OC.10.2: Hepatocellular Carcinoma (Hcc) in Cirrhosis: Long-Term Results of Percutaneous Radiofrequency Ablation of Both the Nodule and the Portal Venous Tumor Thrombus

Giorgio, Antonio; Stefano, Giuliano De; Sarno, Antonella Di; Farella, Nunzia; Scognamiglio, U.; Rogatis, A. De; Trapanese, Ersilio; Giorgio, Valentina

doi:10.1016/s1590-8658(11)60208-9

Cited by 7 publications

(12 citation statements)

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“…The initial search resulted in 2,779 citations for both questions. We eventually included 14 studies (three RCTs and 11 observational studies). Figure shows the study selection process.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen comparative studies compared several interventions to treat adults with CP class A or B cirrhosis and advanced HCC with macrovascular involvement. Eleven studies included advanced HCC patients with portal vein tumor thrombosis (PVTT). Summary of the evidence is presented in Table .…”

Section: Resultsmentioning

confidence: 99%

“…One observational study compared percutaneous RFA versus control. The study enrolled 57 advanced HCC patients with PVTT.…”

Section: Resultsmentioning

confidence: 99%

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Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: A systematic review and meta‐analysis

et al. 2017

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Hepatocellular carcinoma (HCC) is a complex disease most commonly arising in the background of chronic liver disease. In the past two decades, there has been a significant increase in our understanding of both the clinical and molecular heterogeneity of HCC. There has been a robust increase in clinical trial activity in patients with poor prognostic factors, such as macrovascular invasion and extrahepatic spread (EHS). We aimed to synthesize the evidence for the treatment of patients with advanced HCC based on these baseline characteristics, including patients with both Child-Pugh (CP) scores of A and B. A comprehensive search of several databases from each database inception to February 15, 2016 any language was conducted. We included 14 studies (three randomized controlled studies [RCTs] and 11 observational studies). We included studies that compared sorafenib, transarterial bland embolization/transarterial chemoembolization, yttrium-90/ radiation therapy, ablation (or combination), and no therapy. Two RCTs comparing sorafenib to best supportive care demonstrated a consistent improvement in overall survival (OS) for patients with advanced HCC and metastatic vascular invasion (MVI) and/or EHS and CP A liver disease (hazard ratio, 0.66 [95% confidence interval, 0.51-0.87]; I 2 5 0%). Several observational studies evaluated locoregional therapies alone or in combination with other treatments and were limited by very-low-quality of evidence. This was true for both patients with EHS and MVI. Conclusion: In patients with advanced HCC and CP A liver function, sorafenib is the only treatment that has been shown to improve OS in randomized studies. High-quality data supporting the use of other treatment modalities in this setting, or in the setting of patients with less compensated (CP B) liver disease, are lacking. (HEPATOLOGY 2018;67:422-435) T he optimal management of hepatocellular carcinoma (HCC) requires a multidisciplinary approach that brings together expertise in liver surgery, hepatology, interventional radiology, and medical oncology. Current recommendations for screening aim to identify smaller tumors that can be treated with curative intent with surgical resection, radiofrequency ablation (RFA), and/or liver transplant. (1) However, a large number of patients present with disease beyond criteria that would be considered for curative approaches.Historically there has been a large unmet need for systemic treatments in HCC. Only in 2008 were data with the multikinase inhibitor, sorafenib, shown to

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“…The initial search resulted in 2,779 citations for both questions. We eventually included 14 studies (three RCTs and 11 observational studies). Figure shows the study selection process.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: A systematic review and meta‐analysis

et al. 2017

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“…Several measures have been suggested to avoid complications from damage to hepatic hilum structures during RFA and MW ablation[ 46 ], however none of these approaches have been extensively applicated in large series. In 2009 and in 2014 Giorgio et al[ 16 , 17 ] published their long-term results of RFA in 35 HCC patients with Vp3 and/or Vp4 PVTT. They reported absence of major complications, complete recanalization of main portal trunk in 26/35 (74%) patients and cumulative survival rates at 1, 3, and 5 years of 63%, 30% and 20%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, all these therapies did not substantially modify prognosis in patients with PVTT in the main PV and/or its 1 st order branches (Vp3 and Vp4). Some previous isolated reports advocated a possible role of percutaneous ethanol injection (PEI)[ 15 ], RFA[ 16 , 17 ] or interstitial laser therapy (ILT)[ 18 ] in the treatment of Vp3-Vp4 PVTT. However, the use of PEI remains unreliable in such clinical settings because of the easy escaping of the ethanol in the blood stream and the high probability of producing neoplastic thrombi.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study

Tarantino¹,

Busto²,

Nasto³

et al. 2017

WJG

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AIMTo treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.METHODSSix patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.RESULTSPost-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.CONCLUSIONIn patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.

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Therapeutics for advanced hepatocellular carcinoma: Recent advances, current dilemma, and future directions

Zhu

Yin

et al. 2019

Journal Cellular Physiology

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Hepatocellular carcinoma (HCC) is one of the most common malignancies and is a serious threat to people's health worldwide. The prognosis of advanced HCC is dim if left untreated. In the clinic, the treatment options for advanced HCC include surgery, radiotherapy, transcatheter arterial chemoembolization, and so forth. In recent years, molecular targeted therapy and immunotherapy have also made great progress, bringing new hope to patients with advanced HCC. In this study, therapeutic advances, current dilemma, and future directions of advanced HCC are reviewed, which might serve as a summary for clinicians and may stimulate future research.

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OC.10.2: Hepatocellular Carcinoma (Hcc) in Cirrhosis: Long-Term Results of Percutaneous Radiofrequency Ablation of Both the Nodule and the Portal Venous Tumor Thrombus

Cited by 7 publications

References 0 publications

Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: A systematic review and meta‐analysis

Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: A systematic review and meta‐analysis

Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study

Therapeutics for advanced hepatocellular carcinoma: Recent advances, current dilemma, and future directions

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