Management of hepatocellular carcinoma

被引:100
作者
Cormier, Janice N. [1 ]
Thomas, K. Tyson [1 ]
Chari, Ravi S. [1 ]
Pinson, C. Wright [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Sch Med, Div Hepatobiliary Surg & Liver Transplantat, Nashville, TN 37232 USA
关键词
hepatocellular carcinorna; HCC; liver resection; liver transplantation; chemoembolization; TACE; hepatic artery infusion; cirrhosis; cryosurgery; percutaneous ethanol injection; PEI; radiofrequency ablation; RFA;
D O I
10.1016/j.gassur.2005.10.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Hepatocellular carcinoma (HCC) is one of the most common tumors globally, with varying prevalence based on endemic risk factors. In high-risk populations, including those with hepatitis B or C or with cirrhosis, serum alpha-fetoprotein (AFP) and screening ultrasound have improved detection of resectable HCC. Treatment options, including surgical resection, for patients with HCC must be selected based on the number and size of hepatic tumors, underlying hepatic function, patient condition, and available resources. An approach, which has been summarized shows the corresponding treatment choices under given clinical circumstances. For cirrhotic patients with less than three tumor nodules of a size less than 3 cm or a solitary HCC less than 5 cm, liver transplantation offers long-term survival similar to that observed in patients transplanted for nonmalignant disease. Ablative treatment using either chemical or thermal techniques provides locally effective tumor destruction. Transcatheter arterial chemoembolization (TACE) is commonly used for palliation of unresectable tumors as well as an adjunct to surgical resection, treatment of tumors before transplant, and in conjunction with other ablative therapies in a multimodality approach. Regional approaches to chemotherapy have produced more encouraging results than systemic chemotherapy, although both remain ineffective for long-term tumor control. Several newer treatment modalities are under investigation, including gene therapy, tagged antibodies, isolated perfusion, and novel radiotherapy techniques.
引用
收藏
页码:761 / 780
页数:20
相关论文
共 206 条
[41]  
EL SH, 1999, NEW ENGL J MED, V340, P745
[42]   Liver resection for hepatocellular carcinoma on cirrhosis - Univariate and multivariate analysis of risk factors for intrahepatic recurrence [J].
Ercolani, G ;
Grazi, GL ;
Ravaioli, M ;
Del Gaudio, M ;
Gardini, A ;
Cescon, M ;
Varotti, G ;
Cetta, F ;
Cavallari, A .
ANNALS OF SURGERY, 2003, 237 (04) :536-543
[43]   Portal vein embolization before right hepatectomy - Prospective clinical trial [J].
Farges, O ;
Belghiti, J ;
Kianmanesh, R ;
Regimbeau, JM ;
Santoro, R ;
Vilgrain, V ;
Denys, A ;
Sauvanet, A .
ANNALS OF SURGERY, 2003, 237 (02) :208-217
[44]   RESPONSE TO CYPROTERONE-ACETATE TREATMENT IN PRIMARY HEPATOCELLULAR-CARCINOMA IS RELATED TO FALL IN FREE 5-ALPHA-DIHYDROTESTOSTERONE [J].
FORBES, A ;
WILKINSON, ML ;
IQBAL, MJ ;
JOHNSON, PJ ;
WILLIAMS, R .
EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY, 1987, 23 (11) :1659-1664
[45]   RESECTION OF HEPATOCELLULAR CARCINOMAS - RESULTS IN 72 EUROPEAN PATIENTS WITH CIRRHOSIS [J].
FRANCO, D ;
CAPUSSOTTI, L ;
SMADJA, C ;
BOUZARI, H ;
MEAKINS, J ;
KEMENY, F ;
GRANGE, D ;
DELLEPIANE, M .
GASTROENTEROLOGY, 1990, 98 (03) :733-738
[46]  
Frederick L., 2002, Ajcc cancer staging manual
[47]  
Gambarin-Gelwan M, 2000, AM J GASTROENTEROL, V95, P1535
[48]  
*GASTR TUM STUD GR, 1990, CANCER, V66, P135
[49]   Herpes simplex virus thymidine kinase-mediated suicide gene therapy for hepatocellular carcinoma using HIV-1-derived lentiviral vectors [J].
Gerolami, R ;
Uch, R ;
Faivre, J ;
Garcia, S ;
Hardwigsen, J ;
Cardoso, J ;
Mathieu, S ;
Bagnis, C ;
Brechot, C ;
Mannoni, P .
JOURNAL OF HEPATOLOGY, 2004, 40 (02) :291-297
[50]   Chemoembolization for hepatocellular carcinoma: Where does the truth lie? [J].
Geschwind, JFH .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 2002, 13 (10) :991-994