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Objective:To investigate the workflow, efficacy and safety of MR-Linac in liver malignancies.Methods:Clinical data of 15 patients with hepatocellular carcinomas (HCC) or liver metastases treated with MR-Linac between November 2019 and July 2021 were retrospectively analyzed. The workflow of MR-Linac was investigated and image identification rate was analyzed. Patients were followed up for response and toxicity assessment.Results:Fifteen patients (6 HCC, 8 liver metastases from colorectal cancer, 1 liver metastasis from breast cancer) were enrolled. A total of 21 lesions were treated, consisting of 10 patients with single lesion, 4 patients with double lesions and 1 patient with triple lesions. The median tumor size was 2.4 cm (0.8-9.8 cm). The identification rate for gross tumor volume (GTV) in MR-Linac was 13/15. Although GTV of two patients were unclearly displayed in MR-Linac images, the presence of adjacent blood vessel and bile duct assisted the precise registration. All the patients were treated with stereotactic body radiation therapy (SBRT). For HCC, the median fraction dose for GTV or planning gross tumor volume (PGTV) was 6 Gy (5-10 Gy) and the median number of fractions was 9(5-10). The median total dose was 52 Gy (50-54 Gy) and the median equivalent dose in 2 Gy fraction (EQD 2Gy) at α/ β= 10 was 72 Gy (62.5-83.3 Gy). For liver metastases, the median fraction dose for GTV or PGTV was 5 Gy (5-10 Gy) and the median number of fractions was 10(5-10). The median total dose was 50 Gy (40-50 Gy) and the median EQD 2Gy at α/ β=5 was 71.4 Gy (71.4-107.1 Gy). At 1 month after SBRT, the in-field objective response rate (ORR) was 8/13 and the disease control rate was 13/13. At 3-6 months after SBRT, the in-filed ORR was increased to 6/6. During the median follow-up of 4.0 months (0.3-11.6), 4-month local progression-free survival, progression-free survival and overall survival were 15/15, 11/15 and 15/15, respectively. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusions:MR-Linac provides a platform with high identification rates of liver lesions. Besides, the presence of adjacent blood vessel and bile duct also assists the precise registration. It is especially suitable for liver malignancies with promising local control and well tolerance.
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Objective@#To investigate the feasibility of a nurse-led exercise and cognitive behavioral intervention for medium-advanced hepatocellular carcinoma patients with cancer-related fatigue, sleep quality and depression outcomes.@*Methods@#A total of seventy-nine medium-advanced hepatocellular carcinoma patients were enrolled in this study, the patients were randomly assigned to intervention group and control group. The control group given conventional nursing intervention, intervention group received exercise and cognitive behavioral therapy. The baseline characteristics between two groups were compared, the fatigue outcome was measured by the Piper Fatigue Scale at before intervention, after a 2-week intervention, after a 6-week intervention. Besides, depression and sleep quality were measured using the self-rating depression scale and the Pittsburgh sleep quality index questionnaire, respectively.@*Results@#After 2-week and 6-week of intervention, the fatigue scores in the intervention group (4.14±0.40 and 3.91±0.37) were markedly higher than in the control group (4.94±0.38 and 5.03±0.44) (t=9.116,12.195, all P<0.05). Moreover, the intervention group (44.74±6.01) points and (41.30±7.43) points demonstrated lower scores of depressions compared to the control group (50.53±7.49) and (48.39±6.16) after 2-week and 6-week of intervention (t=3.771,4.630, all P<0.05). The intervention group (7.25±0.36) points and (6.29±0.96) points also showed lower scores of sleep quality when compared to the control group (8.86±0.57) points and (7.86±0.91) points after 2-week and 6-week of intervention (t=2.013, 2.189, all P<0.05).@*Conclusion@#Nurse-delivered exercise and cognitive behavioral intervention have benefits in helping medium-advanced hepatocellular carcinoma patients to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.
