Hepatocellular carcinoma medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Medical therapy for hepatocellular carcinoma=== | ===Medical therapy for hepatocellular carcinoma=== | ||
====Protein | ====Protein kinase inhibitors==== | ||
Sorafenib is the only systemic therapy approved for the management of advanced hepatocellular carcinoma. | [[Sorafenib]] is the only systemic therapy approved for the management of advanced hepatocellular carcinoma.<ref name="pmid4870992">{{cite journal |vauthors=Howe CW |title=Experimental wound sepsis from transient bacteremia |journal=Surg Gynecol Obstet |volume=126 |issue=5 |pages=1066–70 |year=1968 |pmid=4870992 |doi= |url=}}</ref> | ||
====Percutaneous ethanol injection==== | ====Percutaneous ethanol injection==== | ||
*Percutaneous ethanol injection (PEI) is best-known image-guided percutaneous ablation for hepatocellular carcinoma:<ref name="pmid3466412">{{cite journal |vauthors=McCollum AG, Reyneke JP, Evans WG |title=An introduction to surgical orthodontics |journal=J. Dent. Assoc. S. Afr. |volume=41 |issue=6A Suppl |pages=397–420 |year=1986 |pmid=3466412 |doi= |url=}}</ref><ref name="pmid7682378">{{cite journal |vauthors=Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, Hamada E, Takahashi M, Shiratori Y, Terano A |title=Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients |journal=AJR Am J Roentgenol |volume=160 |issue=5 |pages=1023–8 |year=1993 |pmid=7682378 |doi=10.2214/ajr.160.5.7682378 |url=}}</ref><ref name="pmid11268965">{{cite journal |vauthors=Livraghi T |title=Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis |journal=Hepatogastroenterology |volume=48 |issue=37 |pages=20–4 |year=2001 |pmid=11268965 |doi= |url=}}</ref><ref name="pmid27583865">{{cite journal |vauthors=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 |title=Percutaneous ethanol injection therapy is comparable to radiofrequency ablation in hepatocellular carcinoma smaller than 1.5 cm: A matched case-control comparative analysis |journal=Medicine (Baltimore) |volume=95 |issue=35 |pages=e4551 |year=2016 |pmid=27583865 |pmc=5008549 |doi=10.1097/MD.0000000000004551 |url=}}</ref><ref name="pmid8966281">{{cite journal |vauthors=Basilico R, Filippone A, Muzi M, Sergiacomo L, Del Roio L, Bonomo L |title=[Assessment of the therapeutic effectiveness of alcohol administration in hepatocarcinoma: comparison of spiral computerized tomography and Doppler color ultrasonography] |language=Italian |journal=Radiol Med |volume=92 |issue=1-2 |pages=92–6 |year=1996 |pmid=8966281 |doi= |url=}}</ref><ref name="pmid15918148">{{cite journal |vauthors=Beaugrand M, N'kontchou G, Seror O, Ganne N, Trinchet JC |title=Local/regional and systemic treatments of hepatocellular carcinoma |journal=Semin. Liver Dis. |volume=25 |issue=2 |pages=201–11 |year=2005 |pmid=15918148 |doi=10.1055/s-2005-871199 |url=}}</ref> | *Percutaneous ethanol injection (PEI) is best-known image-guided percutaneous ablation for hepatocellular carcinoma:<ref name="pmid3466412">{{cite journal |vauthors=McCollum AG, Reyneke JP, Evans WG |title=An introduction to surgical orthodontics |journal=J. Dent. Assoc. S. Afr. |volume=41 |issue=6A Suppl |pages=397–420 |year=1986 |pmid=3466412 |doi= |url=}}</ref><ref name="pmid7682378">{{cite journal |vauthors=Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, Hamada E, Takahashi M, Shiratori Y, Terano A |title=Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients |journal=AJR Am J Roentgenol |volume=160 |issue=5 |pages=1023–8 |year=1993 |pmid=7682378 |doi=10.2214/ajr.160.5.7682378 |url=}}</ref><ref name="pmid11268965">{{cite journal |vauthors=Livraghi T |title=Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis |journal=Hepatogastroenterology |volume=48 |issue=37 |pages=20–4 |year=2001 |pmid=11268965 |doi= |url=}}</ref><ref name="pmid27583865">{{cite journal |vauthors=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 |title=Percutaneous ethanol injection therapy is comparable to radiofrequency ablation in hepatocellular carcinoma smaller than 1.5 cm: A matched case-control comparative analysis |journal=Medicine (Baltimore) |volume=95 |issue=35 |pages=e4551 |year=2016 |pmid=27583865 |pmc=5008549 |doi=10.1097/MD.0000000000004551 |url=}}</ref><ref name="pmid8966281">{{cite journal |vauthors=Basilico R, Filippone A, Muzi M, Sergiacomo L, Del Roio L, Bonomo L |title=[Assessment of the therapeutic effectiveness of alcohol administration in hepatocarcinoma: comparison of spiral computerized tomography and Doppler color ultrasonography] |language=Italian |journal=Radiol Med |volume=92 |issue=1-2 |pages=92–6 |year=1996 |pmid=8966281 |doi= |url=}}</ref><ref name="pmid15918148">{{cite journal |vauthors=Beaugrand M, N'kontchou G, Seror O, Ganne N, Trinchet JC |title=Local/regional and systemic treatments of hepatocellular carcinoma |journal=Semin. Liver Dis. |volume=25 |issue=2 |pages=201–11 |year=2005 |pmid=15918148 |doi=10.1055/s-2005-871199 |url=}}</ref> | ||
Revision as of 17:03, 18 January 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [3]
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Hepatocellular carcinoma Microchapters |
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Differentiating Hepatocellular carcinoma from other Diseases |
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Hepatocellular carcinoma medical therapy On the Web |
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American Roentgen Ray Society Images of Hepatocellular carcinoma medical therapy |
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Risk calculators and risk factors for Hepatocellular carcinoma medical therapy |
Overview
Patients with hepatocellular carcinoma are treated with ethanol injections, transcatheter arterial chemoembolization (TACE), sealed source radiotherapy, radiofrequency ablation (RFA), intra-arterial iodine-131-lipiodol administration, high intensity focused ultrasound (HIFU), hormonal therapy, and chemotherapy.
Medical Therapy
Medical therapy for hepatocellular carcinoma
Protein kinase inhibitors
Sorafenib is the only systemic therapy approved for the management of advanced hepatocellular carcinoma.[1]
Percutaneous ethanol injection
- Percutaneous ethanol injection (PEI) is best-known image-guided percutaneous ablation for hepatocellular carcinoma:[2][3][4][5][6][7]
- It is well tolerated and is preferred in small (< 3 cm) solitary tumors.
- It is an inexpensive procedure
- It has few adverse effects
- It can be repeated in patients with relapse
- Survival is comparable with the patients who undergo surgical resection
- Efficacy is comparable to radiofrequency ablation
Transcatheter arterial chemoembolization (TACE)
- Transcatheter arterial chemoembolization is performed in the following conditions:[8][9][10][11]
- Transcatheter arterial chemoembolization (TACE) is usually performed in the treatment of large tumors (larger than 3 cm and less than 4 cm in diameter), most frequently by intraarterially injecting an infusion of antineoplastic agents mixed with iodized oil (such as Lipiodol).
- Combined PEI and TACE can be used for tumors larger than 4 cm in diameter.
- TACE followed by sorafenib provides optimal results of progression-free survival and survival in patients with HCC who are non responsive to TACE.
Sealed source radiotherapy
- Sealed source radiotherapy can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue). TheraSphere is an FDA approved treatment which has been shown in clinical trials to increase survival rate of low-risk patients. This method uses a catheter (inserted by a radiologist) to deposit radioactive particles to the area of interest.[12]
Radiofrequency ablation (RFA)
- Radiofrequency ablation (RFA) uses high frequency radio-waves to ablate the tumour.
Intra-arterial iodine-131–lipiodol administration
- Intra-arterial iodine-131–lipiodol administration demonstrated some efficacy in unresectable tumors, especially in patients with portal vein thrombus. This treatment is also used as adjuvant therapy in resected patients. It is believed to raise the 3-year survival rate from 46 to 86%.
High intensity focused ultrasound (HIFU)
- High intensity focused ultrasound (HIFU) is a new technique which uses much very powerful ultrasound to treat the tumour. Still at a very experimental stage. Most of the work has been done in China. Some early work is being done in Oxford and London in the UK.
