Local Therapies For Unresectable Primary Hepatocellular Carcinoma

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Local Therapies For Unresectable Primary Hepatocellular Carcinoma

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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-07

Local Therapies For Unresectable Primary Hepatocellular Carcinoma written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-07 with Medical categories.

This comparative effectiveness review evaluates local hepatic therapies for patients with unresectable primary hepatocellular carcinoma (HCC) who are not candidates for surgical resection or liver transplantation. Here we describe the epidemiology and staging of HCC, as well as currently available treatment strategies. We also discuss the current practice guidelines and the impetus for this review. Hepatocellular carcinoma is the most common primary liver tumor. It is the fifth most common cancer and the third leading cause of cancer death worldwide. Overall 5-year survival rates for HCC are less than 10 percent in Europe and the United States. The main etiology of HCC is chronic infection with the hepatitis B and hepatitis C viruses. Approximately 4 million individuals in the United States are chronically infected with hepatitis C virus, and the annual incidence rate of HCC among patients with hepatitis C–related cirrhosis is estimated to be between 2 and 8 percent. Unlike the case with most solid tumors, the incidence of and mortality rate due to HCC are projected to increase worldwide in the next 20 years, primarily due to the dissemination of hepatitis C virus infection.Other causes include cirrhosis due to any cause (e.g., alcohol), hereditary hemochromatosis and iron overload syndromes, nonalcoholic fatty liver disease, obesity, diabetes, and environmental toxins (e.g., aflatoxin, chewing of betel quid, and contaminated water). While there are several causes of HCC, etiology is not an independent prognostic factor for HCC; rather, the underlying cirrhosis impacts prognosis and treatment decisions. In the United States, most cases of HCC occur in patients with cirrhosis.1A small proportion, approximately 5 percent, of all HCC cases in Western countries occur in patients without cirrhosis. For patients with early-stage HCC without underlying cirrhosis, surgical resection is the preferred treatment and offers a high probability of a cure. The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend hepatectomy for patients with a single lesion less than 5 cm in size and mild or no underlying cirrhosis. In contrast, patients with severe cirrhosis are not considered resectable and receive supportive care instead. This report focuses on the approximately 80 percent of patients who are not surgical candidates due to advanced-stage disease at diagnosis, inadequate hepatic reserve to tolerate resection, tumors in unresectable locations, or medical comorbidities that result in a high surgical risk. The following are the Key Questions (KQs) addressed in this review. KQ1. What is the comparative effectiveness of the various liver-directed therapies in patients with HCC who are not otherwise candidates for surgical resection or transplantation with no evidence of extrahepatic disease regarding survival and quality of life? KQ2. What are the comparative harms of the various liver-directed therapies in patients with HCC who are not otherwise candidates for surgical resection or transplantation with no evidence of extrahepatic disease regarding adverse events? KQ3. Are there differences in comparative effectiveness of various liver-directed therapies in patients with HCC who are not otherwise candidates for surgical resection or transplantation for specific patient and tumor characteristics, such as age, gender, disease etiology, and Child-Pugh score?

Local Therapies For Unresectable Primary Hepatocellular Carcinoma

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Author : Suzanne Belinson
language : en
Publisher:
Release Date : 2013

Local Therapies For Unresectable Primary Hepatocellular Carcinoma written by Suzanne Belinson and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.

OBJECTIVES: To characterize the comparative effectiveness and harms of various local hepatic therapies for patients with unresectable primary hepatocellular carcinoma (HCC) who are not candidates for surgical resection or liver transplantation. Local hepatic therapies include those related to ablation, embolization, and radiotherapy. DATA SOURCES: We searched MEDLINE(r) and Embase(r) from January 2000 to July 2012. We also searched for gray literature in databases with regulatory information, clinical trial registries, abstracts and conference papers, as well as information from manufacturers. REVIEW METHODS: We sought studies reporting two final health outcomes--overall survival and quality of life--and various adverse events related to the different interventions. Data were dually abstracted by a team of four reviewers. A third reviewer resolved conflicts when necessary. We assessed the quality of individual studies and graded the strength of the body of evidence according to prespecified methods. RESULTS: We identified 1,707 articles through the literature search, excluded 1,665 at various stages of screening, and included 42 articles. To these we added 6 hand-searched articles for a total of 48 articles included in this review. Our searches of gray literature sources did not yield any additional published studies. The included literature was comprised of 6 randomized controlled trials (RCTs), 4 nonrandomized comparative studies, 35 case series, and 3 case reports. One RCT was rated as good, three were rated as fair, and two were rated as poor quality. We included 13 local hepatic therapies in this review; however, there was sufficient comparative evidence (three RCTs) to assess only one direct comparison: radiofrequency ablation (RFA) versus percutaneous ethanol injection (PEI)/percutaneous acetic acid injection (PAI). Three-year survival when treated with RFA was superior to that for PEI/PAI for unresectable HCC, with a moderate grade of evidence. Time to progression (TTP) and local recurrence were better for RFA than PEI/PAI, but length of stay (LOS) was longer after RFA than PEI/PAI. Strength of evidence for all other comparisons was rated insufficient. There was a low level of evidence to support longer overall survival following RFA than PEI/PAI for the subgroup of patients with larger lesion size. CONCLUSIONS: Of the 13 interventions included in this report, only 1 comparison had sufficient evidence to receive a rating above insufficient. There was moderate strength of evidence demonstrating better overall survival at 3 years, a low level of evidence supporting improved overall survival for patients with larger lesion sizes, and low strength of evidence for improved TTP and local control for RFA than PEI/PAI for the treatment of unresectable HCC. A low level of evidence also supports a longer LOS following RFA than PEI/PAI. For all other outcomes and comparisons, there is insufficient evidence to permit conclusions on the comparative effectiveness of local hepatic therapies for unresectable HCC. Additional RCTs are necessary for all comparisons. Focusing on comparisons with RFA may allow for the greatest integration of new data with the current body of evidence.

