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Volume 12(1); February 2012
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Review Articles
Imaging Technique of Liver MRI
Young Kon Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):1-4.   Published online February 28, 2012
  • 346 Views
  • 6 Downloads
AbstractAbstract PDF
Magnetic resonance (MR) imaging provides exquisite, versatile, and unique soft tissue contrast, which allows for an effective evaluation of a wide range of liver disorders. A careful selection of imaging strategies can yield a comprehensive assessment of the liver in a reasonable examination time. Recent advances in MR hardware and software allow for rapid acquisition times that can reduce many of motion artifacts that previously posed limitations to abdominal MR imaging. The ability to obtain artifact-free images with sufficient contrast-to-noise ratios across a broad range of techniques is now feasible with rapid scanning. Recently, the use of 3T in liver imaging allows further improvement in image quality.
Hepatic Artery Infusion Chemotherapy for Advanced Hepatocellular Carcinoma
Myeong Jun Song, Si Hyun Bae
Journal of the Korean Liver Cancer Study Group. 2012;12(1):5-9.   Published online February 28, 2012
  • 479 Views
  • 3 Downloads
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Surgery, percutaneous ablation and liver transplantation are the only curative treatment modality for HCC. However, a majority of patients have unresectable disease at diagnosis. Despite radical treatment, high risk of tumor recurrence is the most common problem. Therefore, there is a need for effective treatment options for patients with advanced or recurrent HCC. For patients with advanced stage of HCC according to the Barcelona Clinic Liver Cancer staging system, the multikinase inhibitor sorafenib is the current standard of care. However, hepatic arterial infusion chemotherapy (HAIC) have been applied to advanced stage HCC with a view to improve the therapeutic indexes in Asia. HAIC provides direct drug delivery into tumor bed and a greater first‐pass effect; also systemic side effects can be potentially minimized. However, the sample size of researches on HAIC was small and large randomized trials are still lacking. In this article, we describe the treatment efficacy of HAIC for advanced stage HCC and discuss future therapeutic possibilities.
Standardization of Conventional Chemoembolization for Hepatocellular Carcinoma
Jin Wook Chung
Journal of the Korean Liver Cancer Study Group. 2012;12(1):10-13.   Published online February 28, 2012
  • 335 Views
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AbstractAbstract PDF
In conventional chemoembolization for hepatocellula carcinoma, there are diversities in selecting chemotherapeutic drugs and embolic materials and their delivery techniques. And there is no convincing evidence which one is better than the others. As a
result
, lack of standarized protocol has been indicated as a limitation of conventional chemoembolization. However, we have to understand that hepatic functional reserve and tumoral factors are more important prognostic factors than technical factors in chemoembolization. In patients with diverse hepatic function and tumoral status, it is practically impossible to apply standardized protocol of chemoembolization. Standardized protocol in chemoembolization may increase the risk of the procedure or decrease the therapeutic efficacy and, as a result, shorten the survival of the patients. Chemoembolization technique should be customized individually depending on hepatic functional reserve and tumoral factors. More importantly, we should keep the basic principle of chemoembolization. The most important basic principle is to perform superselective chemoembolization of all tumor feeders. Cone-beam CT and low-profile microcatheters may greatly help interventional radiologists identify and superselectively catheterize tumor feeders and monitor the completeness of the procedure.
Technical Advances in Radiofrequency Ablation of Hepatocellular Carcinoma
Dongil Choi, Hyunchul Rhim, Min Woo Lee
Journal of the Korean Liver Cancer Study Group. 2012;12(1):14-15.   Published online February 28, 2012
  • 417 Views
  • 5 Downloads
AbstractAbstract PDF
Lots of recent technical advances in radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) have introduced. First, contrast-enhanced ultrasound can help to detect the index tumors, residual tumor, and local recurrence. After contrast-enhanced ultrasound for subtle small tumors, we can perform RFA with high confidence. The use of artificial ascites in RFA is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window. Fusion imaging between US and CT or MR during RFA is useful since US can provide real-time imaging and CT or MR provides high quality images with good contrast and spatial resolution. RFA can be performed with fluoroscopy guidance to lipiodol retention tumors.
Treatment Response Evaluation of Hepatocellular Carcinoma
Joon-Il Choi
Journal of the Korean Liver Cancer Study Group. 2012;12(1):16-22.   Published online February 28, 2012
  • 362 Views
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AbstractAbstract PDF
The most important and primary endpoint in oncology research is overall survival. However, other endpoints such as time-to-progression, time-to-recurrence and response rate have their roles in oncology trials and these endpoints are assessed by the imaging evaluation of tumor burden. Recently published the revised version (version 1.1) of response evaluation criteria in solid tumors (RECIST) is now the standards for the tumor response evaluation after treatment, and especially for cytotoxic agents. However, the problems are more complicated for hepatocellular carcinoma (HCC). RECIST are mainly used for the response evaluation of chemotherapeutic agents. However, for the treatment of HCC, there are some locoregional treatments and molecular targeted agents, and after these treatments, tumor necrosis remains as non-enhanced tumor areas, whereas viable tumor parts can be noted by the enhanced areas. However, these necrotic areas should be included as being tumor when we adopt the pure anatomical criteria such as RECIST and this can distort the results of the response evaluation. For overcoming this problem, some new criteria were introduced and their principle is the measurement of enhancing portion of the tumor only. However, these new criteria still have limitations and functional imaging is thought to be the future problem-solving tool for the evaluation of response for molecular targeted agents.
