Journal of Liver Cancer

Volume 15(2); September 2015

Review Articles

Radiofrequency Ablation for Hepatocellular Carcinoma: Se Young Jang, So Young Park; J Liver Cancer. 2015;15(2):79-83. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.79

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Abstract PDF: Radiofrequency ablation (RFA) takes an important role in management of hepatocellular carcinoma (HCC) as the most popular local therapy in the world. There are many data supporting that RFA is an excellent treatment modality for early-stage HCC with favorable treatment outcomes and minimal invasiveness. Currently, RFA extends treatement indications from unresectable early-stage HCC to intermediate-stage HCC in selected cases. Thus, with technical advances in guidance and ablation as well as devices, RFA widens its territory in the combat field against HCC. (J Liver Cancer 2015;15:79-83)

An A to Z of Lipiodol Beyond the Clinical Practice in the Management of Hepatocellular Carcinoma: Eileen L. Yoon; J Liver Cancer. 2015;15(2):84-97. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.84

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Abstract PDF: Lipiodol based conventional transarterial chemoembolization (TACE) is a standard of care for unresectable, non-invasive, and multinodular Hepatocellular carcinoma (HCC)s. The procedure relies on the intra-arterial administration of lipiodol/cytotoxic agent emulsion followed by the infusion of embolic material. Lipiodol, with its oily nature and radiopacifying properties, is in the center of the TACE procedure. Unstability and unpredictable therapeutic effect of hydrophilic cytotoxic drugs emulsified in the lipiodol and technical problems lie beyond the control of clinicians. Thus, interest in the properties and respective roles for lipiodol in the management of HCC is essential for the clinicians. (J Liver Cancer 2015;15:84-87)

A Concise Review of Autoantibodies to Tumor-Associated Antigens for Diagnosis of Hepatocellular Carcinoma: Sonn Young Ko; J Liver Cancer. 2015;15(2):88-91. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.88

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Abstract PDF: Ultrasonography and tests for alpha-fetoprotein are recommended as routine surveillance tools for the early detection of hepatocellular carcinoma (HCC). However, ultrasonography is highly operator dependent and alpha-fetoprotein assays do not yield satisfactory results in diagnosing early stage HCC. Therefore, the development of more sensitive and specific tools for early HCC detection is necessary. Recent studies have shown that tumor-associated antigens (TAAs) elicited by cellular and/or humoral effectors of the immune system are attractive targets for development of diagnostic and therapeutic tools for human cancers including HCC. Most importantly, autoantibodies to TAAs can be detected prior to a clinical diagnosis of HCC. This review focuses on the important features of TAAs and the possible use of autoantibodies to TAAs as biomarkers for early HCC detection. (J Liver Cancer 2015;15:88- 91)

Original Articles

Comparative Study between Metronomic Chemotherapy and Transarterial Chemoembolization in Patients with Child-Pugh Class B Advanced Hepatocellular Carcinoma: Hyun Yang, Myeong Jun Song, Hee Chul Nam, Hae Lim Lee, Sung Won Lee, Do Seon Song, Jeong Won Jang, Si Hyun Bae, Jong Yong Choi, Seung Kew Yoon; J Liver Cancer. 2015;15(2):92-99. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.92

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Abstract PDF

Background/Aims
Metronomic (MET) chemotherapy is a treatment characterized by frequent infusion of low doses of chemotherapeutic agent without extended break. The aim of this study is to evaluate the efficacy of MET chemotherapy compared with transarterial chemoembolization (TACE) in patients with child B class advanced hepatocellular carcinoma (HCC).
Methods
Seventy-three patients with child B class advanced HCC were analyzed between April, 2007 and August, 2013 according to two treatment groups: (i) MET chemotherapy group (n=43, Epirubicin 35 mg/body surface area [BSA] every 4 weeks, and cisplatin 15 mg/BSA and 5-fluorouracil 50 mg/BSA weekly for 3 weeks) via an implantable port system with 1 week break. (ii) TACE group (n=30, Adriamycin 20-50 mg) every 4 weeks. Primary endpoint was overall survival (OS).
Results
The median survival times in the MET and TACE groups were 4.5 months and 3.1 months, respectively. The overall survival rate showed significantly better in the MET treatment group than in the TACE group (P=0.039). When the factors affecting patient OS were analyzed, MET chemotherapy (P=0.038, hazard ratio {HR} 0.538 [95% confidence interval {CI} 0.299-0.967]) was independently associated with OS. Larger maximal tumor size, extrahepatic metastasis and advanced stage also were significant factors for OS (P=0.009, HR 1.064 [95% CI 1.014-16.064]; P=0.014, HR 2.120 [95% CI 1.164-3.861]; P=0.019, HR 2.046 [95% CI 1.125-3.720], respectively).
Conclusions
MET chemotherapy showed survival benefit than TACE in patients with child class B advanced HCC. Therefore, MET chemotherapy may be considered as a treatment option for advanced HCC with poor liver function. (J Liver Cancer 2015;15:92-99)

