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A Case of Sarcomatoid Cholangiocarcinoma Which Developed at the Site Previously Treated by Transarterial Chemoembolization.

Changkun LEE ; Kyung Min KANG ; Hae Lim LEE ; Sung Won LEE ; Heejeong LEE ; Nam Ik HAN

Journal of Liver Cancer.2017;17(1):100-104. doi:10.17998/jlc.17.1.100

Intrahepatic sarcomatoid carcinoma is a rare tumor with poor prognosis due to its highly invasive and metastatic nature and difficulty for early detection. The most common form of intrahepatic sarcomatoid carcinoma is the sarcomatoid hepatocellular carcinoma, the development of which is usually associated with previous treatment for hepatocellular carcinoma. In contrast, sarcomatoid cholangiocarcinoma is extremely rare and results from spontaneous sarcomatoid transformation during the development of tumor. Here, we report a case of sarcomatoid cholangiocarcinoma, in a 58-year-old male, which developed at the site of previous treatment for hepatocellular carcinoma. A 9 × 7 cm sized tumor which had not been detected in the computed tomography exam 3 months before diagnosis was newly observed. The tumor rapidly progressed and the patient died only 31 days after the diagnosis.
Carcinoma, Hepatocellular ; Cholangiocarcinoma* ; Diagnosis ; Humans ; Male ; Middle Aged ; Prognosis

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A Case of Simultaneous Resection of Recurrent Combined Hepatocellular Cholangiocarcinoma and Hypovascular Hepatocellular Carcinoma.

Tae Hyung KIM ; Soon Ho UM ; Sang Jung PARK ; Seung Woon PARK ; Han Ah LEE ; Yeon Seok SEO ; Young Dong YU ; Dong Sik KIM ; Joo Young KIM

Journal of Liver Cancer.2017;17(1):94-99. doi:10.17998/jlc.17.1.94

Liver cancer is more complex to treat compared to cancers in other organs, since liver function should be considered. In addition, only a few patients can be applied curative treatment due to advanced stage at diagnosis. Therefore, early stage detection is important and has been increased through screening and surveillance programs using image modalities recently. However, it is still difficult to diagnose small or hypovascular hepatocellular carcinoma (HCC) even using advanced image modalties. In particular, hypovascular HCCs do not show arterial contrast enhancement which is a typical finding of HCC on computed tomography (CT) and magnetic resonance imaging (MRI). Those also account for a considerable portion of early HCC. We present 54 yearsold man who had recurrent hypervascular and hypovascular nodules on three phase CT and gadoxetic acid-enhanced MRI. The nodules were removed by surgical resection and confirmed as combined hepatocellular-cholangiocarcinoma and well differentiated HCC respectively.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Diagnosis ; Early Diagnosis ; Humans ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Mass Screening

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A Case of Achieving Complete Remission with Combination of Sorafenib and Tegafur in Patients with Hepatocellular Carcinoma with Progression of Disease after Sorafenib Therapy.

Sang Youn HWANG ; Seon Mi LEE ; Jung Woo IM ; Ki Jeong JEON ; Sang Bu AHN ; Jin Young PARK ; Cheol Won CHOI ; Kwang Mo YANG

Journal of Liver Cancer.2017;17(1):88-93. doi:10.17998/jlc.17.1.88

Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy.
Carcinoma, Hepatocellular* ; Disease Progression ; Humans ; Salvage Therapy ; Tegafur* ; Treatment Failure

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A Case of Advanced Hepatocellular Carcinoma with Long-term Post-progression Survival under Repeated Transarterial Chemoembolization after Sorafenib Failure.

