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Cressman E, Stolley D, Fowlkes N, Felix E, Priebe W, Parrish S, Fuentes D. Harnessing Electrophiles In Vivo: A Pilot Study in Swine Using a Hydrophobic Radiopaque Formulation of 2-Propylpentanoyl Chloride. Mol Pharm 2025. [PMID: 40359181 DOI: 10.1021/acs.molpharmaceut.4c01456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Abstract
Manipulating biology through chemistry is older than the discipline of chemistry itself. Traditionally, selectivity of oral or intravenous drugs relied on preferential drug-receptor binding. A novel approach exploiting image-guided techniques to impart spatial selectivity opens up a wide range of new possibilities for study and manipulation of biology. Motivated initially by the poor prognosis for solid tumors such as liver cancer, we demonstrate the use of an extreme form of in vivo chemistry for targeted delivery of 2-propylpentanoyl chloride in a swine model. The ensuing reaction in tissue devitalizes it by multiple mechanisms with lasting effects and, critically, demonstrates very low systemic exposure compared to controls. This work points toward a new, powerful strategy for investigating the interface between chemistry and biology in vivo.
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Affiliation(s)
- Erik Cressman
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Danielle Stolley
- Flow Cytometry & Cellular Imaging Core Facility, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Natalie Fowlkes
- Department of Veterinary Medicine and Surgery, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Edd Felix
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Waldemar Priebe
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Steve Parrish
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - David Fuentes
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, Texas 77030, United States
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2
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Ma J, Wei Z, Ye X. Interventional oncology and immunotherapy: current status and future perspectives. Front Immunol 2025; 16:1541105. [PMID: 40264767 PMCID: PMC12011731 DOI: 10.3389/fimmu.2025.1541105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 03/19/2025] [Indexed: 04/24/2025] Open
Abstract
Interventional oncology has become an important part of multidisciplinary cancer treatment following the development of interventional radiology. Tumors can release antigens, activate immunity, and cause an abscopal effect after interventional therapy. However, the activated immune response is limited and involves a complex process. New methods to solve the problems were developed following the advent of immunotherapy. The combination therapies enhanced the antitumor immune response and improved patient outcomes with good application prospects. In this review, we have summarized the interventional therapies used to improve immune efficacy and discussed the advancements in combining interventional therapy and immunotherapy.
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Affiliation(s)
- Ji Ma
- Department of Oncology, Lung Cancer Center, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China
| | - Zhigang Wei
- Department of Oncology, Lung Cancer Center, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Ye
- Department of Oncology, Lung Cancer Center, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China
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Zhong BY, Fan W, Guan JJ, Peng Z, Jia Z, Jin H, Jin ZC, Chen JJ, Zhu HD, Teng GJ. Combination locoregional and systemic therapies in hepatocellular carcinoma. Lancet Gastroenterol Hepatol 2025; 10:369-386. [PMID: 39993404 DOI: 10.1016/s2468-1253(24)00247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 02/26/2025]
Abstract
Locoregional therapies play a fundamental role in the treatment of patients with early and intermediate and locally advanced hepatocellular carcinomas. With encouraging recent advances in immunotherapy-based systemic therapies, locoregional therapies are being both promoted and challenged by new systemic therapy options. Combined locoregional and systemic therapies might enhance treatment outcomes compared with either option alone. This Series paper summarises the existing data on locoregional and systemic therapies for hepatocellular carcinoma, and discusses evidence from studies investigating their combination with a focus on their synergistic efficacy and safety.
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Affiliation(s)
- Bin-Yan Zhong
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China; Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Justin J Guan
- Division of Interventional Radiology, Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Zhenwei Peng
- Department of Radiation Oncology, Cancer Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Haojie Jin
- Shanghai Cancer Institute, State Key Laboratory of Systems Medicine for Cancer, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Cheng Jin
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jian-Jian Chen
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
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Tombesi P, Cutini A, Grasso V, Di Vece F, Politti U, Capatti E, Labb F, Petaccia S, Sartori S. Past, present, and future perspectives of ultrasound-guided ablation of liver tumors: Where could artificial intelligence lead interventional oncology? Artif Intell Cancer 2024; 5:96690. [DOI: 10.35713/aic.v5.i1.96690] [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: 05/14/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024] Open
Abstract
The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound (US) guidance. Later, radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide. In the past decade, microwave ablation systems have achieved larger ablation areas than radiofrequency ablation, suggesting that the 3-cm barrier could be broken in the treatment of liver tumors. Likewise, US techniques to guide percutaneous ablation have seen important progress. Contrast-enhanced US (CEUS) can define and target the tumor better than US and can assess the size of the ablation area after the procedure, which allows immediate retreatment of the residual tumor foci. Furthermore, fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS. Recently, software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures, aiding in procedure planning, assessing ablation completeness, and targeting the residual viable foci with greater precision than CEUS. Hopefully, this could lead to the ablation of tumors up to 5-7 cm in size.
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Affiliation(s)
- Paola Tombesi
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Andrea Cutini
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Valentina Grasso
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Francesca Di Vece
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Ugo Politti
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Eleonora Capatti
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | | | | | - Sergio Sartori
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
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Chelales E, von Windheim K, Banipal AS, Siebeneck E, Benham C, Nief CA, Crouch B, Everitt JI, Sag AA, Katz DF, Ramanujam N. Determining the Relationship between Delivery Parameters and Ablation Distribution for Novel Gel Ethanol Percutaneous Therapy in Ex Vivo Swine Liver. Polymers (Basel) 2024; 16:997. [PMID: 38611255 PMCID: PMC11013462 DOI: 10.3390/polym16070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Ethyl cellulose-ethanol (ECE) is emerging as a promising formulation for ablative injections, with more controllable injection distributions than those from traditional liquid ethanol. This study evaluates the influence of salient injection parameters on forces needed for infusion, depot volume, retention, and shape in a large animal model relevant to human applications. Experiments were conducted to investigate how infusion volume (0.5 mL to 2.5 mL), ECE concentration (6% or 12%), needle gauge (22 G or 27 G), and infusion rate (10 mL/h) impacted the force of infusion into air using a load cell. These parameters, with the addition of manual infusion, were investigated to elucidate their influence on depot volume, retention, and shape (aspect ratio), measured using CT imaging, in an ex vivo swine liver model. Force during injection increased significantly for 12% compared to 6% ECE and for 27 G needles compared to 22 G. Force variability increased with higher ECE concentration and smaller needle diameter. As infusion volume increased, 12% ECE achieved superior depot volume compared to 6% ECE. For all infusion volumes, 12% ECE achieved superior retention compared to 6% ECE. Needle gauge and infusion rate had little influence on the observed depot volume or retention; however, the smaller needles resulted in higher variability in depot shape for 12% ECE. These results help us understand the multivariate nature of injection performance, informing injection protocol designs for ablations using gel ethanol and infusion, with volumes relevant to human applications.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Katriana von Windheim
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Arshbir Singh Banipal
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Elizabeth Siebeneck
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Claire Benham
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Corrine A. Nief
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Jeffrey I. Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Alan Alper Sag
- Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - David F. Katz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
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Nakla T, Chow JJ, Pham K, Abi-Jaoudeh N. Non-Thermal Liver Ablation: Existing and New Technology. Semin Intervent Radiol 2023; 40:497-504. [PMID: 38274216 PMCID: PMC10807968 DOI: 10.1055/s-0043-1777844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Cancer has and continues to be a complex health crisis plaguing millions around the world. Alcohol ablation was one of the initial methods used for the treatment of liver lesions. It was surpassed by thermal ablation which has played a big role in the therapeutic arsenal for primary and metastatic liver tumors. However, thermal ablation has several shortcomings and limitations that prompted the development of alternative technologies including electroporation and histotripsy. Percutaneous alcohol injection in the liver lesion leads to dehydration and coagulative necrosis. This technology is limited to the lesion with relative sparing of the surrounding tissue, making it safe to use adjacent to sensitive structures. Electroporation utilizes short high-voltage pulses to permeabilize the cell membrane and can result in cell death dependent on the threshold reached. It can effectively target the tumor margins and has lower damage rates to surrounding structures due to the short pulse duration. Histotripsy is a novel technology, and although the first human trial was just completed, its results are encouraging, given the sharp demarcation of the targeted tissue, lack of thermal damage, and potential for immunomodulation of the tumor microenvironment. Herein, we discuss these techniques, their uses, and overall clinical benefit.
