-yang Road, Nantong, 226361, Jiangsu, China
| | - Ming Feng Wu
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, No. 30, North Tong-yang Road, Nantong, 226361, Jiangsu, China
| | - Lei Yan Ji
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, No. 30, North Tong-yang Road, Nantong, 226361, Jiangsu, China
| | - Yong Jun Li
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, No. 30, North Tong-yang Road, Nantong, 226361, Jiangsu, China
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Paik EK, Kim MS, Choi CW, Jang WI, Lee SH, Choi SH, Kim KB, Lee DH. Dosimetric comparison of volumetric modulated arc therapy with robotic stereotactic radiation therapy in hepatocellular carcinoma. Radiat Oncol J 2015; 33:233-41. [PMID: 26484307 PMCID: PMC4607577 DOI: 10.3857/roj.2015.33.3.233] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 12/30/2022] Open
Abstract
Purpose To compare volumetric modulated arc therapy of RapidArc with robotic stereotactic body radiation therapy (SBRT) of CyberKnife in the planning and delivery of SBRT for hepatocellular carcinoma (HCC) treatment by analyzing dosimetric parameters. Materials and Methods Two radiation treatment plans were generated for 29 HCC patients, one using Eclipse for the RapidArc plan and the other using Multiplan for the CyberKnife plan. The prescription dose was 60 Gy in 3 fractions. The dosimetric parameters of planning target volume (PTV) coverage and normal tissue sparing in the RapidArc and the CyberKnife plans were analyzed. Results The conformity index was 1.05 ± 0.02 for the CyberKnife plan, and 1.13 ± 0.10 for the RapidArc plan. The homogeneity index was 1.23 ± 0.01 for the CyberKnife plan, and 1.10 ± 0.03 for the RapidArc plan. For the normal liver, there were significant differences between the two plans in the low-dose regions of V1 and V3. The normalized volumes of V60 for the normal liver in the RapidArc plan were drastically increased when the mean dose of the PTVs in RapidArc plan is equivalent to the mean dose of the PTVs in the CyberKnife plan. Conclusion CyberKnife plans show greater dose conformity, especially in small-sized tumors, while RapidArc plans show good dosimetric distribution of low dose sparing in the normal liver and body.
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Affiliation(s)
- Eun Kyung Paik
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chul Won Choi
- Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sung Hyun Lee
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sang Hyoun Choi
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Kum Bae Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dong Han Lee
- CyberKnife Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Park JW, Chen M, Colombo M, Roberts LR, Schwartz M, Chen PJ, Kudo M, Johnson P, Wagner S, Orsini LS, Sherman M. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015; 35:2155-66. [PMID: 25752327 PMCID: PMC4691343 DOI: 10.1111/liv.12818] [Citation(s) in RCA: 920] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 02/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the second most common cause of cancer deaths worldwide. The global HCC BRIDGE study was a multiregional, large-scale, longitudinal cohort study undertaken to improve understanding of real-life management of patients with HCC, from diagnosis to death. METHODS Data were collected retrospectively from January 2005 to September 2012 by chart reviews of eligible patients newly diagnosed with HCC at participating institutions. RESULTS Forty-two sites in 14 countries contributed final data for 18 031 patients. Asia accounted for 67% of patients, Europe for 20% and North America for 13%. As expected, the most common risk factor was hepatitis C virus in North America, Europe and Japan, and hepatitis B virus in China, South Korea and Taiwan. The most common Barcelona Clinic Liver Cancer stage at diagnosis was C in North America, Europe, China and South Korea, and A in Taiwan and Japan. Across all stages, first HCC treatment was most frequently transarterial chemoembolization in North America, Europe, China and South Korea, percutaneous ethanol injection or radiofrequency ablation in Japan and resection in Taiwan. Survival from first HCC treatment varied significantly by region, with median overall survival not reached for Taiwan and 60, 33, 31, 24 and 23 months for Japan, North America, South Korea, Europe and China respectively (P < 0.0001). CONCLUSIONS Initial results from the BRIDGE study confirm previously reported regional trends in patient demographic characteristics and HCC risk factors, document the heterogeneity of treatment approaches across regions/countries and underscore the need for earlier HCC diagnosis worldwide.