Case Reports
A One cm Sized Intrahepatic Cholangiocarcinoma in a Patient with Chronic Hepatiits B Misdiagnosed as Hepatocellular Carcinoma
Gene Hyun Bok, Soung Won Jeong, Jae Young Jang, Kwang Yeun Shim, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Boo Sung Kim, So Young Jin, Sung Sook Hong, Yong Jae Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):23-27.   Published online February 28, 2012
  • 360 Views
  • 1 Download
AbstractAbstract PDF
Morphologically, intrahepatic cholangiocarcinoma (ICC) presents as a parenchymal mass, and it is occasionally resectable and potentially curable. In some cases, differentiation from other hepatic neoplasms such as metastatic lesions and hepatocellular carcinoma (HCC) can be extremely difficult, both clinically and histologically, and definitive diagnosis often needs correlation with clinical and radiologic finding.Contrasted computed tomography (CT) is useful in the diagnosis of ICC and in determining the extent of tumor involvement. Although the majority of liver tumors can be diagnosed by modern imaging modalities such as contrast CT, some cases of ICC show tumor enhancement in the arterial phase the same as that in HCC, or a biliary dilatation without stenosis by intraductal tumor growth. Differences in these patterns of tumor enhancement and status of the bile ducts in ICC may also reflect differences in cellular characteristics, clinical features, and prognosis after treatment. We present a case of a small ICC showing similar clinical and radiologic characteristics to HCC.
A Case of Small HCC
Chang Hyeon Seock, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee
Journal of the Korean Liver Cancer Study Group. 2012;12(1):28-31.   Published online February 28, 2012
  • 390 Views
  • 3 Downloads
AbstractAbstract PDF
According to AASLD practice guideline, nodules that are smaller than 1 cm should be followed with ultrasound at intervals from 3-6 months and nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances are typical of HCC, the lesion should be treated as HCC. We experienced a patient who has a hepatic nodule smaller than 1 cm and followed AASLD guideline and performed radiofrequency ablation for hepatocellularcarcinoma after 13 months later. MRI helped to diagnose hepatic nodule as a hepatocellularcarcinoma during surveillance.
A Case of Early Hepatocellular Carcinoma Treatment Combined by Transarterial Chemoembolization and Radiofrequency Ablation
Jun Uk Lim, Hyun Phiil Shin, Joung Il Lee, Jae Jun Park, Jung Won Jeon, Kyuseong Lim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):32-36.   Published online February 28, 2012
  • 387 Views
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AbstractAbstract PDF
In most early hepatocellular carcinoma (HCC), surgical resection or liver transplantation is the first choice of treatment. However, surgery is often impossible because of patient’s physical condition such as advanced liver cirrhosis, other comorbidities, and radiofrequency ablation (RFA) can be used as substitute treatment. Recently, it has been reported that clinical outcomes of transarterial chemoembolization (TACE) combined with RFA were similar to that of surgical resection. This report describes a 49-year-old male with 1.5 cm sized HCC. Because the patient could not undergo surgical resection and the tumor was not localized on ultrasonography (US), TACE was performed instead. But the residual tumor was still detected on follow-up contrast enhanced US, we performed additional RFA. After combined treatment with TACE and RFA, viable portion of the tumor was not detected on one month follow-up CT and MRI image. The patient remains well without recurrence, 12 months after combined treatment. It is suggested that TACE combined with RFA can be an alternative choice of early small HCC treatment.
Two Cases of Small (< 1 cm) Hepatocellular Carcinoma
Jin Yong Jung, Sun Young Yim, Chang Ha Kim, Jin Dong Kim, Yeon Seok Seo, Hyung Joon Yim, Ho Sang Ryu, Min Ju Kim, Beom Jin Park, Soon Ho Um
Journal of the Korean Liver Cancer Study Group. 2012;12(1):37-41.   Published online February 28, 2012
  • 380 Views
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AbstractAbstract PDF
Tumor size is one of the most important factors for decision of therapeutic plan and prognosis of hepatocellular carcinoma (HCC). If the diagnosis of HCC is made earlier in its small size, the prognosis is better. However the diagnosis of small HCC is not easy because small HCC lacks the typical clinical and radiologic feature. We experienced two cases of small HCC less than 1 cm that was confirmed after first treatment.