Hepatocellular Carcinoma

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Author : Yujin Hoshida
language : en
Publisher: Springer
Release Date : 2019-08-05

Hepatocellular Carcinoma written by Yujin Hoshida and has been published by Springer this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-08-05 with Medical categories.

This book provides a comprehensive overview of the current limitations and unmet needs in Hepatocellular Carcinoma (HCC) diagnosis, treatment, and prevention. It also provides newly emerging concepts, approaches, and technologies to address challenges. Topics covered include changing landscape of HCC etiologies in association with health disparities, framework of clinical management algorithm, new and experimental modalities of HCC diagnosis and prognostication, multidisciplinary treatment options including rapidly evolving molecular targeted therapies and immune therapies, multi-omics molecular characterization, and clinically relevant experimental models. The book is intended to assist collaboration between the diverse disciplines and facilitate forward and reverse translation between basic and clinical research by providing a comprehensive overview of relevant areas, covering epidemiological trend and population-level patient management strategies, new diagnostic and prognostic tools, recent advances in the standard care and novel therapeutic approaches, and new concepts in pathogenesis and experimental approaches and tools, by experts and opinion leaders in their respective fields. By thoroughly and concisely covering whole aspects of HCC care, Hepatocellular Carcinoma serves as a valuable reference for multidisciplinary readers, and promotes the development of personalized precision care strategies that lead to substantial improvement of disease burden and patient prognosis in HCC.

Encyclopedia Of Cancer

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Author : Manfred Schwab
language : en
Publisher: Springer Science & Business Media
Release Date : 2008-09-23

Encyclopedia Of Cancer written by Manfred Schwab and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-09-23 with Medical categories.

This comprehensive encyclopedic reference provides rapid access to focused information on topics of cancer research for clinicians, research scientists and advanced students. Given the overwhelming success of the first edition, which appeared in 2001, and fast development in the different fields of cancer research, it has been decided to publish a second fully revised and expanded edition. With an A-Z format of over 7,000 entries, more than 1,000 contributing authors provide a complete reference to cancer. The merging of different basic and clinical scientific disciplines towards the common goal of fighting cancer makes such a comprehensive reference source all the more timely.

Diagnosis And Treatment Of Hepatocellular Carcinoma

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Author : Tito Livraghi
language : en
Publisher: Greenwich Medical Media
Release Date : 1997-01-01

Diagnosis And Treatment Of Hepatocellular Carcinoma written by Tito Livraghi and has been published by Greenwich Medical Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 1997-01-01 with Medical categories.

The book is edited by a multidisciplinary team, with an international group of contributors. After discussing the basic and clinical aspects of HCC the main focus of the book is on diagnosis and therapy. The book is both authoritative and practical, providing expert guidance on the various techniques used in diagnosis, such as ultrasound, CT and MRI and the appropriate therapeutic options, for example, surgical resection, transcatheter therapies and radiofrequency ablation. It is fully illustrated throughout in both colour and black and white.

Colorectal Cancer Liver Metastases

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Author : Mauro Monteiro Correia
language : en
Publisher: Springer Nature
Release Date : 2019-12-28

Colorectal Cancer Liver Metastases written by Mauro Monteiro Correia and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-12-28 with Medical categories.

