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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Primary Liver Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11865357
AU - Margarit C; Charco R; Hidalgo E; Allende H; Castells L; Bilbao I
TI -
Liver transplantation for malignant diseases: selection and pattern of
recurrence.
SO - World J Surg 2002 Feb;26(2):257-63
AD - Liver Transplantation Unit, Department of Surgery, Hospital General Vall
Hebron, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain.
margarit@hg.vhebron.es
Liver transplantation (LT) for malignant tumors should be accepted if,
with adequate case selection, long-term results are similar to those in
patients transplanted for benign diseases. The aim of the present study
was to reexamine selection criteria for LT in malignant diseases with
particular emphasis on hepatocellular carcinoma (HCC) in cirrhosis. One
hundred-three of 369 patients transplanted in our unit had HCC in
cirrhosis (28%), 15 of which were incidental tumors, and 234 patients
underwent LT for non-cholestatic cirrhosis. Pretransplant arterial
chemoembolization(TACE) was performed in 36 cases (41%) of known HCC.
Only early,well-delimited tumors in advanced cirrhosis with no
extrahepatic disease were accepted for LT. Hepatocellular carcinoma
characteristics included mean tumor size (3.1 cm), multiple (59%),
bilobular involvement (31%), and vascular invasion (9.2%). Postoperative
mortality was 4%. Median follow-up was 67.5 months. Tumor recurrence
rate was 14.5%, 33% (5/15) in incidental tumors and 11.4% (10/88) in
known HCC and by tumor stage (pTNM): 7.7% (1/13) in stage I, 16.7%(5/30)
in stage II, 15% (3/20) in stage III, and 17% (6/35) in stage IV. Mean
time for recurrence was 20.6 months. Tumoral vascular invasion, tumor
differentiation, and satellite tumors were significant factors for tumor
recurrence in univariate analysis, whereas tumor vascular invasion was
the only significant factor for tumor recurrence in multivariate
analysis. Actuarial survival rates at 1, 3, and 5 years were 81%, 66%,
58%, respectively, in patients with HCC and were similar to those of
cirrhotic patients 76%, 67%, 63%, respectively.In conclusion, patients
with early HCC in cirrhosis are good candidates for LT; results are
similar when compared with those of cirrhotic patients without tumor.
Liver transplantation for other malignancies is admitted only in
fibrolamellar hepatoma, hepatoblastoma, epithelioid hemangioendothelioma
without extrahepatic disease, and in metastases from carcinoid tumors.
2
UI - 11980508
AU - Crawford LM Jr
TI -
From the Food and Drug Administration.
SO - JAMA 2002 May 1;287(17):2203
AD - US Food and Drug Administration, USA.
3
UI - 11859717
AU - Qian J; Qin S; He Z
TI -
[Arsenic trioxide in the treatment of advanced primary liver and
gallbladder cancer]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):487-9
AD - Oncology Center, 81 Hospital, PLA, Nanjing 210002, China.
OBJECTIVE: To evaluate the effect and toxicity of arsenic trioxide
(As2O3) in treating primary liver and gallbladder cancer. METHODS:
Twenty-nine advanced primary liver cancer and 4 gallbladder cancer
patients were treated with As2O3 injection only, 15 mg i.v. qd for 14-21
days and was repeated after 2 weeks. RESULTS: The overall response rate
was 15.2%, 13.8% in primary liver cancer (PR 4, NC 21 and PD 4). It was
25.0% in gallbladder cancer (CR 1, NC 2, PD 1). The major side reactions
were mild bone marrow suppression and hepatic functional damage.
CONCLUSION: As2O3 injection is effective in treating primary liver and
gallbladder cancer with mild side reactions. It is worth studying in the
future.
4
UI - 11859718
AU - Li C; Shi Z; Hao Y
TI -
[Combined percutaneous ethanol injection through liver puncture and
transcatheter hepatic arterial chemoembolization for hepatocellular
carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):490-2
AD - Department of Diagnostic Radiology, Cancer Institute (Hospital), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing
100021, China.
OBJECTIVE: To study the therapeutic effects of transcatheter arterial
chemoembolization (TACE) combined with beta-ultrasound guided
percutaneous ethanol injection (PEI) at multiple points for
hepatocellular carcinoma. METHODS: Eighty-seven patients with
hepatocellular carcinoma were divided into two groups: Group A, 45
patients were treated with TACE only, group B, 42 patients were treated
with TACE plus PEI. RESULTS: In group A patients, the 1-, 2-, and 3-year
survival rates were 66.7%, 41.4%, and 21.4%, respectively. Only 26.1% of
cancer specimens showed complete necrosis by pathologic examination in
group A. In group B, the 1-, 2-, and 3-year survival rates were 97.1%,
85.71% and 65.71%, respectively, with complete necrosis in 81.8%.
CONCLUSION: The therapeutic effects of transcatheter arterial
chemoembolization combined with percutaneous multiple point ethanol
injection through liver puncture is much better than that of TACE alone.
5
UI - 11943133
AU - Wong LL
TI -
Current status of liver transplantation for hepatocellular cancer.
