Management strategies for hepatocellular carcinoma: old certainties and new realities

Abstract

Hepatocellular carcinoma (HCC) is a highly prevalent disease ranking among the ten most common cancers worldwide with increasing trend of incidence in most developed countries. The great healthcare costs and economic burden of HCC dictate proper preventive interventions as well as surveillance and screening programs to decrease disease incidence and allow early diagnosis. HCC treatment outcomes are affected by several variables, including liver function, patient's performance status, and tumor stage. In line with the Barcelona Clinic Liver Cancer (BCLC) staging curative treatments, such as surgery or radio-frequency ablation, are indicated in early-stage HCC (BCLC-A), and the noncurative treatments are indicated in intermediate and advanced stages of HCC (BCLC-B, C). Transarterial chemoembolization (TACE) represents the treatment of choice for intermediate-stage HCC with Child-Pugh A cirrhosis, and the long-term survival after liver transplantation is inferior to that of early-stage HCCs. In advanced-stage HCC or when complete necrosis is not achieved or early recurrence after TACE develops, individualized treatments such as systemic treatment or combined radiation therapy are indicated. The increasing knowledge of the genomic landscape of HCC and the development of molecular-targeted therapies is heading toward expanding the armamentarium for HCC management.

Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

“…The use of RFA has been widely used in cancer treatment, and some researchers have applied thermal ablation in parathyroid gland. Adda et al and Andrioli et al reported using laser ablation to treat 3 and 6 patients with primary HPT, respectively, and the results indicated that it could control PTH levels to a certain degree.…”

“…4,26 Therefore, minimally invasive local chemical and thermal ablation methods have been investigated as alternative therapies. 28,29 The use of RFA has been widely used in cancer treatment, [9][10][11][12][13][14] and some researchers have applied thermal ablation in parathyroid gland. Adda et al 15 and Andrioli et al 16 reported using laser ablation to treat 3 and 6 patients with primary HPT, respectively, and the results indicated that it could control PTH levels to a certain degree.…”

Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation

“…bRFA proves to be a further development of an established method (mRFA), already in use for numerous organs [14][15][16][17][18][19]. It has already been successfully used as a treatment for thyroid neoplasms [20,21].…”

Fasting inhibits hepatic stellate cells activation and potentiates anti‐cancer activity of Sorafenib in hepatocellular cancer cells

“…There is large interest in understanding the genetic variation and epigenetic predisposition in developing HCC (Balasus et al, 2016;Barchitta, Quattrocchi, Maugeri, Vinciguerra, & Agodi, 2014;Podrini et al, 2013). Non-resectable HCC has a poor survival and is refractory to chemotherapeutic drugs, with the exception of small molecular inhibitor of intracellular tyrosine and serine/threonine protein kinases such as Sorafenib (Bruix et al, 2017;Mazzoccoli, Tarquini et al, 2015).…”