J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 51(5); 2008 > Article
Bae: Up-to-date Information for Hepatocellular Carcinoma Treatment

Abstract

Despite therapeutic advances, the overall survival of patients with hepatocellular carcinoma (HCC) has not been significantly improved in the last two decades. In the majority of the cases, there is underlying cirrhosis, therefore the prognosis of HCC depends not only on tumor stage but also on liver function. Patients at an early stage are those who present with an asymptomatic single HCC with a maximum diameter of 5cm or up to three nodules each less than 3cm. They will be benefitted by curative therapies, including resection, liver transplantation (LT), and percutaneous ablation, such as destroying tumor cells via the injection of chemical substances, radiation, or heating or cooling. Patients exceeding these limits, but who are free of cancer?related symptoms and vascular invasion or extrahepatic spread may be benefitted by palliation with chemoembolization and hepatic arterial infusion chemotherapy. Recently, other treatments were developed under investigation treatments arising from technical advances in ablation and radiation. New promising image?guided therapies are continuously emerging and minimize hepatic toxicity and ultimately improve quality of life and survival of patients with HCC. The 3? dimensional conformal RT, tomotherapy, stereotatic radiosurgery, high intensity focused ultrasound, and proton beam radiotherapy will provide the opportunity for curative treatment of HCC, while avoiding critical normal tissue. New drugs, such as tyrosine kinase inhibitors and anti-angiogenic agents, are currently being tested in the setting of clinical trials. These new approaches may help to address the enormous need for expanded treatment options for patients with HCC. In the future, patients with HCC will be best treated by a multidisciplinary team approach, utilizing a combination of techniques to improve the patient survival.

Figure 1.
Surgical resection of hepatocellular carcinoma.
jkma-51-457f1-l.jpg
Figure 2.
Transcatheter arterial chemoembolization. (A) CT shows 5cm sized hypodense nodular mass in the angle of right hepatic lobe. (B) Schematic figure of hepatic arterial embolization. (C) Arteriogram shows a hypervascular mass with prominent feeding artery in the right hepatic lobe. (D) After TACE, CT shows a complete retention of lipiodol within the mass in the right hepatic lobe.
jkma-51-457f2-l.jpg
Figure 3.
Photograph during the Ethanol Injection. The echogenicity of targeted mass is increased after injection of ethanol.
jkma-51-457f3-l.jpg
Figure 4.
Radiofrequency ablation. (A) Pre?treatment sonogram shows a hypoechoic mass in the right lobe of liver. (B) The echogenicity of the tumor is increased by micro?bubbles immediately after ablation.
jkma-51-457f4-l.jpg
Figure 5.
Implantation of arterial chemoport subcutaneously above the right inguinal area. (A) Hepatic arteriogram after catheterization at hepatic proper artery. (B) Right gastroduodenal artery was embolized with multiple microcoils. (C) Chemoport was inserted in the right inguinal area.
jkma-51-457f5-l.jpg
Figure 6.
3-dimensional conformal radiation threapy.
jkma-51-457f6-l.jpg
Figure 7.
Stereotactic radiosurgery (CyberKnife) and therapeutic planning.
jkma-51-457f7-l.jpg
Figure 8.
Radiotherapy planning in Helical tomotherapy.
jkma-51-457f8-l.jpg
Figure 9.
High Intensiy Focused Ultrasound (HIFU).
jkma-51-457f9-l.jpg
Table 1.
Survival rate of patients with HCC treated by hepatic resection
      Actuual survivval (%)
Reference Size N 1 yr 3 yr 5 yr
  early HCC   15 100 - 93
  overt HCC ≤ 2cm 52 92 - 54
Fong (5) < 5cm 38 86 66 59
Llovet (6)   77 85 61 51
  no portal HT, normmal bilirubin 35 91 87 74
Ari (7)
     Stage I < 2cm 1 1,318 96 88 72
  2∼5cm 2 2,722 95 - 58
     Stage II HCC < 2cm 502 92 - 55
  2∼5cm 1 1,548 95 - 58
Table 2.
Survival rate after liver transplantation in patients with HCC who meet Milan criteria
Reference Actual survival (%)
N 1 yr 3 yr 5 yr
1. Cadaveric liver transplantation        
 Mazzaferro (9) 48 84   74*
 Bismuth (10) 45 82   72
 Llovet (6) 79 86   75
 Jonas (11) 120 90   71
 Gonzalez-Uriate (12) 64 87   73
 Adam (13) 195 80   61
 Hayashi (14) 45 -   74
2. Living donor liver transplantation
 Gondolesi (15) 15   86  
 Todo (16) 137   79  