SO - Am J Surg 2002 Mar;183(3):309-16
AD - Transplant Institute, Department of Surgery, St. Francis Medical Center,
2226 Liliha St., Suite 402, Honolulu, Hawaii 96817, USA.
hepatoma@aol.com
The incidence of hepatocellular cancer is increasing in the United
States and is one of the most common cancers worldwide. Traditionally,
the gold standard treatment for hepatocellular cancer has been surgical
resection, but most patients were not suitable candidates due to
advanced disease. Other treatments include locally ablative techniques
(cryosurgery, radiofrequency ablation and various injection therapies),
chemotherapeutic options and rarely, radiation therapies. In the 1980s,
liver transplant emerged as the treatment of choice for end-stage liver
disease and also became an option for patients with hepatocellular
cancer. When comparing liver transplant with resection in retrospective
studies, liver transplant patients had better survival and reduced
recurrence. However, not all patients with hepatocellular cancer will be
candidates for liver transplant. Size, stage, and histological grade of
tumor all affect prognosis after transplant. Use of chemotherapeutic
treatments and locally ablative techniques may be beneficial prior to
liver transplant, but larger controlled studies are needed. Liver
transplant is the most effective treatment for hepatocellular cancer in
the subgroup of smaller tumors, but ultimately we are limited by the
number of available donors. Future goals in this area include increasing
the donor pool and determining optimal management to allow patients to
wait for an appropriate donor.
6
UI - 11287540
AU - Rose SC; Hassanein TI; Easter DW; Gamagami RA; Bouvet M; Pretorius DH;
TI -
Nelson TR; Kinney TB; James GM
Value of three-dimensional US for optimizing guidance for ablating focal
liver tumors.
SO - J Vasc Interv Radiol 2001 Apr;12(4):507-15
AD - Department of Radiology, University of California Medical Center, 200
West Arbor Drive, San Diego, CA 92103, USA. scrose@ucsd.edu
PURPOSE: To determine if three-dimensional ultrasound (3D US), by nature
of its ability to simultaneously evaluate structures in three orthogonal
planes and to study relationships of devices to tumor(s) and surrounding
anatomic structures from any desired orientation, adds significant
additional information to real-time 2D US used for placement of devices
for ablation of focal liver tumors. MATERIALS AND METHODS: Sixteen
patients underwent focal ablation of 23 liver tumors during two
intraoperative cryoablation (CA) procedures, three intraoperative
radiofrequency ablation (RFA) procedures, 11 percutaneous ethanol
injections (PEI) procedures, and six percutaneous RFA procedures. After
satisfactory placement of the ablative device(s) with 2D US guidance, 3D
US was used to reevaluate adequacy to device position. Information added
by 3D US and resultant alterations in device deployment were tabulated.
RESULTS: 3D US added information in 20 of 22 (91%) procedures and caused
the operator to readjust the number or position of ablative devices in
10 of 22 (45%) of procedures. Specifically, 3D US improved visualization
and confident localization of devices in 13 of 22 (59%) procedures,
detected unacceptable device placement in 10 of 22 (45%), and determined
that 2D US had incorrectly predicted device orientation to a tumor in
three of 22 (14%). CONCLUSIONS: Compared to conventional 2D US, 3D US
provides additional relationship information for improved placement and
optimal distribution of ablative agents for treatment of focal liver
malignancy.
7
UI - 11775431
AU - Rose DM; Chapman WC
TI -
Chemoembolization and interstitial therapies for hepatocellular
carcinoma.
SO - Cancer Treat Res 2001;109():101-16
AD - John Wayne Cancer Institute, Santa Monica, CA, USA.
8
UI - 11775432
AU - Curley SA
TI -
Diagnosis and management of intrahepatic and extrahepatic
cholangiocarcinoma.
SO - Cancer Treat Res 2001;109():117-44
AD - University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
9
UI - 11775445
AU - Jones SM; Roh MS
TI -
Results of surgical resection for hepatocellular carcinoma.
SO - Cancer Treat Res 2001;109():59-75
AD - Allegheny Hospital, Pittsburgh, PA, USA.
The overall prognosis of HCC is very poor because most patients are
unresectable at the time of initial evaluation. Surgical resection is
the only potentially curative treatment for HCC, however the recurrence
rate after resection remains high as well. Utilizing screening protocols
which incorporates the use of hepatic ultrasound and biochemical
markers, HCC can be identified earlier and enable the patient to
withstand surgical resection. Morbidity and mortality after resection is
multifactorial and relates to HCC itself, underlying liver disease and
comorbid conditions. Utilizing tests such as ICG R15, Redox Tolerance
Index and Tc-GSA to define the functional status of the liver and
staging systems helps define who will tolerate hepatic resection.
Morbidity and mortality from hepatic resections has also improved with
minimizing intraoperative blood loss and minimizing the amount of
functional tissue resected. The use of maneuvers such as total vascular
exclusion with or without venovenous bypass has expanded the indications
for surgery. Utilizing therapeutic combinations, including TAE, portal
vein embolization or ablative therapies widens the indications for
resection of HCC. Since there are no chemotherapeutic regimens that have
been found to prolong survival, surgical resection remains the procedure
of choice for treating HCC.
10
UI - 11830625
AU - Ishida T; Murakami T; Shibata T; Inoue Y; Takamura M; Niinobu T; Sato T;
TI -
Nakamura H
Percutaneous microwave tumor coagulation for hepatocellular carcinomas
with interruption of segmental hepatic blood flow.
SO - J Vasc Interv Radiol 2002 Feb;13(2 Pt 1):185-91
AD - Department of Radiology, Toyonaka Municipal Hospital, Toyonaka, Japan.
PURPOSE: To assess the effect of hepatic artery occlusion with or
without hepatic venous outflow interruption on coagulation diameter
during percutaneous microwave coagulation therapy (PMCT) for
hepatocellular carcinoma (HCC) by a prospective and randomized trial.