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Affiliation(s)
- Tiffany Nakla
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada
| | - Jacqueline J. Chow
- School of Medicine, University of California, Irvine, Irvine, California
| | - Kathleen Pham
- Department of Radiological Sciences, University of California, Irvine, Irvine, California
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, Irvine, California
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7
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Gerber TS, Witzel HR, Weinmann A, Bartsch F, Schindeldecker M, Galle PR, Lang H, Roth W, Ridder DA, Straub BK. Reduced Lipid Peroxidation Predicts Unfavorable Prognosis in Hepatocellular Carcinoma, but Not Intrahepatic Cholangiocarcinoma. Biomedicines 2023; 11:2471. [PMID: 37760911 PMCID: PMC10525544 DOI: 10.3390/biomedicines11092471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Primary liver cancer, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), remains a significant contributor to cancer-related mortality worldwide. Oxidative stress and lipid peroxidation play a key role in chronic liver diseases and have been shown to be pivotal for tumor initiation and progression. 4-hydroxy-nonenal (4-HNE), one of the major mediators of oxidative stress and a well-established biomarker for lipid peroxidation, can act as a signal transducer, inducing inflammation and exerting carcinogenic effects. However, the role of 4-HNE in primary liver cancer remains poorly explored. In this study, we investigated 4-HNE levels in 797 liver carcinomas, including 561 HCC and 236 iCCA, by immunohistochemistry. We then correlated 4-HNE levels with comprehensive clinical data and survival outcomes. In HCC, lower expression levels of 4-HNE were associated with vascular invasion, a high tumor grade, a macrotrabecular-massive HCC subtype, and poor overall survival. Concerning iCCA, large duct iCCA showed significantly higher 4-HNE levels when compared to small duct iCCA. Yet, in iCCA, 4-HNE levels did not correlate with known prognostic parameters or survival outcomes. To conclude, in HCC but not in iCCA, low amounts of 4-HNE predict unfavorable survival outcomes and are associated with aggressive tumor behavior. These findings provide insights into the role of 4-HNE in liver cancer progression and may enable novel therapeutic strategies.
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Affiliation(s)
- Tiemo Sven Gerber
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
| | - Hagen Roland Witzel
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (A.W.); (P.R.G.)
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (F.B.); (H.L.)
| | - Mario Schindeldecker
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
- Tissue Biobank, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany
| | - Peter R. Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (A.W.); (P.R.G.)
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (F.B.); (H.L.)
| | - Wilfried Roth
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
| | - Dirk Andreas Ridder
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
| | - Beate Katharina Straub
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.S.G.); (H.R.W.); (M.S.); (W.R.); (D.A.R.)
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Pfahl M, Gallaher HM. Successful minimally invasive simple hepatic cyst ablation via ethanol sclerotherapy in a cat. JFMS Open Rep 2023; 9:20551169231215273. [PMID: 38115861 PMCID: PMC10729625 DOI: 10.1177/20551169231215273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Case summary A 12-year-old neutered male domestic shorthair cat was evaluated at the Michigan State University Veterinary Medical Center (MSU-VMC) for an abdominal cyst that was initially noted on ultrasound 1 year prior by the referring veterinarian. The cystic mass was causing clinical signs, including vomiting, diarrhea, hyporexia and abdominal pain. Cyst drainage had originally been performed every few months, but by referral, the required frequency of drainage had increased to every 2 weeks for a total of eight drainage events; therefore, a more definitive curative option was sought. CT evaluation revealed a large simple hepatic cyst - largest diameter 7.2 cm - likely associated with the right medial liver lobe. Minimally invasive ethanol sclerotherapy was performed. A locking-loop catheter was placed percutaneously and transhepatically into the cyst using ultrasound guidance. The cyst was drained, and contrast injected under fluoroscopic guidance to ensure no communication between the cyst and liver. Sclerotherapy was performed using a volume of 99.5% ethanol calculated from the volume of cyst fluid removed. The patient was discharged on the same day and had complete resolution of clinical signs. At a 6-month follow-up, the cyst had decreased in volume by an estimated 95%. The patient remains asymptomatic more than 1 year postoperatively. Relevance and novel information To our knowledge, this is the first report of a feline hepatic cyst treated via percutaneous transhepatic ethanol ablation. Minimally invasive simple hepatic cyst ablation is a viable treatment option in cats that could avoid the need for a more invasive surgical intervention.
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Affiliation(s)
- Madison Pfahl
- Veterinary Medical Center, Michigan State University, East Lansing, MI, USA
| | - Hayley M Gallaher
- Veterinary Medical Center, Michigan State University, East Lansing, MI, USA
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Song J, Zhang T, Wang J, Liu Y. Ablation treatment of hepatocellular carcinoma: a bibliometric analysis. Front Oncol 2023; 13:1166775. [PMID: 37427105 PMCID: PMC10325560 DOI: 10.3389/fonc.2023.1166775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Ablation is a common treatment for hepatocellular carcinoma (HCC). This study aimed to assess research trends in the ablation treatment of HCC using bibliometric analysis. Methods Publications between January 1, 1993 and December 31, 2022 were retrieved from the Web of Science database. The bibliometrix package from R software, CiteSpace, VOSviewer and an online analytical platform were used for data analysis and plotting. Results A total of 4,029 publications were retrieved from the Web of Science database between 1993 and 2022. The annual growth rate of publication numbers was 10.14%. China had the largest number of publications in the field of HCC ablation. China and the United States of America have the most notable cooperation. Sun Yat-sen University had the largest number of publications in the field of HCC ablation. The most relevant journals were Hepatology, Journal of Hepatology, Gastroenterology, and Radiology. High-frequency keywords mainly focused on "therapy," "resection," "radiofrequency ablation" and "survival". Conclusions With the increase in related publications, the research direction of ablation treatment of HCC is mainly focused on "therapy," "resection," "radiofrequency ablation" and "survival", and the ablation treatment method has gradually changed from percutaneous ethanol injection to radiofrequency ablation and microwave ablation. Irreversible electroporation may become the main method of ablation therapy in the future.
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Affiliation(s)
- Jianping Song
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Tingxiao Zhang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jianlei Wang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yanfeng Liu
- Department of Hepatobiliary Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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10
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Chami P, Jarnagin W, Abou-Alfa GK, Harding J, Kim N, Lin H, El Homsi M, Crane C, Hajj C. Non-Surgical Locoregional Therapies Alone or in Combination with Systemic Therapy in Patients with Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:1748. [PMID: 36980634 PMCID: PMC10046599 DOI: 10.3390/cancers15061748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the third-leading cause of cancer-related deaths worldwide. Curative intent treatment options for patients with HCC include liver transplantation, resection and ablation of small lesions. Other potentially curative therapies include cryoablation, microwave ablation and percutaneous alcohol injection. For locally advanced disease, different arterially directed therapies including transarterial chemoembolization and selective internal radiation therapy, plus external beam radiation including three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic body radiation therapy and proton beam therapy, are available or studied. Systemic therapies based on checkpoint inhibitors and tyrosine kinase inhibitors are available for the management of metastatic HCC and sometimes for locally advanced disease. Combinations of locoregional therapies with systemic drugs are currently the subject of several clinical trials.
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Affiliation(s)
- Perla Chami
- Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107, Lebanon
| | - William Jarnagin
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
- Department of Surgery, Weill Medical College at Cornell University, New York, NY 10021, USA
| | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
- Department of Medicine, Weill Medical College at Cornell University, New York, NY 10021, USA
| | - James Harding
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
- Department of Medicine, Weill Medical College at Cornell University, New York, NY 10021, USA
| | - Neal Kim
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
| | - Haibo Lin
- New York Proton Center, New York, NY 10035, USA
| | - Maria El Homsi
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
| | | | - Carla Hajj
- Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA
- New York Proton Center, New York, NY 10035, USA
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11
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Solbiati LA, Arai Y. Interventional oncology of liver tumors: how it all started and where are we now. Br J Radiol 2022; 95:20220434. [PMID: 35776630 PMCID: PMC9815741 DOI: 10.1259/bjr.20220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023] Open
Abstract
Liver was the very first organ for which interventional procedures were applied for the local treatment of primary and secondary malignancies. In this paper, the history of Interventional Oncology of liver, from the very beginning to the current situation, is summarized, including both percutaneous and intravascular procedures, and together with the evolution of the techniques for image guidance. The main ongoing developments, such as new techniques, combined interventional treatments and association of local interventions with new drugs are briefly described, too.
