How I Do It: Triaging Patients with Hepatocellular Carcinoma
| Autor: | Charles E. Ray, Janette D. Durham |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Sorafenib
Oncology medicine.medical_specialty Cirrhosis business.industry Selective internal radiation therapy medicine.disease Malignancy Article law.invention Surgery Randomized controlled trial law Hepatocellular carcinoma Internal medicine Medicine Radiology Nuclear Medicine and imaging Stage (cooking) Cardiology and Cardiovascular Medicine business Liver cancer medicine.drug |
| Zdroj: | Seminars in Interventional Radiology. 29:064-068 |
| ISSN: | 1098-8963 0739-9529 |
| DOI: | 10.1055/s-0032-1302454 |
| Popis: | Hepatocellular carcinoma (HCC) is a malignancy that is increasing in incidence in the United States (4.9 per 100,000) with mortality rates that remain close to 50% at 1 year, despite improvement in programs aimed at the prevention of cirrhosis and early detection of liver cancer in high-risk patients. Liver cancer is now the third cause of cancer-related death. Diagnosis at an advanced stage excludes >85% of patients from curative surgical therapies. Medical therapy remains of limited benefit for nonsurgical patients. Sorafenib has shown the most promising results for palliative therapy in HCC patients, imparting a 10-week survival benefit in patients with advanced disease. Liver-directed therapies provide alternatives to patients with HCC who are not considered surgical candidates. Radiofrequency ablation (RFA) has survival rates comparable with surgical resection in optimally selected patients with early disease; however, increasing size (>3 cm), multiple lesions (more than three), and central location limits application in patients with stage III disease and patients whose tumor location is adjacent to vascular structures or central bile ducts. Chemoembolization with single or multiple drugs mixed with ethiodized oil (cTACE) has the longest track record in the treatment of nonsurgical HCC patients and has been shown to improve survival in several randomized controlled trials compared with symptomatic treatment. Chemoembolization with drug-eluting beads (DEB) and selective internal radiation therapy (SIRT) with yttrium are newer therapies that appear to have similar efficacy and may be preferred in certain subpopulations. When to use them remains controversial because direct comparative evidence to guide choices is lacking. This article presents several common scenarios of patients presenting with HCC to highlight the clinical and anatomical factors that lead to a treatment decision. |
| Databáze: | OpenAIRE |
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