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World Journal of Gastroenterology Jul 2015Hepatocellular carcinoma (HCC) represents a unique challenge for physicians and patients. There is no definitively curative treatment. Rather, many treatment and... (Review)
Review
Hepatocellular carcinoma (HCC) represents a unique challenge for physicians and patients. There is no definitively curative treatment. Rather, many treatment and management modalities exist with differing advantages and disadvantages. Both current guidelines and individual patient concerns must be taken into account in order to properly manage HCC. In addition, quality of life issues are particularly complex in patients with HCC and these concerns must also be factored into treatment strategies. Thus, considering all the options and their various pros and cons can quickly become complex for both clinicians and patients. In this review, we systematically discuss the current treatment modalities available for HCC, detailing relevant clinical data, risks and rewards and overall outcomes for each approach. Surgical options discussed include resection, transplantation and ablation. We also discuss the radiation modalities: conformal radiotherapy, yttrium 90 microspheres and proton and heavy ion radiotherapy. The biologic agent Sorafenib is discussed as a promising new approach, and recent clinical trials are reviewed. We then detail currently described molecular pathways implicated in the initiation and progression of HCC, and we explore the potential of each pathway as an avenue for drug exploitation. We hope this comprehensive and forward-looking review enables both clinicians and patients to understand various options and thereby make more informed decisions regarding this disease.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Early Detection of Cancer; Humans; Liver Neoplasms; Neoplasm Staging; Palliative Care; Patient Selection; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 26229392
DOI: 10.3748/wjg.v21.i28.8478 -
Digestive Surgery 2013Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that... (Review)
Review
Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that offers the potential for long-term cure. Appropriate patient selection for surgery and improvements in perioperative care have resulted in low morbidity and mortality rates, resulting in this being the therapy of choice for suitable patients. Modern management of colorectal liver metastases is multimodal incorporating open and laparoscopic surgery, ablative therapies such as radiofrequency ablation or microwave ablation and (neo)adjuvant chemotherapy. The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
Topics: Biopsy; Colorectal Neoplasms; Diagnostic Imaging; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Preoperative Care; Survival Analysis
PubMed: 24051581
DOI: 10.1159/000351442 -
Radiology May 2023
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Neoplasm Recurrence, Local; Tomography, X-Ray Computed; Biomarkers
PubMed: 37097138
DOI: 10.1148/radiol.230657 -
Diagnostic and Interventional Imaging 2020The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software.
MATERIALS AND METHODS
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD.
RESULTS
A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%.
CONCLUSION
AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.
Topics: Aged; Angiography, Digital Subtraction; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Cone-Beam Computed Tomography; Female; Humans; Liver Neoplasms; Male; Middle Aged; Software
PubMed: 32035822
DOI: 10.1016/j.diii.2020.01.011 -
Clinical and Molecular Hepatology Sep 2016There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might... (Review)
Review
There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might have been excluded. Based on this idea, various studies have been conducted to further expand the Milan criteria and give more HCC patients a chance of cure. In deceased donor LT (DDLT) setting, expansion of the criteria is relatively tempered because the results of LT for HCC should be comparable to those of patients with non-malignant indications. On the other hand, in living donor LT (LDLT) situation, liver grafts are not public resources. The acceptable target outcomes for LDLT might be much lower than those for DDLT. Patients with biologically favorable tumors might have excellent survivals after LT despite morphological advanced HCCs. Therefore, the significance and utility of biological tumor parameters for selecting suitable LT candidates have been increased to predict HCC recurrence after LT. Although there is no consensus regarding the use of prognostic biomarkers in LT selection criteria for HCC, the combination of conventional morphological parameters and new promising biomarkers could help us refine and expand the LT criteria for HCC in the near future.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Selection; Positron-Emission Tomography
PubMed: 27729631
DOI: 10.3350/cmh.2016.0042 -
World Journal of Gastroenterology Jun 2017Spontaneous tumor regression is an extremely rare phenomenon in the oncology field. However, there are several case reports resulted in the regression of hepatocellular... (Review)
Review
Spontaneous tumor regression is an extremely rare phenomenon in the oncology field. However, there are several case reports resulted in the regression of hepatocellular carcinoma (HCC) and the accumulation of clinical information and analyses of the mechanism can contribute to the development of a novel therapy. For this purpose, we have carefully reviewed 23 cases of spontaneously regressed HCC published in recent 5 years and our case. The information regarding the tumor size, tumor marker, treatments, ., have been summarized. The mechanism of spontaneous regression has been discussed to date and presumed to be due to many factors, including hypoxia and immunological reactions. In this careful review of the 24 cases based on the clinical information, hypoxia, systemic inflammation, and both upon spontaneous regression were seen in 3, 8, and 4 cases, respectively among the 15 cases for which the information regarding the proposed mechanisms are available. Recent development of immunotherapeutic approaches in oncology shows promising results, therefore, accumulation of additional cases and analysis of mechanisms underlying the spontaneous regression of HCC are essential and could lead to the development of a new generation of immunotherapies including antibodies directed against immune reactions.
