We read with interest this article evaluating the results of transarterial radioembolization(TARE)in the management of large(≥5 cm)initially unresectable hepatocellular carcinoma(HCC)(1).The aim of this retrospective...We read with interest this article evaluating the results of transarterial radioembolization(TARE)in the management of large(≥5 cm)initially unresectable hepatocellular carcinoma(HCC)(1).The aim of this retrospective study was to compare the results of upfront resection(single,resectable large HCC)with resection preceded by TARE(single,initially unresectable large HCC).The authors retrospectively analyzed the 216 patients managed with a single HCC larger than 5 cm,between 2015 and 2020 in their center.Patients were divided into two groups:upfront surgery(n=144,66.7%)or TARE if considered unresectable(n=72,33.3%).Then,among those who had undergone TARE,a further dichotomy was made between those who had undergone surgery(“TARE-surgery”,n=20,9%)and those who had not(“TARE-only”,n=52,24%).展开更多
Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patient...Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization(TACE) and radiation therapy. Especially TACE,delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy,has given favorable results on local control and survival. Radiotherapy,as a therapeutic modality of internal radiation therapy with radioisotopes,has also achieved efficacious tumor control in advanced disease. On the contrary,the role of external beam radiotherapy for HCC has been limited in the past,due to the low tolerance of surrounding normal liver parenchyma. However,technological innovations in the field of radiotherapy treatment planning and delivery,have provided the means of delivering radical doses to the tumor,while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy,evaluated for efficacy and safety for HCC,report encouraging results. In this review,we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.展开更多
Hepatocellular carcinoma(HCC)is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally.Cure can be achieved for early stage HCC,which is defined as 3 or fewer lesions less ...Hepatocellular carcinoma(HCC)is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally.Cure can be achieved for early stage HCC,which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0.Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation(LT)also achieve curative outcomes.Traditionally,surgical resection,LT,and ablation are considered curative therapies for early HCC.However,results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC,leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC.This review is based on current evidence for curativeintent loco-regional therapies including radioembolization for early-stage HCC.展开更多
Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postop...Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear.We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction,especially for huge HCC in contact with the diaphragm.Methods:We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital.Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria:same diagnosis,same surgery,same American Society of Anesthesiologists(ASA)score,Child-Turcotte-Pugh(CTP)class,and similar tumor burden.Analysis was done using either a linear or logistic regression.Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications:oxygen flow on day 1,need for intensive oxygen therapy,and pleural effusion.Results:Twenty patients with comparable preoperative characteristics were included in each group.Eight patients(40%)in the SIRT group experienced a postoperative bile leak versus only 2(10%)in the other,with a significantly increased risk[odds ratio(OR)=6;95%confidence interval(CI):1.1-33.3;P<0.05].Similarly,the risk of large postoperative pleural effusion was increased after SIRT,with 6 patients(30%)against 0,respectively(OR=10.5;95%CI:1.8-61.4;P<0.05).Conclusions:SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.展开更多
文摘We read with interest this article evaluating the results of transarterial radioembolization(TARE)in the management of large(≥5 cm)initially unresectable hepatocellular carcinoma(HCC)(1).The aim of this retrospective study was to compare the results of upfront resection(single,resectable large HCC)with resection preceded by TARE(single,initially unresectable large HCC).The authors retrospectively analyzed the 216 patients managed with a single HCC larger than 5 cm,between 2015 and 2020 in their center.Patients were divided into two groups:upfront surgery(n=144,66.7%)or TARE if considered unresectable(n=72,33.3%).Then,among those who had undergone TARE,a further dichotomy was made between those who had undergone surgery(“TARE-surgery”,n=20,9%)and those who had not(“TARE-only”,n=52,24%).
文摘Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization(TACE) and radiation therapy. Especially TACE,delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy,has given favorable results on local control and survival. Radiotherapy,as a therapeutic modality of internal radiation therapy with radioisotopes,has also achieved efficacious tumor control in advanced disease. On the contrary,the role of external beam radiotherapy for HCC has been limited in the past,due to the low tolerance of surrounding normal liver parenchyma. However,technological innovations in the field of radiotherapy treatment planning and delivery,have provided the means of delivering radical doses to the tumor,while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy,evaluated for efficacy and safety for HCC,report encouraging results. In this review,we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.
文摘Hepatocellular carcinoma(HCC)is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally.Cure can be achieved for early stage HCC,which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0.Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation(LT)also achieve curative outcomes.Traditionally,surgical resection,LT,and ablation are considered curative therapies for early HCC.However,results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC,leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC.This review is based on current evidence for curativeintent loco-regional therapies including radioembolization for early-stage HCC.
文摘Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear.We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction,especially for huge HCC in contact with the diaphragm.Methods:We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital.Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria:same diagnosis,same surgery,same American Society of Anesthesiologists(ASA)score,Child-Turcotte-Pugh(CTP)class,and similar tumor burden.Analysis was done using either a linear or logistic regression.Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications:oxygen flow on day 1,need for intensive oxygen therapy,and pleural effusion.Results:Twenty patients with comparable preoperative characteristics were included in each group.Eight patients(40%)in the SIRT group experienced a postoperative bile leak versus only 2(10%)in the other,with a significantly increased risk[odds ratio(OR)=6;95%confidence interval(CI):1.1-33.3;P<0.05].Similarly,the risk of large postoperative pleural effusion was increased after SIRT,with 6 patients(30%)against 0,respectively(OR=10.5;95%CI:1.8-61.4;P<0.05).Conclusions:SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.
