Journal of Liver Cancer

Volume 11(1); February 2011

Review Articles

A Review on Embolic Materials for Transcatheter Arterial Chemoembolization: Byung Kook Kwak, Hyung Jin Shim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):1-5. Published online February 28, 2011

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Abstract PDF: Four procedures on intraarterial catheter-based therapy are available in treating hepatocellular carcinoma: intraarterial chemotherapy (IAC), transcatheter arterial embolization (TAE), conventional transcatheter arterial chemoembolization (cTACE), and transcatheter arterial chemoembolization using drug-eluting bead (DEB-TACE). On the bases of “2009 Practice Guideline for Diagnosis and Treatment of Hepatocellular Carcinoma” by The Korean Liver Cancer Study Group and National Cancer Center, and “2010 AASLD Practice Guideline” by American Association for the Study of Liver Disease, substances and recommendations on interventional managements were reviewed. Various kinds of embolic materials used in the procedures of TAE, cTACE and DEB-TACE were described in detail.

Practice Guidelines for Management of Hepatocellular Carcinoma: Global Discrepancies and Solution of Local Ablation: Hong Soo Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):6-11. Published online February 28, 2011

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Abstract PDF: A curative modality for hepatocellular carcinoma was a resection or a liver transplantation in a past decades, but nowadays local ablation therapy like a percutaneous alcohol injection or a radiofrequency ablation is comparable with a surgical resection. So a local ablation therapy is considered as a curative modality. Recently early detection of a small hepatocellular carcinoma is becoming easy due to use a suveillance ultrasonography and computed tomography in a high risk patients. Grobally, an indication for local ablation therapy is a small hepatocellular carcinoma less than 3 cm in diameter and have a well-reserved liver function. But patients who met above indication is also controlled by a liver transplantation or a surgical resection. So we should pay attention to a difference between treatment guidelines and a strengths and weaknesses of local ablation therapy.

Radiological Evaluation of Treatment Response of Hepatocellular Carcinoma: Yong Moon Shin; Journal of the Korean Liver Cancer Study Group. 2011;11(1):12-17. Published online February 28, 2011

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Abstract PDF: For hepatocelluar carcinoma(HCC), there are several treatment options such as transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA), and radiation therapy. It is essential to be familiar with the radiologic findings to know whether the residual or recurrent tumor exist after treatment. But, radiological image findings show complex responses according to the initial tumor morphology and treatment methods. One purpose of this article is to discuss the guidelines to evaluate the tumor response of HCC after treatment. And the other purpose is to evaluate the imaging features of HCC after various treatment
methods
and to reveal the limitations of each imaging technique in evaluating the therapeutic effect on HCC.

Gobal Discrepancy of Practical Guidelines for Management of Hepatocellular Carcinoma-Resection and Transplanation: Kwang-Woong Lee; Journal of the Korean Liver Cancer Study Group. 2011;11(1):18-22. Published online February 28, 2011

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Abstract PDF: Hepatocellular carcinoma (HCC) usually appears in the setting of underlying liver disease. Therefore, HCC should be managed in multidisciplinary settings. Under these circumstances, several practice guidelines were introduced around the world. Clinically useful practice guidelines should be based on evidences, but socio-economic and medical status of the country should be considered as well. In this review, 6 well-known global practical guidelines (BCLC-AASLD, NCCN, 2 from Japan, APASL, Korean) were compared in terms of resection and liver transplantation (LT). BCLC-AASLD from Europe and the United States stressed more on LT for the patients within Milan criteria. However, the guidelines from the Asia had more extended indication of liver resection. The number of living donor LT in Korea is the highest in the world. Under this circumstance, indication of LT for HCC in Korea is inevitably being expanded. Compared to other guidelines, therefore, Korean guideline allowed a limited expansion of indication for HCC into patients with Child A and/or living donor LT with outside Milan HCC. However, to make more practical guidelines, high quality evidence from Korea and validation study of current Korean guideline are needed.

Recent CT for Liver Disease: Dongil Choi; Journal of the Korean Liver Cancer Study Group. 2011;11(1):23-25. Published online February 28, 2011

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Abstract PDF: The recent advance in CT is the multidetector (MD) CT scanner. MDCT increases scan coverage, and can take shorter scan time, thinner sections and longer scan range. Double arterial phase imaging could show the high sensitivity of in hepatic tumor detection. CT angiography by using MDCT is useful in a detailed assessment of hepatic arterial anatomy using a three-dimensional dataset. Dual-energy CT was more recently introduced and popularized. Dual-source CT uses two energies, 140 and 80 kVp. This technique can measure chemical composition by dual-energy index. Dual-energy CT provides the ability for CT to differentiate between different materials at imaging. The latest technologic advancements in MDCT and availability of commercial software allow perfusion CT to offer a variety of clinical and research applications. Perfusion CT imaging can be used for the characterization and treatment monitoring of hepatic malignancies.