A Case of Small Hepatocellular Carcinoma Less Than 1 cm
Yun Jeong Jo, Young Kul Jung, Dong Hae Chung, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):42-46.   Published online February 28, 2012
  • 362 Views
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AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is one of the most important causes of cancer death in South Korea. Approximately two thirds of the patients are diagnosed in the advanced stage with multiple metastasis and underlying liver dysfunction, so they are not suitable to undergo curative resection. Small HCC has no consensus about diagnostic criteria but became known early stage HCC that means good prognosis. Cases of small HCC have been increasing with the progress of diagnostic methods. We experienced a case of incidentally found small HCC less than 1 cm from liver cirrhosis by liver dynamic imaging, so reported it.
A Case of Improvement of Hypoglycemia by Sorafenib in Hepatocellular Carcinoma
Kwang Il Ko, Young Kul Jung, Jungsuk An, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):47-50.   Published online February 28, 2012
  • 402 Views
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AbstractAbstract PDF
The prevalence of hypoglycemia in hepatocellular carcinoma (HCC) ranged from 4 to 27%. The causes of hypoglycemia in HCC are two type. Type A is a poorly differentiated tumor with mild to moderate severity of hypoglycemia that occurs in the late stage of the disease. The less common type B tumor is a well-differentiated slow growing tumor in which severe hypoglycemia occurs in early stages of the disease. We reported a case of improvement of hypoglycemia due to HCC by sorafenib.
A Case of Advanced Hepatocellular Carcinoma which was Supervening with Renal Cell Cancer Cured by Repeated Transarterial Chemoembolization and Sorafenib after Resection
Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57.   Published online February 28, 2012
  • 345 Views
  • 1 Download
AbstractAbstract PDF
Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected 2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil (FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.
A Case of a Advanced Stage Hepatocelluar Carcinoma Patient with Relatively Good Response after Combination Therapy
Chang Hyeon Seock, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee
Journal of the Korean Liver Cancer Study Group. 2012;12(1):58-61.   Published online February 28, 2012
  • 367 Views
  • 1 Download
AbstractAbstract PDF
According to AASLD practice guideline, for patients who present with advanced hepatocelluar carcinoma, new data indicates the efficacy of sorafenib in prolonging life. But there are no data comparing combination transarterial chemoemboliation with sorafenib to sorafenib treatment alone. We experienced a case that treated a patient with combination therapy including transarterial chemoembolization for intrahepatic hepatocelluarcarcinoma, radiation therapy for portal vein thrombosis and sorafenib treatment. He was in stable disease state after 6 months later. Therefore, it seems to be need to study for comparing combination therapy to sorafenib, or to transarterial chemoembolization.
A Case of Liver Transplantation after Combination of Sorafenib and Hepatic Arterial Infusion Chemotherapy in the Advanced Hepatocellular Carcinoma Patient with Portal Vein Thrombosis
Do Seon Song, Myeong Jun Song, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun, Dong Goo Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):62-66.   Published online February 28, 2012
  • 483 Views
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AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea where chronic hepatitis B virus is prevalent. More than 60-70% of HCC cases are diagnosed at an advanced stage that are not eligible for curative therapy such as surgical resection, liver transplantation, radiofrequency ablation, and percutaneous ethanol injection. According to Barcellona Clinic Liver Cancer (BCLC) staging and treatment, standard treatment of advanced HCC is sorafenib. And there are some reports that hepatic arterial infusion chemotherapy (HAIC) could be a beneficial therapeutic option for patients with advanced HCC. We report a case of advanced HCC with portal vein thrombosis that received liver transplantation after combination treatment of HAIC and sorafenib.
A Case of Successful Treatment of Hepatocellular Carcinoma with a Pulmonary Metastasis by Combining Pulmonary Wedge Resection and Sorafenib
Sun Jae Lee, Hyung Joon Yim, Hwan Hoon Chung, Hae Rim Kim, Eileen L. Yoon, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Rok Son Choung, Sang Woo Lee, Jai Hyun Choi
Journal of the Korean Liver Cancer Study Group. 2012;12(1):67-70.   Published online February 28, 2012
  • 467 Views
  • 1 Download
AbstractAbstract PDF
35-year-old female patient was diagnosed with hepatocellular carcinoma and underwent hepatic resection. 12 months after hepatic resection, serum AFP rose (119.6 ng/mL) but no definite recurrence was found on imaging modalities. 30 months after hepatic resection, serum AFP rose up to 1008.5 ng/mL and metastatic nodule was found in right lower lung in chest CT. Video assisted thoracoscopic wedge resection was performed and 400 mg/day of sorafenib was intiated. Serum AFP returned to normal range after 2 months of pulmonary resection. No evidence of recurrence is noted after 30 months of pulmonary resection. We think that pulmonary resection plus sorafenib combination therapy resulted in favorable treatment outcome in this patient.

JLC : Journal of Liver Cancer