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Affiliation(s)
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan
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12
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Yang P, Li N. Efficacy of percutaneous ethanol injection versus radiofrequency ablation for single hepatocellular carcinoma no larger than 5 cm. J Int Med Res 2022; 50:3000605221111281. [PMID: 35861264 PMCID: PMC9310248 DOI: 10.1177/03000605221111281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the efficacy of percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) of no larger than 5 cm. Methods The data used in this study were retrieved from the SEER database. In total, 3510 patients diagnosed with HCC of no larger than 5 cm who received PEI or RFA were included. Results The median overall survival (mOS) and median cancer-specific survival (mCSS) of RFA-treated patients were not significantly longer than those of PEI-treated patients either before or after propensity score matching (PSM). The subgroup analysis showed that patients with HCC of no larger than 2 cm, HCC of larger than 2 cm, American Joint Committee on Cancer (AJCC) stage I and II, and AJCC stage III and IV who received RFA had mOS and mCSS similar to those of patients who received PEI after PSM. Multivariable regression analysis showed that PEI did not increase the all-cause mortality risk or cancer-specific mortality risk after PSM. Conclusion RFA is still the better choice for patients with a single HCC of no more than 5 cm. However, PEI might be a good choice for these patients who cannot be treated with RFA.
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Affiliation(s)
- Ping Yang
- Department of Ultrasonography, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Ningjie Li
- Department of Radiology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, China
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13
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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14
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Ansari MY, Abdalla A, Ansari MY, Ansari MI, Malluhi B, Mohanty S, Mishra S, Singh SS, Abinahed J, Al-Ansari A, Balakrishnan S, Dakua SP. Practical utility of liver segmentation methods in clinical surgeries and interventions. BMC Med Imaging 2022; 22:97. [PMID: 35610600 PMCID: PMC9128093 DOI: 10.1186/s12880-022-00825-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Clinical imaging (e.g., magnetic resonance imaging and computed tomography) is a crucial adjunct for clinicians, aiding in the diagnosis of diseases and planning of appropriate interventions. This is especially true in malignant conditions such as hepatocellular carcinoma (HCC), where image segmentation (such as accurate delineation of liver and tumor) is the preliminary step taken by the clinicians to optimize diagnosis, staging, and treatment planning and intervention (e.g., transplantation, surgical resection, radiotherapy, PVE, embolization, etc). Thus, segmentation methods could potentially impact the diagnosis and treatment outcomes. This paper comprehensively reviews the literature (during the year 2012-2021) for relevant segmentation methods and proposes a broad categorization based on their clinical utility (i.e., surgical and radiological interventions) in HCC. The categorization is based on the parameters such as precision, accuracy, and automation.
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15
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Nakagomi R, Tateishi R, Mikami S, Wake T, Kinoshita MN, Nakatsuka T, Minami T, Sato M, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Shiina S, Koike K. Infectious complications related to radiofrequency ablation of liver tumors: The role of antibiotics. PLoS One 2021; 16:e0259641. [PMID: 34797828 PMCID: PMC8604344 DOI: 10.1371/journal.pone.0259641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Prophylactic administration of antibiotics within 24 hours of surgery is recommended to reduce the risk of infection. We conducted a prospective study to compare the efficacy of single administration of antibiotics with a historical control of continuous administration of antibiotics for radiofrequency ablation (RFA) of malignant liver tumors. Methods Between February 1, 1999 and November 30, 2010, a total of 6,763 RFA treatments were performed in 2,355 patients, using a protocol with continuous administration of prophylactic antibiotics. On December 1, 2010, we began using a revised protocol with a single administration of prophylactic antibiotics, while continuing to use the old continuous administration protocol for patients who declined the new protocol. Interim analysis was performed to assess the safety of the single administration protocol. Thereafter, from April 1, 2012, all patients were treated using the new protocol. Risk factors for infectious complications of RFA were assessed using logistic regression. Results From December 2010 to March 2012, 766 RFA treatments were performed in 663 patients using the new antibiotic protocol. Infectious complications were observed following 4 of these treatments (0.52%). As the upper limit of the confidence interval (CI) resulting from a one-sided binomial test was exactly the prespecified limit of 1.0%, from April 2012 onwards, we treated all patients using the new protocol with single administration of prophylactic antibiotics. A total of 3,547 RFA treatments were performed using the single administration protocol. Univariable logistic regression indicated that prior transcatheter arterial chemoembolization (TACE) and maximal tumor diameter were significant risk factors for infectious complications (P = 0.04 and P < 0.001, respectively). Multivariable analysis indicated that the adjusted hazard ratio of single vs. continuous administration of antibiotics was 1.20 (95% CI: 0.53–2.75; P = 0.66). Conclusions The rate of infectious complications related to RFA was acceptably low. Single administration of prophylactic antibiotics did not significantly increase the rate of infectious complications related to RFA, compared with a more intensive antibiotic protocol.
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Affiliation(s)
- Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Shintaro Mikami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taijiro Wake
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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16
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Chelales E, Morhard R, Nief C, Crouch B, Everitt JI, Sag AA, Ramanujam N. Radiologic-pathologic analysis of increased ethanol localization and ablative extent achieved by ethyl cellulose. Sci Rep 2021; 11:20700. [PMID: 34667252 PMCID: PMC8526742 DOI: 10.1038/s41598-021-99985-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
Ethanol provides a rapid, low-cost ablative solution for liver tumors with a small technological footprint but suffers from uncontrolled diffusion in target tissue, limiting treatment precision and accuracy. Incorporating the gel-forming polymer ethyl cellulose to ethanol localizes the distribution. The purpose of this study was to establish a non-invasive methodology based on CT imaging to quantitatively determine the relationship between the delivery parameters of the EC-ethanol formulation, its distribution, and the corresponding necrotic volume. The relationship of radiodensity to ethanol concentration was characterized with water-ethanol surrogates. Ex vivo EC-ethanol ablations were performed to optimize the formulation (n = 6). In vivo ablations were performed to compare the optimal EC-ethanol formulation to pure ethanol (n = 6). Ablations were monitored with CT and ethanol distribution volume was quantified. Livers were removed, sectioned and stained with NADH-diaphorase to determine the ablative extent, and a detailed time-course histological study was performed to assess the wound healing process. CT imaging of ethanol-water surrogates demonstrated the ethanol concentration-radiodensity relationship is approximately linear. A concentration of 12% EC in ethanol created the largest distribution volume, more than eight-fold that of pure ethanol, ex vivo. In vivo, 12% EC-ethanol was superior to pure ethanol, yielding a distribution volume three-fold greater and an ablation zone six-fold greater than pure ethanol. Finally, a time course histological evaluation of the liver post-ablation with 12% EC-ethanol and pure ethanol revealed that while both induce coagulative necrosis and similar tissue responses at 1-4 weeks post-ablation, 12% EC-ethanol yielded a larger ablation zone. The current study demonstrates the suitability of CT imaging to determine distribution volume and concentration of ethanol in tissue. The distribution volume of EC-ethanol is nearly equivalent to the resultant necrotic volume and increases distribution and necrosis compared to pure ethanol.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Robert Morhard
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Corrine Nief
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey I Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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17
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Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
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18
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Chen M, Zhang F, Song J, Weng Q, Li P, Li Q, Qian K, Ji H, Pietrini S, Ji J, Yang X. Image-Guided Peri-Tumoral Radiofrequency Hyperthermia-Enhanced Direct Chemo-Destruction of Hepatic Tumor Margins. Front Oncol 2021; 11:593996. [PMID: 34235070 PMCID: PMC8255807 DOI: 10.3389/fonc.2021.593996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/28/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To validate the feasibility of using peri-tumoral radiofrequency hyperthermia (RFH)-enhanced chemotherapy to obliterate hepatic tumor margins. Method and Materials This study included in vitro experiments with VX2 tumor cells and in vivo validation experiments using rabbit models of liver VX2 tumors. Both in vitro and in vivo experiments received different treatments in four groups (n=6/group): (i) RFH-enhanced chemotherapy consisting of peri-tumoral injection of doxorubicin plus RFH at 42°C; (ii) RFH alone; (iii) doxorubicin alone; and (iv) saline. Therapeutic effect on cells was evaluated using different laboratory examinations. For in vivo experiments, orthotopic hepatic VX2 tumors in 24 rabbits were treated by using a multipolar radiofrequency ablation electrode, enabling simultaneous delivery of both doxorubicin and RFH within the tumor margins. Ultrasound imaging was used to follow tumor growth overtime, correlated with subsequent histopathological analysis. Results In in vitro experiments, MTS assay demonstrated the lowest cell proliferation, and apoptosis analysis showed the highest apoptotic index with RFH-enhanced chemotherapy, compared with the other three groups (p<0.01). In in vivo experiments, ultrasound imaging detected the smallest relative tumor volume with RFH-enhanced chemotherapy (p<0.01). The TUNEL assay further confirmed the significantly increased apoptotic index and decreased cell proliferation in the RFH-enhanced therapy group (p<0.01). Conclusion This study demonstrates that peri-tumoral RFH can specifically enhance the destruction of tumor margins in combination with peri-tumoral injection of a chemotherapeutic agent. This new interventional oncology technique may address the critical clinical problem of frequent marginal tumor recurrence/persistence following thermal ablation of large (>3 cm) hepatic cancers.