Staging of Hepatocellular Carcinoma: Joon-Il Choi; Journal of the Korean Liver Cancer Study Group. 2011;11(1):26-32. Published online February 28, 2011

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Abstract PDF: Staging systems of HCC are very complex and disunited because multiple variables, including residual liver function, performance of patients and treatment modalities, can have influence on the survival of the patients and therefore, there is no united and generalized staging system of HCC. Staging systems of HCC can be classified as two categories; Anatomical staging systems and clinical staging systems. In anatomical staging systems, tumor factors are main elements that determine the stage of the patients and LCSGJ systems and AJCC/UICC systems are included in this category. Practice guideline and General rules of HCC by the Korean Liver Cancer Study Group adopted LCSGJ system. In clinical staging systems, not only tumor factors but also clinical factors such as liver function, performance of the patients and treatment modalities are considered to determine the stage of the patients. The BCLC system is the only system that provides treatment recommendations for each of the assigned stages based on the best treatment options currently available. Criteria for liver transplantation are on the way of expansion because of the widespread of living donor liver transplantation and several researchers presented various expanded criteria over Milan’s criteria with comparable survival data to those of Milan’s criteria. Upcoming researches of molecular biology and imaging can help the establishment of more precise and united staging systems for the patients with HCC.

Systemic Therapy in Advanced Hepatocellular Carcinoma: Hye Jin Choi; Journal of the Korean Liver Cancer Study Group. 2011;11(1):33-39. Published online February 28, 2011

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Abstract PDF: Understanding the mechanism of hepatocarcinogenesis has provided the opportunity to evaluate the efficacy of molecularly targeted agents in HCC. Sorafenib is a multikinase inhibitor with antiangiogenic, proapoptotic, and Raf kinase inhibitory effects, and it is the first new agent to consistently prolong overall survival in patients with advanced hepatocellular carcinoma (HCC). The success of sorafenib is a milestone for systemic therapy of HCC, shifting the paradigm of systemic treatment to molecular targeted agents. Many novel agents that inhibit angiogenesis, epidermal growth factor receptor, and mammalian target of rapamycin are under clinical development. This review attempts to summarize the current status and future perspectives of systemic therapy in HCC.

Case Reports

A Patient of Hepatocellular Carcinoma Performed Hepatectomy after Tumor Downing Sizing with Transcatheter Arterial Chemoembolization: Seul Ki Min, Sang Gyune Kim, Young Seok Kim, Sae Whan Lee, Soung Won Jeong, Jae Young Jang, Hong Soo Kim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):40-45. Published online February 28, 2011

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Abstract PDF: Hepatocellular carcinoma (HCC) is the third most common cancer in korean population. Surgical management is the mainstay of HCC. Surgical resection and liver transplantation shows the best outcomes in well-selected patients. But few patients are possible to benefit from surgical resection or liver transplantation. The majority of cases of HCC are unresectable, but there are no proven treatment modalities for these cases. In small number of articles showed the favorable result of adjuvant chemotherapy, and transcatheter arterial chemoembolization (TACE) for unresectable HCCs. But there are some drawbacks, such as small number of sample size and variablity of study design at each studies. Hereby we report a patients of HCC, who was performed hepatectomy after tumor down sizing with TACE.

From Down Staging to Curative Treatment: Based on Hepatic Arterial Infusion Chemotherapy in a Hepatocellular Carcinoma Patient: Chung-Hwa Park, Myung Joon Song, Seung Kew Yoon, Jong Young Choi, Si Hyun Bae; Journal of the Korean Liver Cancer Study Group. 2011;11(1):46-49. Published online February 28, 2011

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Abstract PDF: Hepatic arterial infusion chemotherapy (HAIC) is performed in patients with advanced hepatocellular carcinoma (HCC) in which locoregional therapeutic methods such as transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA) could not be the best choice. Sorafenib, the only approved systemic chemotherapeutic agent for HCC, improves survival rate, but is associated with a low tumor response rate. Thus combining these therapeutic modalities to treat HCC in advanced stage may help downstaging and leading to better treatment results without taking risk for hepatic failure. Here we report a case treated to a complete remission by combining HAIC, PEI and sorafenib.

A Case of Multiple Hepatocellular Carcinoma which was Performed Liver Transplantation after Down-staging by Transcatheter Arterial Chemoembolization: Hee-Jung Wang, Bong-Wan Kim, Sung-Won Cho, Je-Hwan Won; Journal of the Korean Liver Cancer Study Group. 2011;11(1):50-55. Published online February 28, 2011

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Abstract PDF: A case of multiple hepatocellular carcinoma (HCC) which was performed a living donor liver transplantation (LDLT) after down-staging by transcatheter arterial chemoembolization (TACE) is reviewed. Generally, the recommended therapeutic strategy for this kind of HCC is TACE. However, the response of multiple HCC of this 48 year-old male patient was relatively good after 4 times of TACE, and we performed LDLT on the concept of clinical trial under the informed consent of patient and his families. Although there were two times recurrences in the liver and lung, he has overcome them and is still alive 66 months after LDLT. We suggest that liver transplantation could be an alternative strategy in the multiple HCC cases who show good responses after TACE.

