Journal of Liver Cancer

Volume 6(1); June 2006

Review Articles

Surgical Treatment in Advanced Hepatocellular Carcinoma: Kyung Sik Kim; Journal of the Korean Liver Cancer Study Group. 2006;6(1):1-6. Published online June 30, 2006

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Abstract PDF: Hepatic resection has been accepted as one of the most effective treatments for hepatocelluar carcinoma. The various advancements in both operative procedures and perioperative patient management have made the hepatic resection safer and the indications for resection have been also expanded. Recently the International Cooperative Study Group for hepatocellular carcinoma proposed a new staging based on data form multiple centers across the world. According to this new staging, the paradigm of managing advanced hepatocellular carcinoma is being changed. Therefore the experiences on the surgical approach to various situations such as larger HCC above 10 cm in diameter, vascular invasion and lymph node involvement were reviewed.

Efficacy of Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma: Sihyun Bae; Journal of the Korean Liver Cancer Study Group. 2006;6(1):7-11. Published online June 30, 2006

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Abstract PDF: Hepatocellular carcinoma (HCC) ranks as the 3rd most common cancer in Korea. At the time of presentation with HCC, many patients have poor hepatic reserve function and advanced HCC with portal vein thrombosis (PVT) that precludes effective therapy. Surgical resection is the 1st choice treatment but, it is not a suitable option for patients with advanced disease. Other treatment modalities, which have been used for unresectable HCC with PVT, include systemic chemotherapy, hepatic arterial chemotherapy, tumor embolization, radiation therapy, and a combination of the above. Because of the fatal toxicities often encountered with TACE in advanced HCC patients with PVT, hepatic arterial infusion chemotherapy is an alternative modality. This method enable repeated chemotherapy infusions into the HCC lesions, and allows generating high antitumor effect and low adverse effects such as hepatic artery occlusion or stenosis. In this review, the principles and efficacy of hepatic arterial infusion chemotherapy for treatment of advanced HCC are reviewed. In the future, we need large scaled prospective randomized trials to determine the definite role of this hepatic arterial infusion chemotherapy.

Diagnosis and Managements of Extrahepatic Metastases from Hepatocellular Carcinoma: Joon Ho Moon, Sang Hoon Park; Journal of the Korean Liver Cancer Study Group. 2006;6(1):12-19. Published online June 30, 2006

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Abstract PDF: Extrahepatic metastases from hepatocellular carcinoma are not uncommon and now observed more frequently due to improved diagnostic methods and prolonged survival. HCC commonly metastasizes to lung, lymph node, bone, adrenal gland, but rarely to central nervous system, gastrointestinal tract, oral cavity, and so on. Diagnosis of extrahepatic metastases is difficult, because of atypical and slow presentation. Therapy for metastatic HCC is very limited, because of advanced stage at presentation and accompanying liver dysfunction. In this article, we recognize characteristics of extrahepatic metastases from HCC and review current managements and future trends of metastatic HCC.

Case Reports

A Case of Successful Treatment for Recurrent Hepatocellular Carcinoma with Long term Survival: Jin Hyoung Lee, Ja Kyung Kim, Hwa Sook Kim, Sang Hoon Ahn, Chae Yoon Chon, Young Myoung Moon, Kwang-Hyub Han, Woo Jung Lee, Young Nyun Park, Seung Hyoung Kim, Kwang Hoon Lee, Do Yun Lee, Jong Tae Lee; Journal of the Korean Liver Cancer Study Group. 2006;6(1):20-24. Published online June 30, 2006

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Abstract PDF: The long term results of surgery for hepatocelluar carcinoma are not satisfactory, because the high incidence of intrahepatic tumor recurrence, with a 5-year acturial recurrence rate of 75% to 100%. The risk factors for postoperative recurrence such as venous invasion, presence of satellite nodules, large tumor size, advanced TNM stages are the best-established. For the management of postoperative recurrence, studies largely focused on the recurrence in the remnant liver. The therapeutic modalities commonly used for surgical resection, TACE, percutaneous ethanol injection (PEIT), and systemic chemotherapy. We report a case of recurrent hepatocellular carcinoma after curative resection, successfully treated by TACE, TACI, and systemic chemotherapy with long term survival.

