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Haak F, Karli T, Takes M, Zech CJ, Kollmar O, Soysal SD. A Retrospective Cohort Analysis of Transarterial Chemoembolization for Hepatocellular Cancer at a Tertiary Center in Switzerland. J Clin Med 2024; 13:3279. [PMID: 38892990 PMCID: PMC11172573 DOI: 10.3390/jcm13113279] [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: 04/28/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: International guidelines recommend transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC). However, it is used outside these recommendations and has proven beneficial in prolonging survival. Since the role of TACE outside BCLC stage B is unclear, the present study analyzed the results of TACE performed at a tertiary center in Switzerland for different treatment groups, and aims to highlight the treatment outcomes for these groups. Methods: This retrospective cohort study includes 101 HCC patients undergoing TACE at our center. Patients were further subdivided into groups according to therapy combinations (therapies applied before and after index TACE). Kaplan-Meier survival curves were calculated for the Barcelona Center for Liver Cancer (BCLC) subgroups. Results: After TACE, the median survival was 28.1 months for BCLC 0, 31.5 months for BCLC A, 20.5 months for BCLC B, 10.8 for BCLC C, and 7.5 months for BCLC D. A lesion size larger than 55 mm was negatively associated with survival (HR 2.8, 95% CI 1.15-6.78). Complications occurred after TACE procedures: Clavien-Dindo I + II = 30, Clavien-Dindo > 3 = 2. Conclusions: TACE was performed in a substantial part of our cohort outside of routinely used treatment guidelines. The combination of the survival data and complication rate in these patients suggests it was a safe and beneficial strategy. Furthermore, our data show that in our cohort, the survival benefit associated with TACE was restricted to patients with a lesion size smaller than 55 mm.
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Affiliation(s)
- Fabian Haak
- Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, 4058 Basel, Switzerland
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Division of Hepatobiliary Surgery and Visceral Transplant Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Tobias Karli
- Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, 4058 Basel, Switzerland
| | - Martin Takes
- Interventional Radiology, Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Christoph J. Zech
- Interventional Radiology, Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Otto Kollmar
- Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, 4058 Basel, Switzerland
| | - Savas D. Soysal
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
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Suresh D, Srinivas AN, Prashant A, Harikumar KB, Kumar DP. Therapeutic options in hepatocellular carcinoma: a comprehensive review. Clin Exp Med 2023; 23:1901-1916. [PMID: 36780119 DOI: 10.1007/s10238-023-01014-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
Hepatocellular carcinoma (HCC) is a chronic liver disease that is highly fatal if not detected and treated early. The incidence and death rate of HCC have been increasing in recent decades despite the measures taken for preventive screening and effective diagnostic and treatment strategies. The pathophysiology of HCC is multifactorial and highly complex owing to its molecular and immune heterogeneity, and thus the gap in knowledge still precludes making choices between viable therapeutic options and also the development of effective regimens. The treatment of HCC demands multidisciplinary approaches and primarily depends on tumor stage, hepatic functional reserve, and response to treatment by patients. Although curative treatments are limited but critical in the early stages of cancer, there are numerous palliative treatments available for patients with intermediate and advanced-stage HCC. In recent times, the use of combination therapy has succeeded over the use of monotherapy in the treatment of HCC by achieving effective tumor suppression, increasing survival rate, decreasing toxicity, and also aiding in overcoming drug resistance. This work focuses on reviewing the current and emerging treatment strategies for HCC.
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Affiliation(s)
- Diwakar Suresh
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Akshatha N Srinivas
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Akila Prashant
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Kuzhuvelil B Harikumar
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, 695014, India
| | - Divya P Kumar
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India.