MATERIALS AND METHODS: Thirty-one patients with 36 HCCs (10-38 mm in
diameter) were randomly separated into two treatment groups as follows:
group 1 (14 tumors in 14 patients) was treated with PMCT in conjunction
with both segmental hepatic artery embolization with gelatin sponge
particles and temporary interruption of hepatic venous flow by means of
a 6-F balloon catheter to reduce the portal venous flow; group 2 (22
tumors in 17 patients) was treated with PMCT with segmental hepatic
artery embolization only. PMCT under ultrasound (US) guidance was
performed with 2,450 MHz of microwave frequency at 40-60 W and a needle
applicator 1.6 mm in diameter. The coagulated area was measured at the
maximum diameter perpendicular to the needle tract on enhanced computed
tomography (CT) performed immediately after PMCT. The local effect of
the treatment was evaluated by follow-up enhanced CT (6-33 mo). RESULTS:
Patients in group 1 had a significantly larger coagulation area (mean
+/-SD = 42.9 mm +/- 8.3), with coagulation times of 5.3 min +/- 1.4,
than patients in group 2 (32.6 mm +/- 8.0), with coagulation times of
4.2 min +/- 1.3 (P <.05). Follow-up enhanced CT showed no local
enhancement of the tumor, indicating complete necrosis and no local
recurrence, except for four tumors. There were no major complications
after PMCT except liver abscess that developed after PMCT in one patient
with pneumobilia. CONCLUSIONS: PMCT with combined hepatic arterial
embolization and temporary hepatic venous flow interruption can
coagulate significantly larger volumes of tumor than PMCT with only
hepatic arterial embolization.
11
UI - 11830632
AU - Braun SD
TI -
Re: Value of three-dimensional US for optimizing guidance for ablating
focal liver tumors.
SO - J Vasc Interv Radiol 2002 Feb;13(2 Pt 1):216
12
UI - 11960317
AU - Harada-Shiba M; Yamauchi K; Harada A; Takamisawa I; Shimokado K; Kataoka
TI -
K
Polyion complex micelles as vectors in gene therapy--pharmacokinetics
and in vivo gene transfer.
SO - Gene Ther 2002 Mar;9(6):407-14
AD - National Cardiovascular Center Research Institute, Osaka, Japan.
To establish non-viral gene delivery systems for intravenous
administration, complexes of DNA and block copolymer consisting of
poly-L-lysine and poly(ethylene glycol) were tested in in vivo turnover
studies. The polyion complex micelles have self-assembling core-shell
structures, yielding spherical nano-particles with small absolute values
of zeta-potential. Southern blot analysis showed that supercoiled DNA
was observed for 30 min and open circular or linear DNA was seen for 3 h
after intravenous administration of PIC micelles having the charge
ratios of 1:4 and PLL length of 48 mer. The PIC micelles with shorter
PLL length showed lower stability in the blood stream suggesting that
DNA is able to persist as an intact molecule in the blood stream using
this system. Though having no ligands, PIC micelles with charge ratios
of 1:2 and 1:4 transfected efficiently into HepG2 cells. Preincubation
with free copolymer inhibited expression of the reporter gene,
suggesting that adsorption of block copolymer to the cell surface
blocked the interaction site of the PIC micelles. When the PIC micelles
were injected via supramesenteric vein, expression of the gene was
observed only in the liver and was sustained for 3 days. It was
suggested that this gene delivery system is intrinsically efficient.
13
UI - 11935085
AU - Teo EK; Fock KM
TI -
Hepatocellular carcinoma: an Asian perspective.
SO - Dig Dis 2001;19(4):263-8
AD - Department of Medicine, Changi General Hospital, Singapore.
eng_kiong_teo@cgh.com
Hepatocellular carcinoma (HCC) is one of the most frequently occurring
malignancies in Asia. The incidence exceeds 30 cases/100,000/year in the
east Asian region. Worldwide, it accounts for almost 1 million
deaths/year. The high incidence in Asia is due to the high prevalence of
chronic viral hepatitis, mainly chronic hepatitis B. With the
introduction of universal vaccination for hepatitis B in some Asian
countries in the mid 1980s, some of these countries are experiencing a
decline in the incidence of HCC. This probably underscores the point
that HCC caused by hepatitis B is a malignancy preventable by vaccine.
Due to the relative paucity of symptoms in the early stages and the
rapid doubling time of the tumor, most HCCs are discovered late in
advanced stages at presentation. Most Asian countries have adopted a
screening program for patients at risk. Earlier and smaller HCCs are
detected through such programs but these programs have yet to
demonstrate improved patient survival. Physicians managing patients with
HCC are faced with two main challenges, the malignancy itself and the
underlying liver disease. The extent of the tumor and the existing liver
function limits the therapeutic choices available. Hepatic resection
remains the treatment of choice. However, the majority of patients
present with nonresectable tumors. Transarterial chemoembolization,
percutaneous ethanol injection and radiofrequency ablation are the other
treatment modalities. In patients with small tumors (<5 cm) and poor
liver function, liver transplant offers a viable treatment alternative.
In summary, the risk factor for HCC in Asia is predominantly chronic
hepatitis B. Universal vaccination against hepatitis B is likely to
reduce the incidence. The prognosis and outcome of treatment remains
poor with a 5-year survival of 35% for patients treated surgically and
less than 10% for nonresectable tumors. Current management is aimed at
earlier detection and more effective treatment of early HCC. In future,
the challenge will be managing HCC in the premalignant stage. Copyright
2002 S. Karger AG, Basel
14
UI - 11935089
AU - Livraghi T
TI -
Role of percutaneous ethanol injection in the treatment of
hepatocellular carcinoma.
