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Tsochatzis EA, Fatourou EM, Triantos CK, Burroughs AK. Transarterial therapies for hepatocellular carcinoma. Recent Results Cancer Res 2012; 190:195-206. [PMID: 22941022 DOI: 10.1007/978-3-642-16037-0_13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transarterial therapies for hepatocellular carcinoma are considered palliative and should be offered to patients with intermediate stage multinodular disease without extra-hepatic metastases and sufficient liver reserve. They mainly include transarterial chemoembolisation and transarterial embolisation. While transarterial therapy is now a validated treatment for unresectable HCC, there is still a lack of conclusive evidence as to which type and schedule is the optimal procedure. This is mainly due to the lack of standardisation. Combining local therapies or intra-arterial therapies with systemic targeted therapies might prove more effective strategies in the future. In the present article, we review transarterial therapies and critically comment on their indications, complications and outcomes.
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Affiliation(s)
- Emmanuel A Tsochatzis
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, NW3 2QG, UK
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Kim HY, Choi JY, Kim CW, Bae SH, Yoon SK, Lee YJ, Rha SE, You YK, Kim DG, Jung ES. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging predicts the histological grade of hepatocellular carcinoma only in patients with Child-Pugh class A cirrhosis. Liver Transpl 2012; 18:850-7. [PMID: 22407909 DOI: 10.1002/lt.23426] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to investigate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in predicting the histological grade of hepatocellular carcinoma (HCC) according to the hepatic function. Eighty-one consecutive patients with 122 histologically proven HCCs who underwent Gd-EOB-DTPA-enhanced MRI before resection (45 HCCs in 42 patients) or transplantation (77 HCCs in 39 patients) were analyzed retrospectively. We calculated the relative enhancement ratios (RER), which is the ratio of the relative intensity of a tumor versus the surrounding parenchyma on hepatobiliary phase images to the relative intensity on unenhanced MRI scans. We then analyzed the correlation between the RER and the tumor differentiation grade in patients with various degrees of hepatic function. The degree of tumor enhancement, which included the precontrast relative intensity ratio (RIR), the postcontrast RIR, and the RER, for well-differentiated (WD) HCCs was significantly higher than the degree of tumor enhancement for moderately differentiated and poorly differentiated (PD) HCCs (P = 0.001 and P = 0.001, respectively, for precontrast RIRs; P < 0.001 and P < 0.001, respectively, for postcontrast RIRs; and P = 0.01 and P = 0.001, respectively, for RERs). In a subgroup analysis based on liver function, the correlation between the histological grade and the enhancement ratio was demonstrated only in the group of patients with Child-Pugh class A cirrhosis. The accuracy of postcontrast RIRs for predicting WD and PD HCCs was favorable; the areas under the receiver operating characteristic curves were 0.896 [95% confidence interval (CI) = 0.817-0.974] and 0.769 (95% CI = 0.658-0.879), respectively. In conclusion, the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help to predict the differentiation of HCCs, especially in HCC patients with Child-Pugh class A cirrhosis before liver transplantation or resection.
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Affiliation(s)
- Hee Yeon Kim
- Department of Internal Medicine (Division of Hepatology), College of Medicine, Catholic University of Korea, Seoul, Korea
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Treatment of hepatocellular carcinoma (HCC) by intra-arterial infusion of radio-emitter compounds: trans-arterial radio-embolisation of HCC. Cancer Treat Rev 2011; 38:641-9. [PMID: 22169503 DOI: 10.1016/j.ctrv.2011.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/17/2011] [Accepted: 11/21/2011] [Indexed: 12/17/2022]
Abstract
Traditional radiotherapy is only effective in treating hepatocellular cancer (HCC) in doses above 50 Gy, but this is above the recommended liver radiation exposure of about 35 Gy, which is an important limitation making this treatment unsuitable for routine clinical practice. Trans-arterial radio-embolisation (TARE), consists of delivery of compounds linked to radio-emitter particles which end up in hepatic end-arterioles or show affinity for the neoplasm itself, allowing localised delivery of doses beyond 120 Gy. These are well tolerated in patients treated with this type of internal radiation therapy. TARE for HCC is used for palliative treatment of advanced disease which cannot be treated in other ways, or for tumour down-staging before liver transplantation, or as adjuvant therapy for surgically resected HCC. Tumour response after TARE is between 25% and 60% if assessed by using RECIST criteria, and 80% by EASL criteria. In this review we outline the advantages and limitations of radio-emitter therapy including 131-I, 90-Y and 188-Re. We include several observational, and all comparative studies using these compounds. In particular we compare TARE to trans-arterial chemo-embolisation and other intra-arterial techniques.