* Four-year survival

Table 3.
Survival rate of patients with HCC treated by PEIT
Reference Selection criteria N Actual Survival (%)
1 yr 3 yr 5 yr
Livraghi (25) Child A, single ≤3cm 169 99 86 48
  Child A, ≤5cm 293 98 - 47
Sakamoto (26) single, <2cm 88 - - 71
Arii (7) Stage I, <2cm 767 96 - 54
     2∼5cm 587 95 - 38
  Stage II, <2cm 426 92 - 33
     2∼5cm 483 87 - 28
Omata (27) ≤2cm 144 - 85 70
  3 nodules ≤3cm 250 - 80 65
Table 4.
Survival rate of patients with HCC treated by RFA
Reference Selection criteria N Actual Survival (%)
1 yr 3 yr 5 yr
Rossi (30) single <3cm 39 94 58 40
Buscarini (31) single ≤3.5cm 88 89 62 33
Omata (27) single <5cm or        
  3 nodules <3cm 434 95 78 68*
Tateishi (32)   319 94 77 54
  ≤2cm 87 100 91 84
  2.1∼5cm 215 93 74 45

* Four?year survial

Table 5.
Randomized controlled trials comparing PEIT and RFA as treatment for HCC (29)
Refernce Complete response rate 2 year local recurrence rate Survival Rate (%)
2 yr 3 yr
Lencioni (34)
  (single < 5cm, 3 nodules < 3cm, Child-Pugh A/B)
  PEIT (n=50) 82% 38% 88 73
  RFA (n=52) 95% 4% 96 71
Shiina (36)
  (3 nodules < 3cm, Child-Pugh A/B)
  PEIT (n=114) 100% 11% 82 63
  RFA (n=118) 100% 2% 90 80
Table 6.
Anti-tumor effect, hepatic function and viral clearance in treatment modalities for HCC
  Anti-tumor effect Hepatic function Removal of carcinogenic liver Viral clearance
Surgery ≥ 100% ↓↓ Some No, even aggravate
TACE 40∼80% No No
PEI or RFA 80% No No
Transplantation ≥ 100% ↓↓ Yes Yes, in HBV
Table 7.
Treatment response of systemic chemotherapy for HCC
Reference Chemotherapeutic agents Response rate (%)
Chlebowski (38) Doxorubicin 11
Falkson (39) Doxorubicin+5 - FU+methy - CCNU 15
Melia (40) VP - 16 18
Falkson (41) Cisplatin 17
Okada Cisplatin, Mitosantrone+5-FU 33
Patt (42) 5- FU+interferon 18
Table 8.
Treatment response and survival rate of hepatic arterial infusion chemotherapy
Reference Treatment method Actual survival
1yr 2yr
Ando (57) HAIC: Cisplatin (10mg/hr, 5 days) + 5-FU (250mg/hr, 5 days), n=p CR/PR 44%
mean survival 14Mo
3yr survival 40%
Ando (58) HAIC: Cisplatin 7mg/m2 + 5-FU 170mg/m2, n=48 45% 31%
Sumie (59) HAIC: Cisplatin 10mg/m2+5-FU 250mg/m2 (5 days) n=16 4CR/PR 56% CR/PR 24%
  TACE: adriamycin 30mg + lipiodol + gelfoam, n=21, monthly 81% 56%
    76% 33%
Cheong (54) Conservative 0%  
  Systemic chemotherapy: 5 - FU + doxorubicin + MMC 4%  
  HAIC: Cisplatin 10mg/m2 + 5-FU 250mg/m2 (5 days) 21%  
Jang (55) HAIC: Epi 50mg/m2 + Cisplatin 60mg/m2+5-FU 200mg/m2, n=30 CR/PR 17% CR/PR 0%
  TACL: adriamycin 50mg + lipiodol + gelfoam, n=22 57% 17%
    37% 0%
Sim (61) HAIC: Cisplatin 80mg/m2 (1 day), n=67 CR/PR 20% CR/PR 19%
  HAIC: Cisplatin 60mg/m2 (1 day), + 5-FU 200mg/m2 (3 days), n=36    
Jang (60) HAIC: Epi 50mg/m2 + Cisplatin 60mg/m2 + 5-FU 200mg/m2, n=80 CR/PR 17% CR/PR 0%
  conservative, n=23 30% 13.4%
    0%  

TACE; transarterial chemoembolization, HAIC; hepatic arterial chemoinfusion, portal vein tumor thrombi, TACL; transarterial chemoli-piodolization, CR; completer response, PR; partial response, MMC; mitomycin-C

References

1. Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004;127(S):S5-S16.
crossref pmid
2. Annual report cause of death 2004. National Stastical Office; 2005.

3. Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis 2005;25:181-200.
crossref pmid
4. Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, Kosuge T, Okada S, Takayasu K, Yamasaki S. Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 1998;28:1241-1246.
crossref pmid
5. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790-799.
crossref pmid pmc
6. Llovet JM, Fuster J, Bruix J. Intention?to?treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation Hepatology 1999;30:1434-1440.
crossref pmid
7. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R. Results of surgical and nonsurgical treatment for small?sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan Hepatology 2000;32:1224-1229.
crossref pmid pdf
8. Zhou XD, Tang ZY, Yang BH, Lin ZY, Ma ZC, Ye SL, Wu ZQ, Fan J, Qin LX, Zheng BH. Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer 2001;91. : 1479-1486..
crossref
9. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693-699.
crossref pmid
10. Bismuth H, Majno PE, Adam R. Liver transplantation for hepatocellular carcinoma. Semin Liver Dis 1999;19:311-322.
crossref pmid
11. Jonas S, Bechstein WO, Steinmüller T, Herrmann M, Radke C, Berg T, Settmacher U, Neuhaus P. Vascular invasion and histopathologic grading determine outcome after liver trans plantation for hepatocellular carcinoma in cirrhosis. Hepatology 2001;33:1080-1086.
crossref pmid
12. Gonzaález? Uriarte J, Valdivieso A, Gastaca M, Errasti G, Campo M, Hernandez MJ, Montejo M, Bustamante J, Suarez MJ, Testillano M, Fernandez JR, Ortiz de Urbina J. Liver transplantation for hepatocellular carcinoma in cirrhotic patients. Transplant Proc 2003;35:1827-1829.
crossref pmid
13. Adam R, Azoulay D, Castaing D, Eshkenazy R, Pascal G, Hashizume K, Samuel D, Bismuth H. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 2003;238:508-518.
pmid pmc
14. Hayashi PH, Trotter JF, Forman L, Kugelmas M, Steinberg T, Russ P, Wachs M, Bak T, Kam I, Everson GT. Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELD. Liver Transpl 2004;10:42-48.
crossref pmid
15. Gondolesi GE, Roayaie S, Muñoz L, Kim ?Schluger L, Schiano T, Fishbein TM, Emre S, Miller CM, Schwartz ME. Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria. Ann Surg 2004;239:142-149.
pmid pmc
16. Todo S, Furukawa H. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 2004;240:451-461.
pmid pmc
17. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Solá R, Rodés J, Bruix J. Barcelona Liver Cancer Group. Arterial embolisation or che-moembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739.
crossref pmid
18. Pelletier G, Ducreux M, Gay F, Luboinski M, Hagége H, Dao T, Van Steenbergen W, Buffet C, Rougier P, Adler M, Pignon JP, Roche A. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC. J Hepatol 1998;29:129-134.
pmid
19. Bruix J, Llovet JM, Castells A, Montañá X, Brú , Ayuso MC, Vilana R, Rodés J. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 1998;27:1578-1583.
crossref pmid
20. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R. Results of surgical and nonsurgical treatment for small?sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan Hepatology 2000;32:1224-1229.
crossref pmid pdf
21. Lin DY, Liaw YF, Lee TY, Lai CM. Hepatic arterial embolization in patients with unresectable hepatocellluar carcinoma?a randomized controlled trial Gastroenterology 1988;94:453-456.
crossref pmid
22. Bartolozzi C, Lencioni R, Caramella D, Vignali C, Cioni R, Mazzeo S, Carrai M, Maltinti G, Capria A, Conte PF. Treatment of large HCC: transcatheter arterial chemoem?bolization combined with percutaneous ethanol injection versus repeated transcatheter arerial chemoembolization Radiology 1995;197:812-818.
crossref pmid
23. Cheon JH, Park JW, Park KW, Kim YI, Kim SH, Lee WJ, Park HS, Park SJ, Hong EK, Hong EK, Kim CM. The clinical report of 1,078 cases of hepatocellular carcinomas: National Cancer Center experience. Korean J Hepatol 2004;10:288-297.
pmid
24. Beaugrand M, N'Kontchou G, Seror O, Ganne N, Trinchet JC. Local/regional and systemic treatments of hepatocellular carcinoma. Semin Liver Dis 2005;25:201-211.
crossref pmid
25. Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, Pompili M, Brunello F, Lazzaroni S, Torzilli G. Hepatocellular carcinoma and cirrhosis in 746 patients: long?term results of percutaneous ethanol injection Radiology 1995;197:101-108.
crossref pmid
