Journal of Vascular and Interventional Radiology
Multidisciplinary Management of Hepatocellular Carcinoma
Section snippets
CHALLENGE OF HCC
Many factors contribute to the difficulty in treating HCC. First, the presence and degree of co-existing cirrhosis are variables that affect all potential treatment options. Liver function in patients with HCC may be anywhere in the spectrum from normal to severely decompensated. Cirrhosis is present in up to 90% of all HCC cases (4, 5). In the United States, the percentage of HCC patients with Child-Pugh C cirrhosis varied from 4% in a series of patients selected for surgery to 47% in
MULTIDISCIPLINARY APPROACHES TO RESECTION AND TRANSPLANTATION
In general, surgical management (resection or transplantation) is considered the ideal treatment for HCC. Advances in surgical technique and perioperative care have decreased operative morbidity and mortality, even in patients with cirrhosis (10). With proper patient selection, postresection 5-year survival rates of at least 35% have been reported (11). After resection, however, the remaining cirrhotic liver is at high risk for the subsequent development of HCC. Seventy percent of patients
NONSURGICAL TREATMENT OPTIONS
Although multidisciplinary approaches to HCC can improve outcomes for resection and OLT, most patients are unsuitable for surgical therapies at presentation owing to tumor stage, degree of cirrhosis, or both. Therefore, nonsurgical therapies play a central role in this disease (21).
Regional and local ablation techniques are detailed elsewhere in this supplement. Percutaneous ethanol injection (PEI) has a well-documented role in the treatment of small HCC, with results that compare favorably
MULTIDISCIPLINARY CARE OF THE PATIENT WITH HCC
As seen earlier, the integration of multiple therapies has allowed more HCC patients to be treated with transplantation or resection by achieving greater response rates. The choice and sequence of therapies must be individualized with the dual goals of preservation of liver function and maximal tumor response in this patient population with varying degrees of compromised liver function. The invasive therapies must then be melded with preventative approaches, antiviral therapy, surveillance,
References (27)
Hepatocellular carcinoma
J Hepat
(2000)- et al.
Passive imminoprophylaxis after liver transplantation in HBs AG-positive patients
Lancet
(1991) - et al.
Nonsurgical treatment of hepatocellular carcinoma
Cancer J
(1997) - et al.
Rising incidence of hepatocellular carcinoma in the United States
N Engl J Med
(1999) - et al.
Treatment of hepatocellular carcinoma associated with cirrhosis in the era of liver transplantation
Ann Intern Med
(1998) - et al.
Current treatment modalities for hepatocellular carcinoma
Ann Surg
(1994) - et al.
Preoperative hepatic artery chemoembolization followed by orthotopic liver transplantation for hepatocellular carcinoma
Liver Transpl Surg
(1999) - et al.
Multimodality treatment of hepatocellular carcinoma in a hepatobiliary specialty center
Arch Surg
(1996) Clinical, pathologic and etiologic heterogeneosity in hepatocellular carcinoma: evidence from South Africa
Hepatology
(1981)- et al.
Neoadjuvant and adjuvant therapy for operable hepatocellular carcinoma
Cochrane Database of Systematic Reviews
(2000)
Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis
Arch Surg
Hepatic resection for hepatocellular carcinoma: an audit of 343 patients
Ann Surg
Indications for and effectiveness of second hepatic resection for hepatocellular carcinoma
Hepatogastroenterology
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Palliative Care for People With Hepatocellular Carcinoma, and Specific Benefits for Older Adults
2018, Clinical TherapeuticsCitation Excerpt :However, little has been written about the best ways to integrate these services into existing models of HCC care. Palliative care delivery to patients with HCC may ideally be connected to the multidisciplinary tumor board, as previously described.50–53 There is observational evidence that patients managed through a multidisciplinary tumor board have higher rates of therapy and longer survival.6,54
Determinants and outcomes of adherence to recommendations from a multidisciplinary tumour conference for hepatocellular carcinoma
2014, HPBCitation Excerpt :Because the management of patients with HCC is complex, a multidisciplinary approach is crucial.11,12 Increased survival in patients with cirrhosis who develop HCC has been demonstrated in recent years.13 This is likely to in part reflect the imposition of standardized screening guidelines, advances in therapy, and perhaps the tool of interdisciplinary collaboration.
Contrast-enhanced Ultrasound as a Predictor of Treatment Efficacy within 2 Weeks after Transarterial Chemoembolization of Hepatocellular Carcinoma
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2007, Journal of Vascular and Interventional RadiologyHepatocellular carcinoma: Overcoming challenges in disease management
2006, Clinical Gastroenterology and HepatologyTreatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (therasphere): Safety, tumor response, and survival
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Neither author has identified a conflict of interest.