Jihyun LEE ; Hwi Young KIM ; Yong Jin JUNG ; Tae Hun KIM ; Kwon YOO

Journal of Liver Cancer.2017;17(1):82-87. doi:10.17998/jlc.17.1.82

Hepatocellular carcinoma is the third leading cause of cancer related mortality worldwide. Only 30% of patients are eligible for curative surgical resection at diagnosis. For patients with advanced hepatocellular carcinoma with accompanying portal vein tumor thrombosis, Sorafenib is recommended as first-line treatment. However, survival gain from sorafenib is unsatisfactory, and there is no standard therapy for patients who are intolerable or refractory to sorafenib. Here we report a case of a 52-year-old man who initially achieved partial response after sorafenib treatment, but eventually showed disease progression and was treated subsequently with transarterial chemoembolization (TACE). Multinodular recurrence occurred, but he was treated with repeated TACE, and has survived for 4 years so far.
Carcinoma, Hepatocellular* ; Diagnosis ; Disease Progression ; Humans ; Middle Aged ; Mortality ; Portal Vein ; Recurrence ; Thrombosis

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A Case of a Patient with Hepatocellular Carcinoma and Lung Metastasis Who Failed Sorafenib Treatment and Achieved Complete Remission after Lung Resection and Radiation Therapy.

Jung Hwan YU ; Jung Il LEE

Journal of Liver Cancer.2017;17(1):77-81. doi:10.17998/jlc.17.1.77

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

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A Case of Hepatocellular Carcinoma with Pulmonary Metastasis Who Showed Complete Response by Cytotoxic Chemotherapy after Sorafenib Failure.

Hwa Sun PARK ; Jae Young JANG ; Min Young BAEK ; Yong Kwon KIM ; Hyun Jin YOUN ; Su Young BACK ; Soung Won JEONG ; Sae Hwan LEE ; Sang Gyune KIM ; Sang Woo CHA ; Young Seok KIM ; Young Deok CHO ; Hong Soo KIM ; Boo Sung KIM

Journal of Liver Cancer.2017;17(1):72-76. doi:10.17998/jlc.17.1.72

Hepatocellular carcinoma (HCC) is the 2nd most common cause of cancer related death in Korea and well-known malignancy with poor prognosis. Sorafenib is the first-line molecular targeted agent in patients with extra-hepatic spread of HCC. However, complete response is extremely rare in patients treated with sorafenib and the disease control rate is only 43%. We report a 53-year-old man with advanced HCC with pulmonary metastasis who showed complete response by cytotoxic chemotherapy with doxorubicin and cisplatin with relatively tolerable adverse effects after failure of treatment with sorafenib.
Carcinoma, Hepatocellular* ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Humans ; Korea ; Middle Aged ; Neoplasm Metastasis* ; Prognosis

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Factors Affecting Prognosis of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Implications for Future Therapeutic Strategies.

Sang Jun SUH ; Hyung Joon YIM ; Dong Won LEE ; Jong Jin HYUN ; Young Kul JUNG ; Ji Hoon KIM ; Yeon Seok SEO ; Jong Eun YEON ; Kwan Soo BYUN ; Soon Ho UM

Journal of Liver Cancer.2017;17(1):60-71. doi:10.17998/jlc.17.1.60

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

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Outcomes of Surgical Resection for Ruptured Hepatocellular Carcinoma.

Hae Won LEE ; Chang Sup LIM ; Hyo Sin KIM

Journal of Liver Cancer.2017;17(1):54-59. doi:10.17998/jlc.17.1.54

BACKGROUND/AIMS: Many recent studies have shown excellent outcomes of surgical resection for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after surgical resection. However, the impact of HCC rupture on recurrence and patient survival has not yet been clarified. METHODS: The medical data of patients who underwent surgical resection for ruptured HCC in our center between January 2011 and December 2015 were retrospectively reviewed. The outcomes of the patients were investigated. RESULTS: Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial chemoembolization (TACE) was performed for achieving hemostasis in four patients except one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one patient died due to HCC recurrence during the median follow-up duration of 28.3 months (range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0 months after resection was managed well by means of radiofrequency ablation and TACE and is now alive for 5 years without any evidence of viable tumor. However, the other patient who showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive treatments. CONCLUSIONS: Rupture of HCC might result in peritoneal seeding of the tumor in the early postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be the best treatment option yielding good survival, even for a ruptured HCC.
Carcinoma, Hepatocellular* ; Catheter Ablation ; Follow-Up Studies ; Hemostasis ; Humans ; Recurrence ; Retrospective Studies ; Rupture

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Selection of Proper Modality in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma.

