OBJECTIVETo compare the effectiveness of percutaneous microwave ablation ( MWA) versus hepatectomy for multifocal hepatocellular carcinoma.

METHODSFrom August 2002 to March 2012, one hundred and twenty-two patients with multifocal hepatocellular carcinoma (diameters 1 to 7 cm, 2 to 4 lesions) were treated by either complete MWA or radical hepatectomy, and their clinical data were collected and analyzed.The patients were divided into MWA group (n = 50) and resection group (n = 72), and the resection group was matched by MWA group based on clinical parameters. The survival and complications in the two groups were compared.

RESULTSThe overall 1-, 3- and 5-year survival rates were 100.0%, 73.0% and 62.0%, respectively, in the MWA group, and 80.0%, 56.0%, and 41.0%, respectively, in the resection group (P < 0.05). The corresponding recurrence-free survival rates were 88.0%, 63.0%, and 52.0% in the MWA group, and 68.0%, 45.0%, and 36.0%, respectively, in the resection group (P< 0.05). The multivariate Cox regression analysis indicated that albumin level, performance status, treatment modality, and tumor size were independent prognostic factors.

CONCLUSIONCompared with hepatectomy, percutaneous microwave ablation is a minimally invasive and reproducible procedure, and can improve the survival in patients with multifocal hepatocellular carcinoma.

Carcinoma, Hepatocellular ; mortality ; radiotherapy ; surgery ; Catheter Ablation ; Genetic Engineering ; Hepatectomy ; mortality ; Humans ; Liver Neoplasms ; mortality ; radiotherapy ; surgery ; Microwaves ; therapeutic use ; Regression Analysis ; Survival Rate ; Treatment Outcome

BACKGROUND: Craniofacial resection (CFR) has been regarded as a standard treatment for various tumors involving the anterior skull base. The purpose of this study was to evaluate the results of CFR for the patients with anterior skull base malignancies in our hospital. METHODS: We retrospectively analyzed 17 patients with anterior skull base malignancies treated with CFR between 2001 and 2012. Mean follow-up duration was 41 months (range, 2-103 months). RESULTS: Intracranial involvement was found in 11 patients (65%) and orbital extension in 6 patients (35%). Classical bifrontal craniotomy was combined with endoscopic endonasal approach in 14 patients and external approach in 3 patients. Vascularized flap was used for reconstruction of the anterior fossa floor in 16 patients (94%). The most common pathological type was squamous cell carcinoma (6 patients). Gross total resection was achieved in all cases. Postoperative complications developed in 4 patients (24%) and included local wound problem and brain abscess. One patient with liver cirrhosis died from unexpected varix bleeding after the operation. Although postoperative treatment, such as radiotherapy or chemotherapy, was performed in 14 patients, local recurrence was seen in 6 patients. The mean overall survival time after the operation was 69.0 months (95% confidence interval: 47.5-90.5 months) with a 1-, 2-, and 5-year survival rate of 82.3%, 76.5%, and 64.7%, respectively. Postoperative radiotherapy was found to be the powerful prognostic factor for favorable survival. CONCLUSION: Considering the higher local control rate and acceptable complication or mortality rate, CFR with adjuvant radiotherapy is a gold standard treatment option for malignant tumors involving anterior skull base, especially with extensive intracranial involvement.
Brain Abscess ; Carcinoma, Squamous Cell ; Cranial Fossa, Anterior ; Craniotomy ; Drug Therapy ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Liver Cirrhosis ; Mortality ; Orbit ; Paranasal Sinus Neoplasms ; Postoperative Complications ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Skull Base* ; Skull* ; Survival Rate ; Treatment Outcome ; Varicose Veins ; Wounds and Injuries