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Fonseca LG, Chen AT, de Oliveira IS, Chagas AL, Kruger JA, Carrilho FJ. Brazilian Landscape of Hepatocellular Carcinoma. JCO Glob Oncol 2023; 9:e2200416. [PMID: 37348031 PMCID: PMC10497258 DOI: 10.1200/go.22.00416] [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: 12/09/2022] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 06/24/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is expected to increase in the coming years, and strategies to mitigate the burden of this disease are needed in different regions. Geographic variations in epidemiology and risk factors, such as viral hepatitis and metabolic disease, pose challenges in adopting programs for early detection programs and management of patients with HCC. Brazil, like other countries, has high economic and social inequality, with heterogeneous access to health care. Viral hepatitis is the main risk factor but there is growing awareness of fatty liver disease. Risk factor monitoring and screening programs are unmet priorities because patients are often diagnosed at later stages. Advances in the management of patients with HCC have been made in recent years, including new tools for selecting patients for liver transplantation, sophisticated surgical techniques, and new systemic agents. High-volume academic centers often achieve favorable results through the adoption and application of established treatments, but this is not a reality in most regions of Brazil, because of disparities in wealth and resources. As HCC management requires a coordinated and multidisciplinary team, the role of local referral centers in decentralizing access to treatments and promoting health education in different regions should be encouraged and supported.
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Affiliation(s)
- Leonardo G. Fonseca
- Medical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Andre T.C. Chen
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Irai S. de Oliveira
- Department of Radiology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Aline L. Chagas
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jaime A.P. Kruger
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair J. Carrilho
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Cai L, Li H, Guo J, Zhao W, Duan Y, Hou X, Cheng L, Du H, Shao X, Diao Z, Hao Y, Zheng X, Li C, Li W. Treatment efficacy and safety of drug-eluting beads transarterial chemoembolization versus conventional transarterial chemoembolization in hepatocellular carcinoma patients with arterioportal fistula. Cancer Biol Ther 2022; 23:89-95. [PMID: 35230928 PMCID: PMC8890397 DOI: 10.1080/15384047.2021.2020059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study aimed to compare the treatment efficacy and tolerance between drug-eluting beads transarterial chemoembolization (DEB-TACE) and conventional transarterial chemoembolization (cTACE) in hepatocellular carcinoma (HCC) patients with arterioportal fistula (APF). A total of 44 HCC patients with APF scheduled for DEB-TACE (N = 24, as DEB-TACE group) or cTACE (N = 20, as cTACE group) were recruited. Treatment response, hepatic function, and adverse events were assessed or recorded. Besides, progression-free survival (PFS) and overall survival (OS) were calculated. Total treatment response was better in the DEB-TACE group compared with the cTACE group (P = .012). Meanwhile, the objective response rate (87.5% versus 60.0%) was higher (P = .013), while the disease control rate (95.8% versus 85.0%) was similar in the DEB-TACE group compared to the cTACE group (P = .213). Besides, PFS (mean value: 12.2 (95%CI: 9.9-14.6) months versus 7.8 (95%CI: 5.6-10.0) months) (P = .037), but not OS (mean value: 20.0 (95%CI: 18.1-21.9) months versus. 18.6 (95%CI: 15.4-21.8) months) (P = .341) was prolonged in DEB-TACE group compared with cTACE group. Regarding the safety, Child-Pugh stage, albumin level, and bilirubin level after treatment were all similar between the DEB-TACE group and cTACE group (all P > .05); moreover, no difference was found in the occurrence of adverse events during or after treatment between the two groups (all P > .05). Moreover, subsequent analyses found that embolic materials for APF (microspheres) in the DEB-TACE group did not affect the treatment efficacy (all P > .05). DEB-TACE promotes treatment response and PFS compared with cTACE and shows good safety in HCC patients with APF.
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Affiliation(s)
- Liang Cai
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Honglu Li
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiang Guo
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wenpeng Zhao
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Youjia Duan
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaopu Hou
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Long Cheng
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongliu Du
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xihong Shao
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhenying Diao
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yiwei Hao
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xinmei Zheng
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Changqing Li
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Oncology, Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Zhang C, Dai YH, Lian SF, Liu L, Zhao T, Wen JY. Efficacy of transcatheter arterial chemoembolization using pirarubicin-loaded microspheres combined with lobaplatin for primary liver cancer. World J Clin Cases 2022; 10:9650-9656. [PMID: 36186198 PMCID: PMC9516916 DOI: 10.12998/wjcc.v10.i27.9650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Drug-eluting beads show good safety and promising efficacy when used as part of a transarterial chemoembolization regimen for primary liver cancer. However, data on the clinical efficacy and safety of pirarubicin-loaded beads combined with lobaplatin are lacking in China.
