Biological Therapy ; Carcinoma, Hepatocellular ; drug therapy ; radiotherapy ; therapy ; Humans ; Liver Neoplasms ; drug therapy ; radiotherapy ; therapy ; Radiography, Interventional ; Ultrasonic Therapy

In hepatocellular carcinoma (HCC), sorafenib is the only approved systemic chemotherapy, and has been applied for those with advanced HCC especially with systemic metastasis. However, the treatment results are suboptimal leaving many cases with disease progression despite the use of optimum dose. There is no established guideline for those that fail to respond to sorafenib treatment. In this case, a 46-years-old male with metastatic lung cancer from HCC experienced progression despite sorafenib treatment. Then, the patient received surgical resection of the metastatic lung mass followed by radiation therapy and achieved complete remission for 10 months after the surgical treatment and radiation therapy. Alpha-fetoprotein level was normalized and complete remission has been maintained.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Disease Progression ; Drug Therapy ; Humans ; Lung Neoplasms ; Lung* ; Male ; Neoplasm Metastasis* ; Radiotherapy

External beam radiotherapy, transarterial chemoembolization and sorafenib are currently standard treatments for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. However, hepatic arterial infusion chemotherapy has been applied to advanced stage HCC with a view to improving the therapeutic effect. We experienced a case of advanced HCC with clinical complete response after hepatic artery infusion chemotherapy and radiation therapy and report that.
Carcinoma, Hepatocellular* ; Chemoradiotherapy ; Drug Therapy* ; Hepatic Artery* ; Portal Vein* ; Radiotherapy* ; Thrombosis* ; Venous Thrombosis

Surgical resection is mainstay treatment of hepatocellular carcinoma (HCC). However, its prognosis is poor, because of the high incidence of HCC recurrence (cumulative 5-year HCC recurrence rate of 70-80%). The most common site of HCC recurrence is the remnant liver, and extrahepatic recurrence occurs in 6.7-13.5% of patients. Because the tumor characteristics in extrahepatic recurrence are usually multiple and aggressive, the optimal treatment modality has not yet been determined. We report a case of complete remission and long term survival over 60 months in patient with extrahepatic metastasis after curative resection of HCC by aggressive treatment, which include lung resection for lung metastasis, radiotherapy for mediastinal lymph node metastasis, and systemic chemotherapy.
Carcinoma, Hepatocellular* ; Drug Therapy* ; Humans ; Incidence ; Liver ; Lung* ; Lymph Nodes ; Metastasectomy ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy* ; Recurrence

Hepatocellular carcinoma (HCC) is one of the most critical global health issues. With frequent association of viral liver disease, HCC is highly complex, harboring both cancer and chronic liver disease. The tumor stage and underlying liver function are both major determinants of the treatment selection as well as prognosis in HCC patients, thus allowing no more than a 20% chance for potentially curative therapies. Radiotherapy technology has been evolved remarkably during the past decade, and radiation can be precisely delivered, thereby permitting higher doses to the tumour and reduced doses to surrounding normal tissues. There has been increasing interest in the merits of radiotherapy in HCC over the past few years, as indicated by a Pub Med search. Radiotherapy has been used as the definitive therapy with curative intent in early stage tumours. It has been used also in combination with TACE for intermediate stage tumours. In locally advanced tumours, radiotherapy has been combined with systemic agents. Despite its efficacy, radiotherapy has not yet been incorporated into the standard management guidelines of HCC. The lack of high evidence level data, especially randomized controlled trials, has posed an obstacle in including radiotherapy into the routine treatment schema of HCC. Therefore, well-designed prospective studies are strongly recommended using developing technology for radiotherapy alone or combination therapies. Also, many issues such as the optimal dose-fractionation, intra- or extrahepatic metastasis after radiotherapy, and radiation-induced hepatic dysfunction remain to be solved. In this review, current status of radiotherapy for HCC will be discussed with regard to technical consideration and combination strategy. The limitation and future perspectives will also be discussed.
Carcinoma, Hepatocellular/drug therapy/radiography/*radiotherapy ; Humans ; Liver/radiation effects ; Liver Neoplasms/drug therapy/radiography/*radiotherapy ; Neoplasm Metastasis ; Radiation Dosage ; Radiotherapy, Adjuvant/adverse effects/methods ; Treatment Outcome