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Affiliation(s)
- Minjiang Chen
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.,Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, China
| | - Feng Zhang
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jingjing Song
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.,Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, China
| | - Qiaoyou Weng
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.,Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, China
| | - Peicheng Li
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Qiang Li
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kun Qian
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Hongxiu Ji
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.,Department of Pathology, Overlake Medical Center and Incyte Diagnostics, Bellevue, WA, United States
| | - Sean Pietrini
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, China
| | - Xiaoming Yang
- Image-Guided Bio-Molecular Interventions Research & Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
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Abstract
Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.
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Affiliation(s)
- Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julie K Heimbach
- Division of Transplant Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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20
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Alqahtani SA, Sanai FM, Alolayan A, Abaalkhail F, Alsuhaibani H, Hassanain M, Alhazzani W, Alsuhaibani A, Algarni A, Forner A, Finn RS, Al-hamoudi WK. Saudi Association for the Study of Liver diseases and Transplantation practice guidelines on the diagnosis and management of hepatocellular carcinoma. Saudi J Gastroenterol 2020; 26:S1-S40. [PMID: 33078723 PMCID: PMC7768980 DOI: 10.4103/sjg.sjg_477_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Saleh A. Alqahtani
- Liver Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Faisal M. Sanai
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ashwaq Alolayan
- Adult Medical Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Faisal Abaalkhail
- Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Hamad Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Abdullah Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Algarni
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Richard S Finn
- Division of Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California,United States
| | - Waleed K. Al-hamoudi
- Liver Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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21
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Chagas AL, Mattos AAD, Carrilho FJ, Bittencourt PL, Vezozzo DCP, Horvat N, Rocha MDS, Alves VAF, Coral GP, Alvares-DA-Silva MR, Barros FMDR, Menezes MR, Monsignore LM, Coelho FF, Silva RFD, Silva RDCMA, Boin IDFSF, D Albuquerque LAC, Garcia JHP, Felga GEG, Moreira AM, Braghiroli MIFM, Hoff PMG, Mello VBD, Dottori MF, Branco TP, Schiavon LDL, Costa TDFA. BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:1-20. [PMID: 32294682 DOI: 10.1590/s0004-2803.202000000-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.
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Affiliation(s)
- Aline Lopes Chagas
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Angelo Alves de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Flair José Carrilho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | - Natally Horvat
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Manoel de Souza Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Venâncio Avancini Ferreira Alves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | | | - Marcos Roberto Menezes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
- Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Lucas Moretti Monsignore
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, SP, Brasil
| | | | - Renato Ferreira da Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | - Rita de Cássia Martins Alves Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | | | | | | | | | - Airton Mota Moreira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | - Paulo Marcelo Gehm Hoff
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | - Tiago Pugliese Branco
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
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Giorgio A, Gatti P, De Luca M, Matteucci P, Giorgio V. Editorial on "Role of thermal ablation in the management of colorectal liver metastasis". Hepatobiliary Surg Nutr 2020; 9:62-64. [PMID: 32142060 PMCID: PMC7026782 DOI: 10.21037/hbsn.2019.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/21/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy
| | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | | | - Valentina Giorgio
- Fondazione Policlinico A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Roma, Italy
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23
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Acetic acid versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A randomized controlled trial. Diagn Interv Imaging 2020; 101:101-110. [DOI: 10.1016/j.diii.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 12/25/2022]
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24
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Goldberg SN. Interventional Oncologists Are All Fired Up about PANFIRE-2. Radiology 2020; 294:221-222. [DOI: 10.1148/radiol.2019192295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Nahum Goldberg
- From the Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
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25
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McMillan RR, Agopian VG. The Management of Hepatocellular Carcinoma. THE CRITICALLY ILL CIRRHOTIC PATIENT 2020:237-271. [DOI: 10.1007/978-3-030-24490-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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26
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Lewis AR, Padula CA, McKinney JM, Toskich BB. Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions. Semin Intervent Radiol 2019; 36:303-309. [PMID: 31680721 DOI: 10.1055/s-0039-1697641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Thermal ablation is widely regarded as definitive therapy for early-stage hepatocellular carcinoma, but its efficacy decreases in tumors greater than 3 cm. Extensive clinical studies have supported improved outcomes provided through combining transarterial embolic therapy with ablation in the treatment of larger tumors. This article will provide a survey of the science and data for combination therapy in both thermal and nonthermal ablation modalities, as well as describe emerging applications.
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Affiliation(s)
- Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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27
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McKinley SK, Chawla A, Ferrone CR. Inoperable Biliary Tract and Primary Liver Tumors: Palliative Treatment Options. Surg Oncol Clin N Am 2019; 28:745-762. [PMID: 31472917 DOI: 10.1016/j.soc.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Primary liver tumors are most commonly hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Although surgical resection offers a chance for cure, these tumors generally present at a late, inoperable stage, necessitating an understanding of noncurative and palliative treatment options. These options include ablative therapies, including radiofrequency ablation; intra-arterial therapies, including transcatheter chemoembolization; biliary decompression; radiotherapy; systemic therapies, including traditional chemotherapeutic agents; and molecular therapies, such as sorafenib. Selection of nonoperative treatment depends on patient and tumor factors as well as institutional resources and expertise.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB-425, Boston, MA 02114, USA
| | - Akhil Chawla
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 4-460, Boston, MA 02114, USA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 4-460, Boston, MA 02114, USA.
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28
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Systemic Management for Advanced Hepatocellular Carcinoma: A Review of the Molecular Pathways of Carcinogenesis, Current and Emerging Therapies, and Novel Treatment Strategies. Dig Dis Sci 2019; 64:1016-1029. [PMID: 30887150 DOI: 10.1007/s10620-019-05582-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) arises from a number of cirrhosis-related and non-cirrhosis-related exposures and is one of the leading causes of cancer-related deaths worldwide. Achieving a durable cure currently relies on either resection or transplantation, but since most patients will be diagnosed with inoperable disease, there is great interest in achieving more effective systemic therapies. At a molecular level, HCC is heterogeneous, but initial treatment strategies, including the use of multi-targeted tyrosine kinase inhibitors and checkpoint inhibitors, have been fairly homogenous, depending on general host factors and overall tumor burden rather than specific molecular signatures. Over the past 2 decades, however, there has been significant success in identifying key molecular targets, including driver mutations involving the telomerase reverse transcriptase, p53, and beta-catenin genes, and significant work is now being devoted to translating these discoveries into the development of robust and well-tolerated targeted therapies. Furthermore, multi-modal therapies have also begun to emerge, harnessing possible synergism amongst a variety of different treatment classes. As the findings of these landmark trials become available over the next several years, the landscape of the systemic management of advanced HCC will change significantly.
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29
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Gong N, Ma X, Ye X, Zhou Q, Chen X, Tan X, Yao S, Huo S, Zhang T, Chen S, Teng X, Hu X, Yu J, Gan Y, Jiang H, Li J, Liang XJ. Carbon-dot-supported atomically dispersed gold as a mitochondrial oxidative stress amplifier for cancer treatment. NATURE NANOTECHNOLOGY 2019; 14:379-387. [PMID: 30778211 DOI: 10.1038/s41565-019-0373-6] [Citation(s) in RCA: 379] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/11/2019] [Indexed: 05/20/2023]
Abstract
Mitochondrial redox homeostasis, the balance between reactive oxygen species and antioxidants such as glutathione, plays critical roles in many biological processes, including biosynthesis and apoptosis, and thus is a potential target for cancer treatment. Here, we report a mitochondrial oxidative stress amplifier, MitoCAT-g, which consists of carbon-dot-supported atomically dispersed gold (CAT-g) with further surface modifications of triphenylphosphine and cinnamaldehyde. We find that the MitoCAT-g particles specifically target mitochondria and deplete mitochondrial glutathione with atomic economy, thus amplifying the reactive oxygen species damage caused by cinnamaldehyde and finally leading to apoptosis in cancer cells. We show that imaging-guided interventional injection of these particles potently inhibits tumour growth in subcutaneous and orthotopic patient-derived xenograft hepatocellular carcinoma models without adverse effects. Our study demonstrates that MitoCAT-g amplifies the oxidative stress in mitochondria and suppresses tumour growth in vivo, representing a promising agent for anticancer applications.