AIM To evaluate the efficacy and safety of transcatheter arterial chemoembolization using pirarubicin-loaded beads combined with lobaplatin for primary liver cancer.
METHODS Between January 2019 and March 2020, 60 patients with primary liver cancer were selected at Hebei North University Affiliated First Hospital. According to different treatment methods, the participants were categorized into two groups with 30 patients treated with pirarubicin-loaded microspheres combined with lobaplatin included in an observation group and 30 patients treated with pirarubicin emulsion with lipiodol combined with lobaplatin were included in a control group. The progression-free survival, overall survival, clinical response rate, disease control rate, liver and kidney function and adverse reactions were compared between the two groups.
RESULTS The progression-free survival was 14 mo in the observation group, which was significantly higher than 9 mo of the control group (P < 0.05). The 6-mo, 12-mo and 18-mo survival rates were 93.33% (28/30), 66.67% (20/30) and 23.33% (7/30), respectively in the observation group, which were significantly higher than 83.33% (25/30), 50.00% (15/30) and 13.33% (4/30), respectively, of the control group (all P < 0.05). The clinical efficacy rate and disease control rate were 73.33% and 93.33%, respectively, in the observation group, which were significantly higher than those of the control group (53.55% and 80.00%, respectively, all P < 0.05). There was no significant difference in alpha-fetoprotein between the two groups before the treatment (P > 0.05). After the treatment, alpha-fetoprotein was 289.06 ± 76.21 ng/mL in the observation group and 365.01 ± 73.11 ng/mL in the control group, which were low in both groups compared with those before the treatment (all P < 0.05). The incidence of nausea and vomiting was significantly lower in the observation group than in the control group (P < 0.05). There was no significant difference for the adverse reactions of pain and fever between the two groups (P < 0.05).
CONCLUSION The combination of pirarubicin-loaded beads and lobaplatin can improve treatment efficacy resulting in mild liver function damage and postoperative complications in patients with primary liver cancer. It can be used in clinical practice.
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Affiliation(s)
- Chao Zhang
- Department of Interventional Therapy, Hebei North University Affiliated First Hospital, Zhangjiakou 075000, Hebei Province, China
| | - Yu-Hui Dai
- Department of Interventional Therapy, Hebei North University Affiliated First Hospital, Zhangjiakou 075000, Hebei Province, China
| | - Shu-Feng Lian
- Zhangjiakou Qiaoxi District Maternal and Child Health Care Hospital, Zhangjiakou 075000, Hebei Province, China
| | - Liang Liu
- Department of Interventional Therapy, Hebei North University Affiliated First Hospital, Zhangjiakou 075000, Hebei Province, China
| | - Ting Zhao
- Department of Interventional Therapy, Hebei North University Affiliated First Hospital, Zhangjiakou 075000, Hebei Province, China
| | - Jun-Ye Wen
- Department of Hepatobiliary Surgery, Hebei People’s Hospital, Shijiazhuang 050055, Hebei Province, China
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Emerging Polymer Materials in Trackable Endovascular Embolization and Cell Delivery: From Hype to Hope. Biomimetics (Basel) 2022; 7:biomimetics7020077. [PMID: 35735593 PMCID: PMC9221114 DOI: 10.3390/biomimetics7020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Minimally invasive endovascular embolization is a widely used clinical technique used for the occlusion of blood vessels to treat various diseases. Different occlusive agents ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) (PVA) have been commercially used for embolization. However, these agents have some drawbacks, such as undesired toxicity and unintended and uncontrolled occlusion. To overcome these issues, several polymer-based embolic systems are under investigation including biocompatible and biodegradable microspheres, gelling liquid embolic with controlled occlusive features, and trackable microspheres with enhanced safety profiles. This review aims to summarize recent advances in current and emerging polymeric materials as embolization agents with varying material architectures. Furthermore, this review also explores the potential of combining injectable embolic agents and cell therapy to achieve more effective embolization with the promise of outstanding results in treating various devastating diseases. Finally, limitations and challenges in developing next-generation multifunctional embolic agents are discussed to promote advancement in this emerging field.