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Modern medical imaging techniques,such as computed tomorgraphy (CT),magnetic resonance imaging (MRI) and position emission tomorgraphy/computed tomorgraphy (PET-CT) can accurately delineate the gross target volume (GTV) of hepatocellular carcinoma (HCC).Comparison of postoperative pathological subclinical lesions,imaging and clinical parameters contributes to the precise delineation of clinical target volume (CTV).Moreover,radiotherapy-assisted techniques,such as fourdimensional computed tomography (4DCT),compression of abdomen,active breathing control and respiratory gating,can minimize the internal target volume (ITV).In addition,immobilization with vacuum cushion and body membrane can reduce the set-up error,minimize the planning target volume (PTV) and avoid or decrease the irradiation error or missing irradiation.All these approach can minimize the target volume,elevate the dose and reduce the complications during radiotherapy for HCC.In this article,the research progress on the target delineation for external beam radiotherapy in HCC patients was reviewed.
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Objective To investigate the feasibility of a nurse-led exercise and cognitive behavioral intervention for medium-advanced hepatocellular carcinoma patients with cancer-related fatigue, sleep quality and depression outcomes. Methods A total of seventy-nine medium-advanced hepatocellular carcinoma patients were enrolled in this study, the patients were randomly assigned to intervention group and control group. The control group given conventional nursing intervention, intervention group received exercise and cognitive behavioral therapy. The baseline characteristics between two groups were compared, the fatigue outcome was measured by the Piper Fatigue Scale at before intervention, after a 2-week intervention, after a 6-week intervention. Besides, depression and sleep quality were measured using the self-rating depression scale and the Pittsburgh sleep quality index questionnaire, respectively. Results After 2-week and 6-week of intervention, the fatigue scores in the intervention group (4.14±0.40 and 3.91±0.37) were markedly higher than in the control group (4.94±0.38 and 5.03±0.44) (t=9.116,12.195, all P<0.05). Moreover, the intervention group (44.74±6.01) points and (41.30±7.43) points demonstrated lower scores of depressions compared to the control group (50.53±7.49) and (48.39±6.16) after 2-week and 6-week of intervention (t=3.771,4.630, all P<0.05). The intervention group (7.25±0.36) points and (6.29±0.96) points also showed lower scores of sleep quality when compared to the control group (8.86±0.57) points and (7.86±0.91) points after 2-week and 6-week of intervention (t=2.013, 2.189, all P<0.05). Conclusion Nurse-delivered exercise and cognitive behavioral intervention have benefits in helping medium-advanced hepatocellular carcinoma patients to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.
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Purpose To analyse the correlation between the Toll-like receptor 3 (TLR3) expression and clinic pathologic factors,stromal microenvironment in hepatocellular carcinoma (HCC).Methods The tissue microarrays of human HCC were prepared with self-owned patent technology.The expression of TLR3 in HCC cells as well as various indexes in HCC stroma was examined with immunohistochemistry of SP.The correlation between TLR3 expression with the clinic pathologic factors of HCC,and the correlation between TLR3 expression with the reaction of stromal cells in HCC microenvironment were analyzed by multi-factor correlation analysis.Results The positive expression rate of TLR3 in HCC was 71.57％.The expression of TLR3 in HCC had negative correlation with vascular invasion (P =0.001),cirrhosis (P =0.007),Edmondson's grades (P =0.001) and staging of TNM (P =0.000).It had positive correlation with hepatitis B surface antigen (HBsAg) (P =0.000).It had positive correlation with T cells (P =0.002) and natural killer (NK) cells (P =0.000).It had negative correlation with carcinoma-associated fibroblasts (CAFs) (P =0.000) and microvessel density (MVD) (P =0.000).Conclusion TLR3 has an important influence on the interstitial microenvironment of HCC.