Topics: Antibodies; Carcinoma, Hepatocellular; Cell Hypoxia; Cytotoxicity, Immunologic; Humans; Immunotherapy; Liver; Liver Neoplasms; Neoplasm Regression, Spontaneous; Prognosis; T-Lymphocytes; Tomography, X-Ray Computed
PubMed: 28638219
DOI: 10.3748/wjg.v23.i21.3797 -
BioMed Research International 2014
Topics: Humans; Liver Neoplasms; Molecular Targeted Therapy; Neoplasm Metastasis
PubMed: 25162000
DOI: 10.1155/2014/148783 -
Discovery Medicine Sep 2017Hepatocellular carcinoma (HCC) is one of the most common malignancies and a major cause of cancer-related deaths. HCC often has an insidious onset, fast progression, and... (Review)
Review
Hepatocellular carcinoma (HCC) is one of the most common malignancies and a major cause of cancer-related deaths. HCC often has an insidious onset, fast progression, and high tendency of metastasis and recurrence, hence it is a highly fatal malignant tumor. The origin of HCC is still a topic of debate but studies over the past decade have clearly identified liver cancer stem cells (LCSCs) being a cardinal source of liver cancer. LCSCs are a small subset of cells with the unlimited ability of self-renewal, differentiation, and uncontrollable growth. LCSCs are also resistant to conventional therapies and are thus believed to be responsible for treatment failure. Recent studies have indicated that long noncoding RNA (lncRNAs) may play important roles in the regulation of the biological functions of cancer stem cells (CSCs). The roles of lncRNAs on the biological properties of LCSCs are unknown. In this review, we briefly summarize the published studies on the functions and underlying mechanisms of commonly reported lncRNAs in the regulation of LCSCs.
Topics: Animals; Carcinoma, Hepatocellular; Cell Differentiation; Cell Proliferation; Humans; Liver Neoplasms; Neoplasm Metastasis; Neoplastic Stem Cells; RNA, Long Noncoding; RNA, Neoplasm
PubMed: 28972877
DOI: No ID Found -
Gut May 2014Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death and is currently the main event leading to death in patients with cirrhosis. Evolving... (Review)
Review
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death and is currently the main event leading to death in patients with cirrhosis. Evolving information suggests that the metabolic syndrome with non-alcoholic liver disease may be an important cause of HCC in addition to viral hepatitis and alcohol-induced liver disease. The molecular pathogenesis is extremely complex and heterogeneous. To date the molecular information has not impacted on treatment decisions. Periodic surveillance imaging of patients with cirrhosis is widely practiced, especially because diagnostic, radiographic criteria for early-stage HCC have been defined (including nodules between 1 and 2 cm) and effective treatment is available for tumours detected at an early stage. Worldwide the approach to resection versus transplantation varies depending upon local resources, expertise and donor availability. The criteria for transplantation are discussed, and the controversial areas highlighted with evidence-based recommendations provided. Several approaches are available for intermediate stage disease, including radiofrequency ablation, transarterial chemoembolisation and radioembolisation; the rationale for these therapies is buttressed by appropriate outcome-based studies. For advanced disease, systemic therapy with sorafenib remains the option best supported by current data. Thus, while several trials have failed to improve the benefits of established therapies, studies assessing the sequential or combined application of those already known to be beneficial are needed. Also, new concepts are provided in regards to selecting and stratifying patients for second-line studies, which may help explain the failure of prior studies.
Topics: Antineoplastic Agents; Biomarkers, Tumor; Carcinoma, Hepatocellular; Catheter Ablation; Combined Modality Therapy; Decision Support Techniques; Embolization, Therapeutic; Genome-Wide Association Study; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Recurrence, Local; Niacinamide; Phenylurea Compounds; Prognosis; Risk Assessment; Sorafenib
PubMed: 24531850
DOI: 10.1136/gutjnl-2013-306627 -
Seminars in Liver Disease Feb 2013Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide, and the incidence of HCC continues to rise. Improved understanding of... (Review)
Review
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide, and the incidence of HCC continues to rise. Improved understanding of risk factors for HCC has allowed the development of more effective prevention and surveillance strategies to reduce the global burden of this malignancy. Because of the complex nature of HCC, arising in a background of chronic liver dysfunction and often associated with viral infection, appropriate treatment requires a multidisciplinary approach designed to control the cancer and treat the underlying liver disease. Treatment approaches vary based on disease stage and severity, making accurate diagnosis and staging of disease critical. This has been aided by the development of new staging criteria, such as the Barcelona Clinic Liver Cancer Staging System. For earlier-stage disease, resection, radiofrequency ablation, transplantation, and transarterial chemoembolization (TACE) are preferred treatment modalities that provide optimal outcome. Until recently, few treatment options existed for patients with more advanced disease. Improved understanding of the underlying biology of the disease and the development of molecularly targeted therapies, including the multitargeted angiokinase inhibitor sorafenib, has improved outcomes in this patient population. Research into therapeutic targets and novel agents continues for more advanced disease.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Combined Modality Therapy; Early Detection of Cancer; Humans; Liver Neoplasms; Molecular Targeted Therapy; Neoplasm Staging; Patient Care Team; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Signal Transduction
PubMed: 23457037
DOI: 10.1055/s-0033-1333631