SO - Dig Dis 2001;19(4):292-300
AD - Department of Radiology, Ospedale Civile, Vimercate, Italy.
lalivra@tin.it
In the treatment of early and intermediate hepatocellular carcinoma, the
range of indications for percutaneous ablation techniques is becoming
wider than surgery or intra-arterial therapies. Indeed, whereas for some
years only patients with up to three small tumors were treated, with the
introduction of the single-session percutaneous ethanol injection (PEI),
performed under general anesthesia, even patients with more advanced
disease are now being treated. Although it is understood that partial
resection assures the highest local control, the survival rates after
surgery are roughly comparable with PEI. The explanation for this is a
balance among the advantages and disadvantages of the two therapies. PEI
survival curves are better than curves for resected patients who present
adverse prognostic factors, and this means that surgery needs a better
selection of the patients. Indications for both therapies are reported.
An open question remains the choice between PEI and other new ablation
procedures. In our department we currently use radiofrequency ablation
in the majority of patients but consider PEI and segmental transarterial
chemoembolization complementary, and use them according to the features
of the disease and the response. Copyright 2002 S. Karger AG, Basel
15
UI - 11935090
AU - Allgaier HP; Galandi D; Zuber I; Blum HE
TI -
Radiofrequency thermal ablation of hepatocellular carcinoma.
SO - Dig Dis 2001;19(4):301-10
AD - Department of Medicine II, University Hospital Freiburg, Germany.
allgaier@medizin.ukl.uni-freiburg.de
Hepatocellular carcinoma (HCC) is one of the major malignancies
worldwide. Due to advanced or decompensated liver cirrhosis, comorbidity
and multicentricity of the tumor lesions, 70-80% of HCC patients are
inoperable at the time of diagnosis. Radiofrequency thermal ablation
(RFTA) is a new minimally invasive and sage technique for the
nonsurgical treatment of HCCs. Similar to other ablation techniques, the
treatment strategy depends on several factors, including the patient's
clinical status, the stage of liver cirrhosis and of the HCC. RFTA can
be performed percutaneously, laparoscopically or after laparotomy.
Advanced RFTA equipment, refined techniques of modifying tumor tissue
response to RFTA, and combined treatment strategies should lead to
better response rates even in larger HCCs. Copyright 2002 S. Karger AG,
Basel
16
UI - 11935091
AU - Treiber G
TI -
Systemic treatment of hepatocellular carcinoma.
SO - Dig Dis 2001;19(4):311-23
AD - Department of Gastroenterology/Hepatology and Infectious Diseases,
University Hospital, Magdeburg, Germany.
Systemic treatment for hepatocellular carcinoma is indicated in locally
advanced or metastatic disease. Monochemotherapies have yielded
unsatisfactory results with response rates of around 20% but survival is
often not improved. Polychemotherapies may induce complete responses but
have substantial toxicity and are limited to selected patients with
preserved liver function. Hormonal treatment with tamoxifen is
ineffective while megestrol has shown an improvement in quality of life.
Octreotide can be given even in cases of impaired liver function, has
also a favorable side effect profile and can lead to disease
stabilization. Adjuvant therapy with interferon is indicated after
successful liver resection or transplantation in patients with chronic
viral hepatitis, the role of interferon in other indications or in
combination with chemotherapy remains to be determined. Copyright 2002
S. Karger AG, Basel
17
UI - 11935093
AU - Frilling A; Malago M; Broelsch CE
TI -
Current status of liver transplantation for treatment of hepatocellular
carcinoma.
SO - Dig Dis 2001;19(4):333-7
AD - Department of General Surgery and Transplantation, University Hospital
Essen, Germany.
Hepatocellular carcinoma accounts for more than 5% of all malignancies
with a continuous increase worldwide. The most important risk factor is
liver cirrhosis, frequently associated with hepatitis B virus or
hepatitis C virus infection. Liver resection is the only treatment that
can potentially achieve cure. In carefully selected patients with a
tumor smaller than 5 cm the 5-year survival is around 50%. The presence
of liver cirrhosis and portal hypertension limits the feasibility of
hepatic resection. Child-Pugh A patients without major associated risk
factors may be considered as the ideal target group for resection. A
significant local disease recurrence rate of more than 70% at 5 years is
the main problem of hepatic resection. Orthotopic liver transplantation
offers the possibility of removing a potentially multicentric tumor and
the underlying end-stage liver disease. Due to pure selection of
suitable candidates the initial reports on the efficacy of liver
replacement in a cohort of patients with hepatocellular carcinoma were
disappointing. Taking the shortness of donor organs and the high
posttransplant tumor recurrence rate into account, several groups
developed criteria qualifying transplantation. A tumor size of >6 cm and
gross intrahepatic portal vein involvement seem to be of significant
prognostic importance. Patients with smaller solitary tumors or less
than 3 tumors with a total tumor diameter of <8 cm have the same
survival after transplantation as those with benign liver disease.
Living donor liver transplantation offers a new approach to overcome the
organ shortage and to theoretically extend the indication for
transplantation in hepatocellular carcinoma. Copyright 2002 S. Karger
AG, Basel
18
UI - 11935094
AU - Plesch FN; Kubicka S; Manns MP
TI -
Prevention of hepatocellular carcinoma in chronic liver disease:
molecular markers and clinical implications.
