Management of hepatocellular carcinoma: An update

Bruix, Jordi; Sherman, Morris

doi:10.1002/hep.24199

Cited by 7,292 publications

(6,704 citation statements)

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“…Another reason for the unfavorable overall survival is that liver transplantation and RFA were not routinely performed during the protocol time frame (1998‐2003) in Japan. Among the 64 patients with recurrent lesions before CIRT, only 3 received RFA; moreover, no patients were treated by transplantation after CIRT in the current study, even though these treatments are currently regarded as essential for HCC 35. Nevertheless, the 3‐year overall survival rate (50.0%) and MST (35.4 months) achieved with CIRT in the current study were not inferior to those achieved with TACE (3‐year overall survival rate, 29%; MST, 28.7 months)36 or sorafenib treatment (MST, 10.7 months),37 which are recommended for patients with Barcelona Clinic Liver Cancer stage B or C disease, respectively 35…”

Section: Discussionmentioning

confidence: 89%

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Kasuya

Kato²,

Yasuda

et al. 2017

Cancer

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BACKGROUNDThe objective of this study was to evaluate the safety and efficacy of carbon‐ion radiotherapy (CIRT) in patients with hepatocellular carcinoma (HCC) with stepwise dose escalation and hypofractionation in 2 combined prospective trials.METHODSSequential phase 1/2 (protocol 9603) and phase 2 (protocol 0004) trials were conducted for patients with histologically proven HCC. The phase 1 component of protocol 9603 was a dose‐escalation study; CIRT was delivered in 12, 8, or 4 fractions. After determination of the recommended dose, 2 phase 2 trials were performed in an expanded cohort, and the data were pooled to analyze toxicity, local control, and overall survival.RESULTSIn the phase 1 component of protocol 9603, 69.6, 58.0, and 52.8 Gy (relative biological effectiveness [RBE]) in 12, 8, and 4 fractions, respectively, constituted the maximum tolerated doses, and 52.8 Gy (RBE) in 4 fractions was established as the recommended dose regimen for the 2 phase 2 studies. In 124 patients with a total of 133 lesions, few severe adverse effects occurred, and local‐control and overall survival rates at 1, 3, and 5 years were 94.7% and 90.3%, 91.4% and 50.0%, and 90.0% and 25.0%, respectively; this included 1‐, 3‐, and 5‐year local‐control rates of 97.8%, 95.5%, and 91.6%, respectively, in the phase 2 study. In a multivariate analysis, Child‐Pugh class B and the presence of a tumor thrombus were significant factors for mortality.CONCLUSIONSThe safety and efficacy of CIRT in 12, 8, and 4 fractions were confirmed, with 52.8 Gy (RBE) in 4 fractions established as the recommended treatment course for eligible HCC patients. Cancer 2017;123:3955‐65. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Section: Discussionmentioning

confidence: 89%

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Kasuya

Kato²,

Yasuda

et al. 2017

Cancer

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“…Similarly, oncologists in our institution also manage patients with advanced HCC, but as the majority of these patients also have a background of liver cirrhosis, they would concurrently be under the care of our department. HCC was diagnosed based on conventional diagnostic criteria according to the time period 13, 14, 15. These criteria included histology and diagnostic radiology imaging techniques, such as hepatic angiography and positive lipiodol angiography, prior to 1990 and dynamic contrast‐enhanced radiology modalities thereafter.…”

Section: Methodsmentioning

confidence: 99%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

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“…Excluding patients who underwent transplantation because of liver failure is another relevant concern for their propensity analysis. Finally, a 5% postoperative mortality rate currently exceeds the expected ratio 5,6 and suggests that several factors in addition to portal hypertension have to be factored in their analysis. Ultimately, if presence and degree of portal hypertension is a powerful predictor for survival in patients with cirrhosis even if compensated, there is no reason to expect that this value would disappear in patients diagnosed with HCC.…”

Section: Replymentioning

confidence: 99%