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Purpose To study the role of lnc-HOTAIR and its target-controlled miR-21 on invasion and metastasis of hepatocellular carcinoma cells (HCC) and its related mechanisms.Methods The expression of miR-21 in 30 cases of HCC was detected by quantitative real-time PCR (qRT-PCR),and correlation with clinical pathology was also analyzed.siRNA of lncHOTAIR was transfected to HCC HepG2 cell (HepG2),invasive activities of HepG2 was detected by Transwell,the expression of miR-21 was determined by qRT-PCR,the expression of protein MMP-2 was determined by Western blotting,and the correlation with miR-21 expression was analyzed.Results Compared with pericarcinous tissue,the expressions of miR-21 in tumor tissue increased apparently (P ＜ 0.05).The expressions of miR-21 correlated positively with malignancy degree,differentiation degree and invasion and metastasis respectively,and correlated negatively with tumour size,tumour number and level of AFP respectively.After silencing the HOTAIR gene,the invasive activities of HepG2 were suppressed,the expression of miR-21 gene and MMP-2 protein were down regulated,and both of them were positively correlated.Conclusion High expressions of miR-21 in liver cancer correlate positively with malignancy degree,differentiation degree,intrahepatic and extrahepatic metastases and portal vein tumor thrombus respectively.HOTAIR may inhibit the invasion and metastasis of HCC by controlling the expression level of miR-21.
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Objective To discuss the safety and feasibility of radiofrequency ablation (RFA)combined with transcatheter arterial chemoembolization(TACE)for patients with primary liver carcer(PLC).Methods 64 cases with PLC were selected and randomly divided into two groups,32 cases in each group.The observation group accepted TACE combined with RFA therapy,while the control group only received TACE treatment.Term efficacy (after 1 year)and 1,2,3 -year survival rate were compared in the two groups.The changes of liver function parameters including aspartate aminotransferase (AST),alanine aminotransferase (ALT) and γ-aminoacyl transferase (γ-GT)of the two groups were analyzed and compared.Results After 1 year of treatment,the remission rate was 71.9% (23 /32)in the observation group,which in the control group was 43.8% (14 /32),the difference was statis-tically significant (χ2 =5.189,P <0.05).The 1,2,3 -year cumulative survival rates were 65.6% (21 /32),65.6%(21 /32)and 62.5% (20 /32)in the observation group,which in the control group were 37.5% (12 /32),28.1%(9 /32)and 21.9% (7 /32),the differences were statistically significant (χ2 =5.067,9.035,10.83,all P <0.05). After 2 months of treatment,AST,ALT and γ-GT levels in the observation group were significantly higher than those in the control group(t =4.218,2.449,8.647,all P <0.05).Conclusion TACE combined with RFA therapy can significantly improve the clinical symptoms of patients with PLC,which can improve liver function in patients and help prolong the survival time.
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Objective To compare the results of the anterior approach (AA) with the conventional approach in the treatment of large hepatocellular carcinoma (HCC).Methods We searched the Medline,PubMed,Cochrane Library,Wanfang database on randomized clinical controlled trials and non-randomized clinical controlled trials comparing AA with the CA in right hepatic resection for large hepatocellular carcinoma.The data were analyzed with the RevMan5 software.Results Five non-randomized clinical controlled trials (NRCTs) and three randomized clinical controlled trials involving 615 patients (304 in the AA group,311 in the CA group) were enrolled into the analysis.There was no significant difference in the operation time between the two groups.Compared with the CA,the AA had lower intraoperative blood loss (WMD=-680.2 ml; 95％CI,-1023.97～-336.43;P=0.0001),blood transfusion rate (OR=0.38;95％ CI,0.25～0.59;P＜0.0001),intraoperative tumor rupture (OR=0.33;95％CI,0.11～0.97;P=0.04),surgical complication (OR=0.59;95％CI,0.38 ～ 0.93 ; P =0.02),hospital mortality (OR =0.37 ; 95 ％ CI,0.21 ～ 0.67 ; P =0.0009),and hospital stay (WMD=-4.75 d;95％CI,-7.82～-1.67;P=0.002).Conclusion AA is superior to CA in the treatment of larger.The operation time is the same for the 2 approaches.