26. Sakamoto M, Hirohashi S. Natural history and prognosis of adenomatous hyperplasia and early hepatocellular carcinoma: multi? institutional analysis of 53 nodules followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical resection or percutaneous ethanol injection Jpn J Clin Oncol 1998;28:604-608.
crossref pmid
27. Omata M, Tateisho T, Yoshida H, Shiina S. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection theapy and radiofrequency ablation. Gastroenterology 2004;127:S159-S166.
crossref pmid
28. Ebara M, Okabe S, Kita K, Sugiura N, Fukuda H, Yoshikawa M, Kondo F, Saisho H. Percutaneous ethanol injection for small hepatocellular carcinoma: therapeutic efficacy based on 20? year observation J Hepatol 2005;43:458-464.
crossref pmid
29. Lencioni R, Llovet JM. Percutaneous ethanol injection for hepatocellular carcinoma: alive or dead? J Hepatol 2005;43:377-380.
crossref pmid
30. Rossi S, Di Stasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L, Paties CT, Silverman DE, Buscarini L. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. Am J Roentgenol 1996;167:759-768.
crossref
31. Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long?term results Eur Radiol 2001;11:914-921.
crossref pmid pdf
32. Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, Yoshida H, Kawabe T, Omata M. Percutaneous radiofrequency ablation for hepatocellular cardinoma. An analysis of 1000 cases. Cancer 2005;103:1201-1209.
crossref pmid
33. Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, Bartolozzi C. Early? stage hepatocellular carcinoma in cirrhosis: long?term results of percutaneous image?guided radiofrequency ablation Radiology 2005;234:961-967.
crossref pmid
34. Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, Frings H, Laubenberger J, Zuber I, Blum HE, Bartolozzi C. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio?frequency thermal ablation versus percutaneous ethanol injection Radiology 2003;228:235-240.
crossref pmid
35. Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or = 4cm. Gastroenterology 2004;127:1714-1723.
crossref pmid
36. Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, Ishikawa T, Koike Y, Yoshida H, Kawabe T, Omata M. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005;129:122-130.
crossref pmid
37. Huang GT, Lee PH, Tsang YM, Lai MY, Yang PM, Hu RH, Chen PJ, Kao JH, Sheu JC, Lee CZ, Chen DS. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma. A prospective study. Ann Surg 2005;242:36-42.
pmid pmc
38. Chlebowski RT, Brzechwa?Adjukiewicz A, Cowden A, Block JB, Tong M, Chan KK. Doxorubicin (75mg/m2) for hepatocellular carcinoma: clinical and pharmacokinetic results. Cancer Treat Rep 1984;68:487-491.
pmid
39. Falkson G, MacIntyre JM, Moertel CG, Johnson LA, Scherman RC. Primary liver cancer. An Eastern Cooperative Oncology Group Trial. Cancer 1984;54:970-977.
crossref pmid
40. Melia WM, Johnson PJ, Williams R. Induction of remission in hepatocellular carcinoma. A comparison of VP 16 with adriamycin. Cancer 1983;51:206-210.
crossref pmid
41. Falkson G, Ryan LM, Johnson LA, Simson IW, Coetzer BJ, Carbone PP, Creech RH, Schutt AJ. A random phase II study of mitoxantrone and cisplatin in patients with hepatocellular carcinoma. An ECOG study. Cancer 1987;60:2141-2145.
crossref pmid
42. Patt YZ, Hassan MM, Lozano RD, Brown TD, Vauthey JN, Curley SA, Ellis LM. Phase II trial of systemic continuous fluorouracil and subcutaneous recombinant interferon Alfa?2b for treatment of hepatocellular carcinoma J Clin Oncol 2003;21:421-427.
crossref pmid
43. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236.
crossref pmid
44. Colleoni M, Audisio RA, De Braud F, Fazio N, Martinelli G, Goldhirsch A. Practical considerations in the treatment of hepatocellular carcinoma. Drugs 1998;55:367-382.
crossref pmid
45. Baur M, Walter R, Gebauer A, Tscholakoff D, Lochs H, Mühlbacher F, Turetschek K, Binder R, Hudec M, Gangl A, Ferenci P, Dittrich C. Chemoembolization with cisplatin, lipiodol and Gelfoam and subsequent systemic chemotherapy with cisplatin and interferon in patients with hepatocellular carcinoma: a non?randomized prospective study Int J Oncol 2003;23:811-819.
crossref pmid
46. Suzuki M, Suzuki H, Yamamoto T, Mamada Y, Mizuno H, Tominaga T, Suga M, Suemori S, Kato Y, Sato A, Yamanouchi E, Sakuyama K, Maeyama S, Shinagawa T, Okabe K. Indication of chemoembolization therapy without gelatin sponge for hepatocellular carcinoma. Semin Oncol 1997;24S:S110-S115.