Citations

Citations to this article as recorded by

A comparative study of sorafenib and metronomic chemotherapy for Barcelona Clinic Liver Cancer-stage C hepatocellular carcinoma with poor liver function
Hyun Yang, Hyun Young Woo, Soon Kyu Lee, Ji Won Han, Bohyun Jang, Hee Chul Nam, Hae Lim Lee, Sung Won Lee, Do Seon Song, Myeong Jun Song, Jung Suk Oh, Ho Jong Chun, Jeong Won Jang, Angelo Lozada, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon
Clinical and Molecular Hepatology.2017; 23(2): 128. CrossRef

Academic Trend and Clinical Status of Radiotherapy for Hepatobiliary Cancer Over the Past 20 Years in Korea: Won IL Jang, Yong-Seok Seo, Mi-Sook Kim, Heejin Kim; J Liver Cancer. 2015;15(2):100-105. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.100

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Abstract PDF: Background/Aims
To analyze the future trends through the status of radiotherapy in the hepatobiliary cancer in Korea and related articles published in the world.
Methods
Science citation index (SCI) and science citation index expanded (SCIE) articles, published in the 20 years from 1995 until 2014, were searched that contain the keywords related hepatobiliary cancer and radiotherapy using the Scopus. The incidence of hepatobiliary cancer was analyzed using annual reports from the Korea Central Cancer Registry. The status of radiotherapy was analyzed using data obtained form the Korean Society for Radiation Oncology and the National Health Insurance Service.
Results
Total 2,302 papers related radiotherapy for hepatobiliary cancer were searched in the world. By 2014, the cumulative number of papers published by domestic authors was a total 221 pieces. In 1999, total 16,305 hepatobiliary cancer patients were developed, of which 729 patients have been treated with radiotherapy. In 2013, it was expected that total 22,482 hepatobiliary cancer patients would be developed, of which 3,075 patients have been treated with radiotherapy.
Conclusions
Over the past 20 years, South Korea has made clinically and academically remarkable advances in the area of radiotherapy for hepatobiliary cancer. The researchers will continue to announce the results such as an objective status data and published papers in the future. (J Liver Cancer 2015;15:100-105)

Bakri and Coda Balloon Placement between the Liver and Bowel in a Swine Model: A Feasibility Study: Man Deuk Kim; J Liver Cancer. 2015;15(2):106-111. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.106

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Abstract PDF: Background/Aims
To investigate the feasibility of Bakri balloon and Coda balloon placement as a spacer between the liver and bowels using a swine model.
Methods
Six adult female swine weighing from 24.0 to 41.5 kg (mean, 31.5 kg) were included for the study. After peritoneal puncture using a 21-G micro-puncture needle under ultrasound and fluoroscopic guidance, a 0.035-inch guidewire (Terumo, Tokyo, Japan) was advanced through the micro-introducer sheath. With sequential dilation of the tract with dilators up to 18-Fr or 10 mm balloon, the Coda and Bakri balloon was advanced between the liver and bowels. 50 mL and 200 mL of contrast were inflated for Coda and Bakri balloon, respectively. Gross examinations focused on whether placement of the Coda or Bakri balloon was at the correct location.
Results
Technical success was achieved for Coda balloon placement in six of the six (100%) swine, and for Bakri balloon placement in five of the six (83.3 %) swine. The median placement time for the Coda balloon was 10 minutes (range, 7-15 minutes), while the median placement time for the Bakri balloon was 25 minutes (range, 17-35 minutes), which was significantly longer (p<0.05). Gross observations at necropsy revealed that the Coda and Bakri balloon was well placed between the liver and bowel.
Conclusions
Placement of Coda and Bakri balloons between the liver and bowels was feasible. These balloons have a potential role as spacers between the liver and bowel during radiation therapy for hepatocellular carcinoma patients. (J Liver Cancer 2015;15:106-111)

Case Reports

A Case of Early Multiply Recurred Hepatocellular Carcinoma after Surgical Resection in Patient Who Unprecedented Chronic Liver Disease: Wang Yong Choi, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang; J Liver Cancer. 2015;15(2):112-117. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.112