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Affiliation(s)
- Ningqiang Gong
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
- Department of Chemistry, Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Tsinghua University, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xiaowei Ma
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Xiaoxia Ye
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Qunfang Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoai Chen
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Xiaoli Tan
- School of Environment and Chemical Engineering, North China Electric Power University, Beijing, China
| | - Shengkun Yao
- School of Physical Science and Technology, Shanghai Tech University, Shanghai, China
| | - Shuaidong Huo
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Tingbin Zhang
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Shizhu Chen
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
- Key Laboratory of Medicinal Chemistry and Molecular Diagnosis of the Ministry of Education, Hebei University, Baoding, China
| | - Xucong Teng
- Department of Chemistry, Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Tsinghua University, Beijing, China
| | - Xixue Hu
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yaling Gan
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Huaidong Jiang
- School of Physical Science and Technology, Shanghai Tech University, Shanghai, China
| | - Jinghong Li
- Department of Chemistry, Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Tsinghua University, Beijing, China.
| | - Xing-Jie Liang
- Laboratory of Controllable Nanopharmaceuticals, Chinese Academy of Sciences (CAS) Center for Excellence in Nanoscience and CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
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Abstract
The most common primary liver malignancy, hepatocellular carcinoma (HCC), has a high likelihood of mortality, and much effort into early detection and treatment has occurred. Multiple staging systems have surfaced of which some guide treatment. Curative intent is a goal of early-staged HCC treatment, and this can be achieved with surgical resection, liver transplantation, and minimally invasive percutaneous therapies such as tumor ablation. Many of the newer ablation techniques have evolved from shortcomings of prior methods which have resulted in an expanded number of applications for tumor ablation. Our review focuses on current mainstream image-guided percutaneous ablation modalities which are commonly performed as an alternative to surgery.
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31
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Hughes D, Al- Sarireh B. Hepatocellular carcinoma’s 100 most influential manuscripts: A bibliometric analysis. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2019. [DOI: 10.5348/100083z04dh2019oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Molecular Mechanisms of Hepatocarcinogenesis Following Sustained Virological Response in Patients with Chronic Hepatitis C Virus Infection. Viruses 2018; 10:v10100531. [PMID: 30274202 PMCID: PMC6212901 DOI: 10.3390/v10100531] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
Despite the success of direct-acting antiviral (DAA) agents in treating chronic hepatitis C virus (HCV) infection, the number of cases of HCV-related hepatocellular carcinoma (HCC) is expected to increase over the next five years. HCC develops over the span of decades and is closely associated with fibrosis stage. HCV both directly and indirectly establishes a pro-inflammatory environment favorable for viral replication. Repeated cycles of cell death and regeneration lead to genomic instability and loss of cell cycle control. DAA therapy offers >90% sustained virological response (SVR) rates with fewer side effects and restrictions than interferon. While elimination of HCV helps to restore liver function and reverse mild fibrosis, post-SVR patients remain at elevated risk of HCC. A series of studies reporting higher than expected rates of HCC development among DAA-treated patients ignited debate over whether use of DAAs elevates HCC risk compared to interferon. However, recent prospective and retrospective studies based on larger patient cohorts have found no significant difference in risk between DAA and interferon therapy once other factors are taken into account. Although many mechanisms and pathways involved in hepatocarcinogenesis have been elucidated, our understanding of drivers specific to post-SVR hepatocarcinogenesis is still limited, and lack of suitable in vivo and in vitro experimental systems has hampered efforts to examine etiology-specific mechanisms that might serve to answer this question more thoroughly. Further research is needed to identify risk factors and biomarkers for post-SVR HCC and to develop targeted therapies based on more complete understanding of the molecules and pathways implicated in hepatocarcinogenesis.
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33
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Nakano R, Ohira M, Kobayashi T, Ide K, Tahara H, Kuroda S, Shimizu S, Kimura T, Nagata Y, Aikata H, Chayama K, Ohdan H. Hepatectomy versus stereotactic body radiotherapy for primary early hepatocellular carcinoma: A propensity-matched analysis in a single institution. Surgery 2018; 164:219-226. [PMID: 29801728 DOI: 10.1016/j.surg.2018.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/14/2018] [Accepted: 03/10/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of both surgical resection and stereotactic body radiotherapy for small hepatocellular carcinoma. BACKGROUND Although the number of stereotactic body radiotherapies being performed for hepatocellular carcinoma has gradually increased, data comparing surgical resection and stereotactic body radiotherapy are limited. METHODS Between 2008 and 2015, a total of 281 patients with 1 to 3 small hepatocellular carcinoma tumors (≤3 cm in diameter), treated initially with curative intent (surgical resection, 254; stereotactic body radiotherapy, 27), were retrospectively analyzed. Overall survival and disease-free survival were compared in a propensity score matching analysis. RESULTS Patients in the surgical resection group tended to be younger, had more tumors, and had better hepatic function than those in the stereotactic body radiotherapy group (P < .05). The percent recurrence of the same sub-segment in the stereotactic body radiotherapy group was significantly higher than that in the surgical resection group (P = .0034). Propensity score analysis revealed that 54 patients with surgical resection and 27 with stereotactic body radiotherapy had the same baseline characteristics. The 5-year overall survival and disease-free survival rates for the surgical resection and stereotactic body radiotherapy groups were 75.2% vs 47.8% (P = .0149) and 33.8% vs 16.4% (P = .0512), respectively. Multivariate analysis showed that surgical resection was a significant favorable factor for overall survival and disease-free survival of patients with one to three small hepatocellular carcinomas. CONCLUSION Surgical resection provided better long-term overall survival and disease-free survival in patients with small hepatocellular carcinoma tumors. However, stereotactic body radiotherapy may be an effective alternative treatment for inoperable patients with early hepatocellular carcinoma.
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Affiliation(s)
- Ryosuke Nakano
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan; Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Japan.
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Seiichi Shimizu
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Hiroshi Aikata
- Liver Research Project Center, Hiroshima University, Japan; Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical & Health Science, Hiroshima University, Japan
| | - Kazuaki Chayama
- Liver Research Project Center, Hiroshima University, Japan; Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical & Health Science, Hiroshima University, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Liver Research Project Center, Hiroshima University, Japan
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Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, Schirmacher P, Vilgrain V. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69:182-236. [PMID: 29628281 DOI: 10.1016/j.jhep.2018.03.019] [Citation(s) in RCA: 5921] [Impact Index Per Article: 845.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
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Viganò L, Laurenzi A, Solbiati L, Procopio F, Cherqui D, Torzilli G. Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy. Dig Surg 2018; 35:359-371. [PMID: 29890512 DOI: 10.1159/000489836] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with a single hepatocellular carcinoma (HCC) ≤3 cm and preserved liver function have the highest likelihood to be cured if treated. The most adequate treatment methods are yet a matter that is debated. METHODS We reviewed the literature about open anatomic resection (AR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA). RESULTS PTA is effective as resection for HCC < 2 cm, when they are neither subcapsular nor perivascular. PTA in HCC of 2-3 cm is under evaluation. AR with the removal of the tumor-bearing portal territory is recommended for HCC > 2 cm, except for subcapsular ones. In comparison with open surgery, LRR has better short-term outcomes and non-inferior long-term outcomes. LLR is standardized for superficial limited resections and for left-sided AR. CONCLUSIONS According to the available evidences, the following therapeutic proposal can be advanced. Laparoscopic limited resection is the standard for any subcapsular HCC. PTA is the first-line treatment for deep-located HCC < 2 cm, except for those in contact with Glissonean pedicles. Laparoscopic AR is the standard for deep-located HCC of 2-3 cm of the left liver, while open AR is the standard for deep-located HCC of 2-3 cm in the right liver. HCC in contact with Glissonean pedicles should be scheduled for resection (open or laparoscopic) independent of their size. Liver transplantation is reserved to otherwise untreatable patients or as a salvage procedure at recurrence.