A Case of Successful Hepatic Resection for Hepatocellular Carcinoma with Tumor Thrombus Extending into the Right Atrium: Yong Beom Cho, Kuhn Uk Lee, Hyo-Suk Lee, Hyuk Ahn, Hae Won Lee, Eung-Ho Cho, Sung-Hoon Yang, Jai Young Cho, Nam-Joon Yi, Kyung-Suk Suh; Journal of the Korean Liver Cancer Study Group. 2006;6(1):25-27. Published online June 30, 2006

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Abstract PDF: Hepatocellular carcinoma (HCC) with extension of its tumor thrombus into the inferior vena cava (IVC) and right atrium has been regarded as beyond the realm of surgical resection. It could cause sudden death due to pulmonary embolism or heart failure by the detached fragments of tumor thrombus. In recent years, successful surgery has been reported for hepatic malignancies with its tumor thrombus to the IVC and right atrium by some centers of Taiwan and Japan. We also did a successful en bloc resection of the liver tumor and its tumor thrombus in the IVC and right atrium using cardiopulmonary bypass and report herein.

A Case of Successful Hepatic Resection after Transarterial Chemoembolization and Perfusion Chemotherapy for Huge Hepatocellular Carcinoma with Tumor Thrombus Extending into the Inferior Vena Cava: Yong Beom Cho, Kuhn Uk Lee, Hyo-Suk Lee, Jae Hyung Park, Hae Won Lee, Eung-Ho Cho, Sung-Hoon Yang, Jai Young Cho, Nam-Joon Yi, Kyung-Suk Suh; Journal of the Korean Liver Cancer Study Group. 2006;6(1):28-31. Published online June 30, 2006

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Abstract PDF: The use of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) has become increasingly popular in the last 20 years. By TACE overall survival might be prolonged in patients with moderately advanced HCC, and some surgically untreatable tumors have been rendered resectable subsequently and some patients achieved cures. However, it would be recommended to proceed with liver resection when we were unable to ascertain clinically the complete success of post-TACE tumor destruction, even when the size of the huge tumor was reduced obviously and the alpha-fetoprotein returned to normal after TACE treatments. Sequential surgical resection has been advocated for a curative outcome even after effective TACE treatments. We report a case of successful hepatic resection with right hepatic vein and its adjacent IVC after TACE and perfusion chemotherapy for huge HCC with tumor thrombus extending into IVC.

Successful Surgical Cases for Advanced Hepatocellular Carcinoma: Hyung-Il Seo, Sang-Jae Park, Sung Wha Hong, Seong Hoon Kim, Soon-Ae Lee, Joon Il Choi, Hyun Bum Kim, Eun Kyung Hong, Joong-Won Park, Chang-Min Kim; Journal of the Korean Liver Cancer Study Group. 2006;6(1):32-37. Published online June 30, 2006

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Abstract PDF: Advanced hepatocellular carcinoma (HCC) suggests a significantly high risk of recurrence, and the role of hepatic resection for advanced HCC is unclear. We will describe two cases of advanced HCC treated by hepatic resection. The two patients had liver tumors greater than 10 cm in diameter, with good liver function, and without tumor invasion to the main portal vein. The hepatic resection types were 5, 6 segmentectomy and hemihepatectomy. The lengths of surgical margins were 4.5 cm and 3.0 cm, each. In one patient, tumor invasion to resected diaphragm was detected in the 1st operation specimen. This patient received the second and third operation due to local recurrence. All these patients survived over 3 years without tumor recurrence. The hepatic resection for large HCC and repeated resection for local recurrence in selected cases can put in the way of long-term survival and cure.

A Case of Advanced Hepatocellular Carcinoma : Curative Resection after Repeated Transcatheter Arterial Chemoembolization, Systemic Chemotherapy and Radiotherapy: So Yeon Lee, Seung Kew Yoon, Min Su Kim, Si Hyun Bae, Jong Young Choi, Byung Gil Choi, Ho Jong Chun, Dong Gu Kim, Seok Whan Moon; Journal of the Korean Liver Cancer Study Group. 2006;6(1):38-41. Published online June 30, 2006

