Subject(s)
Civil Disorders , Communications Media , Ethics, Medical , Humans , Physician's Role , Professional Misconduct , ThailandABSTRACT
From July 1989 to July 1999, 120 male and 30 female patients with hepatocellular carcinoma (HCC), whose ages ranged from 18 to 71 years, were treated by different modalities. The patients were divided into 3 groups according to treatment modalities: group 1 consisted of 35 cases treated by transarterial embolization (TAE) using gelatin sponge permeated with mitomycin-c 20 mg, group 2 - 100 cases treated by transcatheter oily chemoembolization (TOCE) using lipiodol 10 cc with mitomycin-c 20 mg together with gelatin sponge for hepatic embolization, and group 3 - 15 cases treated by TOCE followed by surgical wedge hepatic resection. The prognostic features following treatments were retrospectively analysed in relation to therapeutic modalities. The results revealed that TOCE was superior to TAE and that TOCE plus adjunct wedge hepatic resection was the best treatment modality with the best cumulative surgical rate (median survival 46.69 months). Analysis of the life-table methods of group 2 patients revealed that the stage of tumors and serum biochemistry on entry, both of which corresponded well with hepatic reserve function were statistically significant prognostic factors for treatment result and long-term outcomes. Further analysis of all the patients also revealed that tumor size and stage of tumors were significant prognostic factors for the treatment of hepatocellular carcinomas.
Subject(s)
Adolescent , Adult , Aged , Carcinoma, Hepatocellular/blood , Chemoembolization, Therapeutic , Embolization, Therapeutic , Female , Humans , Life Tables , Liver Neoplasms/blood , Male , Middle Aged , Prognosis , Treatment OutcomeABSTRACT
Four cases of gigantic hepatocellular carcinoma, considered by surgeons to be inoperable, were treated with repeated transcatheter chemoembolization (TOCE) until the serum alfafetoprotein reduced to normal or less than half of the original level or until the tumor reduced to less than half of the original size documented by CT scan and angiogram. Wedge hepatic resection was performed using ultrasonic dissector. Histologic section of the resected tumor mass revealed tumor necrosis. The extent of tumor necrosis was related to tumor size and corresponded inversely to the thickness of the tumor capsule. The survival periods were 48 to 108 months with only one to two episodes of recurrence during follow-up. Repeated wedge hepatic resection was performed successfully for recurrent cases. Serum alfafetoprotein (AFP) is a very sensitive and reliable tumor marker for follow-up results and appears to be a sensitive indicator for tumor recurrence.
Subject(s)
Adult , Angiography , Carcinoma, Hepatocellular/diagnosis , Chemoembolization, Therapeutic/methods , Combined Modality Therapy , Fluorouracil/administration & dosage , Follow-Up Studies , Hepatectomy/methods , Humans , Liver Neoplasms/diagnosis , Male , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
IOC is definitely indicated in patients with clinical indications. It avoided unnecessary exploration of the common bile duct in 32.7 per cent. Of all the clinical indications, palpable common bile duct stone was the most accurate. Dilated common bile duct, dilated cystic duct, elevated serum alkaline phosphatase, multiple small stones and positive imaging investigations were a statistically significant prediction of common bile duct stones. IOC is not justified in patients without clinical indications because of the low incidence of unsuspected common bile duct stone (0.66%) and on the basis of cost-effectiveness. The results support the view that IOC is invaluable and should be used selectively.