In spite of the nice screening program using the state-of-the-art imaging modalities, most patients with hepatocellular carcinoma (HCC) are not eligible for curative resection due to poor hepatic functional reserve and multiplicity of the tumors. Therefore they greatly rely on percutaneous interventional procedures. Among these, transcatheter arterial chemoembolization and local ablation therapies including ethanol injection therapy or radiofrequency (RF) thermal ablation have gained wider acceptance for the local treatment of unresectable HCC with growing evidence of survival gain. Although we need more prospective randomized trials to determine the definite role of these interventional therapies, the current consensus is that they are safe and effective for the local control of small HCC and have a potential to replace definitive surgical options. In this review, the basic principles and published clinical results including long-term survival rates and complications are reviewed. The benefits and limitations of each therapy are also discussed.
Carcinoma, Hepatocellular/radiography/*therapy ; Combined Modality Therapy ; English Abstract ; Humans ; Liver Neoplasms/radiography/*therapy ; *Radiography, Interventional

No abstract available.
Tomography, X-Ray Computed ; Liver Neoplasms/*radiography/*therapy ; Humans ; *Chemoembolization, Therapeutic/methods ; Carcinoma, Hepatocellular/radiography/*therapy

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

With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.
Carcinoma, Hepatocellular/radiography/*therapy ; Chemoembolization, Therapeutic ; Cone-Beam Computed Tomography ; Hepatic Artery/radiography ; Humans ; Imaging, Three-Dimensional ; Liver Neoplasms/radiography/*therapy ; Severity of Illness Index

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

The prognosis for gastric cancer with liver metastasis continues to be poor. We present our preliminary findings from 4 cases of liver metastasis from gastric adenocarcinomas treated using radiofrequency ablation (RFA). Between 1995 and 2004, the clinical history and course of 4 patients who underwent radiofrequency ablation for liver metastases from gastric cancer were reviewed. Two patients with smaller metachronous metastasis are currently alive without recurrence at 16 and 14 months and the other patients with larger synchronous metastatic lesions died after 4 and 12 months after RFA. Although this study was limited to a few cases and had a short follow-up duration, our findings suggest that RFA may provide an alternative treatment modality for liver metastasis resulting from gastric adenocarcinoma. Additional study is needed with a larger group of patients and longer follow up to evaluate the efficacy of RFA.
Adenocarcinoma/radiography/*secondary/*therapy ; Adult ; Aged ; Catheter Ablation/*methods ; Humans ; Liver Neoplasms/radiography/*secondary/*therapy ; Male ; Middle Aged ; *Stomach Neoplasms ; Tomography, X-Ray Computed

Antineoplastic Agents ; administration & dosage ; Carcinoma, Hepatocellular ; therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms ; therapy ; Male ; Radiography, Interventional

A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved.
Venous Thrombosis/*complications ; Portal Vein ; Middle Aged ; Male ; Liver Neoplasms/complications/radiography/*therapy ; Humans ; *Chemoembolization, Therapeutic ; Carcinoma, Hepatocellular/complications/radiography/*therapy

OBJECTIVE: To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images. MATERIALS AND METHODS: Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient. RESULTS: Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p < 0.001). CONCLUSION: We can predict the tumor feeder with an accuracy of 85% as the first intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*blood supply/radiography/therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms/*blood supply/radiography/therapy ; Male ; Middle Aged ; *Multidetector Computed Tomography

Extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) occurs frequently. The most common site of metastasis is the lung, followed by regional lymph nodes and bones. However, gastrointestinal metastasis of HCC is a rare condition and solitary polypoid metastatic lesion on stomach without any evidence of direct invasion from primary mass is very rare. These metastatic lesions are usually asymptomatic, and most are discovered at postmortem examination or are found incidentally during laparotomy. The choice of treatment for gastrointestinal metastatic lesion of HCC includes surgery, transarterial chemoembolization, and local injection but the treatment is often difficult and unsuccessful. We report a case of 69 years old man who presented disappearance of a polypoid metastatic lesion of HCC on the gastric fundus by transarterial chemoembolization.
Aged ; Carcinoma, Hepatocellular/*diagnosis/secondary/therapy ; *Chemoembolization, Therapeutic ; Duodenoscopy ; Gastric Fundus/radiography ; Humans ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Stomach Neoplasms/*diagnosis/secondary/therapy ; Tomography, X-Ray Computed