Several anticancer chemotherapeutic agents (5-fluorouracil, adriamycin and cisplatinum) and desferrioxamine, an iron chelator, were tested with regard to cytotoxicity and to the combined effect on radiation induced cell killing using two human hepatoma cell lines (HepG2 and PLC/PRF/5). Survival fractions were measured by quantitative colorimetric assay (MTT assay) and dose-response curves were plotted. MTT assay could be successfully used in the assessment of radiosensitivity in addition to chemosensitivity, because a good linear relationship between optical densities and cell numbers was observed and cells approached exponential growth for the first 7 days of culture when 5 x 10(3) or less cells were inoculated per well in our study. Steepness of the final slope (D0), width of the shoulder (D0) and the extrapolation number (n) of radiation survival curves were 1061.72 rad, 226.43 rad and 1.25 respectively in HepG2 and 1091.38 rad, 268.42 rad and 1.29 respectively in PLC/PRF/5. After combining anticancer chemotherapeutic agents and desferrioxamine with radiation, the widths of the shoulders were decreased whereas sensitizer enhancement ratios were increased as the concentration of drugs increased in both cell lines. These results suggest that neither anticancer chemotherapeutic agents nor desferrioxamine enhance cell killing induced by radiation alone, but suggested the possibility that they inhibit the repair of radiation damage.
Antineoplastic Agents/*pharmacology ; Carcinoma, Hepatocellular/*drug therapy/*radiotherapy ; Deferoxamine/*pharmacology ; Human ; Liver Neoplasms/*drug therapy/*radiotherapy ; Support, Non-U.S. Gov't ; Tumor Cells, Cultured/drug effects/radiation effects

PURPOSE: The adrenal gland is one of most the common sites for an extrahepatic metastasis from a hepatocellular carcinoma (HCC). However, there are no definitive guidelines for the treatment of adrenal metastasis. This study examined the effect of each therapeutic modality in an attempt to clarify the treatment strategy for adrenal metastases from a HCC. METHODS: This study reviewed the records of 11,770 consecutive HCC patients in the Yonsei University Medical Center from 1991 to 2005. Among the 11,770 patients, 648 were diagnosed with an extrahepatic metastasis. Of the extrahepatic metastases, 45 (6.9%) had an adrenal metastasis. Among these 45 patients, 15 patients with multiorgan metastases including the adrenal gland were excluded leaving 30 patients for review. The survival duration was evaluated according to the treatment modality, which included an adrenalectomy, non-surgical treatment (TACE, Chemotherapy), and conservative treatment. RESULTS: There were 24 men and 6 women, and the average age was 52.3 years (+/-9.1 years). The location of the adrenal metastasis was in the Rt, Lt, and both glands in 17 (56.7%), 9 (30.0%), and 4 (13.3%) patients, respectively. The initial HCC had been treated by a hepatectomy in 6 patients, and by non-surgical treatments such as TACE, chemotherapy and radiotherapy in 24 patients. The adrenal metastasis was treated by an adrenalectomy in 5 patients, by non-surgical treatment in 19 patients, and by conservative treatment in 6 patients. The overall median survival duration in the 30 cases was 11.1 months. The median survival time of the adrenalectomy, non-surgical treatment and conservative treatment groups was 21.4 months, 11.1 months, and 2.2 months respectively. The difference in the cumulative survival according to the treatment modality was statistically significant. CONCLUSION: The prognosis of an adrenal metastasis from HCC is quite poor. However, an adrenalectomy for an adrenal metastasis from a HCC is a safe procedure, and an acceptable way of achieving long-term survival.
Academic Medical Centers ; Adrenal Glands ; Adrenalectomy ; Carcinoma, Hepatocellular* ; Drug Therapy ; Female ; Hepatectomy ; Humans ; Male ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy