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Abstract PDF: A 46 year-old male patient was admitted to our hospital for evaluation of hepatic mass which was detected on ultrasonography. He had a history of chronic hepatitis B carrier. Laboratory findings showed that HBsAg was positive, and HBeAg was negative. AFP was 2,081.1 ng/mL. Abdomen CT showed a large well-defined low density lesion involving entire right hepatic lobe which was compatable with advanced hepatocellular carcinoma (stage III). Celiac and hepatic arteriogram reveled huge hypervascular mass at both lobe of the liver. Transcatheter arterial chemoembolization (TACE), systemic chemotherapy, percutaneous ethanol injection therapy (PEIT), and radiotherapy were combined as the treatment of huge hepatoma. After combined therapy, tumor decreased in size. As a result, curative right lobectomy could be performed. Six months after surgery, chest CT showed two small metastatic nodules in both lung, so wedge resection was performed. We followed the patient for 5 years after operation and there was no evidence of regional tumor recurrence or distant metastasis.

Excellent Response to Hepatic Arterial Infusional Chemotherapy in Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Keun-Ho Lee, Ja Kyung Kim, Kwang-Hyub Han, Jong Tae Lee, Do Youn Lee, Jong Yoon Won, Hyun Woong Lee, Hwa Sook Kim, Ki Tae Yoon, Sang Hoon Ahn, Chae Yoon Chon, Young Myoung Moon; Journal of the Korean Liver Cancer Study Group. 2006;6(1):42-46. Published online June 30, 2006

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Abstract PDF: There is no treatment of curative aim in advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT), which is associated with poor prognosis. Albeit one of the treatment options is intra-arterial infusional chemotherapy, its therapeutic efficacy was minimal. In this report, we present an unusual case of a patient with favorable result after intra-arterial infusional chemotherapy. This patient was HBV carrier and diagnosed having HCC of stage IVb (T4N0M1) with right PVT on February 1999. Direct right adrenal gland and right kidney invasion and numerous intrahepatic metastases were also noted. The serum AFP level showed more than 60,000 ng/mL, and the Child-Pugh score was 5 (class A). The patient received three sessions of intra-arterial 5-fluorouracil (5-FU) and cisplatin combination chemotherapy and two additional sessions of systemic (5-FU) chemotherapy combined with intra-arterial cisplatin infusion. After total 5 sessions of combination chemotherapy, follow-up CT scan revealed grossly total necrosis of main HCC and numerous intrahepatic metastases, without evidence of viable portion in July 1999. The AFP level decreased to 79.4 ng/mL. The latest CT scan taken in November 2005 also showed no evidence of recurrence. It is noteworthy that the patient with advanced HCC with PVT showed complete remission only after 5 sessions of intra-arterial chemotherapy and the status of complete remission is maintained for more than 76 months.

Two Cases of Good Response after Intra-arterial Chemotherpy in Patients with Advanced Hepatocellular Carcinoma: Youn Ho Kim, Yong Sik Kim, Youn Tae Jeen, Hoon Jae Jun, Soon Ho Um, Chang Duk Kim, Ho Sang Ryu; Journal of the Korean Liver Cancer Study Group. 2006;6(1):47-51. Published online June 30, 2006

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Abstract PDF: Advanced hepatocellular carcinoma has a poor prognosis, especially in the case of advanced hepatocelluar carcinoma with portal vein thrombosis. In such cases, variable therapeutic modalities have been tried to improve the prognosis. Intra-arterial chemotherapy is one of these modalities, but the effect of this therapeutic modality is unclear. We report two cases of good response after intra-arterial chemotherpy in patients with advanced hepatocellular carcinoma.

A Case of Advanced Hepatocellular Carcinoma Treated with Hepatic Arterial Infusion Chemotherapy: So Yeon Lee, Si Hyun Bae, Min Su Kim, Jong Young Choi, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Choen; Journal of the Korean Liver Cancer Study Group. 2006;6(1):52-55. Published online June 30, 2006

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Abstract PDF: A 57 year-old-male patient was admitted to our hospital for evaluation of hepatic mass which was detected on ultrasonography. He had history of chronic hepatitis B and alcoholism. Laboratory findings showed that HBsAg was positive, and HBeAg was negative. AFP was 5.39 ng/mL. Abdominal CT showed large ill-defined low density lesion in 4, 7 and 8 segment of the liver with tumor thrombosis at umbilical portion of left portal vein, which was compatible with advanced hepatocellular carcinoma (stage IVb). Celiac and hepatic arteriogram revealed huge hypervascular mass at both lobe of the liver. Chemoport catheter was inserted to the right hepatic artery and intra-arterial chemotherapy (epirubicin 50 mg every 4 weeks, cisplatin 25 mg and 5-FU 200 mg weekly) was started with continuous infusion device. After 3 cycles of repeated intra-arterial chemotherapy, tumor mass in both hepatic lobe were decreased in size and extent. He is planned to be treated with additional intra-arterial chemotherapy.