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Can Posttransarterial Chemoembolization Volumetric Oil Deposition on Computed Tomography Predict Treatment Response on Magnetic Resonance Imaging in Leiomyosarcoma Metastases to the Liver? J Comput Assist Tomogr 2022; 46:327-332. [PMID: 35405712 DOI: 10.1097/rct.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To predict early tumor response to transarterial chemoembolization (TACE) based on volumetric oil deposition on posttreatment computed tomography (CT) in patients with leiomyosarcoma liver metastases. METHODS This retrospective lesion-by-lesion based study included 32 lesions. The volumetric percent enhancing tumor on pre-TACE and 1-month post-TACE venous phase magnetic resonance imaging (MRI), and the percent oil deposition on CT 1 day after TACE were calculated. The predicted post-TACE enhanced percentage was computed by subtracting percent oil deposition from baseline percent enhanced. RESULTS Mean percentage of viable tumor on pre-TACE MRI was 90.6% ± 9.3%. Mean oil deposition was calculated as 51.4% ± 26.2%. Mean percentage of measured residual tumor enhancement 1 month after TACE was 58.3% ± 27%, which correlates with predicted enhancement percentage of 43.9% ± 25.1% (r = 0.72, P < 0.001). A threshold of 35.5% for enhancement reduction was determined to predict tumor response with an accuracy of 78.1%. CONCLUSION Volumetric oil deposition on CT can predict residual enhancement on post-TACE MRI.
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Liu KC, Lv WF, Lu D, Hou CL, Xie J, Lu YH, Cao QS, Tan YL, Zhang YZ, Liu J. Initial Experience of Drug-Eluting Bead-Transcatheter Arterial Chemoembolization After Lipiodol-Based Transcatheter Arterial Chemoembolization Failure for Patients with Advanced Hepatocellular Carcinoma. Cancer Manag Res 2021; 13:7973-7980. [PMID: 34703317 PMCID: PMC8541737 DOI: 10.2147/cmar.s332571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose To investigate the potential safety and efficacy of drug-eluting bead-transcatheter arterial chemoembolization (DEB-TACE) in treating TACE-refractory hepatocellular carcinoma (HCC). Methods We retrospectively evaluated the treatment outcomes of DEB-TACE for 41 HCC nodules in 30 patients who were refractory to conventional TACE (c-TACE) according to tumor response. The antitumor response was evaluated according to mRECIST criteria, and changes in alpha-fetoprotein (AFP), albumin-bilirubin score, the incidence of adverse events, and the time to disease progression were observed. Results The objective response rate and disease control rates were 60.98% and 95.12% at 4 weeks after DEB-TACE, 63.41% and 92.68% at 8 weeks, respectively. The median time of disease progression was 4.60 ± 0.23 months. The AFP of patients decreased continuously at 2–6 weeks after operation, and the AFP at 4 weeks was significantly lower than that at 2 weeks (P = 0.038). Adverse reactions were well tolerated, and no grade 4 adverse reactions were reported. The albumin-bilirubin score did not deteriorate within 6 weeks. Conclusion DEB-TACE has potential efficacy and safety after failure of c-TACE in patients with advanced liver cancer. Further studies are needed to confirm the efficacy of DEB-TACE treatment after failure of c-TACE.