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Affiliation(s)
- Joong-Won Park
- Center for Liver Cancer, National Cancer CenterGoyang, Korea
| | - Minshan Chen
- Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Massimo Colombo
- Policlinic IRCCS Maggiore Hospital, University of MilanMilan, Italy
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo ClinicRochester, MN, USA
| | | | | | - Masatoshi Kudo
- Kinki University School of MedicineOsaka-Sayama, Osaka, Japan
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Kanda T, Ogasawara S, Chiba T, Haga Y, Omata M, Yokosuka O. Current management of patients with hepatocellular carcinoma. World J Hepatol 2015; 7:1913-1920. [PMID: 26244066 PMCID: PMC4517151 DOI: 10.4254/wjh.v7.i15.1913] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/02/2015] [Accepted: 06/04/2015] [Indexed: 02/06/2023] Open
Abstract
The current management therapies for hepatocellular carcinoma (HCC) patients are discussed in this review. Despite the development of new therapies, HCC remains a "difficult to treat" cancer because HCC typically occurs in advanced liver disease or hepatic cirrhosis. The progression of multistep and multicentric HCC hampers the prevention of the recurrence of HCC. Many HCC patients are treated with surgical resection and radiofrequency ablation (RFA), although these modalities should be considered in only selected cases with a certain HCC number and size. Although there is a shortage of grafts, liver transplantation has the highest survival rates for HCC. Several modalities are salvage treatments; however, intensive care in combination with other modalities or in combination with surgical resection or RFA might offer a better prognosis. Sorafenib is useful for patients with advanced HCC. In the near future, HCC treatment will include stronger molecular targeted drugs, which will have greater potency and fewer adverse events. Further studies will be ongoing.
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Affiliation(s)
- Tatsuo Kanda
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
| | - Sadahisa Ogasawara
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
| | - Tetsuhiro Chiba
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
| | - Yuki Haga
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
| | - Masao Omata
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
| | - Osamu Yokosuka
- Tatsuo Kanda, Sadahisa Ogasawara, Tetsuhiro Chiba, Yuki Haga, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8677, Japan
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45
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Sasaki R, Kanda T, Nakamoto S, Haga Y, Nakamura M, Yasui S, Jiang X, Wu S, Arai M, Yokosuka O. Natural interferon-beta treatment for patients with chronic hepatitis C in Japan. World J Hepatol 2015; 7:1125-1132. [PMID: 26052401 PMCID: PMC4450189 DOI: 10.4254/wjh.v7.i8.1125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/15/2015] [Accepted: 01/30/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection can cause liver cirrhosis and hepatocellular carcinoma (HCC). Several studies have demonstrated that the eradication of HCV reduces the occurrence of HCC. In Japan, as many people live to an advanced age, HCV-infected patients are also getting older, and the age at HCC diagnosis has also increased. Although older HCV-infected patients have a risk of developing HCC, the treatment response to peginterferon-alpha plus ribavirin therapy is relatively poor in these patients because of drop-out or discontinuation of this treatment due to adverse events. It is established that the mechanism of action between interferon-alpha and interferon-beta is slightly different. Short-term natural interferon-beta monotherapy is effective for patients with acute hepatitis C and patients infected with HCV genotype 2 and low viral loads. Natural interferon-beta plus ribavirin for 48 wk or for 24 wk are also effective for some patients with HCV genotype 1 or HCV genotype 2. Natural interferon-beta plus ribavirin has been used for certain "difficult-to-treat" HCV-infected patients. In the era of direct-acting anti-virals, natural interferon-beta plus ribavirin may be one of the therapeutic options for special groups of HCV-infected patients. In the near future, signal transduction pathways of interferon-beta will inform further directions.
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Affiliation(s)
- Reina Sasaki
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Tatsuo Kanda
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Shingo Nakamoto
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Yuki Haga
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Masato Nakamura
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Shin Yasui
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Xia Jiang
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Shuang Wu
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Makoto Arai
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
| | - Osamu Yokosuka
- Reina Sasaki, Tatsuo Kanda, Shingo Nakamoto, Yuki Haga, Masato Nakamura, Shin Yasui, Xia Jiang, Shuang Wu, Makoto Arai, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8670, Japan
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Rapaccini GL. Percutaneous ablative treatments of hepatocellular carcinoma. Hepatology 2015; 61:1465-6. [PMID: 25418611 DOI: 10.1002/hep.27615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/18/2014] [Indexed: 01/17/2023]
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Addissie BD, Roberts LR. Classification and staging of hepatocellular carcinoma: an aid to clinical decision-making. Clin Liver Dis 2015; 19:277-94. [PMID: 25921663 DOI: 10.1016/j.cld.2015.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Classification and staging of hepatocellular carcinoma in a way that allows optimal treatment selection is challenging. This article summarizes some of the classification and staging schemes and discusses the conceptual framework that guides optimal treatment selection for each patient. The article does not exhaustively discuss each staging system proposed in the last three decades, but rather reviews the most commonly used staging systems, evaluates the rationale behind some of the newer staging systems, and compares them focusing on their use in clinical decision-making, notably choice of therapy.
