PURPOSE: To investigate the frequency and clinical significance of detected incidental lung nodules found on computed tomography (CT) simulation images for hepatocellular carcinoma (HCC) using computer-aided diagnosis (CAD) and a physician review. MATERIALS AND METHODS: Sixty-seven treatment-naive HCC patients treated with transcatheter arterial chemoembolization and radiotherapy (RT) were included for the study. Portal phase of simulation CT images was used for CAD analysis and a physician review for lung nodule detection. For automated nodule detection, a commercially available CAD system was used. To assess the performance of lung nodule detection for lung metastasis, the sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. RESULTS: Forty-six patients had incidental nodules detected by CAD with a total of 109 nodules. Only 20 (18.3%) nodules were considered to be significant nodules by a physician review. The number of significant nodules detected by both of CAD or a physician review was 24 in 9 patients. Lung metastases developed in 11 of 46 patients who had any type of nodule. The sensitivities were 58.3% and 100% based on patient number and on the number of nodules, respectively. The NPVs were 91.4% and 100%, respectively. And the PPVs were 77.8% and 91.7%, respectively. CONCLUSION: Incidental detection of metastatic nodules was not an uncommon event. From our study, CAD could be applied to CT simulation images allowing for an increase in detection of metastatic nodules.
Carcinoma, Hepatocellular* ; Diagnosis* ; Diagnosis, Computer-Assisted ; Humans ; Lung ; Neoplasm Metastasis ; Radiotherapy

BACKGROUND/AIMS: Determination of the optimal radiotherapeutic parameters for radiotherapy of hepatocellular carcinoma (HCC) is still under investigation. The purpose of this study is to identify the risk factors associated with radiation-related morbidity. METHODS: We evaluated one hundred fifty-eight patients, who were given radiotherapy for HCC between January 1992 and March 2000. Radiation-induced liver disease (RILD) was defined as the development of nonmalignant ascites without disease progression and an anicteric elevation of the alkaline phosphatase level by at least twofold. Gastrointestinal toxicity was assessed by using the RTOG-EORTC scale. RESULTS: Six patients (3.8%) displayed RILD. In these patients, three patients had not responded to other previous treatments. Two patients with portal vein thrombosis or huge sized mass, above 10 cm, showed liver toxicity and two other patients presented with Child-Pugh class B liver cirrhosis. Eight patients (5%) had gastro-duodenal ulcers. In one of these 8 patients, the left lobe close to the stomach was involved and two patients had been treated for gastro-duodenal ulcer. In two more patients, the radiation field, with using anterior/posterior radiation ports, covered a significant volume of the gastrointestinal tract. One of eight patients had been irradiated with a large fraction size (250 cGy). CONCLUSIONS: The efforts should be made to reduce the radiation-related complications for hepatocellular carcinoma by considering the volume and the function of remaining liver, the location of tumor, the tumor size and the severity of liver cirrhosis.
Adult ; Aged ; Carcinoma, Hepatocellular/complications/*radiotherapy ; Female ; Humans ; Liver Cirrhosis/diagnosis/*etiology ; Liver Neoplasms/complications/*radiotherapy ; Male ; Middle Aged ; Peptic Ulcer/etiology ; Radiotherapy Dosage ; Risk Factors

OBJECTIVETo observe the long-term effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy for patients with large hepatocellular carcinoma (HCC) and to analyze the prognostic factors.

METHODSA total of 107 patients with large unresectable HCC (the largest diameter of tumor ranged from 5 to 18 cm) were treated with TACE followed by external-beam irradiation. Acute effects and survival rates were observed. The Cox proportional hazards model was used to analyze the prognostic factors.

RESULTSAn objective response was achieved in 48.6% of the cases. The cumulative survival rates at 1, 3, and 5 years were 59.4%, 28.4%, and 15.8%, respectively. The tumor number and irradiation dose were the independent prognostic factors. The cumulative survival rates of the patients with a solitary lesion (75.8%, 43.9%, and 26.8% at 1, 3, and 5 years, respectively) were significantly higher than those with multiple lesions (31.3%, and 5.0% at 1 and 3 years, respectively, P=0.0005). The survival rates of the patients received irradiation above 40 Gy (95.8%, 74.7%, and 37.4% at 1, 3, and 5 years, respectively) were significantly higher than those received 20~40 Gy (60.9%, 20.7%, and 10.3%, respectively) and those received radiation lower than 20 Gy (26.7%, 7.1%, and 7.1%, respectively, P=0.0001).