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Affiliation(s)
- Kai-Cai Liu
- Infection Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Wei-Fu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Chang-Long Hou
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Jun Xie
- Department of Interventional Radiology, Fuyang People's Hospital, Fuyang, People's Republic of China
| | - Yu-He Lu
- Department of Interventional Radiology, Chuzhou First People's Hospital, Chuzhou, People's Republic of China
| | - Qi-Sheng Cao
- Department of Interventional Radiology, Ma'anshan People's Hospital, Ma'anshan, People's Republic of China
| | - Yu-Lin Tan
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Ying-Zhan Zhang
- Department of Interventional Radiology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Jie Liu
- Department of Interventional Radiology, Yingshang People's Hospital, Fuyang, People's Republic of China
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Chen S, Yu W, Zhang K, Liu W, Chen C. Comparison of the efficacy and safety of conventional transarterial chemoembolization with and without drug-eluting beads embolization for the treatment of unresectable large hepatocellular carcinoma. Hepatol Res 2021; 51:482-489. [PMID: 33462925 DOI: 10.1111/hepr.13620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
AIM Hepatocellular carcinoma (HCC) has a poor prognosis. Moreover, large HCCs have been commonly observed. We aimed to evaluate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) combined with conventional TACE (cTACE) for the treatment of patients with unresectable large HCCs (main tumor ≥5 cm in diameter) compared with cTACE alone. METHODS A retrospective matched cohort study was performed on consecutive patients with unresectable large HCCs who underwent TACE as the initial treatment at the Fujian Medical University Cancer Hospital from May 2017 and March 2019. Fifty-five patients who underwent DEB-TACE combined with cTACE were compared with a case-matched control group of 110 patients who received cTACE alone. We compared the tumor response at 1 and 3 months after TACE, time to progression (TTP), and adverse events between the groups. RESULTS The objective response rate was higher for the DEB-TACE combined with cTACE group than for the cTACE alone group at 1 (39 of 55 [70.9%] vs. 57 of 110 [51.8%], p = 0.019) and 3 months (27 of 43 [62.8%] vs. 31 of 71 [43.7%], p = 0.048) post-treatment. The DEB-TACE combined with cTACE group also had a significantly longer median TTP than that of the cTACE group (7.2 vs. 5.3 months, p = 0.039). Compared with the cTACE group, occurrences of abdominal pain, nausea/vomiting, and constipation were significantly more frequent in the DEB-TACE combined with cTACE group (p < 0.05). CONCLUSION Compared with cTACE alone, DEB-TACE combined with cTACE significantly increased the objective response rate at 1 and 3 months after the treatment of unresectable large HCCs, and had a longer TTP, without any significant increase in the number of severe complications.
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Affiliation(s)
- Shiguang Chen
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wenchang Yu
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Kongzhi Zhang
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Weifu Liu
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Department of Radiotherapy Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
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SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study). J Gastrointest Cancer 2020; 52:907-914. [PMID: 32901445 DOI: 10.1007/s12029-020-00502-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. METHODS This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. RESULTS Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p ≤ 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85-2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1-1.02, p = 0.025)) on multivariate analysis. CONCLUSION This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.
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Luo J, Zheng J, Shi C, Fang J, Peng Z, Huang J, Sun J, Zhou G, Li T, Zhu D, Xu H, Hou Q, Ying S, Sun Z, Du H, Xie X, Cao G, Ji W, Han J, Gu W, Guo X, Shao G, Yu Z, Zhou J, Yu W, Zhang X, Li L, Hu H, Hu T, Wu X, Chen Y, Ji J, Hu W. Drug-eluting beads transarterial chemoembolization by CalliSpheres is effective and well tolerated in treating intrahepatic cholangiocarcinoma patients: A preliminary result from CTILC study. Medicine (Baltimore) 2020; 99:e19276. [PMID: 32195932 PMCID: PMC7220404 DOI: 10.1097/md.0000000000019276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of drug-eluting beads (DEB) transarterial chemoembolization (TACE) treatment in Chinese intrahepatic cholangiocarcinoma (ICC) patients.37 ICC patients underwent DEB-TACE treatment in CTILC study (registered on clinicaltrials.gov with registry No. NCT03317483) were included in this present study. Treatment response was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Overall survival (OS) was calculated from the time of DEB-TACE operation until the date of death from any causes. Liver function change and adverse events (AEs) were recorded during and after DEB-TACE operation.3 (8.1%) patients achieved complete response (CR) and 22 (59.5%) patients achieved partial response (PR), with objective response rate (ORR) of 67.6%. After DEB-TACE treatment, mean OS was 376 days (95%CI: 341-412 days). Multivariate logistic regression analysis revealed that Bilobar disease (P = .040, OR: 0.105, 95% CI: 0.012-0.898) and portal vein invasion (P = .038, OR: 0.104, 95% CI: 0.012-0.881) could independently predict less possibility of ORR. Patients with ALB abnormal, TP abnormal, ALT abnormal and AST abnormal were increased at 1-week post DEB-TACE treatment (P = .034, P = .001, P < .001, P = .006, respectively), while returned to the levels at baseline after 1 to 3 months (all P > .050). Besides, most of the AEs were mild including pain, fever, vomiting, and nausea in this study.DEB-TACE was effective and well tolerated in treating ICC patients, and bilobar disease as well as portal vein invasion were independently correlated with less probability of ORR achievement.