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Objective To investigate the expression and significance of β-catenin and peroxisome prolifera-tot-activated receptor-γ,(PPARγ) in bepatocellular carcinoma. Methods Tissue microarrays were established to detect β-catenin and PPARγ expression in 49 cases of hepatocellular carcinoma,49 cases of adjacent nontumoral liv-er tissue and 6 cases of normal liver tissue. The relationships between PPARγ and β-catenin as well as between PPARγ and clinicopathological parameters were observed. Results The aberrant expression rate of β-catenin was 69.39%,48.98 % and 0 respectively (P=0.001). The positive expression rate of PPARγ was 51.02%,30.61% and 0 respectively (P=0.016). Clinicopathological analysis revealed that the increase of PPARγ expression was not associated with age,tumor size,serum alpha fetoprotein (AFP) levels,tumor embolus of portal vein or inferior vena cava,and HBsAg infection(χ2=0.214,3.201,0.046,3.201,P>0.05 for each),but correlated with differentiation grades(χ2=4.693,P<0.05). Aberrant expression of β-catenin was associated with PPARγ expression(χ2= 5.130,P<0.05). Conclusion Aberrant expression of β-catenin may involve in the liver carcinogenesis. The high expression of PPARγ in hepatocellular carcinoma is significantly correlated with the clinicopathological characteris-tics. Detection of PPARγ is valuable for diagnosing hepatocellular carcinoma,and evaluating malignancy extent and prognosis.
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PURPOSE: Hepatocellular carcinomas (HCC) are one of the most common cancers in Korea. The mechanism of HCC development is still unclear, and the aberration of the tumor suppressor genes in HCC remains to be clarified. MATERIALS AND METHODS: To study the expressions of p53 and Rb protein, and their correlation with the clinicopathological parameters in HCC, 68 patients, with surgically resected hepatocellular carcinomas, were analyzed by an immunohistochemical method. The expressions of p53 and Rb protein were classified into three categorizes, depending on the percentage of stained cells. RESULTS: The expression of the p53 protein was 51.5% (35/68), and was significantly correlated with differentiation (p0.05). There was a positive correlation between p53 and Rb protein overexpression (p<0.05). The expressions of p53 and Rb protein had correlation with the Ki-67 labeling index (p<0.05). CONCLUSION: These findings suggest the aberrant expressions of p53 and Rb protein may play a role in the progression and carcinogenesis of HCC.
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Humans , Carcinogenesis , Carcinoma, Hepatocellular , Fibrosis , Genes, Tumor Suppressor , Korea , Retinoblastoma ProteinABSTRACT
Hepatocellular carcinomas are one of the most common malignancies in the world. However, no effective therapeutic modality has been proven to prolong the survival of patients in an inoperable stage. The purpose of this study was to determine the response rate and the toxicities of a combination of pirarubicin, UFT and leucovorin in patients with non-embolizable hepatocellular carcinomas, or who had progressed during their transcatheter arterial chemoembolization treatment. MATERIALS AND METHODS: Of 23 patients with a hepatocellular carcinoma, 11 had progressed during a transcatheter arterial chemoembolization, with the other 12 being transcatheter arterial chemoembolization-naive. All the patients were treated with pirarubicin (70 mg/m2 i.v., day 1), UFT (350 mg/m2 P.O., day 1~21), and leucovorin (25 mg/m2 P.O., day 1~21). RESULTS: Twenty patients were able to be evaluated, with a partial response being achieved in four, giving an overall response rate of 20% (95% confidence interval, 7~44%). The median overall survival time was 6 months, and the median survival time of the transcatheter arterial chemoembolization-naive patients was significantly longer than that of those treated by transcatheter arterial chemoembolization (p=0.012). The most significant dose-limiting toxicity was leucopenia and thrombocytopenia. CONCLUSION: The combination of pirarubicin, UFT and leucovorin therapies showed marginal antitumor activity and significant toxicity in patients with non-embolizable or failed transcatheter arterial chemoembolization hepatocellular carcinomas.