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Abstract PDF: Hepatocellular carcinoma (HCC) have relatively well known causative factors such as chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, Non-alcoholic fatty liver disease (NAFLD), liver cirrhosis and so on. Recently, interesting reports that HCC in the absence of cirrhosis or other chronic liver disease and HCC associated with NAFLD and metabolic syndrome are increasing in USA. So far, there is no report about these issues in Korea. We present a 65 yearold obesity male who had no preceding chronic liver disease history. He was diagnosed as primary HCC and the mass was removed completely. However, HCC recurred shortly after operation. Multiple recurred HCC were treated with transcatheter arterial chemoembolization. (J Liver Cancer 2015;15:112-117)

A Case of Management for Early Recurrence after Hepatic Resection for the Treatment of Small Hepatocellular Carcinoma: Kyung Woo Park, Young Seok Kim, Sang Gyune Kim, Soung Won Jeong, Jae Young Jang, Hong Soo Kim, Sae Hwan Lee, Boo Sung Kim, Jun Cheol Jeong, Min Hee Lee, Jae Myeong Lee, Hee Kyung Kim; J Liver Cancer. 2015;15(2):122-125. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.122

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Abstract PDF: For a small hepatocellular carcinoma (HCC), liver resection shows most favorable outcome in
case
which liver transplantation is not available, although it has also substantial recurrence rate. Here, we report a case of recurred HCC with multiple intrahepatic metastasis at 5 months after surgical resection for small HCC was done. A 55-year-old man with chronic HBV infection received subsegmentectomy for HCC less than 2 cm. A follow-up computed tomography (CT) at 5 months from operation revealed that there were multiple enhancing nodules in entire remnant liver. Intra-arterial injections of adriamycin mixed lipiodol and gelfoam particles were instituted through hepatic artery. We assume that poorly differentiated cellular feature would be attributable to this kind of very early and aggressive recurrence of HCC. (J Liver Cancer 2015;15:122-125)

Two Cases of Early Recurred Hepatocellular Carcinoma after Surgical Resection Which Showed Different Outcomes: Young Youn Cho, Jeong-Hoon Lee, Nam Joon Yi, Kwang Woong Lee, Kyung Suk Suh, Yoon Joon Kim, Jung-Hwna Yoon; J Liver Cancer. 2015;15(2):126-131. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.126

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Abstract PDF: Hepatocellular carcinoma (HCC) has poor prognosis, even after curative resection. Early recurrence after curative treatment is a major cause of the poor prognosis. Pathologic factors such as vessel invasion, satellite nodule, size of tumor and pathologic grade are prognostic factors predicting early recurrence and poor prognosis. We share our experience of two
case
s which both showed early recurrence after curative hepatic resection, but eventually demonstrated different prognosis. Since the most common cause of death after potentially curative treatment is tumor recurrence, suppression of tumor recurrence might be linked to survival gain. Currently, there is no adjuvant therapy for HCC endorsed by international guidelines. However, recent studies have shown that antiviral treatment for hepatitis B virusrelated HCC and immunotherapy using autologous cytokine-induced killer cell reduced HCC recurrence. Further study is needed to select patients who will benefit from adjuvant treatments.

A Case of Long Term Survival in Patient with Early Intrahepatic Recurrence and Extrahepatic Metastasis after Curative Resection of Hepatocellular Carcinoma: Dong Il Jeong, Young Mi Hong, Mong Cho, Ki Tae Yoon; J Liver Cancer. 2015;15(2):132-135. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.132

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Abstract PDF: The most effective therapy in patients with hepatocellular carcinoma (HCC) is curative resection of liver cancer. However, the long-term prognosis is not good in high intrahepatic recurrence. The recurrence rate after curative resection of HCC is 70-100% and the average survival time was about 15.8 months in early relapse after curative resection. Extra hepatic metastases in HCC is associated not uncommon, in general, lungs are the most common organ, lymph nodes, bone, and adrenal gland is relatively often observed. Extrahepatic recurrence after curative resection of HCC has been reported in 14-26% of the total recurrent cancer. Most of the recurrent cancer is multiple and the median survival time of patients after the extrahepatic recurrence is about 4-5 months it found that the prognosis is very poor. Therefore, the authors report a case showed long term survival in patients with early intrahepatic recur and extrahepatic metastasis after curative resection of HCC.

A Case of Rapidly Recurred Hepatocellular Carcinoma with Distant Metastasis after Surgical Resection: Mi Yeon Kim, Hye Won Lee, Kyu Sik Jung, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Do Young Kim; J Liver Cancer. 2015;15(2):136-139. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.139

1,042 Views
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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical resection is the treatment of choice as curative aim for early HCC with preserved liver function. A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly recurred HCC with bone metastasis after surgical resection. In our case, microscopically microvessel invasion was present after resection. Microvascular invasion (MVI) is an important factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI need to follow up intensively and adjuvant therapy may be considered.

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