Successful Resection of Modified UICC stage Ⅳa Hepatocellular Carcinoma after Arterial Chemoembolization & Radiation Therapy: A Case Report: Min An, Joong-Won Park, Jung A Shin, Tae Hyun Kim, Seong-Hoon Kim, Sang-Jae Park, Woo Jin Lee, Eun Kyung Hong, Chang-Min Kim; Journal of the Korean Liver Cancer Study Group. 2006;6(1):56-59. Published online June 30, 2006

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Abstract PDF: Surgical resection is not candidate for advanced stage hepatocellular cacinoma with portal vein thrombosis, but transcatheter arterial chemoembolization (TACE) or radiotherapy can be considered as palliative treatment option. We experienced a 44-old-male who has stage Ⅳa hepatocellular carcinoma. We performed TACE and 3-dimensional conformal radiotherapy for hepatocellular carcinoma and portal vein thrombosis. Because follow up image study showed no viable tumor, we then performed surgical resection. Surgical specimen also showed complete tumor necrosis.

Two Cases of Advanced Hepatocellular Carcinoma Showing Good Response to Hepatic Arterial Infusion Therapy: Byoung Kuk Jang, Woo Jin Chung, Kyung Sik Park, Kwang Byum Jo, Jae Seok Hwang, Sung Hoon Ahn, Young Hwan Kim, Jin Soo Choi, Jung Hyuk Kwun; Journal of the Korean Liver Cancer Study Group. 2006;6(1):60-64. Published online June 30, 2006

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Abstract PDF: Prognosis of advanced hepatocellular carcinoma (HCC) treated by conventional therapies has been considered to be poor. Hepatic arterial infusion therapy (HAIT) has been tried for advanced hepatocellular carcinoma with portal vein tumor thrombosis or ineffective response to other treatment. We report two cases of advanced HCC showing good respense to transarterial chemoembolization and CT guided percutaneous ethanol injection therapy.

A Case of Complete Regression of Hepatocellular Carcinoma during COX-2 Inhibitor Administration: Hae Jung Song, Yun Soo Kim, Chang Hee Han, Jae Young Jang, Jung Hoon Kim, Young Koog Cheon, Young Seok Kim, Jong Ho Moon, Young Deok Cho, Chan Sup Shim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2006;6(1):65-69. Published online June 30, 2006

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Abstract PDF: Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit their invasion to surrounding tissues. We report a case of complete regression of advanced HCC during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as advanced hepatocellular carcinoma (HCC) which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase was completely disappeared without specific treatment for the HCC, and the size of mass markedly decreased on follow-up CT scan.

A Case of Complete Remission after Multiple Sessions of Local Treatment in Metastatic Hepatocellular Carcinoma: Tae Gun Moon, Joon Hyeok Lee, Moon Seok Choi, Kwang Cheol Koh, Jae J. Kim, Seung Woon Paik, Byung Cheol Yoo, Jong Chul Rhee; Journal of the Korean Liver Cancer Study Group. 2006;6(1):70-76. Published online June 30, 2006

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Abstract PDF: With advances in the diagnosis and local treatement of HCC, which have resulted in a prolongation of survival, extrahepatic metastasis of HCC influence the survival of HCC patients. In particular, the frequency of death due to respiratory failure resulting from pulmonary metastases, pain and fractures resulting from bone metastases has been increased gradually. The efficacy of systemic treatment for the extrahepatic metastases is discouraging because of a lack of effective chemotherapeutic agents, reduced hepatic reserve and adverse effects. We report one
case
of the prolonged survival in a patient with hepatocellular carcinoma after treatment of bone and lung metastases.

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