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14 "Young-Suk Lim"
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Original Article
Outcomes of Liver Resection and Transarterial Chemoembolization in Patients with Multinodular BCLC-A Hepatocellular Carcinoma
Jiwon Yang, Won-Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Deok-Bog Moon, Dong-Hwan Jung, Jonggi Choi
Received March 3, 2024  Accepted March 25, 2024  Published online April 3, 2024  
DOI: https://doi.org/10.17998/jlc.2024.03.25    [Accepted]
  • 585 Views
  • 43 Downloads
AbstractAbstract PDF
Background
This study aimed to compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) in patients with multinodular hepatocellular carcinoma (HCC) within the Milan criteria who were not eligible for liver transplantation.
Methods
We retrospectively analyzed 483 patients with multinodular HCC within the Milan criteria, who underwent either LR or TACE as an initial therapy between 2013 and 2022. The overall survival (OS) in the entire population and recurrence-free survival (RFS) in patients who underwent LR and TACE and achieved a complete response were analyzed. Propensity score (PS) matching analysis was also used for a fair comparison of outcomes between the two groups.
Results
Among the 483 patients, 107 (22.2%) and 376 (77.8%) underwent LR and TACE, respectively. The median size of the largest tumor was 2.0 cm, and 72.3% of the patients had two HCC lesions. The median OS and RFS were significantly longer in the LR group than in the TACE group (p <0.01 for both). In the multivariate analysis, TACE (adjusted hazard ratio [aHR], 1.81 and aHR, 2.41) and large tumor size (aHR, 1.43 and aHR, 1.44) were significantly associated with worse OS and RFS, respectively. The PS-matched analysis also demonstrated that the LR group had significantly longer OS and RFS than the TACE group (PS <0.05).
Conclusion
In this study, LR showed better OS and RFS than TACE in patients with multinodular Barcelona Clinic Liver Cancer stage A HCC. Therefore, LR can be considered an effective treatment option for these patients.
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Review Article
Advancing Korean nationwide registry for hepatocellular carcinoma: a systematic sampling approach utilizing the Korea Central Cancer Registry database
Bo Hyun Kim, E Hwa Yun, Jeong-Hoon Lee, Geun Hong, Jun Yong Park, Ju Hyun Shim, Eunyang Kim, Hyun-Joo Kong, Kyu-Won Jung, Young-Suk Lim
J Liver Cancer. 2024;24(1):57-61.   Published online March 26, 2024
DOI: https://doi.org/10.17998/jlc.2024.03.03
  • 578 Views
  • 24 Downloads
AbstractAbstract PDFSupplementary Material
Hepatocellular carcinoma (HCC) presents a substantial public health challenge in South Korea as evidenced by 10,565 new cases annually (incidence rate of 30 per 100,000 individuals), in 2020. Cancer registries play a crucial role in gathering data on incidence, disease attributes, etiology, treatment modalities, outcomes, and informing health policies. The effectiveness of a registry depends on the completeness and accuracy of data. Established in 1999 by the Ministry of Health and Welfare, the Korea Central Cancer Registry (KCCR) is a comprehensive, legally mandated, nationwide registry that captures nearly all incidence and survival data for major cancers, including HCC, in Korea. However, detailed information on cancer staging, specific characteristics, and treatments is lacking. To address this gap, the KCCR, in partnership with the Korean Liver Cancer Association (KLCA), has implemented a systematic approach to collect detailed data on HCC since 2010. This involved random sampling of 10-15% of all new HCC cases diagnosed since 2003. The registry process encompassed four stages: random case selection, meticulous data extraction by trained personnel, expert validation, anonymization of personal data, and data dissemination for research purposes. This random sampling strategy mitigates the biases associated with voluntary reporting and aligns with stringent privacy regulations. This innovative approach positions the KCCR and KLCA as foundations for advancing cancer control and shaping health policies in South Korea.