SO - Dig Dis 2001;19(4):338-44
AD - Department of Gastroenterology and Hepatology, Medizinische Hochschule
Hannover, Germany.
The development of hepatocellular carcinoma is generally preceded by
chronic liver damage leading to cirrhosis. Prevention of chronic liver
diseases can decrease the incidence of hepatic cancer impressively. Many
recent investigations have also explored the power of secondary and
tertiary prevention in established liver cirrhosis. Screening programs
for patients at high risk, antiviral treatment of patients with
progressed hepatitis, and adjuvant interventions after curative
resection are some of the approaches. However, the cost effectiveness
and benefits of such procedures and the prognosis is also dependent on
the remaining liver function, there is no consensus to date on how
patients should be handled. In the future molecular markers and
prognostic scores may help better define the group at risk of
developing. To give a perspective to these patients, it is necessary to
improve the treatment of hepatocellular carcinoma as well as cirrhosis.
Copyright 2002 S. Karger AG, Basel
19
UI - 11935097
AU - Ma K; Min C; Ian HX; Jiahong D
TI -
Prevention and cure of complications from multiple-electrode
radiofrequency treatment of liver tumors.
SO - Dig Dis 2001;19(4):364-6
AD - Center of Hepatobiliary Surgery, Southwest Hospital, Third Military
Medical College, Chongqing, PR China. makuan@yahoo.com
BACKGROUND/AIMS: To determine the complication rate of
multiple-electrode radiofrequency treatment of liver tumors, and their
prevention and cure. METHODS: 114 patients with liver tumors were
treated 170 times using multiple-electrode radiofrequency. The clinical
complications and their prevention and cure were observed. RESULTS: The
complication rate was 9.6%. The complications included 1 case of colon
perforation, 4 cases of skin burn, 5 cases of hydrothorax, and 1 case
subcutaneous hemorrhage, but none of the patient died due to these
complications. CONCLUSION: The complication rate of multiple-electrode
radiofrequency treatment of liver tumors is low and the complications
could be prevented and cured. Copyright 2002 S. Karger AG, Basel
20
UI - 11940443
AU - Barrett JR
TI -
Cancer. Plants provide prevention.
SO - Environ Health Perspect 2002 Apr;110(4):A180
21
UI - 11993229
AU - Nanashima A
TI -
[Liver transplantation for hepatocellular carcinoma: experience at an
Australian transplantation unit]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):381-5
AD - First Department of Surgery, Nagasaki University School of Medicine,
Nagasaki, Japan.
The author experienced 11 cases of orthotopic liver transplantation
(LTx) for hepatocellular carcinoma (HCC) in Sydney, Australia, series.
LTx was selected in 5 cases for the treatment of HCC and in 6 for
terminal liver failure. Three patients had new lesions, which were not
detected on preoperative imaging, and 5 had vascular or extrahepatic
infiltrations. Two patients with hepatitis C had recurrence of hepatitis
at an early stage. Two had tumor recurrence, one of which had 7 lesions
with invasion to the vessels and bare area. Thus some problems remain in
LTx for HCC, including the recurrence of hepatitis in hepatitis C and
tumor recurrence in cases with high-risk factors based on the pathologic
findings.
22
UI - 11917477
AU - Oto M; Ebara M; Sugiura N
TI -
[Treatment of hepatic cancer by transcutaneous ethanol injection]
SO - Nippon Naika Gakkai Zasshi 2002 Feb 10;91(2):581-4
23
UI - 11977643
AU - Chen Y; Chen H; Wu M; Zhou W; Wei G; Wang P; Li X
TI -
[Curative effect of percutaneous microwave coagulation therapy for
hepatocellular carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2002 Jan;24(1):65-7
AD - Department of Ultrasound Intervention, Eastern Hepatobiliary Hospital,
Second Military Medical University, Shanghai 200438, China.
OBJECTIVE: To observe the curative effect of percutaneous microwave
coagulation therapy (PMCT) with 2450 MHz microwave antenna for
hepatocellular carcinoma. METHODS: Under local or epidural anesthesia, a
thin percutaneous microwave antenna was introduced with ultrasound
guidance into the tumor in the liver for thermo-coagulation. RESULTS:
Among the 97 hepatic cancer lesions in 52 patients, 61(62.9%) with phi <
3 cm were coagulated once. In follow-up of 6-12 months of these lesions,
57(93.4%) showed no recurrence by CT or MRI. Thirty-six (37.1%) with 3
cm < phi < 5 cm coagulated twice showed that 27 (75.0%) gave CR and 9
(25.0%) gave PR by CT or MRI in follow up of 6 months. There were no
serious clinical side effects or complications in the PMCT patients.
CONCLUSION: Percutaneous microwave coagulation therapy gives good
curative effect on liver tumor with phi < 3 cm. It is partly effective
on lesions 3 cm < phi < 5 cm.
24
UI - 10757382
AU - Sugawara Y; Yamamoto J; Shimada K; Yamasaki S; Kosuge T; Takayama T;
TI -
Makuuchi M
Splenectomy in patients with hepatocellular carcinoma and hypersplenism.
SO - J Am Coll Surg 2000 Apr;190(4):446-50
AD - Department of Hepatobiliary Pancreatic Surgery, National Cancer Center
Hospital, Tokyo, Japan.