47. Llovet JM, Real MI, Montan ?a X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Sola R, Rode's J, Bruix J. Barcelona Liver Cancer Group. Arterial embolisation or che-moembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739.
crossref pmid
48. Bruix J, Llovet JM, Castells A, Montan ?a' X, Bru' C, Ayuso MC, Vilana R, Rode's J. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 1998;27:1578-1583.
crossref pmid
49. Park JH, Chung JW, Lee SK. Chemoemboliazation of hepatocellular carcinoma: long?term survival and prognostic factors J Korean Radiol Society 1996;35:315-323.

50. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, Fan ST, Wong J. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171.
crossref pmid pdf
51. Haskell CM. Cancer treatment. 5th ed.. Philadelphia: WB Saunders Company; 2001. p. 2038-2039.

52. Iwamiya T, Sawada S, Ohta Y. Repeated arterial infusion chemotherapy for inoperable hepatocellular carcinoma using an implantable drug delivery system. Cancer Chemother Pharmacol 1994;33(S):S134-138.
crossref pmid pdf
53. Seno H, Ito K, Kojima K, Nakajima N, Chiba T. Efficacy of an implanted drug delivery system for advanced hepatocellular carcinoma using 5 ?fluorouracil, epirubicin and mitomycin C J Gastroenterol Hepatol 1999;14:811-816.
crossref pmid
54. Cheong JY, Lee KM, Cho SW, Won JH, Kim JK, Wang HJ, Hahm KB, Kim JH. Survival benefits of intra?arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis Hepatol Res 2005;32:127-133.
crossref pmid
55. Jang JW, Park YM, Bae SH, Choi JY, Yoon SK, Chang UI, Nam SW, Kim BS. Therapeutic efficacy of multimodal combination therapy using transcatheter arterial infusion of epirubicin and cisplatin, systemic infusion of 5 ?fluorouracil, and additional percutaneous ethanol injection for unresectable hepatocellular carcinoma Cancer Chemother Pharmacol 2004;54:415-420.
crossref pmid pdf
56. Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, Kiriyama S, Suga T, Takahashi M. The efficacy of continuous local arterial infusion of 5? fluorouracil and cisplatin through an implanted reservoir for severe advanced hepatocellular carcinoma Oncology 1995;52:295-299.
crossref pmid pdf
57. Ando E, Tanaka M, Yamashita F, Kuromatsu R, Yutani S, Fukumori K, Sumie S, Yano Y, Okuda K, Sata M. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer 2002;95:588-595.
crossref pmid
58. Ando E, Yamashita F, Tanaka M, Tanikawa K. A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein. Cancer 1997;79:1890-1896.
crossref pmid
59. Sumie S, Yamashita F, Ando E, Tanaka M, Yano Y, Fukumori K, Sata M. Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization. AJR Am J Roentgenol 2003;181:1327-1334.
pmid
60. Jang JW, Bae SH, Choi JY, Oh HJ, Kim MS, Lee SY, Kim CW, Chang UI, Nam SW, Cha SB, Lee YJ, Hoi BG, Byun JY, Yoon SK. Therapeutic value of combination therapy with transarterial chemo?lipiodolization and systemic chemo?infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management Cancer Chemother Pharmacol 2007;59:9-15.
crossref pmid pdf
61. Sim MK, Kim DY, Park JY, Kim JK, Kim SA, Ahn SH, Chon CY, Moon YM, Won JY, Lee DY, Han KH. Efficacy of repeated hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma with portal vein tumor thrombosis. Korean J Hepatol 2005;11:268-274.
pmid