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Abstract
Locoregional therapies for hepatocellular carcinoma have progressed greatly in the last 30 years, beginning with the introduction of chemoembolization. Embolization techniques have evolved with the use of drug-eluting beads and radioembolization with yttrium-90. In the last 10 years, several new ablation techniques were developed including radiofrequency ablation, microwave ablation, cryoablation, laser ablation, and irreversible electroporation. Isolated or in combination, these techniques have already shown that they can improve patient survival and/or provide acceptable palliation.
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Affiliation(s)
- Marcelo Guimaraes
- Division of Vascular & Interventional Radiology, Medical University of South Carolina, 25 Courtenay Drive, MSC 226, Charleston, SC 29425, USA.
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Piscaglia F, Bolondi L. The intermediate hepatocellular carcinoma stage: Should treatment be expanded? Dig Liver Dis 2010; 42 Suppl 3:S258-63. [PMID: 20547312 DOI: 10.1016/s1590-8658(10)60514-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most utilized staging system for establishing the prognosis of patients with hepatocellular carcinoma (HCC) and concurrently supporting the choice of best treatment strategy is the Barcelona Clinic Liver Cancer (BCLC), which includes 4 disease stages (early, intermediate, advanced, terminal). The BCLC intermediate stage (BCLC-B) consists of patients in Child-Pugh A or B with multinodular large HCC and preserved performance status. This definition is rather broad and includes a heterogeneous patient population, according to either tumor extension (from bifocal HCC to subtotal tumor replacement of liver parenchyma) or liver function (from Child-Pugh compensated A5 to decompensated B9). The recommended treatment modality for this HCC stage is, in general, transarterial chemoembolization (TACE). However, according to the heterogeneity of the intermediate population, patients are best served when the treatment decision is individualized and taken within a multidisciplinary team. For instance, patients in Child-Pugh B may not benefit at all from TACE or even suffer detrimental effects. TACE achieves complete radiological necrosis in about 35-60% of cases (after 2-3 courses). Patients not achieving complete necrosis and patients with early large recurrence should be managed individually, taking into consideration systemic treatments, which usually are reserved for advanced cases.
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Affiliation(s)
- Fabio Piscaglia
- Division of Internal Medicine, Dept of Digestive Disease and Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Koschny R, Schmidt J, Ganten TM. Beyond Milan criteria--chances and risks of expanding transplantation criteria for HCC patients with liver cirrhosis. Clin Transplant 2010; 23 Suppl 21:49-60. [PMID: 19930317 DOI: 10.1111/j.1399-0012.2009.01110.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Orthotopic liver transplantation (OLT) is, apart from resection, one important curative treatment for hepatocellular carcinoma (HCC) in liver cirrhosis, and especially attractive because it eliminates both the tumor and the underlying liver disease. The application of restrictive inclusion criteria for OLT in HCC patients resulted in favorable long-term recurrence-free survival. These criteria, however, exclude a subgroup of patients which, despite advanced tumor size, demonstrate an acceptable outcome. As a consequence, expansion of the strict Milan criteria has been discussed. However, this will also deteriorate the average outcome of OLT in HCC patients. Considering that we run short of donor organs, more sophisticated prediction models for survival after OLT for HCC patients are needed to identify patients who benefit best from OLT. Neoadjuvant treatment that is frequently applied as a bridging technique for patients on the waiting list for OLT could provide useful information on tumor behavior to better predict the risk of post-OLT tumor recurrence. This might also allow expansion of the Milan criteria to patients with good response to downstaging methods without negatively affecting post-OLT survival. Furthermore, alternative scoring systems have been suggested to identify HCC patients that might still benefit from resection instead of OLT, and molecular tools are being explored to provide predictive information on HCC biology. This review discusses the advantages and risks of extended inclusion criteria for OLT and the currently available data on alternative prediction models and bridging methods in HCC patients.
