scholarly journals Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons

2021 ◽  
Vol 27 (43) ◽  
pp. 7462-7479
Author(s):  
Mina S Makary ◽  
Stuart Ramsell ◽  
Eric Miller ◽  
Eliza W Beal ◽  
Joshua D Dowell
Keyword(s):  
Hepatocellular Carcinoma ◽  
Locoregional Therapies

scholarly journals Clinical Characterisation and Management of the Main Treatment-Induced Toxicities in Patients with Hepatocellular Carcinoma and Cirrhosis

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 584
Author(s):  
Fausto Meriggi ◽  
Massimo Graffeo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Impairment ◽  
Hepatic Cirrhosis ◽  
Disease Stage ◽  
The Past ◽  
Systemic Treatments ◽  
Key Points ◽  
Locoregional Therapies ◽  
Almost All ◽  
Selection Of

The incidence of hepatocellular carcinoma (HCC) continues to increase worldwide, particularly in Western countries. In almost all cases, HCC develops in subjects with hepatic cirrhosis, often as the result of hepatitis B or C virus infection, alcohol abuse or metabolic forms secondary to non-alcoholic steatohepatitis. Patients with HCC and hepatic symptoms can therefore present symptoms that are attributable to both conditions. These patients require multidisciplinary management, calling for close interaction between the hepatologist and the oncologist. Indeed, the treatment of HCC requires, depending on the disease stage and the degree of hepatic impairment, locoregional therapies that can in turn be broken down into surgical and nonsurgical treatments and systemic treatments used in the event of progression after the administration of locoregional treatments. The past decade has seen the publication of countless papers of great interest that have radically changed the scenario of treatment for HCC. Novel therapies with biological agents and immunotherapy have come to be standard options in the approach to treatment of this cancer, obtaining very promising results where in the past chemotherapy was almost never able to have an impact on the course of the disease. However, in addition to being costly, these drugs are not devoid of adverse effects and their management cannot forgo the consideration of the underlying hepatic impairment. Patients with HCC and cirrhosis therefore require special attention, starting from the initial characterisation needed for an appropriate selection of those to be referred for treatment, as these patients are almost never fit. In this chapter, we will attempt to investigate and clarify the key points of the management of the main toxicities induced by locoregional and systemic treatments for HCC secondary to cirrhosis.

Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis

2021 ◽  
Vol 21 (2) ◽  
pp. 105-112
Author(s):  
Sang Jin Kim ◽  
Jong Man Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Radiation Therapy ◽  
Portal Vein ◽  
Alpha Fetoprotein ◽  
Advanced Hepatocellular Carcinoma ◽  
Portal Vein Tumor Thrombosis ◽  
Donor Liver Transplantation ◽  
Tumor Thrombosis ◽  
Locoregional Therapies

Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included three-dimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed.

scholarly journals Current locoregional therapies and treatment strategies in hepatocellular carcinoma

2020 ◽  
Vol 27 (S3) ◽  
Author(s):  
L. Cardarelli-Leite ◽  
A. Hadjivassiliou ◽  
D. Klass ◽  
J. Chung ◽  
S.G.F. Ho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Percutaneous Ablation ◽  
Transarterial Radioembolization ◽  
Combined Use ◽  
Liver Morphology ◽  
Locoregional Therapies ◽  
Bridging To Transplant

Locoregional therapies (LRT) play an important role in the treatment of hepatocellular carcinoma (HCC), with the aim of increasing overall survival while preserving liver function. Different forms of LRT are available and choosing which one is best will depend on technical aspects, liver morphology, tumor biology, and patient’s symptoms. The purpose of this review article is to provide an overview of the current evidence regarding the use of percutaneous ablation, transarterial chemoembolization and transarterial radioembolization for the curative or palliative treatment of HCC. Special situations are also reviewed, including the combined use of systemic therapy with LRT; indications and techniques for bridging to transplant and downstaging; and the use of LRT to treat patients with HCC and macrovascular invasion.

scholarly journals Diagnosis, Staging, and Patient Selection for Locoregional Therapy to Treat Hepatocellular Carcinoma

2020 ◽  
Vol 37 (05) ◽  
pp. 441-447
Author(s):  
Zachary T. Berman ◽  
Isabel Newton
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Options ◽  
Intermediate Stage ◽  
Family Education ◽  
Locoregional Therapy ◽  
Stage Disease ◽  
Incidence And Mortality ◽  
Tumor Boards ◽  
Diagnostic Approaches ◽  
Locoregional Therapies

AbstractHepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality and the only cancer for which the incidence and mortality are on the rise. Sensitive and specific screening and diagnostic approaches, robust staging regimens, multidisciplinary tumor boards, and patient/family education and engagement in the shared decision-making process help to identify a patient's optimal treatment options. Locoregional therapies have been the mainstay for treating intermediate-stage disease, but they are finding special applications for early and advanced disease. This review discusses the diagnosis of HCC, current accepted staging models, and treatment of HCC, with a focus on locoregional therapies.

The effect of bridging locoregional therapies on survival in hepatocellular carcinoma patients undergoing orthotopic liver transplantation: UNOS population study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 346-346 ◽  
Author(s):  
Minzhi Xing ◽  
Hyun Sik Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Large Scale ◽  
Population Based ◽  
Meld Score ◽  
Kaplan Meier ◽  
Comparison Groups ◽  
Locoregional Therapies ◽  
End Stage

346 Background: The effect of bridging locoregional therapies (LRT) on overall survival (OS) in pts with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) has not been investigated in large-scale population studies. Methods: TheUnited Network for Organ Sharing (UNOS) database was used to identify pts with HCC who received OLT between 2002 and 2010. Pts within Milan Criteria for whom an HCC Model for End-Stage Liver Disease (MELD) exception was approved were included. OS was compared between pts who received bridging LRT (including transarterial chemoembolization (TACE)) and those who did not. Kaplan-Meier estimation and Cox proportional hazard models were used for OS analysis. Results: Of 11,287 pts with HCC who received OLT, 9,876 pts had LRT data, mean age 56.6 yrs, 77% male; 5,103 received bridging LRT, including 3,676 who received TACE. Comparison groups were similar for age at OLT, waitlist duration, sex, race, BMI and MELD score (p>.05 for all). Significantly prolonged OS with bridging LRT vs. none was observed from both OLT (111.6 vs 106.4 mo, p<.001) and from Listing (176.1 vs 169.4 mo, p=.001). Similarly, significantly prolonged OS with bridging TACE vs. none was observed from both OLT (112.0 vs 107.2 mo, p<.001) and from Listing (177.7 vs 169.9 mo, p=.001). Conclusions: In HCC pts undergoing OLT, both bridging LRT and TACE correlated with prolonged survival from OLT and from Listing in a UNOS population-based study. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document