Management of hepatocellular carcinoma

Bruix, Jordi; Sherman, Morris

doi:10.1002/hep.20933

Cited by 5,318 publications

(4,705 citation statements)

References 311 publications

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“…HCC was diagnosed on the basis of positive results in serum alpha-fetoprotein determination (serum alpha-fetoprotein level >20 lg/L) along with positive imaging findings, or on the basis of at least 2 coincident imaging findings that indicated HCC in high-risk patients. 4 A total of 37 patients who satisfied the following eligibility criteria were enrolled in this study: (1) Eastern Cooperative Oncology Group performance status score of 2 or less; (2) Child-Pugh liver function class A or B; (3) the presence of a solitary lesion; (4) maximum tumor diameter of 3.1 to 5.0 cm; (5) the lesion could be detected by using ultrasonography (US); (6) the divergence of the hepatic artery was suitable for TACE; (7) no evidence of portal and/or venous thrombosis, extrahepatic metastasis, or uncontrollable ascites; (8) adequate hematologic function (platelet count >50 Â 10 9 cells/L, hemoglobin >8.0 g/dL, and prothrombin time <80%); (9) adequate hepatic function (albumin >2.5 g/dL, total bilirubin <3 mg/dL, and alanine aminotransferase and aspartate aminotransferase levels <5Â the upper limit of the normal range); and (10) adequate renal function (serum creatinine concentration <1.5Â the upper limit of the normal range). Patients were excluded if they had previously received any treatment for hepatocellular carcinoma.…”

Section: Patientsmentioning

confidence: 99%

“…However, many patients have poor hepatic reserve owing to underlying chronic liver disease; therefore, only 5% to 40% of the patients with HCCs are candidates for hepatectomy. 4 Various local ablation therapies such as percutaneous ethanol injection 5,6 or percutaneous radiofrequency ablation (RFA) have been proposed as nonsurgical treatment options for small-sized HCCs, and excellent survival rates have been reported with these treatments. 7,8 Complete necrosis was achieved in 76% to 100% of the treated small-sized HCCs.…”

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confidence: 99%

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Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

280

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BACKGROUND:To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate-sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone. METHODS: The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1-5.0 cm in the greatest dimension) to 2 groups: the TACE-RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA. RESULTS: Technical success was achieved after 1.4 AE 0.5 RFA sessions in the RFA group and after 1.1 AE 0.2 RFA sessions in the TACE-RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA-induced ablated areas were 50 AE 8.0 mm and 41 AE 7.1 mm, respectively, in the RFA group and 58 AE 13.2 mm and 50 AE 11.3 mm, respectively, in the TACE-RFA group; the mean diameters of the shorter axes were significantly different (P ¼ .012). The rates of local tumor progression at the end of the third year in the RFA and TACE-RFA groups were 39% and 6%, respectively (P ¼ .012). The 3-year survival rates of the patients in the RFA and TACE-RFA groups were 80% and 93%, respectively (P ¼ .369). CONCLUSIONS: In patients with intermediate-sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010;116:5452-60.

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Section: Patientsmentioning

confidence: 99%

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confidence: 99%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

280

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“…Overwhelmingly, viral hepatitis is the leading factor associated with the development of HCC and its association with hepatitis B or hepatitis C is largely driven by the geographic incidence of these two entities. 3 In addition, other risk factors associated with the development of liver disease and cirrhosis carry a significant risk for the development of HCC including alcohol liver disease, aflatoxin exposure and metabolic liver disease from nonalcoholic steatohepatitis (NASH) and hemochromatosis among others. 3 Again, in contrast to most other malignancies, because of its integral association with liver disease, the assessment of patients with HCC for treatment (i.e., ''staging'') must not only take into account the tumor burden (''anatomical staging'') but also the patients underlying liver function (''physiological staging'').…”

Section: The Problemmentioning

confidence: 99%

Drug therapy: Sorafenib

Finn

2010

Hepatology

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A 72-year-old active male patient with cirrhosis secondary to nonalcoholic steatohepatitis is evaluated for liver masses. He has no stigmata of end-stage liver disease such as ascites, icterus, or hepatic encephalopathy on physical examination. Laboratory values include a hemoglobin of 12 g/dL with a mean corpuscular volume of 98, white cell count of 3.9 thousand, platelet count of 76,000, total bilirubin of 1.2 mg/dL, albumin of 3.5 g/dL, international normalized ratio of 1.2, and serum creatinine of 1.3 mg/dL. The alpha-fetoprotein is 620 ng/mL. The computed tomographic scan of the abdomen shows two masses in the right lobe of the liver and three in the left lobe, all with arterial enhancement. The largest mass is 4 cm in diameter and appears to invade the portal vein; the liver appears cirrhotic but there is no ascites.

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“…In Italy, the rules for prescription require a positive Octreoscan as mandatory and we therefore recruited 25 consecutive patients diagnosed in the last 6 months, who had advanced stage HCC, according to the American Association for the Study of Liver Disease (AASLD) (Bruix and Sherman, 2005) (Table 1) and performed the imaging technique. In contrast with that found by Cebon, only 2/25 (8%) patients tested positive.…”

Section: Sirmentioning

confidence: 99%