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Affiliation(s)
- Luca Viganò
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Andrea Laurenzi
- Department of Surgery, Centre Hépatobiliaire, Paul Brousse Hospital, Villejuif, France
| | - Luigi Solbiati
- Department of Radiology, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Fabio Procopio
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy
| | - Daniel Cherqui
- Department of Surgery, Centre Hépatobiliaire, Paul Brousse Hospital, Villejuif, France
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
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36
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Hatooka M, Kawaoka T, Aikata H, Inagaki Y, Morio K, Nakahara T, Murakami E, Tsuge M, Hiramatsu A, Imamura M, Kawakami Y, Awai K, Masaki K, Waki K, Kohno H, Kohno H, Moriya T, Nagaoki Y, Tamura T, Amano H, Katamura Y, Chayama K. Hepatic arterial infusion chemotherapy followed by sorafenib in patients with advanced hepatocellular carcinoma (HICS 55): an open label, non-comparative, phase II trial. BMC Cancer 2018; 18:633. [PMID: 29866075 PMCID: PMC5987491 DOI: 10.1186/s12885-018-4519-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/18/2018] [Indexed: 11/25/2022] Open
Abstract
Background In patients with advanced hepatocellular carcinoma (HCC), evidence is unclear as to whether hepatic arterial infusion chemotherapy (HAIC) or sorafenib is superior. We performed a prospective, open-label, non-comparative phase II study to assess survival with HAIC or HAIC converted to sorafenib. Methods Fifty-five patients were prospectively enrolled. Patients received HAIC as a second course if they had complete response, partial response, or stable disease (SD) with an alpha fetoprotein (AFP) ratio < 1 or a des-γ-carboxy prothrombin (DCP) ratio < 1. Patients were switched to sorafenib if they had SD with an AFP ratio > 1 and a DCP ratio > 1 or disease progression. The primary endpoint was the 1-year survival rate. Secondary endpoints were the 2-year survival rate, HAIC response, survival rate among HAIC responders, progression-free survival, and adverse events. Results Of the 55 patients in the intent-to-treat population, the 1-year and 2-year survival rates were 64.0 and 48.3%, respectively. After the first course of HAIC, one (1.8%) patient showed complete response, 13 (23.6%) showed partial response, 30 (54.5%) had SD, and 10 (18.1%) patients had progressive disease. Twenty-three patients (41.8%) had SD with AFP ratios < 1 or DCP ratios < 1, and 7 (12.7%) had SD with AFP ratios > 1 and DCP ratios > 1. Thirty-seven patients (68.5%) were responders and 17 (30.9%) were non-responders to HAIC. In responders, the 1-year and 2-year survival rates were 78 and 62%, respectively. Conclusion Given the results of this study, this protocol deserves consideration for patients with advanced HCC. This trial was registered prospectively from December 12. 2012 to September 1. 2016.
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Affiliation(s)
- Masahiro Hatooka
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan.
| | - Yuki Inagaki
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Kei Morio
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Takashi Nakahara
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Eisuke Murakami
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Masataka Tsuge
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yoshiiku Kawakami
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima, 734-8551, Japan
| | | | - Koji Waki
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | | | | | | | | | | | | | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, 734-8551, Japan.,Liver Research Project Center, Hiroshima University, Hiroshima, Japan.,Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan
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Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol 2018; 2018:4756147. [PMID: 29974040 PMCID: PMC6008833 DOI: 10.1155/2018/4756147] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/03/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023] Open
Abstract
Image-guided percutaneous ablation is considered best in the treatment of early-stage hepatocellular carcinoma (HCC). Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. Ethanol injection used to be the standard in ablation. However, radiofrequency ablation has recently been the most prevailing ablation method for HCC. Many investigators have reported that radiofrequency ablation is superior to ethanol injection, from the viewpoints of treatment response, local tumor curativity, and overall survival. New-generation microwave ablation can create a larger ablation volume in a shorter time period. Further comparison studies are, however, mandatory between radiofrequency ablation and microwave ablation, especially in terms of complications and long-term survival. Irreversible electroporation, which is a non-thermal ablation method that delivers short electric pulses to induce cell death due to apoptosis, requires further studies, especially in terms of long-term outcomes. It is considerably difficult to compare outcomes in ablation with those in surgical resection. However, radiofrequency ablation seems to be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis. Furthermore, radiofrequency ablation may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. Various innovations would further improve outcomes in ablation. Training programs may be effective in providing an excellent opportunity to understand basic concepts and learn cardinal skills for successful ablation. Sophisticated ablation would be more than an adequate alternative of surgery for small- and possibly middle-sized HCC.
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Staudacher C, Chiappa A, Biella F, Audisio RA, Bertani E, Zbar AP. Validation of the Modified Tnm-Izumi Classification for Hepatocellular Carcinoma. TUMORI JOURNAL 2018; 86:8-11. [PMID: 10778759 DOI: 10.1177/030089160008600102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS AND BACKGROUND The clinical value of the UICC TNM classification and the Izumi TNM modification regarding prognosis after hepatic resection was evaluated. METHODS Between January 1993 and December 1998, survival and disease-free survival were analyzed in 53 cirrhotic patients (40 males, 13 females; mean age, 65 years; range, 43-81) who underwent hepatic resection for HCC. RESULTS The 1-, 3-, and 5-year overall survivals were: 89%, 54%, and 50%, with disease-free survivals of 70%, 38%, and 28%, respectively. The difference between stages 1 and 2 or stages 3 and 4A using the UICC TNM classification was not significant with respect to survival or disease-free survival. Conversely, the Izumi TNM modification showed a significant difference between each stage with respect to survival and disease-free survival. In a multivariate analysis the lack of micro/macro vascular invasion was predictive of long-term outcome. CONCLUSIONS Our results show that the UICC TNM classification for hepatocellular carcinoma is inadequate. The Izumi modified TNM staging system is superior in assessing prognosis for surgical HCC patients.
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Affiliation(s)
- C Staudacher
- Department of Emergency Surgery, Surgical Oncology, University of Milan, School of Medicine, San Raffaele Scientific Institute, Italy
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Bryce K, Tsochatzis EA. Downstaging for hepatocellular cancer: harm or benefit? Transl Gastroenterol Hepatol 2017; 2:106. [PMID: 29354763 DOI: 10.21037/tgh.2017.11.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022] Open
Abstract
Downstaging of hepatocellular carcinoma (HCC) to enable liver transplantation has become an area of intense interest and research. It may allow a curative option in patients outside widely accepted transplantation criteria, with outcomes that, in some studies, are comparable to transplantation for patients within criteria. There have been conflicting opinions on the best downstaging protocols, criteria for downstaging eligibility and for assessment of response. We therefore aimed to review the literature and evidence for downstaging, as well as considering its drawbacks. CONCLUSION Pooled analyses have suggested success in down staging in about half of patients treated, but with higher recurrence rates than patients initially within transplantation criteria. Studies with strict inclusion criteria and mandatory waiting time before transplantation reported survival equivalent to patients who did not require downstaging. In carefully selected patients, there is a role for down staging to provide the chance of transplantation and cure, with acceptable outcomes. Further multi center, well-designed studies are required to clarify who will mostly benefit. Until such data is available, downstaging criteria should be stated within transplantation programs and relevant decisions should be discussed by multidisciplinary teams.
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Affiliation(s)
- Kathleen Bryce
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
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Bilbao JI, Páramo M, Madrid JM, Benito A. Hepatocellular carcinoma treatment: ablation and arterial embolization. RADIOLOGIA 2017; 60:156-166. [PMID: 29108656 DOI: 10.1016/j.rx.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
Abstract
Percutaneous and endovascular techniques take an important role in the therapeutic management of patients with hepatocarcinoma. Different techniques of percutaneous ablation, especially indicated in tumors up to 2cm diameter offer, at least, similar results to surgical resection. Taking advantage of double hepatic vascularization and exclusive tumor nutrition by the artery, several endovascular techniques of treating the tumor have been developed. Intra-arterial administration of embolizing particles, alone or charged with drug (chemoembolization), will produce ischemia and consequent necrosis with excellent results in selected patients. Certain types of particles may exclusively be carriers of a therapeutic agent when they incorporate a radioisotope that facilitates the direct intratumoral selective irradiation (radioembolization). This technique has demonstrated its efficacy in lesions not susceptible to be treated with other methods and should be considered, together with ablation and chemoembolization, in the therapeutic algorithms of hepatocarcinoma.
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Affiliation(s)
- J I Bilbao
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España.
| | - M Páramo
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Madrid
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España
| | - A Benito
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España
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Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, Tateishi R, Han KH, Chawla YK, Shiina S, Jafri W, Payawal DA, Ohki T, Ogasawara S, Chen PJ, Lesmana CRA, Lesmana LA, Gani RA, Obi S, Dokmeci AK, Sarin SK. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017; 11:317-370. [PMID: 28620797 PMCID: PMC5491694 DOI: 10.1007/s12072-017-9799-9] [Citation(s) in RCA: 1609] [Impact Index Per Article: 201.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.