Hormonal therapy
- Hormonal therapy with antiestrogen therapy and tamoxifen can be used in hepatocellular carcinoma treatment.
Chemotherapy
- Regimens that included doxorubicin, cisplatin, fluorouracil, interferon, epirubicin, or taxol, as a single agent or in combination, did not show any survival benefit (Response rate, 0%-25%); a few isolated major responses allowed patients to undergo partial hepatectomy.
Interventional radiology
- Intervention radiology may help in hepatocellular carcinoma treatment.
Contraindicated medications
Hepatocellular carcinoma is considered an absolute contraindication to the use of the following medications:
- Drospirenone and Ethinyl estradiol
- Norethindrone acetate and Ethinyl estradiol
- Norgestimate and Ethinyl estradiol
- Norgestrel and Ethinyl estradiol
- Hydroxyprogesterone caproate
Effectiveness of medical therapy
The effectiveness of medical therapy depends on the following:
- Size
- Involvement of liver vessels
- Presence of a tumor capsule
- Presence of extrahepatic metastases
- Presence of daughter nodules
- Vascularity of the tumor
References
- ↑ Howe CW (1968). "Experimental wound sepsis from transient bacteremia". Surg Gynecol Obstet. 126 (5): 1066–70. PMID 4870992.
- ↑ McCollum AG, Reyneke JP, Evans WG (1986). "An introduction to surgical orthodontics". J. Dent. Assoc. S. Afr. 41 (6A Suppl): 397–420. PMID 3466412.
- ↑ Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, Hamada E, Takahashi M, Shiratori Y, Terano A (1993). "Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients". AJR Am J Roentgenol. 160 (5): 1023–8. doi:10.2214/ajr.160.5.7682378. PMID 7682378.
- ↑ Livraghi T (2001). "Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis". Hepatogastroenterology. 48 (37): 20–4. PMID 11268965.
- ↑ 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 (2016). "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). 95 (35): e4551. doi:10.1097/MD.0000000000004551. PMC 5008549. PMID 27583865. hair space character in
|title=at position 125 (help) - ↑ Basilico R, Filippone A, Muzi M, Sergiacomo L, Del Roio L, Bonomo L (1996). "[Assessment of the therapeutic effectiveness of alcohol administration in hepatocarcinoma: comparison of spiral computerized tomography and Doppler color ultrasonography]". Radiol Med (in Italian). 92 (1–2): 92–6. PMID 8966281.
- ↑ Beaugrand M, N'kontchou G, Seror O, Ganne N, Trinchet JC (2005). "Local/regional and systemic treatments of hepatocellular carcinoma". Semin. Liver Dis. 25 (2): 201–11. doi:10.1055/s-2005-871199. PMID 15918148.
- ↑ Ohki T, Sato K, Yamagami M, Ito D, Yamada T, Kawanishi K, Kojima K, Seki M, Toda N, Tagawa K (2015). "Efficacy of transcatheter arterial chemoembolization followed by sorafenib for intermediate/advanced hepatocellular carcinoma in patients in Japan: a retrospective analysis". Clin Drug Investig. 35 (11): 751–9. doi:10.1007/s40261-015-0333-3. PMC 4621710. PMID 26446004.
- ↑ Acunaş B, Rozanes I (1999). "Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization". Eur J Radiol. 32 (1): 86–9. PMID 10580325.
- ↑ Ahmad J, Rhee J, Carr BI (2005). "The effects of hepatic artery chemotherapy on viral hepatitis in patients with hepatocellular carcinoma". Dig. Dis. Sci. 50 (2): 331–5. PMID 15745096.
- ↑ Arai H, Kobayashi T, Izuka K, Ueno T, Mori K, Takizawa D, Toyoda M, Takayama H, Abe T (2012). "[Clinical evaluation of transcatheter arterial chemolipiodolization of miriplatin for multiple hepatocellular carcinoma]". Gan To Kagaku Ryoho (in Japanese). 39 (13): 2513–6. PMID 23235170.
- ↑ Novell JR, Hilson A, Hobbs KE (1991). "Therapeutic aspects of radio-isotopes in hepatobiliary malignancy". Br J Surg. 78 (8): 901–6. PMID 1655152.
- ↑ [1] American Society of Clinical Oncology, 2005 Annual Meeting, Abstracts on Hepatobiliary Cancer