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Affiliation(s)
- Benyam D Addissie
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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Imai K, Beppu T, Chikamoto A, Mima K, Okabe H, Hayashi H, Nitta H, Ishiko T, Baba H. Salvage treatment for local recurrence of hepatocellular carcinoma after local ablation therapy. Hepatol Res 2014; 44:E335-45. [PMID: 24552247 DOI: 10.1111/hepr.12313] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 02/08/2023]
Abstract
AIM Local recurrence of hepatocellular carcinoma (HCC) after local ablation therapy (LAT) is a serious problem; however, the optimal treatment strategy remains unclear. METHODS A retrospective analysis was conducted of 50 patients with local recurrence of HCC after LAT that underwent either salvage hepatectomy (n = 23) or radiofrequency ablation (RFA; n = 27). Their background characteristics, intraoperative data, and postoperative short- and long-term outcome were analyzed. RESULTS The RFA group was found to be significantly associated with an impaired liver functional reserve, smaller number and size of tumors. The hepatectomy group showed a significantly longer operation time, greater intraoperative blood loss and more frequent red blood cell transfusion. In-hospital stay mortality and morbidity rate did not significantly differ. The disease-free and overall survival showed no significant difference between the groups. Although local recurrence after salvage treatment was found in zero (0%) for hepatectomy and in seven (25.9%) for RFA, that did not affect the overall survival. The tumor size at the prior LAT was identified as an independent prognostic factor for disease-free survival and serum albumin for overall survival. CONCLUSION Whereas salvage hepatectomy for local recurrent HCC is recommended for selected patients in terms of its good local control effect, salvage RFA is also acceptable because it is less invasive and also has a reasonable long-term outcome.
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Affiliation(s)
- Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Xu X, Li X, Ye X, Liu G, Wang J, Peng Z, Liang T, Yang W, Hao X. Chemical ablation therapy of recurrent mediastinal nodal metastasis in post-radiotherapy cancer patients. Med Oncol 2014; 31:224. [PMID: 25204412 DOI: 10.1007/s12032-014-0224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
The aim of our study was to evaluate the treatment of post-radiotherapy recurrent mediastinal nodal metastasis. Post-radiotherapy esophageal cancer patients with mediastinal lymph node recurrence were enrolled in this study. Patients were randomized into the radiation (±chemotherapy) or the chemoablation group. Patients randomized to the chemoradiotherapy group received additional radiotherapy, second-line chemotherapy, or both. Patients randomized to the chemoablation group received CT-guided percutaneous chemical ablation. Clinical remission was assessed at 1 month by contrast CT. Reirradiation dose ranged from 2,200 to 3,600 cGy depending on dose-limiting constraints in consideration of prior radiotherapy dose. The RECIST criteria were used in the evaluation of response to therapy. The median length of follow-up is 6 months. Thirty-one patients were enrolled in the study. In the chemoradiation group, all patients underwent CT imaging at 1-month follow-up. Among these patients, seven had progressive disease, five had stable disease (SD), and four had partial response (PR). The 6-month survival rate was 12.5%. In the chemoablation group at 1-month follow-up, 12 patients had SD and three patients had PR, and the 6-month survival rate was 46.6%. Our results suggest that chemoablation therapy as salvage treatment after post-radiotherapy relapse is efficacious and safe.
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Affiliation(s)
- Xinglu Xu
- Department of Oncology, Pingyi Branch of Qilu Hospital, Shandong University, Linyi, Shandong, China,
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Nishikawa H, Nishijima N, Arimoto A, Inuzuka T, Kita R, Kimura T, Osaki Y. Effect of nucleoside analog use in patients with hepatitis B virus-related hepatocellular carcinoma. Hepatol Res 2014; 44:608-20. [PMID: 23701455 DOI: 10.1111/hepr.12169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/15/2013] [Accepted: 05/20/2013] [Indexed: 01/06/2023]
Abstract
AIM To examine the effect of nucleoside analog (NA) therapy on clinical outcome in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) who underwent curative therapy. METHODS A total of 131 patients with HBV-related HCC who underwent curative therapy were analyzed. They were divided into an NA group who received NA therapy (n = 99, group A) and a control group (n = 32, group B). Group A was further classified into two groups of patients who either received NA therapy before HCC therapy (n = 34, group Aa) or who received NA therapy with initial HCC therapy (n = 65, group Ab). Overall survival (OS) and recurrence-free survival (RFS) were compared in the three groups. RESULTS The 1- and 3-year cumulative OS rates were both in group Aa, 100% and 88.0% in group Ab, and 100% and 75.7% in group B (overall significance, P = 0.002), respectively. The corresponding RFS rates were 93.1% and 36.0% in group Aa, 78.3% and 45.7% in group Ab, and 78.0% and 38.0% in group B (overall significance, P = 0.734), respectively. Multivariate analysis revealed that being part of group Aa (P < 0.001) or group Ab (P < 0.001) and having albumin levels of 4.0 g/dL or more (P = 0.040) were significantly associated with OS, while HCC stage (P = 0.001) and hepatitis B e-antigen positivity (P < 0.001) were independent predictors linked to RFS. CONCLUSION NA therapy in patients with HBV-related HCC may improve survival after curative therapy.
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Affiliation(s)
- Hiroki Nishikawa
- Departments of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka
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