Curative treatment of hepatocellular carcinoma (HCC) with portal vein invasion is difficult to achieve, and the prognosis is dismal. Combining external beam radiotherapy (EBRT) with hepatic arterial infusion chemotherapy (HAIC) has shown favorable local therapeutic effects for patients with HCC exhibiting portal vein invasion. Stereotactic body radiotherapy (SBRT) is a recently developed EBRT modality that shows excellent tumor control. The combination of SBRT and HAIC for HCC with portal vein invasion has not been well-studied. We report a patient with HCC and portal vein invasion who achieved 15 months of survival with complete response status after combination SBRT and HAIC. The patient later experienced grade 3 biliary stricture and died of liver abscesses of unknown etiologies that subsequently appeared.
Carcinoma, Hepatocellular ; Constriction, Pathologic ; Drug Therapy ; Humans ; Liver Abscess ; Portal Vein ; Prognosis ; Radiosurgery ; Radiotherapy ; Therapeutic Uses ; Venous Thrombosis

Hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) is a rare and intractable disease. A standard treatment has not been established yet, owing to the rarity of disease and difficulties in the therapeutic treatment. Herein, we report the case of a patient who had recurrent HCC (after a prior lobectomy) involving both IVC and RA and underwent multimodality treatments including external beam radiotherapy and transarterial chemotherapy, followed by sorafenib treatment. The disease was well controlled with local treatments and sustained for 7 years until last follow-up after the systemic treatments. Our case shows a possibility of long-term survival for patients affected by HCC involving IVC and/or RA, after a rigorous multimodality treatment strategy.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Heart Atria ; Humans ; Liver Neoplasms ; Radiotherapy ; Vena Cava, Inferior

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) exhibits poor prognosis. The aim of this study is to evaluate factors associated with survival of HCC patients with PVTT to suggest better therapeutic options. METHODS: Patients with HCC which were newly diagnosed at three tertiary hospitals between January 2004 and December 2012, were reviewed retrospectively. Among them, Barcelona Clinic of Liver Cancer stage C patients with PVTT were identified. Factors affecting overall survival (OS) were analyzed and efficacies of the treatment modalities were compared. RESULTS: Four hundred sixty five patients with HCC and PVTT were included. Liver function, tumor burden, presence of extrahepatic tumor, alfa fetoprotein, and treatment modalities were significant factors associated with OS. Treatment outcomes were different according to the initial modalities. OS of the patients who received hepatic resection, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), sorafenib, systemic cytotoxic chemotherapy, radiation therapy (without combination), and supportive care were 27.8, 7.1, 6.7, 5.3, 2.5, 3.0, 1.8, and 0.9 months, respectively (P<0.001). Curative-intent treatments such as hepatic resection or RFA were superior to noncurativeintent treatments (P<0.001). TACE or HAIC was superior to sorafenib or systemic chemotherapy (P<0.001). Combining radiotherapy to TACE or HAIC did not provide additional benefit on OS (P=0.096). CONCLUSIONS: Treatment modalities as well as baseline factors significantly influenced on OS of HCC patients with PVTT. Whenever possible, curative intent treatments should be preferentially considered. If unable, locoregional therapy would be a better choice than systemic therapy in HCC patients with PVTT.
Carcinoma, Hepatocellular* ; Catheter Ablation ; Drug Therapy ; Fetal Proteins ; Humans ; Liver ; Liver Neoplasms ; Portal Vein* ; Prognosis* ; Radiotherapy ; Retrospective Studies ; Tertiary Care Centers ; Thrombosis* ; Tumor Burden