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Original Articles
Subclassification of advanced-stage hepatocellular carcinoma with macrovascular invasion: combined transarterial chemoembolization and radiotherapy as an alternative first-line treatment
Sujin Jin, Won-Mook Choi, Ju Hyun Shim, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Jinhong Jung, Sang Min Yoon, Jonggi Choi
J Liver Cancer. 2023;23(1):177-188.   Published online March 23, 2023
DOI: https://doi.org/10.17998/jlc.2023.03.04
  • 1,601 Views
  • 92 Downloads
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Background/Aim
The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend systemic therapy as the only first-line treatment for patients with BCLC stage C hepatocellular carcinoma (HCC) despite its heterogeneity of disease extent. We aimed to identify patients who might benefit from combined transarterial chemoembolization (TACE) and radiation therapy (RT) by subclassifying BCLC stage C.
Methods
A total of 1,419 treatment-naïve BCLC stage C patients with macrovascular invasion (MVI) who were treated with combined TACE and RT (n=1,115) or systemic treatment (n=304) were analyzed. The primary outcome was overall survival (OS). Factors associated with OS were identified and assigned points by the Cox model. The patients were subclassified into three groups based on these points.
Results
The mean age was 55.4 years, and 87.8% were male. The median OS was 8.3 months. Multivariate analysis revealed a significant association of Child-Pugh B, infiltrative-type tumor or tumor size ≥10 cm, main or bilateral portal vein invasion, and extrahepatic metastasis with poor OS. The sub-classification was categorized into low (point ≤1), intermediate (point=2), and high (point ≥3) risks based on the sum of points (range, 0–4). The OS in the low, intermediate, and high-risk groups was 22.6, 8.2, and 3.8 months, respectively. In the low and intermediate-risk groups, patients treated with combined TACE and RT exhibited significantly longer OS (24.2 and 9.5 months, respectively) than those who received systemic treatment (6.4 and 5.1 months, respectively; P<0.0001).
Conclusions
Combined TACE and RT may be considered as a first-line treatment option for HCC patients with MVI when classified into low- and intermediate-risk groups.

Citations

Citations to this article as recorded by  
  • Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis
    Manuel Lim, Jongman Kim, Jinsoo Rhu, Gyu-Seong Choi, Jae-Won Joh
    Journal of Liver Cancer.2024; 24(1): 102.     CrossRef
  • Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis
    Jeayeon Park, Yun Bin Lee, Yunmi Ko, Youngsu Park, Hyunjae Shin, Moon Haeng Hur, Min Kyung Park, Dae-Won Lee, Eun Ju Cho, Kyung-Hun Lee, Jeong-Hoon Lee, Su Jong Yu, Tae-Yong Kim, Yoon Jun Kim, Tae-You Kim, Jung-Hwan Yoon
    Journal of Liver Cancer.2024; 24(1): 81.     CrossRef
  • How to optimize the treatment strategy for advanced-stage hepatocellular carcinoma with macrovascular invasion
    Beom Kyung Kim
    Journal of Liver Cancer.2023; 23(1): 121.     CrossRef
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Stereotactic body radiation therapy for elderly patients with small hepatocellular carcinoma: a retrospective observational study
Jeong Yun Jang, Jinhong Jung, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Jin-hong Park, Sang Min Yoon
J Liver Cancer. 2022;22(2):136-145.   Published online September 16, 2022
DOI: https://doi.org/10.17998/jlc.2022.08.18
  • 3,119 Views
  • 75 Downloads
  • 5 Citations
AbstractAbstract PDFSupplementary Material
Background/Aim
We aimed to investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) in elderly patients with small hepatocellular carcinomas (HCC).
Methods
Eighty-three patients (89 lesions) with HCC who underwent SBRT between January 2012 and December 2018 were reviewed in this retrospective observational study. The key inclusion criteria were as follows: 1) age ≥75 years, 2) contraindications for hepatic resection or percutaneous ablative therapies, 3) no macroscopic vascular invasion, and 4) no extrahepatic metastasis.
Results
The patients were 75-90 years of age, and 49 (59.0%) of them were male. Most patients (94.0%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Seventy-four patients (89.2%) had Child-Pugh class A hepatic function before SBRT. The median tumor size was 1.6 cm (range, 0.7-3.5). The overall median follow-up period was 34.8 months (range, 7.3-99.3). The 5-year local tumor control rate was 90.1%. The 3-year and 5-year overall survival rate was 57.1% and 40.7%, respectively. Acute toxicity grade ≥3 was observed in three patients (3.6%) with elevated serum hepatic enzymes; however, no patient experienced a worsening of the Child-Pugh score to ≥2 after SBRT. None of the patients developed late toxicity (grade ≥3).