BACKGROUND: Hypersplenism secondary to portal hypertension is common in
hepatocellular carcinoma (HCC), but surgeons still face the unresolved
problem of how to manage HCC patients with hypersplenism. STUDY DESIGN:
The records of 48 patients with HCC and hypersplenism were
retrospectively examined and postoperative changes in platelet counts,
serum total bilirubin levels, and dinical staging scores were analyzed
to evaluate the clinical value of combined splenectomy and liver
resection. Hepatectomy and splenectomy were performed as a two-stage
operation in 13 patients and synchronously in 35. RESULTS: Postoperative
platelet counts were significantly increased, and serum total bilirubin
levels were significantly decreased. Clinical staging scores were also
reduced after splenectomy in patients who underwent splenectomy before
hepatectomy. CONCLUSIONS: Synchronous or metachronous splenectomy can
increase the safety of hepatectomy in selected patients with HCC by
reducing both the likelihood of bleeding complications and bilirubin
overload.
25
UI - 10989911
AU - Hanazaki K; Kajikawa S; Adachi W; Amano J
TI -
Portal vein thrombosis may be a fatal complication after synchronous
splenectomy in patients with hepatocellular carcinoma and hypersplenism.
SO - J Am Coll Surg 2000 Sep;191(3):341-2
26
UI - 11030243
AU - Hanazaki K; Kajikawa S; Shimozawa N; Mihara M; Shimada K; Hiraguri M;
TI -
Koide N; Adachi W; Amano J
Survival and recurrence after hepatic resection of 386 consecutive
patients with hepatocellular carcinoma.
SO - J Am Coll Surg 2000 Oct;191(4):381-8
AD - Second Department of Surgery, Shinshu University School of Medicine,
Matsumoto, Japan.
BACKGROUND: Although hepatic resection is one of the most effective
treatments for hepatocellular carcinoma (HCC), the longterm results of
hepatic resection of this malignancy are far from satisfactory. The
potential benefits of hepatectomy for patients with HCC have not been
fully delineated. This study aimed to identify surgical outcomes of 386
consecutive patients with HCC undergoing hepatic resection. STUDY
DESIGN: The retrospective study looked at records of 293 men and 93
women. The mean age was 63.2 years. Preoperative transarterial
chemoembolizaton and portal vein embolization were performed in 138
patients (35.8%) and 8 patients (2.1%), respectively. Sixty-two patients
(16.1 %) had major hepatectomy and the other 324 (83.9%) had minor
hepatectomy. Thirty-seven of 386 patients (9.6%) had a noncurative
operation. RESULTS: The 30-day (operative) mortality rate was 4.1%, and
there were 11 additional late deaths (2.9%). Two hundred fourteen of 327
patients (65.4%) had recurrence after curative resection. Unfavorable
factors for survival and recurrence were resection between 1983 and
1990, Child class B or C, cirrhosis, a high value of indocyanine green
retention-15, a large amount of intraoperative blood loss, stage IV
disease, positive surgical margin, vascular invasion, and postoperative
complications. Preoperative transarterial chemoembolization increased
the recurrence rate and showed no contribution to prognosis. Currently,
106 patients (27.5%) are alive: 7 (1.8%) after more than 10 years and 43
(11.1%) after more than 5 years. Mean and median overall survivals after
operation were 38 months and 29 months, respectively. The 5-year and
10-year overall or disease-free survival rates after hepatic resection
were 34.4% and 10.5% or 23.3% and 7.8%, respectively. CONCLUSIONS: The
longterm survival rate after operation remains unsatisfactory mainly
because of the high recurrence rate. Preoperative transarterial
chemoembolization should be avoided because of a high risk of
postoperative recurrence. Treatment strategies for recurrent HCC may
play an important role in achieving better prognosis after operation,
especially in patients with more than Child class B, cirrhosis, high
values of indocyanine green retention-15, massive intraoperative blood
loss, stage IV disease, positive surgical margin, vascular invasion, and
postoperative complications.
27
UI - 11938045
AU - Ganne-Carrie N; Mohand D; N'kontchou G; Grando-Lemaire V; Trinchet JC
TI -
[Synopsis: Diagnosis and treatment of hepatocellular carcinoma in
patients with cirrhosis]
SO - Gastroenterol Clin Biol 2002 Jan;26(1):73-7
AD - Service d'Hepato-Gastroenterologie, Hopital Jean-Verdier, AP-HP et UFR
SMBH, Universite Paris 13, 93143 Bondy Cedex, France.
28
UI - 11938047
AU - Beaugrand M
TI -
[Diagnosis and treatment of hepatocellular carcinoma. Questions for
Professor Michel Beaugrand]
SO - Gastroenterol Clin Biol 2002 Jan;26(1):84-6
AD - Service d'Hepato-Gastroenterologie, Hopital Jean-Verdier, AP-HP et UFR
SMBH, Universite Paris 13, 93143 Bondy Cedex.
29
UI - 11992318
AU - Escudier B; Lassau N; Leborgne S; Angevin E; Laplanche A
TI -
Thalidomide and venous thrombosis.
SO - Ann Intern Med 2002 May 7;136(9):711
30
UI - 11930874
AU - Martin RC 2nd; Jarnagin WR
TI -
Randomized clinical trials in hepatocellular carcinoma and biliary
cancer.
SO - Surg Oncol Clin N Am 2002 Jan;11(1):193-205, x
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
New York 10021, USA. martinr@mskcc.org
Primary hepatocellular carcinoma (HCC) remains among the most common
malignancies in the world. Many of the advances in the treatment of this
disease have come from combinations of early detection in endemic areas,
improved radiologic evaluation in defining extent of disease, an
increased use of nonsurgical treatment and improvements in surgical
technique.
