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The treatment modality of recurrent hepatocellular carcinoma(HCC) includes surgical resection, liver transplantation, ablation, interventional therapy, targeted therapy,and systemic chemotherapy. However,the complexity of disease condition often leads to unsatisfying outcome by single treatment, making multidisciplinary treatment an inevitable choice. Commonly used combined therapies are transarterial chemoembolization(TACE) combined with surgical resection,TACE combined with local ablation,and TACE combined with systemic treatment. In clinical practice,the goal of comprehensive treatment is prolonged survival and improved quality of life. Choosing different combination of therapies according to different liver function,general condition and recurrence of tumors can significantly improve the patients' survival.
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Objective To evaluate the therapeutic effects of postoperative TACE (transarterial chemoembolization) in patients with hepatocellular carcinoma after liver resection.Methods The search was conducted on China biomedical literature database,Chinese CNKI,VIP,Wanfang and PubMed,OVID,Embase and Cochrane library.All the literatures were searched till the end of January 2016.The quality of the included studies were evaluated using the modified Jadad score for randomized controlled trials and the Newcastle-Ottawa Scale for case controlled studies.The trials were analyzed by Stata12.0.Results A total of 2184 patients from 1 randomized controlled trial (RCT) and 14 case-control studies were included.These patients were divided into two groups based on the treatment method.469 patients were included into the hepatic resection only group and 1087 patients were into the postoperative TACE group.The results showed that postoperative TACE improved the 1-year survival for hepatocellular carcinoma.Subgroup analyses were conducted on the risk factor group (tumor diameter greater than 5cm;multiple nodules and blood vessel invasion) and the no risk factor group.Postoperative TACE played an important role in the risk factor group (subgroup analysis for the no risk factor group:RR =1.10,95％ CI:0.97,1.25,P ＞0.05;subgroup analysis for the risk factor group:RR =1.16,95％ CI:1.02,1.32,P ＜ 0.05).Postoperative TACE significantly improved the 3 year survival rate in the postoperative TACE group (RR =1.33,95％ CI:1.15,1.53,P ＜0.05),but the five-year survival rate showed no significant difference between the two groups (RR=1.21,95％CI:0.95,1.15,P＞0.05).Conclusions Postoperative TACE prolonged the survival rate of patients with hepatocellular carcinoma,especially those who had the following risk factors:tumor diameter greater than 5 cm;multiple nodules;blood vessel invasion.Postoperative TACE can be recommended as a routine treatment.
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Objective To study multimodal analgesia in patients who underwent transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods 60 patients who underwent TACE for HCC from Aug.2016 to Nov.2016 were randomized into two groups:the multimodal analgesia group and the control group.The pain scores of these two groups of patient during the procedure and at different posttreatment time points,and the rates of adverse effect and pharmacoeconomic differences were recorded.Results When compared to the control group,the pain scores at 0 h,2 h,4 h,6 h,12 h after treatment in the multimodal analgesia group were significantly lower (P ＜ 0.05),and the satisfactory scores for the patients were significantly improved (96.6％ vs.66.7％).The multimodal group of patients also had significandy lower adverse effect rates of nausea and vomiting,and it was more cost-effective.Conclusions Patients who required multimodal analgesia had better pain relieve,patient satisfaction and less adverse reactions after TACE than patients in the control group.Multimodal analgesia was a safe,effective and economic way to control TACE pain and it was worth recommended in clinical practice.
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Transarterial chemoembolization (TACE) is the worldwide procedure performed for patients with various stage hepatoceullar carcinoma (HCC), but is not yet considered as curative treatment because of relatively high local recurrence rate. Moreover, many clinicians frequently experience treatment failure (incomplete necrosis or stage progression etc.) after repeated TACE, but no clear guidelines have been recommended about salvage treatment modalities for this situation. Recently, studies for combination of radiation therapy and TACE for HCC with TACE refractoriness have been tried and reported better therapeutic efficacy. Based on above suggestions, we herein offer our experience of a patient with macrovascular invasion developed after repeated TACE that achieve complete remission by stereotactic body radiation therapy. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with TACE refractoriness.
Subject(s)
Humans , Carcinoma, Hepatocellular , Necrosis , Recurrence , Salvage Therapy , Treatment FailureABSTRACT
The jaundice in hepatocellular carcinoma patient can be found when the tumor progresses or hepatic function deteriorates. Rarely, it can be occurred when the bile duct is obstructed. The main reason of obstructive jaundice in hepatocellular carcinoma is bile duct invasion of tumor, tumor thrombus, blood clot of hemobilia and direct bile compression by tumor or metastatic lymph node. Although the tumor thrombi among them is difficult to think, prompt diagnosis and treatment should be done because the symptom and prognosis can be improved by removal of the tumor thrombus. We experienced a case of hepatocellular carcinoma patient associated with obstructive jaundice caused by tumor thrombus after transarterial chemoembolization (TACE). The tumor thrombus was removed by endoscopic retrograde cholangiopancreatography (ERCP) and confirmed as degenerated hepatocellular carcinoma cell.
