Chemotherapy of Primary Liver Cancer

Falkson, Geoffrey; Coetzer, Buks

doi:10.1007/978-4-431-68349-0_24

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…Its use is currently reserved for cases in which no other treatment is possible. [116][117] The place for nonsurgical treatment in conjunction with transplantation is vigorously pursued especially to compensate for the increased waiting time.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in association with hepatocellular carcinoma: An update of the International Tumor Registry

Molmenti

Klintmalm

2002

Liver Transplantation

122

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Hepatocellular carcinoma is an epithelial tumor derived from hepatocytes that accounts for more than 80% of all primary hepatic tumors. The severity of the underlying disease is almost always the key factor in deciding whether to consider liver resection or transplantation as its treatment. Data in our registry corresponding to almost 800 patients from transplant centers throughout the world showed that patient survival after liver transplantation was significantly affected by histologic grade, tumor size >5 cm, and the presence of positive nodes. Recurrencefree survival showed a correlation with tumor size >5 cm, positive nodes, bilobar spread, and vascular invasion. At the present time, 59% of patients in our registry are alive, 84% of whom are free of tumor. Of those who died, half did so without evidence of tumor. (Liver Transpl 2002;8: 736-748.) P rimary hepatic tumors can be epithelial, mesenchymal, or mixed in nature. Hepatocellular carcinoma (HCC), an epithelial tumor derived from hepatocytes, accounts for more than 80% of all such malignancies. It affects men three times more frequently than women and is almost always associated with underlying hepatic cirrhosis. 1,2 There is a strong association between hepatitis B (HBV) and HCC, especially in non-Western countries. [3][4][5][6] In Western countries, cirrhosis associated with alcoholism and hepatitis C (HCV) infection shows the strongest association. 1,7 When associated with cirrhosis, HCC usually presents as a nodular, encapsulated, and well-circumscribed tumor. In advanced stages it becomes infiltrative or expansile with associated satellite lesions within the liver parenchyma. The right lobe of the liver tends to be involved more frequently than the left lobe. Multifocal tumors may or may not represent independent entities. Bilobar masses are not infrequent. Advanced cases show involvement of the portal vein sometimes manifest by a tumor thrombus. Hematogenous spread is more common than lymphatic dissemination. 1,8,9 Tumor cells may show a wide range of differentiation. 10,11 Ultrasound examination and serum alpha-fetoprotein levels are useful screening tools. Computerized tomography (CT) scanning has a detection rate for HCC lower than 70%. When combined with arteriography, sensitivity increases. Magnetic resonance imaging (MRI), especially in association with dynamic bolus gadolinium contrast, shows the highest detection rate. 1 Percutaneous fine needle biopsy (2% to 3% incidence of needle tract seeding) allows for histologic confirmation in cases of tumors with inconclusive characteristics. [12][13][14][15][16][17][18] At the time of diagnosis, 20% to 60% of small HCCs were found to be multifocal [19][20][21] and up to 30% of tumors in cirrhotic patients were understaged despite elaborate preoperative workups. 22 Materials and MethodsWe recently updated our worldwide registry, which now includes 973 patients, 790 of whom had a diagnosis of HCC. Three percent of these 790 patients had the fibrolamellar type of HCC. Seventy-three percent were male....

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Section: Discussionmentioning

confidence: 99%

Liver transplantation in association with hepatocellular carcinoma: An update of the International Tumor Registry

Molmenti

Klintmalm

2002

Liver Transplantation

122

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“…Hepatocellular carcinoma is a tumour that responds poorly to therapy with cytotoxic agents (Falkson et al 1978). One reason may be primary or acquired resistance of the hepatoma cells to the cytostatic drugs applied.…”

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confidence: 99%

Verapamil Potentiates 4′‐Epidoxorubicin Cytotoxicity in a Rat Hepatoma Cell Line and in a Substrain Resistant to 4′‐Epidoxorubicin

Hall¹,

Endresen

Rugstad³

1990

Pharmacology & Toxicology

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We have examined the influence of verapamil (VP) on the in vitro effect of 4'-epidoxorubicin (Epi-A) in a rat hepatocarcinoma cell line (MHlCl) and in an Epi-A resistant substrain. A VP concentration of 500 ng/ml (1.1 mumol/l) markedly potentiated the cytotoxic effect of Epi-A in the parent line. The resistant cells grow at an Epi-A concentration of 7500 ng/ml (12.9 mumol/l). This is approximately 15-fold higher than the concentration tolerated by parental cells. In these cells VP reversed the acquired resistance to Epi-A in a concentration dependent manner; thus, a concentration in the range of 500-750 ng/ml (1.1-1.7 mumol/l) of VP restored the sensitivity to Epi-A in the resistant cells. Our results demonstrate that VP increases the sensitivity to Epi-A in hepatocarcinoma cells never exposed to this drug, as well as in hepatocarcinoma cells with acquired Epi-A resistance.

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“…diagnosis of a malignant liver tumor is often establish ed too late, the tumor being already unrcsectable, either for technical reasons, or because of coincidental cirrhosis with limited residual liver function. In this situation, survival time is reduced to a few months only and quality of life is poor because the fast growing tumor causes jaundice and pain and the patients are left with hopelessness [9], For those patients, total hepatectomy with orthotopic liver transplantation (OLT) is the only therapeutic modality with, at least theoretically, a chance for cure.…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation for Liver Cancer

Steffen¹,

Neuhaus²,

Blumhardt³

et al. 1991

Oncol Res Treat

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Since its pioneer days, liver transplantation for malignant liver tumors has decreased worldwide, the present percentage within Europe being roughly 15%. There are mainly two reasons for this decrease: First, liver transplantation has matured to an officially recognized therapy for a wide variety of benign endstage liver diseases, favoring patients with these indications in the competition for the sparse donor organs. Secondly, the overall results in tumor patients remained discouraging with unacceptably high, inevitably lethal tumor recurrence rates. In this article, a review of the literature is presented along with our own restrictive concept based mainly on the encouraging Pittsburgh experience with small ( < 5cm largest diameter), solitary hepatocellular carcinomas (HCC). Eight (=7%) of our first 114 patients were transplanted for unresectable liver cancers, six of them are presently without tumor recurrence (three to 23 months observation time). One patient died from tumor recurrence and one from tumor unrelated complications. In addition, four patients were found to have incidental carcinomas: Three HCC, all alive and without tumor and one cholangiocarcinoma presenting with peritoneal carcinomatosis five months postoperatively. Cholangiocarcinomas, metastatic liver disease (except neuroendocrine tumors), and sarcomas as well as extrahepatic tumor spread are excluded from transplantation at our institution. The importance, technique and timing of staging laparotomy is emphasized.

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Chemotherapy of Primary Liver Cancer

Cited by 13 publications

References 19 publications

Liver transplantation in association with hepatocellular carcinoma: An update of the International Tumor Registry

Liver transplantation in association with hepatocellular carcinoma: An update of the International Tumor Registry

Verapamil Potentiates 4′‐Epidoxorubicin Cytotoxicity in a Rat Hepatoma Cell Line and in a Substrain Resistant to 4′‐Epidoxorubicin

Liver Transplantation for Liver Cancer

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