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Affiliation(s)
- Jun Luo
- Department of Intervention, Zhejiang Cancer Hospital, Hangzhou
| | - Jiaping Zheng
- Department of Intervention, Zhejiang Cancer Hospital, Hangzhou
| | - Changsheng Shi
- Department of Intervention, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China
| | - Jian Fang
- Department of Hepatobiliary Surgery, Quzhou People's Hospital, Quzhou
| | - Zhiyi Peng
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Jing Huang
- Department of Hepatobiliary Surgery, Ningbo Medical Center, Lihuili Eastern Hospital, Ningbo
| | - Junhui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Guanhui Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Tiefeng Li
- Department of Radiology, Beilun District People's Hospital of Ningbo, Ningbo
| | - Dedong Zhu
- Department of Liver Oncology, Ningbo No.2 Hospital, Ningbo, China
| | - Huanhai Xu
- Division of Digestive Endoscopy, Yueqing City People's Hospital, Yueqing
| | - Qinming Hou
- Department of Radiology, Xixi Hospital of Hangzhou, Hangzhou 6th People's Hospital, Hangzhou
| | - Shihong Ying
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Zhichao Sun
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou
| | - Haijun Du
- Department of Intervention, Dong Yang people's Hospital, Dongyang
| | - Xiaoxi Xie
- Interventional Center, Xinchang People's Hospital, Shaoxing
| | - Guohong Cao
- Department of Radiology, Shulan (Hangzhou) Hospital, Zhejiang University International Hospital, Hangzhou
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital of Zhejiang Province, Linhai
| | - Jun Han
- Department of Intervention, Jiaxing First Hospital, Jiaxing
| | - Wenjiang Gu
- Department of Intervention, Jiaxing Second Hospital, Jiaxing
| | - Xiaohua Guo
- Department of Intervention, Jinhua Central Hospital, Jinhua
| | - Guoliang Shao
- Department of Intervention, Zhejiang Cancer Hospital, Hangzhou
| | - Zhihai Yu
- Department of Vascular and Interventional Radiology, The Affiliated Hospital of Medical College of Ningbo University, Ningbo
| | - Jian Zhou
- Department of Radiology, Hangzhou Cancer Hospital
| | - Wenqiang Yu
- Department of Intervention, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xin Zhang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Ling Li
- Department of Liver Oncology, Ningbo No.2 Hospital, Ningbo, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou
| | - Tingyang Hu
- Department of Intervention, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou
| | - Yutang Chen
- Department of Intervention, Zhejiang Cancer Hospital, Hangzhou
| | - Jiansong Ji
- Department of Radiology, Lishui Central Hospital, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui
| | - Wenhao Hu
- Department of Intervention, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Han T, Yang X, Zhang Y, Li G, Liu L, Chen T, Zheng Z. The clinical safety and efficacy of conventional transcatheter arterial chemoembolization and drug-eluting beads-transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: A meta-analysis. Biosci Trends 2019; 13:374-381. [PMID: 31611486 DOI: 10.5582/bst.2019.01153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transcatheter arterial chemoembolization (TACE) plays an important role in the treatment of unresectable liver cancer. We conducted this meta-analysis to compare the clinical safety and efficacy of conventional TACE (C-TACE) and drug-eluting beads (DEB)-TACE. A search for those procedures was performed using the PubMed, EMBASE, and Cochrane Library databases. A meta-analysis of patients who underwent C-TACE or DEB-TACE was conducted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Of 334 studies, 30 were analyzed. The complete response rate, disease control rate, objective response rate, 3-year survival rate, and non-response rate were significantly higher in patients who underwent DEB-TACE than those in patients who underwent C-TACE. The 1-year survival rate, 2-year survival rate, 30-day mortality rate, complete response rate, disease control rate, complete necrosis rate, non-response rate, objective response rate, progressive disease rate, and recurrence did not differ significantly between patients who underwent C-TACE and patients who underwent DEB-TACE. Patients who undergo DEB-TACE might have a higher complete response rate, disease control rate, and 3-year survival rate than patients who undergo C-TACE. Safety did not differ significantly between C-TACE and DEB-TACE.