Subject(s)
Humans , Bile , Bile Ducts , Carcinoma, Hepatocellular , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Hemobilia , Jaundice , Jaundice, Obstructive , Lymph Nodes , Prognosis , ThrombosisABSTRACT
PURPOSE: The aims of this study were to find the risk factor and outcomes of patients with an early recurrence (ER) of a hepatocellular carcinoma (HCC) after liver transplantation (LT) and the actual impact of transarterial chemoembolization (TACE) before LT for a HCC on patient survival and HCC recurrence. METHODS: Ninety-eight cases of adult LT, performed between September 1995 and January 2006, were evaluated. The risk factors and prognosis of patient with a HCC after transplantation for an ER, defined as a recurrence within 6 months of transplantation, and the effects of Pre-LT TACE on the disease-free and overall survival rates, as well as the patterns of recurrence after LT, were studied. RESULTS: A total of 18 patients (18.4%) experienced a HCC recurrence after LT; 10 and 8 patients had early and late recurrences, respectively. From a univariate analysis, the serum alpha-fetoprotein (P=0.003), tumor size (P=0.003), serosa invasion (P=0.000), tumor grade (P=0.011) and vascular invasion (P=0.014) were statistically significant risk factors for an ER. From a multivariate analysis, the presence of serosa invasion of a HCC was the only independent risk factor for an ER (P=0.009; OR=9.407: 95% CI, 1.764~50.164). There was no difference in the disease free sur-vival and overall survival rates between the TACE and without TACE groups, but the extrahepatic recurrence rate was higher in the TACE than without TACE group. CONCLUSION: Serosa invasion by a HCC is independently associated with an ER of HCC after LT. Pre-LT TACE does not influence the disease-free and overall survivals after LT for a HCC.
Subject(s)
Adult , Humans , alpha-Fetoproteins , Carcinoma, Hepatocellular , Liver Transplantation , Liver , Multivariate Analysis , Prognosis , Recurrence , Risk Factors , Serous Membrane , Survival RateABSTRACT
Living related liver transplantation(LRLT) is theoretically the best treatment option for end stage liver disease and nonresectable hepatocellular carcinomas. Anastomosed hepatic artery is at high risk in thrombosis after LRLT, which directly related to the patient's life. Usually, recipient hepatic artery is so friable and intimal separation and blood clot between intima and media were noted frequently. From December 2001 to June 2003, consecutive 30 hepatic arteries were harvested from 45 LRLTs patients with end stage liver disease. All hepatic artery were anastomosed with #9-0 nylon by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively. In the histopathologic study of hepatic artery, some had intimal thickening, myxoid change and intimal hyperplasia in 14 out of 30 cases. Since pathologic changes may develop as a result of transarterial chemoembolization(TACE) and others causes, we postulated that the prevalence of hepatic arterial thrombosis, a catastrophic graft-threatening complication of LRLT, might be increased in this subset of LRLT patients who received TACE. But, in our study, patients who underwent hepatic arterial chemoembolization statistically do not show an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after LRLT. And pathologic changes are statistically not correlate with the TACE.
Subject(s)
Humans , Carcinoma, Hepatocellular , End Stage Liver Disease , Hepatic Artery , Hyperplasia , Liver Transplantation , Liver , Nylons , Prevalence , ThrombosisABSTRACT
PURPOSE: Although transarterial chemoembolization (TACE) has been widely used for the treatment of unresectable hepatocellular carcinoma, it has not been determined yet which chemotherapeutic agents were best for TACE. To determine the best chemotherapeutic regimen for TACE, we performed a prospective randomized study comparing 3 chemo- therapeutic regimen (adriamycin alone vs. cisplatin alone vs. adriamycin + cisplatin). MATERIALS AND METHODS: The patients with unresectable hepatocellular carcinoma were eligible for this study and were randomly assigned to three treatment groups (A: adriamycin 30 mg/m(2), B: cisplatin 60 mg/m(2), C: adriamycin 30 mg/m(2) + cisplatin 60 mg/m(2)). The TACE were performed by administering the mixture of lipiodol and the assigned chemotherapeutic drugs through the hepatic artery, followed by embolization with gelfoam powder. The treatment was planned to be repeated every 4 weeks. RESULTS: After 40 patients (14 in group A, 16 in group B, 10 in group C) entered, the study was stopped prematurely because of serious treatment-related complications including 15% of local complications, 18% of hepatic encephalopathy, and 8% of deaths. Because TACE could result in necrosis without reduction of mass size, the response could not be evaluated by the change of mass size, but by the change of serum alpha-fetoprotein level. Of 25 patients who had elevated serum alpha-fetoprotein and were assessable for response, there were one complete response (CR) and 5 partial responses (PR) out of 10 in group A, 5 PRs out of 10 in group B, and 2 PRs out of 5 in group C. There was no difference in response rates among the 3 treatment groups (p > 0.05). The response rate in patients treated with gelform embolization was higher than patients without embolization (63% (12/19) vs 19% (1/6): p<0.05). The median survival (OS) was 23 weeks for all 40 patients, 15 weeks for group A, 42 weeks for group B and 24 weeks for group C. The difference of OS between group A and B was statistically significant (p=0.02). However, the OS was not associated with any prognostic factors including treatment group in multivariate analysis. CONCLUSION: Although cisplatin seemed to be more effective in TACE than adriamycin, no firm conclusion could be drawn from this prematurely ended study. However, we could conclude that the TACE with gelform powder is so toxic that it could not be given safely to the patients with unresectable hepatocellular carcinoma