62. Hwang JY, Jang BK, Kwon KM, Chung WJ, Park KS, Cho KB, Hwang JS, Ahn SH, Kim GC, Kim YH, Choi JS, Kwon JH. Efficacy of hepatic arterial infusion therapy for advanced hepatocellular carcinoma using 5?fluorouracil, epirubicin and mito-mycin?C Korean J Gastroenterol 2005;45:118-124.
pmid
63. Kim JS, Han KH, Lee DY, Seong JS, Youn YH, Cheong JY, Ahn SH, Chon CY, Moon YM. Concurrent chemo?radiation therapy for advanced hepatocellular carcinoma with portal vein thrombosis Taehan Kan Hakhoe Chi 2002;8:71-79.
pmid
64. Ishikura S, Ogino T, Furuse J, Satake M, Baba S, Kawashima M, Nihei K, Ito Y, Maru Y, Ikeda H. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus. Am J Clin Oncol 2002;25:189-193.
crossref pmid
65. Yamada K, Izaki K, Sugimoto K, Mayahara H, Morita Y, Yoden E, Matsumoto S, Soejima T, Sugimura K. Prospective trial of combined transcatheter arterial chemoembolization and three? dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma Int J Radiat Oncol Biol Phys 2003;57:113-119.
crossref pmid
66. Seong J, Keum KC, Han KH, Lee DY, Lee JT, Chon CY, Moon YM, Suh CO, Kim GE. Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 1999;43:393-397.
crossref pmid
67. Shim SJ, Seong J, Han KH, Chon CY, Suh CO, Lee JT. Local radiotherapy as a complement to incomplete transcatheter arterial chemoembolization in locally advanced hepatocellular carcinoma. Liver Int 2005;25:1189-1196.
crossref pmid
68. Choi IB, Choi BO, Kang YN, Han JY, Jung Kew, Bae SH, Choi JY, Yoon SK. Robotic Radiosurgery: CyberKnife Management of Primary HCC. Cyberknife Society 2005;279-286.

69. Lin SM, Lin CJ, Hsu CW, Tai DI, Sheen IS, Lin DY, Liaw YF. Prospectiverandomized controlled study of interferon?alpha in preventing hepatocellular carcinoma recurrence after medical ablation therapy for primary tumors Cancer 2004;100:376-382.
crossref pmid
70. Chung YH, Song IH, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ. Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon?alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis Cancer 2000;88:1986-1991.
crossref pmid
71. Obi S, Yoshida H, Toune R, Unuma T, Kanda M, Sato S, Tateishi R, Teratani T, Shiina S, Omata M. Combination therapy of intraarterial 5?fluorouracil and systemic interferon?alpha for advanced hepatocellular carcinoma with portal venous invasion Cancer 2006;106:1990-1997.
crossref pmid
72. Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 2000;356:802-807.
crossref pmid
73. Kennedy JE. High?intensity focused ultrasound in the treatment of solid tumours Nat Rev Cancer 2005;5:321-327.
crossref pmid pdf
74. Bush DA, Hillebrand DJ, Slater JM, Slater JD. High?dose proton beam radiotherapy of hepatocellular carcinoma: preliminary results of a phase II trial Gastroenterology. 2004;127(S):S189-193.
crossref pmid
75. Liu L, Cao Y, Chen C, Zhang X, McNabola A, Wilkie D, Wilhelm S, Lynch M, Carter C. Sorafenib blocks the RAF/MEK/ERK pathway, inhibits tumor angiogenesis, and induces tumor cell apoptosis in hepatocellular carcinoma model PLC/PRF/5. Cancer Res 2006;66:11851-11858.
crossref pdf
76. Abou?Alfa GK, Schwartz L, Ricci S, Amadori D, Santoro A, Figer A, De Greve J, Douillard JY, Lathia C, Schwartz B, Taylor I, Moscovici M, Saltz LB. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006;24:4293-4300.
crossref pmid


ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next