Seo Hee CHOI ; Joong Yeol WOO ; Jinsil SEONG

Journal of Liver Cancer.2017;17(1):45-53. doi:10.17998/jlc.17.1.45

BACKGROUND/AIMS: As the optimal stereotactic body radiation therapy (SBRT) modality for hepatocellular carcinoma (HCC) has not been confirmed, we aimed herein to provide a practical guideline by our retrospective review. METHODS: Thirty-nine patients with primary HCC who underwent liver SBRT via 3 modalities (helical tomotherapy [HT]: 22, volumetric modulated arc therapy [VMAT]: 13, Cyberknife: 4) at our institution between July 2014 and July 2015 were included. Modalities were compared with regard to dose conformity index (CI), homogeneity index (HI), clinical results, and patient compliance. RESULTS: VMAT SBRT had favorable conformity (CI: 0.7±0.2), homogeneity (HI: 1.1±0.0), and shortest treatment time (100.2±26.1 seconds). HT SBRT yielded good dosimetric outcomes, especially in conformity (CI: 1.0±0.2). Although the Cyberknife SBRT synchrony system allowed real-time tumor targeting, the treatment time was longest (3,015.0±447.3 seconds), invasive pre-treatment procedures were required, and the HI (1.3±0.0) was lowest. CONCLUSIONS: All 3 modalities yielded competent dosimetric planning parameters. VMAT SBRT was most appropriate for tumors with residual lipiodol or patients with poor conditions. HT SBRT is available for multiple or irregular targets. Cyberknife SBRT is recommended for carefully selected patients and tumors indicated for sono-guided fiducial insertion.
Carcinoma, Hepatocellular* ; Ethiodized Oil ; Humans ; Liver ; Patient Compliance ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

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The General Rules for the Study of Primary Liver Cancer.

Jae Young JANG ; June Sung LEE ; Hyung Joon KIM ; Jae Jun SHIM ; Ji Hoon KIM ; Bo Hyun KIM ; Choon Hyuck KWON ; Seung Duk LEE ; Hae Won LEE ; Jung Hoon KIM ; Woo Kyoung JEONG ; Jin Young CHOI ; Heung Kyu KO ; Dong Ho LEE ; Haeryoung KIM ; Baek Hui KIM ; Sang Min YOON ; Won Sup YOON ; Soon Ho UM

Journal of Liver Cancer.2017;17(1):19-44. doi:10.17998/jlc.17.1.19

The General Rules for the Study of Primary Liver Cancer was published in June 2001 as the first edition. Since then, the 5th edition of the General Rules for the Study of Primary Liver Cancer was published by the 17th Committee of the Korean Liver Cancer Association based on the most recent data. The 5th edition of the General Rules for the Study of Primary Liver Cancer ranged over numerous topics such as anatomy, medical assessment of the patients, staging of hepatocellular carcinoma, description of the image findings, summary of hepatic resection, description of the surgical specimens, liver transplantation, reporting the pathological findings, pathological examinations of liver specimen, non-surgical treatment, radiotherapy, and assessment of tumor response after non-surgical treatment of hepatocellular carcinoma. The 5th General Rules for the Study of Primary Liver Cancer will not only become the basis of academic development for liver cancer studies in Korea, but also serve as the primary form of national liver cancer data accumulation based on standardized rules.
Carcinoma, Hepatocellular ; Humans ; Korea ; Liver Neoplasms* ; Liver Transplantation ; Liver* ; Radiotherapy

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