BACKGROUND: Metastatic pathological fractures of the spine are a major problem for cancer patients; however, there is no consensus on treatment strategy. The purpose of this study was to evaluate various treatment options by analyzing their patterns for metastatic pathological fractures of the spine. METHODS: In this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic pathological fractures of spine were recruited. Demographic data, origin of cancer, type of treatment, and results were obtained from electronic medical records. Treatment options were divided into radiotherapy (RT), vertebroplasty (VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results were defined as aggravation, no response, fair response, good response, and unknown. The survival time after detection of pathologic fractures was analyzed with the Kaplan-Meier method. RESULTS: The mean age of the patients was 62.3 years. Hepatocellular carcinoma was the most common cancer of primary origin (n = 9), followed by multiple myeloma (n = 8). RT was the most common primary choice of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n = 10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or good response. The mean survival time following detection of pathological spinal fractures was 11.1 months for 29 patients, who died during the study period. CONCLUSIONS: RT was the most common primary choice of treatment for metastatic pathological fractures of the spine. However, the response rate was suboptimal. Although OP should be considered for the relief of mechanical back pain or neurologic symptoms, care should be taken in determining the surgical indication. VP or KP could be considered for short-term control of localized pain, although the number of cases was too small to confirm the conclusion. It is difficult to determine the superiority of the treatment modalities, hence, a common guideline for the diagnosis and treatment of metastatic pathological fractures of the spine is required.
Carcinoma, Hepatocellular/mortality/pathology ; Female ; Humans ; Liver Neoplasms/mortality/pathology ; Male ; Middle Aged ; Multiple Myeloma/mortality/pathology ; Retrospective Studies ; Spinal Fractures/etiology/mortality/*radiotherapy/*surgery ; Spinal Neoplasms/*complications/secondary ; Spine ; Treatment Outcome

BACKGROUND/AIMS: Spinal metastases often severely limit the quality of life by causing severe pain and neurological deficits. The purpose of this study was to evaluate the palliative effect of radiotherapy (RT) for spinal metastases from hepatocellular carcinoma (HCC) and to identify factors predictive of survival in HCC patients with spinal metastases who received RT. METHODS: A retrospective analysis was performed on 192 patients with spinal metastases from HCC who received RT. RESULTS: Of 192 patients with spinal metastases from HCC, an overall pain response to palliative RT occurred in 187 patients (97.4%), with a complete pain response (CR) in 41 patients (21.4%) and a partial response in 151 patients (78.6%). A higher biologically effective dose (BED) and more advanced RT techniques were identified as predictive factors for a CR. The 1- and 2-year overall survival (OS) rates were 18.1% and 6.3%, respectively, and the median survival time was 4.5 months. A long OS was associated with good performance status, controlled primary HCC, absence of extrahepatic metastases, and a higher BED. CONCLUSIONS: RT provided effective palliation for patients with painful spinal metastases from HCC. Our results provide information regarding pain control, survival outcomes, and predictive factors for the prognosis of HCC patients with spinal metastases treated with RT.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/mortality/*pathology ; Female ; Humans ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Pain/etiology/radiotherapy ; Pain Management/methods ; Palliative Care/*methods ; Retrospective Moral Judgment ; Spinal Neoplasms/mortality/radiotherapy/*secondary ; Survival Analysis ; Treatment Outcome ; Young Adult

PURPOSE: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients. MATERIALS AND METHODS: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors. RESULTS: In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70-99% necrosis. A high level of necrosis (> or =80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015). CONCLUSION: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.
Adult ; Aged ; Antimetabolites, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/mortality/pathology/*therapy ; Chemoradiotherapy/*methods ; Cisplatin/administration & dosage ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Humans ; Liver Neoplasms/mortality/pathology/*therapy ; Male ; Middle Aged ; Prognosis ; Radiotherapy, Conformal ; Remission Induction ; Republic of Korea/epidemiology ; *Salvage Therapy ; Survival Rate ; Treatment Outcome ; Tumor Burden

The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose > or = 80 Gy10 were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy10 is required for BCLC-C stage.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*radiotherapy ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Liver Failure/etiology ; Liver Neoplasms/mortality/*radiotherapy ; Male ; Middle Aged ; Myelitis/etiology ; Neoplasm Staging ; Prognosis ; Radiation Dosage ; Retrospective Studies ; Severity of Illness Index ; Stereotaxic Techniques ; Survival Rate

Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a two-week interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.
Adult ; Carcinoma, Hepatocellular/mortality/radiotherapy/*therapy ; Combined Modality Therapy ; *Embolization, Therapeutic ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality/radiotherapy/*therapy ; Male ; Middle Aged ; Prognosis ; Severity of Illness Index