A Case of Hepatocellular Carcinoma with Portal Vein Tumor Thrombi which was Performed Hepatectomy after Down-staging by Proton Therapy: Hee-Jung Wang, Bong-Wan Kim, Wei-Kwang Xu; Journal of the Korean Liver Cancer Study Group. 2011;11(1):56-59. Published online February 28, 2011

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Abstract PDF: A case of hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT) which was performed hepatectomy after down-staging by proton therapy is reviewed. Generally, the recommended therapeutic strategy for this kind of HCC is radiation therapy, systemic or infusion anticancer chemotherapy. However, the response of HCC and its PVTT of this 56 year-old male patient was relatively good after 22 times of proton therapy, and we performed right hemihepatectomy on the concept of clinical trial under the informed consent of patient and his families. He is still alive without recurrence 15 months after hepatectomy. We suggest that hemihepatectomy with removal of PVTT could be an alternative strategy in the PVTT accompanied HCC cases who show good responses after the above generally recommended therapies.

A Case of Advanced Hepatocellular Carcinoma Treated with Curative Surgical Resection after Downstaging by Hepatic Arterial Infusion Chemotherapy: Jong Ryul Eun, Heon Ju Lee, Jae Woon Kim, Jay Chun Chang, Sung Su Yun, Joon Hyuk Choi; Journal of the Korean Liver Cancer Study Group. 2011;11(1):60-64. Published online February 28, 2011

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Abstract PDF: Cure by single modality for advanced hepatocellular carcinoma (HCC) is difficult. Therefore, multidisciplinary approaches are needed to get a better outcome for advanced HCC. In this paper, we report a case of advanced HCC treated with curative surgical resection after downstaging by hepatic arterial infusion chemotherapy (HAIC). A 50-year-old male patient had a maximum 16.0 cm sized HCC in the right lobe. He achieved a partial response after 2 cycles of HAIC with 5-FU (750 mg/m2) and cisplatin (25 mg/m2). After completion of 6 cycles, he received a curative right hepatectomy and the histopathology revealed 95% of tumor necrosis. He is under follow-up without recurrence at 14 months of surgery. This case suggests that surgery after downstaging by HAIC may provide good clinical outcome in advanced HCC.

A Case of Hepatocellular Carcinoma Who had Surgical Resection Following TACE and Sorafenib Chemotherapy: Geum Youb Noh, Chul Ju Han, Youn Joo Kim, Ki Young Yang, Su Cheol Park, Jin Kim, Yu Cheol Kim, Yoon Hee Choi, Hyo Rak Lee; Journal of the Korean Liver Cancer Study Group. 2011;11(1):65-68. Published online February 28, 2011

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Abstract PDF: Surgical resection for hepatocellular carcinoma (HCC) is one of the managements, showing improved long term survival. Nowadays, it is being accepted as the main curative treatment. However, the biggest problem we used to face is that surgery cannot be applied at the point of presentation in many patients due to advanced stage. Here we present a case of 54 years old female, who had transarterial chemoembolization (TACE) and sorafenib due to advanced stage of HCC, and later underwent curative surgery due to remarkable response. She had a CT scan of abdomen, which showed multiple huge masses. HCC was confirmed by ultrasonography-guided liver biopsy. TACE was performed once. After TACE, the size of masses increased. Therefore, sorafenib was administered and then continued for 9 months. As partial response was obtained at that time, surgical resection was successfully done. In the pathological report of removed tumor, we could confirm total necrosis of tumor. Now, its been 6 months and she is followed up without any recurrence.

A Case of Hepatocellular Carcinoma with Bile Duct Invasion Surgically Resected after Transarterial Chemoembolization; Curative Resection after Tumor Downstaging: Nae-Yun Heo, Han Chu Lee, Ju Hyun Shim, Kang Mo Kim, Young Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh; Journal of the Korean Liver Cancer Study Group. 2011;11(1):69-74. Published online February 28, 2011

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Abstract PDF: A surgical resection is a major curative treatment of hepatocellular carcinoma (HCC) in Korea. However, the respectability of HCC at the time of diagnosis is low (10-30%) because the cancer is often identified as advanced stage. Nevertheless, some of the patients were known to have a curative resection after successful downstaging therapy. We report a HCC with bile duct invasion which was successfully downstaged by the transarterial chemoembolization and treated by surgical resection.

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