Conclusions
SBRT is a safe treatment option with a high local control rate in elderly patients with small HCC who are not eligible for other curative treatments.

Citations

Citations to this article as recorded by  
  • Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
    Jeong-Ju Yoo, Sujin Koo, Gi Hong Choi, Min Woo Lee, Seungeun Ryoo, Jungeun Park, Dong Ah Park
    Current Oncology.2024; 31(1): 324.     CrossRef
  • Radiotherapy trend in elderly hepatocellular carcinoma: retrospective analysis of patients diagnosed between 2005 and 2017
    Bong Kyung Bae, Jeong Il Yu, Hee Chul Park, Myung Ji Goh, Yong-Han Paik
    Radiation Oncology Journal.2023; 41(2): 98.     CrossRef
  • Loco-regional therapies competing with radiofrequency ablation in potential indications for hepatocellular carcinoma: a network meta-analysis
    Ha Il Kim, Jihyun An, Seungbong Han, Ju Hyun Shim
    Clinical and Molecular Hepatology.2023; 29(4): 1013.     CrossRef
  • Has the growing evidence of radiotherapy for hepatocellular carcinoma increased the use of radiotherapy in elderly patients?
    Tae Hyun Kim
    Radiation Oncology Journal.2023; 41(3): 141.     CrossRef
  • Chronic Liver Disease in the Older Patient—Evaluation and Management
    Daniel Anthony DiLeo, Tolga Gidener, Ayse Aytaman
    Current Gastroenterology Reports.2023; 25(12): 390.     CrossRef
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Characteristics and Survival of Korean Patients with Hepatocellular Carcinoma: A Nationwide Random Sample Study
Young-Suk Lim, Seung Hyung Kim, Seung Hyung Kim, Jae Seok Hwang, Kwang-Hyub Han
J Liver Cancer. 2014;14(2):97-107.   Published online September 30, 2014
DOI: https://doi.org/10.17998/jlc.14.2.97
  • 1,319 Views
  • 29 Downloads
  • 2 Citations
AbstractAbstract PDF
Background/Aims
Given the high incidence and mortality rate of hepatocellular carcinoma (HCC), ensuring high quality of registry data is important for the improvement of health service. Registries by voluntary reporting often lack case completeness and may cause selection bias. A statutory Korean Central Cancer Registry (KCCR) has case completeness and provides accurate information on HCC incidence, but provides limited information about HCC characteristics.
Methods
The Korean Liver Cancer Study Group (KLCSG) and the KCCR jointly built a nationwide cohort of patients who were diagnosed with HCC between 2003 and 2005. Out of 31,521 new HCC cases that were registered at the KCCR between 2003 and 2005, 4,630
case
s (14.7% of total HCC cases) were randomly selected and abstracted from 32 hospitals nationwide, and followed up until December 2011. After excluding 110 patients who met the exclusion criteria, a total of 4,520 HCC patients were analyzed.
Results
Mean age at the diagnosis of HCC was 57.1±10.8 years, and males comprised 81.0%. Hepatitis B was the predominant etiology (72%), and hepatitis C comprised 12%. Stage at diagnosis was 10%, 43%, 28%, 11% and 8% for modified International Union Against Cancer (mUICC) stages I, II, III, IV-A and IV-B, respectively. Initial treatment modalities were transarterial therapy in 53%, surgical resection in 10%, local ablation in 7%, and liver transplantation in 1%. The median survival was 1.4 years, and the 1-, 3-, and 5-year survival rates were 56%, 35% and 27%, respectively. Age, gender, Child-Pugh class, etiology, tumor stage at diagnosis, and treatment modality were factors independently related to survival.