CONCLUSIONSCombined TACE with radiotherapy is a promising treatment for large unresectable HCC. The number of tumor is the most important clinical prognostic factor. Delivering the highest irradiation dose within the tolerance of the liver is the key to improve the long-term effect.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnosis ; mortality ; radiotherapy ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Liver Neoplasms ; diagnosis ; mortality ; radiotherapy ; therapy ; Male ; Middle Aged ; Prognosis ; Survival Rate

Radiation dermatitis can develop after fluoroscopy-guided interventional procedures. Cases of fluoroscopy-induced radiation dermatitis have been reported since 1996, mostly documented in the fields of radiology, cardiology and dermatology. Since diagnosis and treatment of fluoroscopy-induced radiation dermatitis can be difficult, high grade of suspicion is required. The extent of this reaction is determined by radiation dose, duration of exposure, type of procedure, and host factors and can be aggravated by concomitant use of photosensitizers. Follow-up is important after long and complicated procedures and efforts to minimize radiation exposure time will be necessary to prevent radiation dermatitis. Herein, we report a case of a 58-year-old man with hepatocellular carcinoma presenting with subacute radiation dermatitis after prolonged fluoroscopic exposure during transarterial chemoembolization and chemoport insertion. Physicians should be aware that fluoroscopy is a potential cause of radiation dermatitis.
Carcinoma, Hepatocellular/*radiotherapy ; Embolization, Therapeutic ; Fluoroscopy ; Fluorouracil/therapeutic use ; Gamma Rays ; Humans ; Liver Neoplasms/*radiotherapy ; Male ; Middle Aged ; Radiodermatitis/*diagnosis/pathology

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.
Carcinoma, Hepatocellular/*diagnosis/*radiotherapy/therapy ; Catheter Ablation/*adverse effects ; Chemoembolization, Therapeutic ; Hernia, Diaphragmatic/*etiology/surgery ; Humans ; Liver Cirrhosis, Alcoholic/complications/*diagnosis ; Liver Neoplasms/*diagnosis/*radiotherapy/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: Spinal cord compression is a common neurologic complication of advanced cancer and it is a medical emergency because delay in treatment often results in irreversible neurologic dysfunction. We analyzed the clinical characteristics, treatment outcome, favorable factors which affect survival and the result of radiation therapy and surgery. METHODS: The records of 50 patients with epidural cord compression during the period from January 1994 to December 2003 were reviewed retrospectively. RESULTS: The most common cause of metastatic spinal cord compression was lung cancer (28%), followed by hepatoma (22%), and colorectal cancer (14%). 44 patients received radiation therapy and 2 patients were treated with surgery. The median survival was 2.9 months irrespective of treatment. The factors which affect survival were initial performance status, radiotherapy and ambulatory function (p<0.05). At diagnosis, 31 (62%) of 50 patients presented with paralytic status. Radiation therapy affected preservation of ambulatory function significantly (p<0.05). Among the patients treated with radiotherapy, 14 of 18 patients who were ambulatory and 5 of 26 paralytic patients before treatment remained ambulatory or became ambulatory (p<0.01). Surgery permitted patients to remain ambulatory, but only 2 patients were received surgery. CONCLUSION: We confirmed that radiation therapy is effective palliative treatment for patients with epidural cord compression. Initial performance status and ambulatory function were identified as important prognostic factors. Prompt diagnosis and treatment were necessary, if not, neurologic function was not regained in the majority of patients. Indivisualized and more aggressive therapy including surgery should be considered.
Carcinoma, Hepatocellular ; Colorectal Neoplasms ; Diagnosis ; Emergencies ; Humans ; Lung Neoplasms ; Neurologic Manifestations ; Palliative Care ; Radiotherapy ; Retrospective Studies ; Spinal Cord Compression* ; Spinal Cord* ; Steroids ; Treatment Outcome

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.
Academic Medical Centers ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular ; Carcinosarcoma ; Chemoradiotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Prognosis ; Radiotherapy ; Survival Rate

In hepatocellular carcinoma distant metastasis after curative surgical resection without intrahepatic metastasis is very rare. A 55-year old man presented with a huge pelvic bone mass. Eight years ago he underwent posterior hepatic segmentectomy following diagnosis of hepatocelluar carcinoma. He has received regular check-ups with abdominal ultrasonography and serum alpha-fetoprotein. On admission an MRI on the pelvic area showed an 18x10 cm sized lobulated mass invading the pelvic bone and acetabulum. Microscopic examination revealed that the tumor was a well differentiated hepatocellular carcinoma. There was no evidence of intrahepatic recurrence. He was treated with transarterial chemoembolization, external radiotherapy (total 3750 cGy), and systemic chemotherapy using 5-fluorouracil.
Acetabulum ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Drug Therapy ; Fluorouracil ; Humans ; Magnetic Resonance Imaging ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Metastasis* ; Pelvic Bones* ; Radiotherapy ; Recurrence* ; Ultrasonography

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).
Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular* ; Diagnosis ; Drug Therapy ; Exophthalmos ; Eye Neoplasms ; Humans ; Korea ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Orbit* ; Prognosis ; Radiotherapy ; Ultrasonography

Carcinoma, Hepatocellular ; diagnosis ; radiotherapy ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Isotopes ; Liver Neoplasms ; diagnosis ; radiotherapy ; Palliative Care ; methods ; Radiopharmaceuticals ; administration & dosage ; Rhenium ; therapeutic use ; Terminally Ill ; Treatment Outcome