31
UI - 11847530
AU - Jianmin Z; Hongfang W; Meifu F
TI -
Resistance of multicellular aggregates to pharmorubicin observed in
human hepatocarcinoma cells.
SO - Braz J Med Biol Res 2002 Feb;35(2):255-60
AD - State Key Laboratory of Biomembrane and Membrane Biotechnology,
Institute of Zoology, Chinese Academy of Sciences, Beijing, China.
The objective of the present study was to investigate the multicellular
resistance of human hepatocarcinoma cells BEL-7402 to pharmorubicin.
Cells (1 x 10(4)) and 200 microcarrier Cytodex-3 beads were seeded onto
a 24-well plate and cultured in RPMI 1640 medium. After the formation of
multicellular aggregates, morphology and cell viability were analyzed by
scanning electron microscopy, transmission electron microscopy and flow
cytometry, respectively. The IC50 was determined by flow cytometry and
MTT assay after the cells cultured in aggregates and monolayers were
treated with pharmorubicin. The culture products exhibited structural
characteristics somewhat similar to those of trabecular hepatocarcinoma
in vivo. Among the microcarriers, cells were organized into several
layers. Intercellular spaces were 0.5-2.0 microm wide and filled with
many microvilli. The percent of viable cells was 87%. The cells cultured
as multicellular aggregates were resistant to pharmorubicin with IC50
4.5-fold and 7.7-fold that of monolayer culture as determined by flow
cytometry and MTT assay, respectively. This three-dimensional culture
model may be used to investigate the mechanisms of multicellular drug
resistance of hepatocarcinoma and to screen new anticancer drugs.
32
UI - 11730613
AU - Margarit C; Hidalgo E; Charco R; Cura D; Castells L; Allende E; Bilbao
TI -
I; Lazaro JL; Murio JE
[Improvement in the results of surgical resection of hepatocellular
carcinoma]
SO - Gastroenterol Hepatol 2001 Dec;24(10):465-72
AD - Unidad de Cirugia Hepatobiliopancreatica y Trasplante Hepatico, Servicio
de Cirugia General, Hospital Vall d'Hebron, Universidad Autonoma de
Barcelona, Spain. margaritJ@hg.vhebron.es
AIM: To present the results of hepatectomies performed for
hepatocellular carcinoma in a specialist unit and to compare the results
of an initial period (1987-1993) with those obtained in a second period
(1995-2000) in which the indications were limited to Child class A
patients without portal hypertension. During the second period technical
improvements such as intermittent selective hilar clamping and greater
hiliar restrictions on transfusions were introduced. PATIENTS AND
METHODS: One hundred and ten hepatectomies were performed in 105
patients with hepatocellular carcinoma in our unit over a 12-year
period. Eighty percent of the tumors occurred in cirrhotic livers,
mainly caused by hepatitis C virus. In the second period, upper
gastrointestinal endoscopy was systematically performed to study the
presence of varices. Hemodynamics studies were optionally performed to
rule out portal hypertension. RESULTS: In the second period larger
tumors were resected, a greater number of major hepatectomies were
performed due to the increased frequency of hepatocellular carcinoma in
non-cirrhotic liver, and fewer patients underwent transfusion. Early
mortality was reduced from 21% to 1.8% and mean survival significantly
increased from 37 to 52 months. Actuarial survival increased from 64% to
91% at 1 year and from 23% to 52% at 5 years in the first and second
periods, respectively. Disease-free survival also increased
significantly from 53% and 84% at 1 year and 27% and 40% at 5 years in
the first and second periods, respectively. Analysis of the results in
cirrhotic patients also showed a statistically significant improvement
in early mortality and survival. Multivariate analysis of prognostic
factors for survival demonstrated that the absence of blood transfusion,
patients who underwent resection in the second period and the presence
of pseudocapsules were independent factors for increased survival.
CONCLUSIONS: The results of liver resection for hepatocellular carcinoma
improved significantly due to the reduction in early mortality produced
by more rigorous patient selection and the introduction of technical
improvements.
33
UI - 11730622
AU - Llovet JM; Fuster J
TI -
[Liver resection in the treatment of hepatocellular carcinoma]
SO - Gastroenterol Hepatol 2001 Dec;24(10):511-3
34
UI - 11794405
AU - Shirato K; Morimoto M; Tomita N; Kokawa A; Sugimori K; Saito T; Numata
TI -
K; Sekihara H; Tanaka K
Small hepatocellular carcinoma: therapeutic effectiveness of
percutaneous radio frequency ablation therapy with a LeVeen needle
electrode.
SO - J Ultrasound Med 2002 Jan;21(1):67-76
AD - Gastroenterological Center, Yokohama City University Medical Center,
Japan.
OBJECTIVE: To evaluate the therapeutic effectiveness of percutaneous
radio frequency ablation of small (< or =3-cm) hepatocellular carcinoma
with a LeVeen needle electrode. METHODS: Thirty patients (mean age, 65.7
years) with 32 hepatocellular carcinomas (range, 1.2-3.0 cm; mean,
2.3+/-0.5 cm) underwent percutaneous radio frequency ablation to the
center of the hepatocellular carcinoma after expansion of the inner
needles. The manufacturer's recommended radio frequency ablation
protocol was used. Posttreatment contrast-enhanced color Doppler
sonography, contrast-enhanced computed tomography, and fine-needle
biopsy were performed to assess the radio frequency ablation-induced
coagulated necrosis. RESULTS: Severe intratreatment pain made us abort
radio frequency ablation in 2 patients. Complete tumor necrosis was
achieved in 1 treatment session with 1 needle electrode insertion in 28
(93.4%) of 30 nodules (28 patients). We found no residual focus on both
color Doppler sonography and computed tomography after any of the
sessions. In follow-ups ranging from 3 to 15 months (mean, 8.4 months),
no local recurrence was found in cases with complete tumor ablation.