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Affiliation(s)
- Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu-city, Yamanashi, Japan.
- The University of Tokyo, Tokyo, Japan.
| | - Ann-Lii Cheng
- Department of Oncology and Internal Medicine, National Taiwan University Hospital, National Taiwan University Cancer Center and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan
| | - Jeong Min Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jidong Jia
- Beijing Key Laboratory of Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoghesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Wasim Jafri
- Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan
| | | | - Takamasa Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cosmas Rinaldi A Lesmana
- Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Laurentius A Lesmana
- Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rino A Gani
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Shuntaro Obi
- Third Department of Internal Medicine, Teikyo University School of Medicine, Chiba, Japan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Giorgio A, Merola MG, Montesarchio L, Merola F, Gatti P, Coppola C, Giorgio V, Calisti G. Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years. Br J Radiol 2017; 90:20160804. [PMID: 28402124 PMCID: PMC5602175 DOI: 10.1259/bjr.20160804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/02/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To report on our 20 years' experience on complications after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in patients with cirrhosis. METHODS From 1994 to 2014, 1787 RFA procedures were performed percutaneously in 1162 patients with cirrhosis (852 Child A and 310 Child B) with HCC nodules (1.2-7 cm), prothrombin time >50%, platelet count of 50.000 mm3 and total bilirubin ranging from 0.80 to 4.5 mg dl-1. In 67 patients, RFA was performed on both intraparenchymal HCC nodule and tumour thrombus extended in the main portal vein and/or its branches. RESULTS Four patients (0.3%) died after RFA. 39 patients (3.2%) changed in Child's class: 26 out of 28 Child A patients with cirrhosis changed to Child B and 2 changed to Child C class; 11 Child B patients changed to Child C class. On multivariate analysis, the total bilirubin pre-RFA was the only independent risk factor for impairment of liver function and death. Complications were hemoperitoneum, abscess and intrahepatic haematoma. CONCLUSION RFA of HCC in patients with cirrhosis is safe, even in case of invasion of the portal venous system. Functional liver reserve should be strictly monitored, mainly when pre-RFA total bilirubin value is >2.5 mg dl-1. The study was approved by our institutional review board. Advances in knowledge: The total bilirubin value >2.5 mg dl-1 represents the main marker of functional liver reserve that predicts decompensation of liver cirrhosis in patients undergoing RFA for HCC.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, D Cotugno Hospital, Naples, Italy
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Maria G Merola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Luca Montesarchio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Francesca Merola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Pietro Gatti
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Carmine Coppola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Valentina Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Giorgio Calisti
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
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Zhao L, Xie C, Liu D, Li T, Zhang Y, Wan C. Early Detection of Hepatocellular Carcinoma in Patients with Hepatocirrhosis by Soluble B7-H3. J Gastrointest Surg 2017; 21:807-812. [PMID: 28243980 DOI: 10.1007/s11605-017-3386-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/05/2017] [Indexed: 01/31/2023]
Abstract
Increasing evidence has demonstrated an association between increased soluble B7-H3 (sB7-H3) levels and unfavorable progression in patients with malignant tumors. In the present study, we detected sB7-H3 levels in serum to investigate the value of sB7-H3 as a tool for differential diagnosis of cirrhotic patients with or without early-stage hepatocellular carcinoma (ESHCC). We also assessed the diagnostic value of sB7-H3regarding the prediction of overall survival (OS) of cirrhotic patients with ESHCC. sB7-H3 expression was measured in 91 healthy volunteers, 149 cirrhotic patients with ESHCC, and 87 cirrhotic patients by ELISA, and correlations between DCP1a level and clinical characteristics were analyzed. SB7-H3 concentrations were significantly higher in patients with ESHCC than in cirrhotic patients (P < 0.001). Using 48.34 ng/mL as a cutoff value, the sensitivity and specificity of sB7-H3 in differentiating between cirrhotic patients and cirrhotic patients with ESHCC were 76.5 and 93.1%, respectively. Moreover, high serum sB7-H3 in cirrhotic patients with ESHCC correlated with tumor size, tumor stage, vascular invasion, and tumor differentiation. The area under the curve (AUC) value for sB7-H3 (0.898) was significantly higher than those for AFP (0.789), CA199 (0.627), and CA125 (0.545) for differentiating between cirrhotic patients with ESHCC and sex- and age-matched cirrhotic patients without ESHCC. Our data indicate that serum sB7-H3 serves as a valuable biomarker for cirrhotic patients with ESHCC and that high levels of sB7-H3 correlate with poor clinical outcomes.
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Affiliation(s)
- Long Zhao
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China
| | - Chao Xie
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China
| | - Danqing Liu
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350000, Fujian Province, People's Republic of China
| | - Tong Li
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China.
| | - Chidan Wan
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China.
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Hernández-Socorro CR, Saavedra P, Ramírez Felipe J, Bohn Sarmiento U, Ruiz-Santana S. Predictive factors of long-term colorectal cancer survival after ultrasound-controlled ablation of hepatic metastases. Med Clin (Barc) 2017; 148:345-350. [PMID: 28073517 DOI: 10.1016/j.medcli.2016.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The risk factors associated to long-term survival were assessed in patients with liver metastases of colorectal carcinoma undergoing ablative therapies. PATIENTS AND METHODS Single-centre cohort study, retrospectively analysed and prospectively collected consecutive patients with unresectable metastatic liver disease of colorectal carcinoma treated with ablative therapies between 1996 and 2013. Factors associated with survival time were identified using Cox's proportional hazard model with time-dependent covariates. A forward variable selection based on Akaike information criterion was performed. Relative risk and 95% confidence intervals for each factor were calculated. Statistical significance was set as P<.05. RESULTS Seventy-five patients with liver metastases of colorectal cancer, with a mean age of 65.6 (10.3) underwent 106 treatments. Variables selected were good quality of life (RR 0.308, 95% CI 0.150-0.632) and tumour extension (RR 3.070, 95% CI 1.776-5.308). The median overall survival was 18.5 months (95% CI 17.4-24.4). The survival prognosis in median was 13.5 vs. 23.4 months for patients with and without tumour extension, and 23.0 vs. 12.8 months for patients with good and fair or poor quality of life, respectively. CONCLUSIONS Good quality of life and tumour extension were the only statistically significant predictors of long-term survival in patients of colorectal carcinoma with liver metastatic disease undergoing ablative treatment with ultrasound.
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Affiliation(s)
- Carmen Rosa Hernández-Socorro
- Unidad de Ecografía Intervencionista, Servicio de Radiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Pedro Saavedra
- Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - José Ramírez Felipe
- Servicio de Cirugía General, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Uriel Bohn Sarmiento
- Servicio de Oncología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Sergio Ruiz-Santana
- Servicio de Medicina Intensiva, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Moghbel M, Mashohor S, Mahmud R, Saripan MIB. Review of liver segmentation and computer assisted detection/diagnosis methods in computed tomography. Artif Intell Rev 2017. [DOI: 10.1007/s10462-017-9550-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Eranki A, Farr N, Partanen A, V. Sharma K, Chen H, Rossi CT, Kothapalli SVVN, Oetgen M, Kim A, H. Negussie A, Woods D, J. Wood B, C. W. Kim P, S. Yarmolenko P. Boiling histotripsy lesion characterization on a clinical magnetic resonance imaging-guided high intensity focused ultrasound system. PLoS One 2017; 12:e0173867. [PMID: 28301597 PMCID: PMC5354405 DOI: 10.1371/journal.pone.0173867] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 02/21/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose High intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that can thermally ablate tumors. Boiling histotripsy (BH) is a HIFU approach that can emulsify tissue in a few milliseconds. Lesion volume and temperature effects for different BH sonication parameters are currently not well characterized. In this work, lesion volume, temperature distribution, and area of lethal thermal dose were characterized for varying BH sonication parameters in tissue-mimicking phantoms (TMP) and demonstrated in ex vivo tissues. Methods The following BH sonication parameters were varied using a clinical MR-HIFU system (Sonalleve V2, Philips, Vantaa, Finland): acoustic power, number of cycles/pulse, total sonication time, and pulse repetition frequency (PRF). A 3×3×3 pattern was sonicated inside TMP’s and ex vivo tissues. Post sonication, lesion volumes were quantified using 3D ultrasonography and temperature and thermal dose distributions were analyzed offline. Ex vivo tissues were sectioned and stained with H&E post sonication to assess tissue damage. Results Significant increase in lesion volume was observed while increasing the number of cycles/pulse and PRF. Other sonication parameters had no significant effect on lesion volume. Temperature full width at half maximum at the end of sonication increased significantly with all parameters except total sonication time. Positive correlation was also found between lethal thermal dose and lesion volume for all parameters except number of cycles/pulse. Gross pathology of ex vivo tissues post sonication displayed either completely or partially damaged tissue at the focal region. Surrounding tissues presented sharp boundaries, with little or no structural damage to adjacent critical structures such as bile duct and nerves. Conclusion Our characterization of effects of HIFU sonication parameters on the resulting lesion demonstrates the ability to control lesion morphologic and thermal characteristics with a clinical MR-HIFU system in TMP’s and ex vivo tissues. We demonstrate that this system can produce spatially precise lesions in both phantoms and ex vivo tissues. The results provide guidance on a preliminary set of BH sonication parameters for this system, with a potential to facilitate BH translation to the clinic.