Conclusions
About half of HCC patients are diagnosed at advanced stages in Korea. Curativeintent treatments are rarely applied to patients. This data provides unbiased information about the characteristics and outcome of HCC patients in Korea. (J Liver Cancer 2014;14:97- 107)

Citations

Citations to this article as recorded by  
  • Hepatocellular Carcinoma in Korea between 2012 and 2014: an Analysis of Data from the Korean Nationwide Cancer Registry
    Young Eun Chon, Han Ah Lee, Jun Sik Yoon, Jun Yong Park, Bo Hyun Kim, In Joon Lee, Suk Kyun Hong, Dong Hyeon Lee, Hyun-Joo Kong, Eunyang Kim, Young-Joo Won, Jeong-Hoon Lee
    Journal of Liver Cancer.2020; 20(2): 135.     CrossRef
  • Subclassification of Barcelona Clinic Liver Cancer B and C hepatocellular carcinoma: A cohort study of the multicenter registry database
    Sangheun Lee, Beom Kyung Kim, Kijun Song, Jun Yong Park, Sang Hoon Ahn, Seung Up Kim, Kwang‐Hyub Han, Do Young Kim
    Journal of Gastroenterology and Hepatology.2016; 31(4): 842.     CrossRef
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Case Reports
A Case of the Effective Treatment of HCC with Bile Duct Invasion and Portal Vein Thrombosis
Jihyun An, 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. 2013;13(2):169-172.   Published online September 30, 2013
DOI: https://doi.org/10.17998/jlc.13.2.169
  • 1,223 Views
  • 2 Downloads
AbstractAbstract PDF
Bile duct invasion of hepatocellular caricinoma (HCC) is rare, ranging from 1.2% to 9%. Moreover, the standard treatment of HCC with bile duct invasion is not yet established. We report a case of HCC with bile duct invasion and portal vein thrombosis which was successfully treated by trasarterial chemoembolization and radiotherapy. A 38-year-old female patient visited our hospital due to right upper quadrant pain. The level of total and direct bilirubin was 6.8 and 4.0 mg/dL, respectively. Her blood test showed HBs Ag positive and the level of alpha-fetoprotein was 43,000 ng/mL. Her CT scan revealed lobulating hypervascular mass involving right hepatic lobe, portal vein and both intrahepatic ducts. We performed endoscopic biliary drainage using biliary stent. She had been diagnosed as HCC on endobiliary biopsy. She was treated with radiotherapy (RT) to portal vein thrombosis, and seven transarterial chemoembolizations. After of all, we carried out radiotherapy to hepatic vein thrombosis and residual HCC near hepatic vein. After the RT, she has been taken care at outpatient clinic without evidence of recurrence during 8 months.
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A Case of Hemolytic Uremic Syndrome after Cisplatin Based Transarterial Chemoembolization
Chang Hyeon Seok, 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(2):169-171.   Published online September 30, 2012
  • 608 Views
  • 4 Downloads
AbstractAbstract PDF
Hemolytic uremic syndrome (HUS) is a rare condition compromising the clinical triad of acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. HUS may be associated with a variety of etiologies, and chemotherapeutic agents have also been reported to be associated with HUS, including mitomycin, cisplatin, bleomycin, and most recently gemcitabine. HUS also has been observed in association with a number of disseminated malignancies in adults, most typically adenocarcinoma of the stomach and breast. But there was no case report of HUS after cisplatin based transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We experienced a case of HUS after cisplatin based TACE and reported this case with several literature reviews.
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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
  • 518 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.
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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
  • 490 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.
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A Case of Pulmonary Metastasis from Hepatocellular Carcinoma Partially Responsive to Sorafenib
Nae-Yun Heo, Han Chu Lee, Ju Hyun Shim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh
Journal of the Korean Liver Cancer Study Group. 2010;10(1):52-54.   Published online June 30, 2010
  • 503 Views
  • 0 Download
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) is one of the most important causes of cancer death in South Korea. Unfortunately, more than half of the patients are diagnosed in the advanced stage with multiple intra- or extrahepatic metastasis, so no more than 30% of patients are suitable to undergo curative resection. Lung is the most common organ of extrahepatic metastasis of HCC, and the pulmonary metastasis is known as poor prognosis factor, but no standard systemic therapy is established yet. Sorafenib is the only molecularly targeted agent which has been proven clinical benefit in the randomized clinical trials, but pulmonary metastasis is known as predictive factor of poor response. However, we experience a case of pulmonary metastasis from hepatocellular carcinoma partially responsive to sorafenib, and report it.