BACKGROUND/AIMS: This study was conducted to investigate the assessment of treatment efficacy of radiotherapy (RT) and other therapeutic modalities compared with palliative care only for treatment with advanced hepatocellular carcinoma (HCC). METHODS: From 2002 to 2010, based on the case of 47 patients with advanced HCC, we have investigated each patients' Child-Pugh's class, ECOG performance, serum level of alpha fetoprotein and other baseline characteristics that is considered to be predictive variables and values for prognosis of HCC. Out of overall patients, the 29 patients who had received RT were selected for one group and the 18 patients who had received only palliative care were classified for the other. The analysis in survival between the two groups was done to investigate the efficacy of RT. RESULTS: Under the analysis in survival, the mean survival time of total patients group was revealed between 30.1 months and 45.9 months in RT group, while it was 4.8 months in palliative care group, respectively. In the univariate analysis for overall patients, there were significant factors which affected survival rate like as follows: ECOG performance, Child-Pugh's class, the tumor size, the type of tumor, alpha fetoprotein, transarterial chemoembolization, and RT. The regressive analysis in multivariate Cox for total patients. No treatment under radiotherapy and high level of Child-Pugh's class grade were independent predictors of worse overall survival rate in patients. In contrast, for the subset analysis of the twenty-nine patients treated with radiotherapy, the higher serum level of alpha fetoprotein was an independent predictors of worse overall survival rate in patients. CONCLUSIONS: We found that the survival of patients with advanced HCC was better with radiotherapy than with palliative care. Therefore, radiotherapy could be a good option for in patients with advanced HCC.
Aged ; Carcinoma, Hepatocellular/mortality/pathology/*radiotherapy ; Chemoembolization, Therapeutic ; Cohort Studies ; Female ; Humans ; Liver Neoplasms/mortality/pathology/*radiotherapy ; Male ; Middle Aged ; *Palliative Care ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; alpha-Fetoproteins/analysis

We performed a retrospective review of 281 hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with radiation therapy (RT) between 1998 and 2008 to develop a prognostic model for those patients. Of the 281 patients, PVTT and intrahepatic main masses completely disappeared in 10 patients (3.6%), and shown a partial response in 141 patients (50.2%). The median survival was 11.6 months. Patients who had more than PR have shown significantly longer survival than the others (22.0 months vs 5.0 months, P < 0.001). On the multivariate analysis, pre-treatment poor prognosticators for overall survival were ECOG performance status, Child-Pugh class, multiple tumors, main PVTT, complete portal vein occlusion, lymph node metastasis, and primary tumor size. Prognostic index of RT for PVTT of HCC (PITH) scores were defined as the number of pre-treatment poor prognostic factors. PITH scores correlated well with overall survival. In the analysis of 1 and 2 yr overall survival rate, patients who had PITH scores of 3 or greater showed a significantly lower rate of overall survival than the others (33.0%, 17.3% vs 70.1%, 40.8%, respectively, P < 0.001). The PITH scoring model, proposed in the current study in HCC patients with PVTT, reliably predict overall survival.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/complications/mortality/*radiotherapy ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/complications/mortality/*radiotherapy ; Male ; Middle Aged ; Neoplasm Staging ; *Portal Vein ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/mortality/*radiotherapy

BACKGROUND AND AIMS: We investigated the five-year survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients who were treated at a single institute, and this is a follow-up study of a previous report. METHODS: Nine hundred four HCC patients who were treated at the National Cancer Center Korea were enrolled and they were followed till February 2007. RESULTS: The mean age of the patients was 56.0 years and 731 patients were male. Six hundred seventy-seven (74.9%) patients died and the overall 5-year survival rate (5-YSR) was 23.9%. The 5-YSRs of the patients with modified UICC stage I, II and III were 61.2%, 54.4% and 18.4%, respectively, and the median survival time was 4.3 and 3.7 months for the stage IVa and IVb patients, respectively. For the analysis of the treatment modality, surgical resection showed significantly better outcomes for the five-year survival as compared with transcatheter arterial chemoembolization (TACE) for Child-Pugh A patients with modified UICC stage I or II disease (80.1% vs 52.8%, respectively, P<.001), or stage III disease (60.7% vs 17.0%, respectively, P<.001). For patients with advanced stage IVb disease, TACE, systemic chemotherapy and radiotherapy increased the median survival period more than conservative management for the Child-Pugh class A patients. The serum alpha-fetoprotein level, portal vein tumor thrombosis, the Child-Pugh class, the tumor stage, the tumor type and symptoms were related to the prognosis. CONCLUSIONS: This study presented, for the first time, the 5-YSRs of a cohort of HCC patients.
Aged ; Carcinoma, Hepatocellular/etiology/*mortality/surgery ; Chemoembolization, Therapeutic ; Cohort Studies ; Combined Modality Therapy ; Female ; Humans ; Korea ; Liver Neoplasms/etiology/*mortality/surgery ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Radiotherapy, Conformal ; Severity of Illness Index ; Survival Rate