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Affiliation(s)
- Avinash Eranki
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail: ,
| | - Navid Farr
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ari Partanen
- Clinical Science MR Therapy, Philips, Andover, Massachusetts, United States of America
| | - Karun V. Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Hong Chen
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, Missouri, United States of America
| | - Christopher T. Rossi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Satya V. V. N. Kothapalli
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, Missouri, United States of America
| | - Matthew Oetgen
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - AeRang Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Ayele H. Negussie
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Woods
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peter C. W. Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Pavel S. Yarmolenko
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
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A clinical study of thermal monitoring techniques of ultrasound-guided microwave ablation for hepatocellular carcinoma in high-risk locations. Sci Rep 2017; 7:41246. [PMID: 28112263 PMCID: PMC5255547 DOI: 10.1038/srep41246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022] Open
Abstract
To confirm the safety and effectiveness of the minimally invasive thermal monitor technique on percutaneous ultrasound-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) in high-risk locations, a total of 189 patients with 226 HCC nodules in high-risk locations were treated with MWA. The real-time temperature of the tissue between the lesion margin and the vital structures was monitored by inserting a 21G thermal monitoring needle. The major indexes of technical success, technique effectiveness, local tumour progression and complications were observed during the follow-up period. Technical success was acquired in all patients. Technique effectiveness was achieved with one session in 119 lesions based on contrast-enhanced ultrasound (CEUS) 3-5 days after treatment. An additional 95 lesions achieved technique effectiveness at the second session. Within the follow-up period of 6-58 months (median 38 months), the 1-, 2-, 3-, and 4-year local tumour progression rate was 11.1%, 18.1%, 19.1%, and 19.9%, respectively. There were no major complications in all the patients except for the common side effects. These results indicate that the thermal monitor technique can be applied to prevent major complications in vulnerable structures and allow percutaneous MWA to achieve satisfactory technique effectiveness in the treatment of HCC in high-risk locations.
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Luo D, Carter KA, Miranda D, Lovell JF. Chemophototherapy: An Emerging Treatment Option for Solid Tumors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2017; 4:1600106. [PMID: 28105389 PMCID: PMC5238751 DOI: 10.1002/advs.201600106] [Citation(s) in RCA: 289] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/21/2016] [Indexed: 05/17/2023]
Abstract
Near infrared (NIR) light penetrates human tissues with limited depth, thereby providing a method to safely deliver non-ionizing radiation to well-defined target tissue volumes. Light-based therapies including photodynamic therapy (PDT) and laser-induced thermal therapy have been validated clinically for curative and palliative treatment of solid tumors. However, these monotherapies can suffer from incomplete tumor killing and have not displaced existing ablative modalities. The combination of phototherapy and chemotherapy (chemophototherapy, CPT), when carefully planned, has been shown to be an effective tumor treatment option preclinically and clinically. Chemotherapy can enhance the efficacy of PDT by targeting surviving cancer cells or by inhibiting regrowth of damaged tumor blood vessels. Alternatively, PDT-mediated vascular permeabilization has been shown to enhance the deposition of nanoparticulate drugs into tumors for enhanced accumulation and efficacy. Integrated nanoparticles have been reported that combine photosensitizers and drugs into a single agent. More recently, light-activated nanoparticles have been developed that release their payload in response to light irradiation to achieve improved drug bioavailability with superior efficacy. CPT can potently eradicate tumors with precise spatial control, and further clinical testing is warranted.
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Affiliation(s)
- Dandan Luo
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260
| | - Kevin A. Carter
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260
| | - Dyego Miranda
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260
| | - Jonathan F. Lovell
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260
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Delicque J, Boulin M, Guiu B, Pelage JP, Escal L, Schembri V, Assenat E, Fohlen A. Interventional oncology for hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2016; 40:530-537. [PMID: 27055387 DOI: 10.1016/j.clinre.2016.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/17/2016] [Indexed: 02/04/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and is increasing in incidence. The overall prognosis of patients with liver cancer is poor. The Barcelona Clinic Liver Cancer (BCLC) classification in 5 stages is endorsed by European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Disease (AASLD). This classification is recommended for treatment allocation. Because a small proportion of patients are suitable for curative surgical treatment, various locoregional therapies are widely used to manage patients with HCC. The image-guided therapies, also called interventional radiology or interventional oncology (IO) techniques consisted in percutaneous or endovascular approach. This article reviews the different IO treatments available in HCC patients and the strength of the data.
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Affiliation(s)
- Julien Delicque
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Mathieu Boulin
- Dijon University Hospital, Department of Pharmacy, 21000 Dijon, France
| | - Boris Guiu
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France.
| | - Jean-Pierre Pelage
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Laure Escal
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Valentina Schembri
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Eric Assenat
- St-Eloi University Hospital, Department of Oncology, 34000 Montpellier, France
| | - Audrey Fohlen
- University and Medical Center of Caen, 14033 Caen cedex, France.
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Yu SJ, Yoon JH, Lee JM, Lee JY, Kim SH, Cho YY, Yoo JJ, Lee M, Lee DH, Cho Y, Cho EJ, Lee JH, Kim YJ, Kim CY. Percutaneous ethanol injection therapy is comparable to radiofrequency ablation in hepatocellular carcinoma smaller than 1.5 cm: A matched case-control comparative analysis. Medicine (Baltimore) 2016; 95:e4551. [PMID: 27583865 PMCID: PMC5008549 DOI: 10.1097/md.0000000000004551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although percutaneous ethanol injection therapy (PEIT) is best indicated for patients with small hepatocellular carcinoma (HCC), the survival advantage of PEIT needs confirmation in real-world practice. This study was approved by the institutional review board, and the informed consent was waived. The study included 535 consecutive patients with newly diagnosed early stage (Barcelona Clinic Liver Cancer [BCLC] 0 or A) HCC who underwent initially radiofrequency ablation (RFA) (n = 288) or PEIT (n = 247) from January 2005 to December 2010. The primary outcome was overall survival (OS) and the secondary outcome was time to progression (TTP). The longest diameters of tumors of the groups differed significantly and larger for RFA group than PEIT group (P < 0.001; 1.94 ± 0.65 cm vs 1.60 ± 0.50 cm, respectively). The 5-year OS rates were 72.2% in the RFA group and 67.4% in the PEIT group (P = 0.608). Even after propensity score matching, OS rates between the 2 groups were similar (5-year OS: 72.8% with RFA [n = 175] and 68.0% with PEIT [n = 175]) (P = 0.709). Moreover, in patients with the longest diameter of tumors (≤1.5 cm), multivariate Cox regression analysis showed that the treatment modality was not a significant prognosticator for OS (hazard ratio [HR], 1.690; 95% confidence interval [CI], 0.828-3.449; P = 0.149) and time to progression (HR, 1.160; 95% CI, 0.773-1.740; P = 0.474). PEIT and RFA show equal effectiveness in treating HCCs <1.5 cm in terms of OS and time to progression.
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Affiliation(s)
- Su Jong Yu
- Department of Internal Medicine and Liver Research Institute
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute
- Correspondence: Jung-Hwan Yoon, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail: )
| | - Jeong Min Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine
| | - Jae Young Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine
| | - Se Hyung Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine
| | - Young Youn Cho
- Department of Internal Medicine and Liver Research Institute
| | - Jeong-Ju Yoo
- Department of Internal Medicine and Liver Research Institute
| | - Minjong Lee
- Department of Internal Medicine and Liver Research Institute
| | - Dong Hyeon Lee
- Department of Internal Medicine and Liver Research Institute
| | - Yuri Cho
- Department of Internal Medicine and Liver Research Institute
- CHA Gangnam Medical Center, Department of Internal Medicine, CHA University, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute
| | - Chung Yong Kim
- Department of Internal Medicine and Liver Research Institute
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