scholarly journals Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan

2021 ◽  
Vol 10 (18) ◽  
pp. 1314-1318
Author(s):  
Ganaraj Kulamarva ◽  
Supriya Prathibha Shankaranarayana Bhat ◽  
Sunil Dadhich ◽  
Narendra Bhargava ◽  
Prabhat Ranjan
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Early Stage ◽  
Management Strategies ◽  
Dynamic Imaging ◽  
Barcelona Clinic Liver Cancer ◽  
Treatment Modalities ◽  
Bclc Staging ◽  
Treatment Adequacy ◽  
Staging Classification

BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patients with cirrhosis. It is usually diagnosed late in the course of the illness and the median survival following diagnosis ranges between 6 - 20 months. India lacks data on management strategies and their efficacy. In the absence of data on treatment protocols and its adequacy; we evaluated our own centre data for a period of 1 year to get the estimate of incidence, aetiology, treatment adequacy and response to treatment. Barcelona Clinic Liver Cancer (BCLC) prognostic staging classification comprising five stages is used for prognostication, which is based on the extent of the primary lesion, performance status, vascular invasion and extrahepatic spread. Surgical therapies including resection and transplantation are feasible in early stages (BCLC stage 0 and stage A). Trans arterial chemoembolisation is recommended in intermediate stage (BCLC stage B) while systemic therapies are recommended in advanced stage (BCLC stage C). Best supportive care is recommended in terminal stage (BCLC stage D). This study has included BCLC staging for staging classification and patients were assessed for adequacy of management. METHODS This study was done as a retrospective hospital based observational study. All HCC patients presenting to Mahatma Gandhi Hospital attached to Dr. Sampurnanand Medical College, Jodhpur, Western Rajasthan from January to December 2014 were included. HCC was diagnosed based on European Association for the study of the Liver–European Organisation for Research and Treatment of Cancer (EASL–EORTC) clinical practice guidelines 2011. Patients were classified according to Barcelona Clinic Liver Cancer staging and management given was recorded. RESULTS Thirty-two patients who were diagnosed with HCC between January to December 2014 were included in the study. In three fourths of the patients (24) HCC was diagnosed based on typical findings on dynamic imaging studies (triple phase contrast enhanced CT-computed tomography abdomen and / or MRI- magnetic resonance imaging abdomen). Liver biopsy was needed in one fourth of the patients. Majority of the patients (87.5 %) had cirrhosis of the liver at the time of diagnosis of HCC. Some of these patients [5 (17.8 %)] were known cirrhotic patients. CONCLUSIONS Hepatitis B was the most common aetiology of HCC as mentioned previously in other studies, which is vaccine preventable. HCC is rarely diagnosed at an early stage in developing countries. Various treatment modalities are available which depend on the stage, local expertise and affordability. If the surveillance recommendations are strictly adhered,HCC can be diagnosed at an early stage. Affordability and compliance will remain issues in HCC management in our country increasing the socio-economic burden on the society. KEY WORDS Hepatocellular Carcinoma (HCC), BCLC Staging, Survival

scholarly journals Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249194
Author(s):  
Yi-Hao Yen ◽  
Yu-Fan Cheng ◽  
Jing-Houng Wang ◽  
Chih-Che Lin ◽  
Chien-Hung Chen ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Liver Surgery ◽  
De Novo ◽  
Staging System ◽  
High Volume ◽  
Barcelona Clinic Liver Cancer ◽  
Treatment Modalities ◽  
Bclc Staging ◽  
Surgery Center ◽  
Stage D

Background and aims The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely applied staging system for hepatocellular carcinoma (HCC) and is recommended for treatment allocation and prognostic prediction. The BCLC guidelines were modified in 2018 to indicate that Child-Pugh A without any ascites is essential for all stages except stage D. This study sought to provide a description of patients with HCC treated at a high-volume liver surgery center in Taiwan where referral is not needed and all treatment modalities are available and reimbursed by the National Health Insurance program. As such, certain variables that could modulate treatment decisions in clinical practice, including financial constraints, the availability of treatment procedures, and the expertise of the hospital, could be excluded. The study further sought to evaluate the adherence to the modified BCLC guidelines. Methods This was a retrospective study with prospectively collected data. 1801 consecutive patients with de novo HCC were enrolled through our institution from 2011–2017. Results There were 302 patients with stage 0, 783 with stage A, 242 with stage B, 358 with stage C, and 116 with stage D HCC. Treatment adhering to the modified BCLC guidelines recommendations was provided to 259 (85.8%) stage 0 patients, 606 (77.4%) stage A patients, 120 (49.6%) stage B patients, 93 (26.0%) stage C patients, and 83 (71.6%) stage D patients. Conclusions We reported treatment adhering to the modified BCLC guidelines at a high-volume liver surgery center in Taiwan. We found that non-adherence to the modified BCLC staging system was common in treating stage B and C patients.

scholarly journals Transarterial Chemoembolization and Radioembolization across Barcelona Clinic Liver Cancer Stages

2017 ◽  
Vol 34 (02) ◽  
pp. 109-115 ◽  
Author(s):  
Joseph Titano ◽  
Amir Noor ◽  
Edward Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Transarterial Chemoembolization ◽  
Advanced Disease ◽  
Tumor Burden ◽  
Barcelona Clinic Liver Cancer ◽  
Evidence Based ◽  
Vein Thrombosis ◽  
Bclc Staging ◽  
Established Treatment

AbstractTransarterial chemoembolization (TACE) is a well-established treatment for hepatocellular carcinoma (HCC). TACE has a clearly delineated role within the Barcelona Clinic Liver Cancer (BCLC) staging framework, and TACE has been shown to bridge patients to transplantation and to downsize patients' tumor burden to meet transplantation criteria. Radioembolization (RE) also has an evolving role in the treatment of HCC. RE has evidence-based applications across the range of BCLC stages ranging from segmentectomy for patients with solitary lesions not amenable to ablation to lobar therapy for patients with multifocal HCC, and to treatment of advanced disease with portal vein thrombosis. This article aims to elucidate the evidence behind these therapies and to provide a rationale for their utilization across the spectrum of BCLC stages in the treatment of HCC.

scholarly journals Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1914 ◽  
Author(s):  
Mina S. Makary ◽  
Umang Khandpur ◽  
Jordan M. Cloyd ◽  
Khalid Mumtaz ◽  
Joshua D. Dowell
Keyword(s):  
Hepatocellular Carcinoma ◽  
Early Stage ◽  
Transarterial Embolization ◽  
Management Strategies ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Liver Malignancy ◽  
Curative Intent ◽  
Ablative Therapies ◽  
Recent Advances

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.

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