Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion

Article Abstract:

Hepatocellular carcinoma (HCC) is a particularly deadly disease, and without treatment the average life expectancy is less than four months. This form of liver cancer is one of the most common malignant tumors in Asia and in sub-Saharan Africa. The best treatment is surgery, but for patients whose cancer has spread too far within the liver, surgery is impossible. However, treatment for these inoperable patients has been improved by the introduction of transcatheter embolization. In this method, a catheter is placed into a branch of the hepatic artery serving the region containing the cancer. This branch is then temporarily blocked, usually with a gelatin sponge. The embolization is usually combined with treatment with chemotherapeutic agents. In an effort to determine which factors most directly influence the response of a HCC patient to transcatheter embolization, researchers studied 250 patients in a prospective trial. Patients with Stage I or Stage II disease were randomized into one of three embolization protocols, while patients with Stage III disease were treated only with the third protocol; the three protocols differed primarily in the chemotherapy that accompanied the embolization. Efforts to catheterize the proper branch of the hepatic artery failed in 20 patients; these patients were treated only with an arterial infusion of chemotherapeutic agents. The two-year survival rates were greater than 60 percent for patients with early stage disease; the two-year survival rate was zero for patients receiving arterial infusion of chemotherapy only. Analysis of patient characteristics revealed that the most important influence on survival was the tumor type, not the treatment protocol. While the treatment protocol did have a significant effect on outcome, the results also showed that the liver functions cannot be ignored, and variables that reflect liver function are significant prognostic factors for the outcome of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery

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Spontaneous regression of hepatocellular carcinoma

Article Abstract:

A case is reported of a 63-year-old woman who had a four-month history of abdominal discomfort, along with bloating after eating, and a one-month history of loss of appetite, weight loss, and nausea without vomiting. Ultrasound scanning showed large tumor-like lesions of the liver, which was confirmed by a liver biopsy. Cancerous liver tissue was present in the biopsy material, which appeared to be hepatocellular carcinoma, cancer arising from liver cells. No treatment was administered. Five months later, the patient had no symptoms and had gained weight. X-ray, ultrasound scanning, and liver biopsy showed that the cancer had spontaneously regressed, although scar tissue remained. One year after the original diagnosis, the woman was well and liver function tests were normal. Hepatocellular carcinoma is the most common malignancy worldwide, although it is rare in Britain, the origin of this patient. Patient survival is usually six months. The cancer is three times more prevalent in men, and is related to alcohol abuse, chronic liver disease, and hepatitis B infection. Treatment is mostly unsuccessful, whether surgical or medical (using drugs). Spontaneous regression of cancer has been previously documented, but the mechanisms of regression are poorly understood. The diagnosis of cancer in this case was confirmed by biopsy, as well as other tests, so it may be stated with confidence that this patient experienced a spontaneous regression of her disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Spontaneous regression of hepatocellular carcinoma

Article Abstract:

Hepatocellular carcinoma, a type of liver cancer, is usually in an advanced stage by the time symptoms appear. As a result, the cancer is often rapidly fatal, and the average survival time is less than four months from diagnosis. Improvements in diagnostic imaging can result in earlier diagnosis, and some cases of long-term survival have been reported. Also reported are cases in which the cancer seemed to spontaneously regress. Unfortunately, the apparent regression was not confirmed by the examination of autopsy material. However, in the case of a 63-year-old man with cirrhosis of the liver, the apparent spontaneous regression of hepatocellular carcinoma has been confirmed. The man survived two years after the initial, biopsy-proven, diagnosis of hepatocellular carcinoma, despite the fact he was not treated. The cancer seemed to regress, both on the basis of computed tomography scans and the normalization of alpha-fetoprotein observed in his blood. The patient experienced repeated hemorrhage of esophageal varices, which are enlarged, twisted veins in the esophagus, and died from complications resulting from these hemorrhages. When the patient's liver was examined, there was no evidence of cancer. This is the first case of apparent regression of hepatocellular carcinoma that has been conclusively confirmed by the examination of autopsy material. (Consumer Summary produced by Reliance Medical Information, Inc.)

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