CONCLUSIONS: Radio frequency ablation with the LeVeen needle electrode
was effective, obtaining complete coagulated necrosis with a safety
margin when used for the treatment of small hepatocellular carcinomas.
35
UI - 11864537
AU - Callado Franca AV; Lescano Lescano MA; Martinelli Canadolo AL
TI -
[Coadjuvant combined treatment of hepatocellular carcinoma prior to
liver transplantation]
SO - Gastroenterol Hepatol 2002 Mar;25(3):153-5
AD - Unidad de Transplante Hepatico, Departamento de Clinica Medica,
Universidad de Sao Paulo, Riberao Preta, Brasil. avcfranca@hotmail.com
The aim of this study was to report the antitumor effect of combination
therapy of hepatocellular carcinoma in patients on the waiting list for
liver transplantation. We studied 3 cirrhotic patients with
hepatocellular carcinoma > 3 cm and < 8 cm who underwent transarterial
embolization and percutaneous ethanol injection as combination
coadjuvant therapy while on the waiting list for liver transplantation.
Transarterial embolization failed to produce total necrosis of the
tumor. In all 3 patients this was subsequently achieved with
percutaneous ethanol injection. All the patients currently remain on the
waiting list and show no signs of local tumor recurrence 9, 10 and 13
months after the procedures. In conclusion, combination adjuvant therapy
with transarterial embolization and percutaneous ethanol injection can
increase tumor necrosis and can be useful prior to liver
transplantation. Further studies with a greater number of patients are
required to confirm the value of this combination therapy.
36
UI - 11952580
AU - Kubo S; Nishiguchi S; Hirohashi K; Tanaka H; Shuto T; Kinoshita H
TI -
Randomized clinical trial of long-term outcome after resection of
hepatitis C virus-related hepatocellular carcinoma by postoperative
interferon therapy.
SO - Br J Surg 2002 Apr;89(4):418-22
AD - Second Department of Surgery, Osaka City University Medical School,
Osaka, Japan. m7696493@msic.med.osaka-cu.ac.jp
BACKGROUND: Interferon therapy seems to decrease the incidence of
recurrence after resection of hepatitis C virus (HCV)-related
hepatocellular carcinoma (HCC). Effects of postoperative interferon
therapy on the survival rate after resection of such HCC are still
unclear. METHODS: A prospective randomized clinical trial of
postoperative interferon therapy was performed. Thirty men were
allocated randomly after liver resection to an interferon-alpha group
(15 patients) or a control group. Patients in the interferon group
received interferon-alpha 6 MIU intramuscularly every day for 2 weeks,
then three times a week for 14 weeks and finally twice a week for 88
weeks. RESULTS: The response to interferon was complete in two patients,
there was a biochemical response in six patients and no response in
seven patients. Interferon administration was not completed in three
patients because of adverse events. Liver function did not change or
worsened after operation in the control group, and did not change or
improved in the interferon group. The cumulative survival rate was
higher in the interferon group than in the control group (P = 0.041).
CONCLUSION: Postoperative interferon therapy seems to improve the
outcome after resection of HCV-related HCC.
37
UI - 11981761
AU - Abiru S; Nakao K; Ichikawa T; Migita K; Shigeno M; Sakamoto M; Ishikawa
TI -
H; Hamasaki K; Nakata K; Eguchi K
Aspirin and NS-398 inhibit hepatocyte growth factor-induced invasiveness
of human hepatoma cells.
SO - Hepatology 2002 May;35(5):1117-24
AD - First Department of Internal Medicine, Nagasaki University School of
Medicine, Japan.
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase
(COX) activity and are considered to exert antitumor actions in a
variety of cancer cells, although the effects are unlikely entirely due
to COX inhibition. Because clinical observations suggest that hepatocyte
growth factor (HGF) can promote metastasis of hepatoma cells while
stimulating tumor invasiveness, we investigated the effect of aspirin
and NS-398, a selective COX-2 inhibitor, on HGF-mediated invasiveness of
HepG2 human hepatoma cells. HGF stimulated the invasiveness of HepG2
cells in Matrigel cell invasion assay, together with increased
expression of matrix metalloproteinase (MMP) 9. Addition of aspirin or
NS-398, similar to PD98059, which acts as a specific inhibitor of
mitogen-activated protein kinase/extracellular signal-regulated kinase
(MEK), an upstream kinase regulating extracellular signal-regulated
kinase (ERK)1/2, abrogated such actions of HGF without affecting cell
viability. Aspirin and NS-398, in contrast to PD98059, did not suppress
ERK1/2 phosphorylation induced by HGF. However, both agents inhibited
the kinase activity of ERK1/2 induced by HGF and repressed HGF-induced
phosphorylation of 90-kd ribosomal S6 kinase (RSK) and Elk-1, key
downstream substrates of ERK1/2, resulting in the suppression of
transcriptional activity of Elk-1 as well as nuclear factor kappaB
(NF-kappaB) and AP
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