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A Case of Advanced Hepatocellular Carcinoma Presenting as Skull Metastasis
Nae-Yun Heo, Han Chu Lee, Ju Hyun Shim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh
Journal of the Korean Liver Cancer Study Group. 2010;10(1):73-75.   Published online June 30, 2010
  • 486 Views
  • 1 Download
AbstractAbstract PDF
Hepatocellular carcinoma is known to spread to distant organ via hematogenous or osseous route in about 15% of the patients during its clinical course. However, it is rare that the distant metastatic symptom and sign are the diagnostic clues to find the primary hepatocellular carcinoma, because most of the patients are likely to expire due to rapid disease progression before the presentation of the clinical findings of metastasis. Detection of early hepatocelluar carcinoma through surveillance of the high risk population will reduce the chance of initial presentation of metastatic symptom. In spite of this trend, we experienced a case of hepatocellular carcinoma presenting as skull metastasis at diagnosis, which suggests that some patients still complain of metastatic symptom as initial presentation of hepatocellular carcinoma.
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A Case of Hepatocellular Carcinoma with Bile Duct Invasion
Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh
Journal of the Korean Liver Cancer Study Group. 2008;8(1):55-58.   Published online June 30, 2008
  • 666 Views
  • 25 Downloads
AbstractAbstract PDF
Bile duct invasion of hepatocellular carcinoma (HCC) is rare, ranging from 1.2% to 9 %. A 51-year-old male patient visited our hospital due to jaundice. He had been infected with hepatitis B virus. He had icteric sclera without abdominal distension or tenderness. The level of total and direct bilirubin was 16.7 and 7.8 mg/dL, each other. The level of AFP was 4690 ng/mL. CT scan showed ill-defined hypervascular mass involving left hepatic lobe, left intrahepatic duct and common hepatic duct. He had been diagnosed as HCC on liver biopsy. We performed total 3 PTBDs in right, left lateral, and left medial side of the bile duct. After then, he was treated with two transarterial chemoembolizations. Finally, we carried out extended left lobectomy. After the surgery, he has been taken care at OPD without evidence of recurrence during 8 months.
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Effect of combination therapy with TACE and 3D-CRT for two patients with PVT and/or IVC tumor thrombus
Hyun Deok Shin, Young-Suk Lim, Soon Joo Kim, Sang Hyun Park, Gang Mo Kim, Han Chu Lee, Young Hwa Jung, Young Sang Lee, Dong Jin Suh
Journal of the Korean Liver Cancer Study Group. 2007;7(1):87-93.   Published online June 30, 2007
  • 566 Views
  • 1 Download
AbstractAbstract PDF
Advanced hepatocellular carcinoma has a poor prognosis, especially in the cases with portal vein or IVC tumor thrombi. In such cases, surgical resection could not be a curative treatment option and transcatheter arterial chemoembolization (TACE) alone is usually ineffective. Recently, three-dimensional conformal radiation therapy (3D-CRT) has been developed to better conform the radiation dose to the tumor volume in order to reach the goal of eradicating local disease without injuring normal tissue. Combination therapy with TACE and 3D-CRT could be considered as a treatment option for advanced HCC with PV or IVC tumor thrombi. We report here two cases with advanced HCC showing response to combination therapy with repeated TACE and 3D-CRT.
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Early Extensive Recurrence of Hepatocellular Carcinoma after Non-surgical Treatment
Myoung Kuk Jang, Han Chu Lee, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh
Journal of the Korean Liver Cancer Study Group. 2004;4(1):67-72.   Published online June 30, 2004
  • 433 Views
  • 0 Download
AbstractAbstract PDF
Although transarterial chemoembolization (TACE) has been reported to have anti-tumor effects in patients with hepatocellular carcinoma (HCC), optimal time schedules and the appropriate follow-up methods have not been determined yet. We experienced a 57-year-old male who underwent radiofrequency ablation(RFA) therapy due to marginal and viable HCC on CT scan after TACE, despite of negative tumor staining on angiography. The patient did not show any evidence of tumor recurrence on CT scan until five months after RFA, However, follow-up CT scan obtained eight months after RFA showed newly developed a massive recurrent tumor with tumor thrombosis in the right portal vein around the previously treated HCC.
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JLC : Journal of Liver Cancer