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Local Ablative Therapy (local + ablative_therapy)

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Medical Sciences100%

Selected Abstracts

Future perspectives for hepatocellular carcinoma

HPB, Issue 4 2003
WY Lau
Background Five facets of hepatocellular carcinoma (HCC) are identified that impact on future directions in the management of the disease: epidemiology, prevention, screening, diagnosis and therapy. Recent papers on HCC have been reviewed, and predictions have been made on developments in HCC over the next decade. Discussion It is predicted that hepatitis B-related HCC will decrease with vaccination, while hepatitis C-related HCC will become an increasing problem. Antiviral treatment and chemopreventive agents will prevent HCC development. Whole-population screening will not be an option, but screening is justified for individuals who can pay for it. There will be more emphasis on the use of tumour markers. Transabdominal ultrasound and triphasic spiral computed tomography will remain important radiological imaging techniques. The results of liver resection will not improve unless neoadjuvant/adjuvant therapy is proven to be effective. More patients with initially unresectable HCC will be down-staged to become resectable with improvements in local, regional and systemic therapies. Liver transplantation will be increasingly used. Local ablative therapy will improve the quality of survival but will have no impact on overall survival compared with surgical resection. The author hopes to review the accuracy of these predictions in 2013. [source]

Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis

CLINICAL TRANSPLANTATION, Issue 2009
André Schaudt
Abstract:, Several authors suggest that local ablative therapies, specifically transarterial chemoembolization (TACE), may control tumor progression of hepatocellular carcinoma (HCC) in patients who are on the waiting list for liver transplantation (orthotopic liver transplantation, OLT). There is still no evidence if TACE followed by OLT is able to prevent recurrence of tumor, to prolong survival rate of the patients on the waiting list, or to improve the survival after OLT. We report 27 patients with HCC who underwent OLT. From these patients, 15 were pre-treated with TACE alone or in combination with percutaneous ethanol injection (PEI) or laser-induced thermo therapy (LITT). Mean time on the waiting list was 214 d for treated patients and 133 d for untreated patients. Comparing pre-operative imaging and histopathological staging post-transplant, we found 13 patients with tumor progression out of which five were treated with TACE. In two of the TACE patients a decrease of lesions could be achieved. In a single patient, there was no evidence of any residual tumor. Only one patient displayed tumor progression prior to OLT despite undergoing TACE. Comparison of outcome in patients undergoing TACE or having no TACE was not statisitically significant (p = 0.5). In addition, our analysis showed that progression either in the total study population or in the TACE group alone is associated with a significant poorer outcome concerning overall survival (p = 0.02 and p = 0.02). [source]

Radiofrequency ablation of hepatic tumors: Lessons learned from 3000 procedures

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2008
Hyunchul Rhim
Abstract Radiofrequency ablation has been accepted as the most popular local ablative therapy for unresectable malignant hepatic tumors. For 9 years from April 1999, we performed 3000 radiofrequency ablation procedures for hepatic tumors in our institution. Our results on the safety (mortality, 0.15%/patient) and therapeutic efficacy (5-year survival rate, 58%) are similar to those of previous studies reported, supporting the growing evidence of a clear survival benefit, excellent results for local tumor control and improved quality of life. The most important lesson learned from our 3000 procedures is that the best planning, safe ablation and complete ablation are key factors for patient outcome. Furthermore, multimodality treatment is the best strategy for recurrent hepatocellular carcinoma encountered after any kind of first-line treatment. [source]

Surveillance programme for hepatocellular carcinoma improves the survival of patients with chronic viral hepatitis

LIVER INTERNATIONAL, Issue 1 2008
Grace Lai-Hung Wong
Abstract Background: The survival benefit of surveillance for hepatocellular carcinoma (HCC) is controversial. Aim: We aimed to examine the survival benefit of HCC surveillance in chronic viral hepatitis. Methods: Survivals of HCC patients related to chronic viral hepatitis from the Hepatology Clinic (surveillance group) were compared with those referred from other hospitals/clinics (no-surveillance group). Lead-time and length-time biases were adjusted based on tumour volume doubling times. Results: Among 579 patients (91% hepatitis B), 472 (82%) patients had HCC and 79 (17%) of these patients were referred from the surveillance programme. HCC was smaller (4.2 vs. 7.7 cm; P<0.001) and fewer in numbers (2.6 vs. 3.8, P=0.03) in the surveillance group vs. the no-surveillance group. Treatment by surgery (20 vs. 10%, P=0.007) and local ablative therapy (46 vs. 19%, P<0.001) were more frequent in the surveillance group than that in the no-surveillance group. The median survival of the surveillance group (88 weeks) was significantly longer than that of the no-surveillance group (26 weeks) (P<0.001). The adjusted cumulative survival at 2 years was significantly longer in the surveillance group if the tumour volume doubling time was <90 days (P=0.0352). Conclusions: HCC surveillance can improve the survival of patients with chronic viral hepatitis B. [source]