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Affiliation(s)
- Tao Han
- Department of Oncology, Cancer Center, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Xiaodan Yang
- Department of Oncology, Cancer Center, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yue Zhang
- Department of Oncology, Cancer Center, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Gao Li
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Lu Liu
- Department of Oncology, Cancer Center, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Tingsong Chen
- Department of Invasive Technology, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhendong Zheng
- Department of Oncology, Cancer Center, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Zhang XR, Ouyang J, Huang JY. Comparison of CEUS and enhanced CT in evaluating efficacy of TACE for hepatocellular carcinoma. Shijie Huaren Xiaohua Zazhi 2019; 27:63-67. [DOI: 10.11569/wcjd.v27.i1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the value of contrast-enhanced ultrasound (CEUS) and enhanced computed tomography (CT) in evaluating the efficacy of transcatheter artery chemoembolization (TACE) for hepatocellular carcinoma (HCC).
METHODS A total of 96 patients with HCC who underwent TACE at Zhejiang Tumor Hospital were selected as research subjects (a total of 128 lesions). Digital subtraction angiography (DSA), CEUS, and enhanced CT were performed one month after operation, and the results of DSA were used as the "gold standard" to compare the clinical value of CEUS and enhanced CT in evaluating the efficacy of TACE.
RESULTS The sensitivity (95.18%) and accuracy (95.31%) of CEUS in the diagnosis of residual lesions were higher than those (84.34% and 88.28%, respectively) of enhanced CT (P < 0.05). The specificities of CEUS and enhanced CT in the diagnosis of residual lesions were both 95.56%, and there was no significant difference between them (P > 0.05).
CONCLUSION CEUS can accurately evaluate the residual lesions of HCC after TACE and has appreciated clinical value, thus providing a reliable imaging method for evaluating the efficacy of TACE.
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Affiliation(s)
- Xin-Rong Zhang
- Department of Ultrasonography, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Jun Ouyang
- Department of Ultrasonography, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Jing-Yuan Huang
- Department of Ultrasonography, Shulan (Hangzhou) Hospital, Hangzhou 310022, Zhejiang Province, China
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14
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Nouri YM, Kim JH, Yoon HK, Ko HK, Shin JH, Gwon DI. Update on Transarterial Chemoembolization with Drug-Eluting Microspheres for Hepatocellular Carcinoma. Korean J Radiol 2018; 20:34-49. [PMID: 30627020 PMCID: PMC6315076 DOI: 10.3348/kjr.2018.0088] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/24/2018] [Indexed: 01/27/2023] Open
Abstract
Conventional transcatheter arterial chemoembolization (c-TACE) is a widely used first-line palliative treatment for patients with unresectable hepatocellular carcinoma (HCC). Despite the effectiveness of c-TACE, to date, technique and procedure scheduling has not yet been standardized. Drug-eluting microspheres (DEMs) were therefore introduced to ensure more sustained and tumor-selective drug delivery for permanent embolization. These DEMs can load various drugs and release them in a sustained manner over a prolonged period. This approach ensures the delivery of high concentrations of chemotherapeutic agents to tumors, without increasing systemic concentrations, and promote tumor ischemia and necrosis. This review summarizes the recent advances in the use of DEM-TACE to treat HCC.