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Affiliation(s)
- Ronald Koschny
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
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Tsochatzis EA, Germani G, Burroughs AK. Transarterial Chemoembolization, Transarterial Chemotherapy, and Intra-arterial Chemotherapy for Hepatocellular Carcinoma Treatment. Semin Oncol 2010; 37:89-93. [DOI: 10.1053/j.seminoncol.2010.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pleguezuelo M, Lopez-Sanchez LM, Rodriguez-Ariza A, Montero JL, Briceno J, Ciria R, Muntane J, de la Mata M. Proteomic analysis for developing new biomarkers of hepatocellular carcinoma. World J Hepatol 2010; 2:127-35. [PMID: 21160983 PMCID: PMC2998961 DOI: 10.4254/wjh.v2.i3.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/14/2010] [Accepted: 01/21/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To identify new markers of hepatocellular carcinoma (HCC) using a proteomic analysis. METHODS Patients with liver cirrhosis of the three most frequent etiologies: hepatitis C virus, hepatitis B virus and alcoholic liver disease, were included in the study. The samples were analysed by 2D-electrophoresis in order to determine the differential protein expression. The proteins were separated according to the charge in immobilized pH 3-10 gradient strips and then by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Proteins of interest were excised, digested with trypsin and the resulting peptides were separated and identified. RESULTS Three differentially expressed apolipoproteins (Apo) were identified based on the protein profile using proteomic techniques: Apo-A1, Apo-A4 and Apo-E. Apo-A4 levels were significantly lower in HCC than in non-HCC patients regardless of etiology (P < 0.01). Multivariate logistic regression showed that Apo-A4 and Apo-A1 were the only independent factors related to HCC diagnosis (P < 0.05). The receiver operating characteristic (ROC) curve including both Apo-A4 and Apo-A1 showed an area under the ROC of 0.944 (P < 0.001), a sensitivity of 0.89 and a specificity of 0.81 for diagnosis of HCC. CONCLUSION Apo-A4 and Apo-A1 may be used clinically as biomarkers of HCC with a high sensibility and specificity. These findings may provide additional insights into the mechanism of HCC development and progression.
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Affiliation(s)
- Maria Pleguezuelo
- Maria Pleguezuelo, Ruben Ciria, Liver Research Unit and Academic Department of Surgery, Reina Sofia University Hospital, Avda Menendez Pidal s/n, Cordoba 14004, Spain
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Affiliation(s)
- Charles H Cha
- Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Shimofusa R, Ueda T, Kishimoto T, Nakajima M, Yoshikawa M, Kondo F, Ito H. Magnetic resonance imaging of hepatocellular carcinoma: a pictorial review of novel insights into pathophysiological features revealed by magnetic resonance imaging. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:583-9. [DOI: 10.1007/s00534-009-0198-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 12/16/2022]
Affiliation(s)
- Ryota Shimofusa
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Takuya Ueda
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
- Department of Radiology; Stanford University School of Medicine; 300 Pasteur Drive, Room S-072 Stanford CA 94305 USA
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Masayuki Nakajima
- Department of General Surgery, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Masaharu Yoshikawa
- Department of Medicine and Clinical Oncology, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Fukuo Kondo
- Department of Pathology; Teikyo University Faculty of Medicine; 2-11-1 Kaga, Itabashi-ku Tokyo 173-8605 Japan
| | - Hisao Ito
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
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