Colorectal cancer is the third most commonly diagnosed condition in oncology, affecting around 1.23 million individuals per year, according to recent statistics. Of these patients, about 50% will develop liver metastases and approximately 20% will present a stage IV disease at diagnosis. These statistics make colorectal liver metastases (CLM) an issue of major importance in current oncology. The area of CLM is subject to great and continuous advances, as its pathophysiologic mechanisms are better understood and more therapeutic and surgical options are developed. Consequently, all professionals involved with the diagnosis, treatment and follow up of CLM should be kept up to date with the latest advances on the field, to provide high standard medical care to their patients. This book is designed to present the state-of-the-art in CLM management and, in doing so, to review the current evidence on CLM, discussing all important topics in the field. Coverage is broad and comprehensive, encompassing introductory topics (history, definitions, epidemiology, etc.), basic science subjects (molecular biology, genetics, dissemination process, etc.) and practical clinical topics (tumor behavior, diagnosis, drug therapy, radiation therapy, surgery, ablation, multidisciplinary teams, etc.). Although comprehensive on the coverage and selection of topics, each chapter is concise and objective, dissecting topics in a practical and direct format. Evidences and recommendations are included. Chapters display a brief introduction of the common knowledge, go straight to the detailed revision of the most recent years of the literature, and end with practical closing observations. This book is a tool for professionals (general and cancer surgeons, HPB surgeons, clinical oncologists, gastroenterologists and medical residents) and interns who search for a qualified and reader friendly revision on topics concerning Colorectal Cancer Liver Metastases.

Cancer Management And Therapy

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Author : Amal Hamza
language : en
Publisher: BoD – Books on Demand
Release Date : 2018-06-20

Cancer Management And Therapy written by Amal Hamza and has been published by BoD – Books on Demand this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-06-20 with Medical categories.

There are many different types of cancer. Some are very common; others are rare. Having some similar features, each cancer has its own characteristics and symptoms, which vary according to the type of cancer and where it is in the body. The treatment selected may be influenced by the patient's age, concurrent health problems, life expectancy, characteristics of the individual's cancer, the patient's goals of treatment, and the bias of the treating physician. In preparing this book, we have considered and reflected on the concept of the recent advances in cancer management and therapy as well as molecular applications in cancer therapy. The readers can find detailed information about the treatment and management of specific cancers in these book chapters.

Hepatocellular Carcinoma

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Author : Costin Teodor Streba
language : en
Publisher: BoD – Books on Demand
Release Date : 2018-11-28

Hepatocellular Carcinoma written by Costin Teodor Streba and has been published by BoD – Books on Demand this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-11-28 with Medical categories.

Hepatocellular carcinoma (HCC) currently ranks as the third most common cause of death. As the primary malignancy of the liver is directly related to an underlying liver condition, its incidence and profile are expected to change soon. While effective prevention programs and antiviral therapies for hepatitis B and C will lower the incidence of HCC, emerging socioeconomic issues will deliver new at-risk populations. Moreover, diagnostic techniques and protocols have undergone significant advancements. Reliance on contrast enhanced ultrasound has been re-evaluated, imaging methods being considered as sufficient diagnostic tools. Molecular characterization remains desirable, since chemotherapeutic agents still have limited applicability. In light of recent diagnostic advancements and novel therapeutic solutions, it is our belief that a comprehensive update on recent paradigm shifts and interesting upcoming developments is highly needed.

Immunotherapy Of Hepatocellular Carcinoma

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Author : Tim F. Greten
language : en
Publisher: Springer
Release Date : 2018-08-22

Immunotherapy Of Hepatocellular Carcinoma written by Tim F. Greten and has been published by Springer this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-08-22 with Medical categories.

In this book we provide insights into liver – cancer and immunology. Experts in the field provide an overview over fundamental immunological questions in liver cancer and tumorimmunology, which form the base for immune based approaches in HCC, which gain increasing interest in the community due to first promising results obtained in early clinical trials. Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death in the United States. Treatment options are limited. Viral hepatitis is one of the major risk factors for HCC, which represents a typical “inflammation-induced” cancer. Immune-based treatment approaches have revolutionized oncology in recent years. Various treatment strategies have received FDA approval including dendritic cell vaccination, for prostate cancer as well as immune checkpoint inhibition targeting the CTLA4 or the PD1/PDL1 axis in melanoma, lung, and kidney cancer. Additionally, cell based therapies (adoptive T cell therapy, CAR T cells and TCR transduced T cells) have demonstrated significant efficacy in patients with B cell malignancies and melanoma. Immune checkpoint inhibitors in particular have generated enormous excitement across the entire field of oncology, providing a significant benefit to a minority of patients.

Adaptive Radiation Therapy

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Author : X. Allen Li
language : en
Publisher: CRC Press
Release Date : 2011-01-27

Adaptive Radiation Therapy written by X. Allen Li and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-01-27 with Medical categories.

Modern medical imaging and radiation therapy technologies are so complex and computer driven that it is difficult for physicians and technologists to know exactly what is happening at the point-of-care. Medical physicists responsible for filling this gap in knowledge must stay abreast of the latest advances at the intersection of medical imaging an