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Affiliation(s)
- Yasir M Nouri
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Sun J, Zhou G, Zhang Y, Zhou T, Nie C, Zhu T, Chen S, Wang B, Yu Z, Wang H, Chen X, Hong L, Chen L, Wang W, Zheng S. Comprehensive analysis of common safety profiles and their predictive factors in 520 records of liver cancer patients treated by drug-eluting beads transarterial chemoembolization. Medicine (Baltimore) 2018; 97:e11131. [PMID: 29952956 PMCID: PMC6039676 DOI: 10.1097/md.0000000000011131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This study aimed to investigate the difference of common adverse events (AEs) between patients experienced first drug-eluting beads transarterial chemoembolization (DEB-TACE; FD) and second or higher DEB-TACE (SHD), and the factors influencing AEs.Five hundred twenty DEB-TACE records were retrospectively reviewed in this cohort study, among which 284 and 236 records were in FD and SHD groups, respectively. The incidence and/or severity of pain, fever, vomiting, and increased blood pressure (BP) were collected.Pain numerical rating scale (NRS) score, pain severity, body temperature, fever severity, and fever lasting days were higher in FD group than in SHD group, while no difference of vomiting and increased BP between 2 groups were disclosed. Age ≥65 years was associated with decreased high fever and less possibility of vomiting in FD group, and lower pain and fever severity in SHD group; Male decreased the possibility of vomiting in both the groups, and reduced increased BP incidence in SHD group; diabetes history correlated with decreased pain degree and less fever in FD group.In conclusion, SHD was better tolerated compared with FD in liver cancer patients, and older age as well as male were correlated with less occurrence or severity of common AEs in DEB-TACE operation.
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Affiliation(s)
- Junhui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Guanhui Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Yuelin Zhang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Tanyang Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Chunhui Nie
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Tongyin Zhu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Shengqun Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Baoquan Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Ziniu Yu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Hongliang Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Xinhua Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Liangjie Hong
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Liming Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Weilin Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Shusen Zheng
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
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Kumari R, Sahu MK, Tripathy A, Uthansingh K, Behera M. Hepatocellular carcinoma treatment: hurdles, advances and prospects. Hepat Oncol 2018; 5:HEP08. [PMID: 31293776 PMCID: PMC6613045 DOI: 10.2217/hep-2018-0002] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/25/2018] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related mortality and is particularly refractory to the available chemotherapeutic drugs. Among various etiologies of HCC, viral etiology is the most common, and, along with alcoholic liver disease and nonalcoholic steatohepatitis, accounts for almost 90% of all HCC cases. HCC is a heterogeneous tumor associated with multiple signaling pathway alterations and its complex patho-physiology has made the treatment decision challenging. The potential curative treatment options are effective only in small group of patients, while palliative treatments are associated with improved survival and quality of life for intermediate/advanced stage HCC patients. This review article focuses on the currently available treatment strategies and hurdles encountered for HCC therapy. The curative treatment options discussed are surgical resection, liver transplantation, and local ablative therapies which are effective for early stage HCC patients. The palliative treatment options discussed are embolizing therapies, systemic therapies, and molecular targeted therapies. Besides, the review also focuses on hurdles to be conquered for successful treatment of HCC and specifies the future prospects for HCC treatment. It also discusses the multi-modal approach for HCC management which maximizes the chances of better clinical outcome after treatment and identifies that selection of a particular treatment regimen based on patients' disease stage, patients' ages, and other underlying factors will certainly lead to a better prognosis.
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Affiliation(s)
- Ratna Kumari
- KIIT School of Biotechnology, KIIT University, Bhubaneswar, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology & Hepatobiliary Sciences, IMS & SUM Hospital, Bhubaneswar, India
| | | | - Kanishka Uthansingh
- Department of Gastroenterology & Hepatobiliary Sciences, IMS & SUM Hospital, Bhubaneswar, India
| | - Manas Behera
- Department of Gastroenterology & Hepatobiliary Sciences, IMS & SUM Hospital, Bhubaneswar, India
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