targeted therapy and multidisciplinary care

... 114 postoperative mortality, 114 M.D. Anderson Cancer Center, criteria for resection, 110t patient selection/preparation, 110 preoperative therapy chemotherapy, 118–120 PVE, perioperative outcomes/survival ... chemotherapy, 161–162 bevacizumab, administration of, 162 hepatic hypertrophy, impact on, 162 hepatic injuries, 162 408 Index PVE, indications and contraindications (cont.) preoperative chemotherapy, ... complications, 173 FLR volume measurement and functions, 157–159 indications and contraindications general contraindications, 162 general indications, 159–160 high-dose chemotherapy, 161–162 normal underlying

Ngày tải lên: 07/07/2014, 09:20

... CarcinomaTrang 4Kelly M McMastersJean-Nicolas Vauthey Editors Hepatocellular Carcinoma Targeted Therapy and Multidisciplinary Care 1 3 Trang 5Kelly M McMasters, MD, PhD Department of Surgery University ... pathophysiology, molecular biology, and clinical features of HCC is important in providing optimal patient care In addi-tion, understanding of the limitations of our current knowledge and therapeutic capabilities ... liver is a massive and complex organ requiring an excellent knowledge of its anatomy and physiology, with an exquisite comprehension of its impact on cardiovascular, pulmonary, and renal function

Ngày tải lên: 07/07/2014, 09:20

... function and posthepatectomy course and the utility of PVE in patients with HCC Palavecino and colleagues [112] evaluated 54 patients that underwent major hepatic resection for HCC between 1998 and ... these perioperative deaths, the overall survival rates at 1, 3, and 5 years were 94, 82, and 72% in the PVE group and 93, 63, and 54% in the non-PVE group, respectively (P = 0.35) Similarly, ... significantly different between the groups, with 1-, 3- and 5-year disease-free survival of 84, 56, and 56% in the PVE group and 66%, 49% and 49% in the non-PVE group, respectively (P = 0.38)

Ngày tải lên: 07/07/2014, 09:20

... considered safe and gasless laparoscopy is no longer in use Port Sites Positioning and Hand Assistance Positioning of port sites is different according to tumor site and it is shown in Figs.12.1and12.2 ... vein if feasible and transection Hand assistance can be used Hand port is introduced through a right iliac or flank transverse incision Surgeon’s left hand or assistant’s right hand helps mobilizing ... technique allows fast and safe resection However, vascular and biliary injuries can occur during blind transection and this technique does not allow fine control of margins and requires that tumors

Ngày tải lên: 07/07/2014, 09:20

... transection and to control bleeding At present, laparoscopic major hepatectomies are still limited to few expert centers and cannot be considered standard procedures Further evaluation and tech-nical ... loss (400 to 100 cc) was observed Morbidity decreased from 43.5 to 13.0 and 8.7% and hospital stay passed from 9 to 7 and 6 days, respectively Left Lateral Sectionectomy Left lateral sectionectomy ... been reconsidered and successful laparoscopic cases have been reported, especially applying hand assistance [19,21,34,74] (Fig.12.7) Laparoscopic right posterior sectionectomies and caudate lobectomies

Ngày tải lên: 07/07/2014, 09:20

... Palpation with the hand and the use of intraoperative ultrasonography through the hand port improve the staging of tumor and permit better delineation of resection margin 2 The hand is the best retractor ... ultrasound, triple phase CT scan, and MR imaging are essential in guiding therapy The latter two are comparable and must be chosen based on local expertise and equipment CT imag-ing characteristics ... Kadiyala V Ravindra and Joseph F Buell Keywords Laparoscopic liver surgery · Laparoscopic liver resection · HCC· Hepatic resection · Patient selection Despite better understanding and advances in

Ngày tải lên: 07/07/2014, 09:20

... open resection and the need for blood transfusion were 9.2 and 9.8%, respec- tively. There were 2 postoperative deaths and the morbidity was detailed as liver specific in 11.6% and nonspecific ... months and died of disseminated cancer at 400 days [2]. As the procedure and immunosuppression were refined, patient and allograft survivals improved to the point that oncologic recurrence and survival ... cryoabla- tion, and more recently, radioembolization with yttrium-90, microwave ablation, and systemic chemotherapy. TACE Given its wide therapeutic window in cirrhotic patients and relatively

Ngày tải lên: 07/07/2014, 09:20

... disease progression and, therefore, limit waitlist dropout These modalities include repetitive transarterial chemoembolization, intraarterial radiotherapy, and systemic chemotherapy Second, several ... modestly expand the tumor size criteria beyond CMC to include those patients with solitary HCC lesions up to 6.5 cm and patients with 2–3 tumors to have an individual upper size limit of 4.5 cm and an ... patients in CMC and those between CMC and UCSF (Table14.2) [22,32, 63,64] Patients with final pathologic staging in excess of UCSF criteria do consis-tently have higher recurrence rates and poorer

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... increased technical demands and risks of any proposed procedure Evaluation and Work-Up of the Patient with HCC for Resection Underlying Liver Disease in the Patient with HCC A careful assessment ... sensitivity, specificity, and accuracy rates of 82, 84, and 86%, respectively [25]. Three-dimensional reconstruction of axial images and volumetric assessment of the total and planned liver remnant ... as IL-6 and STAT3, alterations in energy metabolism, and abrogation of injurious events such as neutrophil accumulation, Trang 10244 R.D Kim and A.W Hemming microcirculatory disturbance, and reactive

Ngày tải lên: 07/07/2014, 09:20

... occlusion, and total vascular isolationis then applied to divide and reconstruct the vascular structures only The portal vein dissection is carried high to gain control of the right and left branches and ... complete resections and were analyzed based on the AJCC classification, the respective 5-year survival rates for T2, T3 and T4 were 56, 31, and 21%, respectively, where T2 and T3 have vascular ... over-all 1-, 3-, and 5-year survival rates of 90, 67, and 45%, respectively [10] Another series of 29 patients who underwent HCC and portal vein resection, the 5-year overall and disease-free

Ngày tải lên: 07/07/2014, 09:20

... Pritesh Mutha, and Sanjay Gupta 319 21 Cytotoxic Chemotherapy and Endocrine Therapy for Hepatocellular Carcinoma Daniel Palmer and Philip J Johnson 337 22 Targeted Therapies ... Albany, and Ghassan K Abou-Alfa 355 23 The Future: Combination Systemic Therapy for Hepatocellular Carcinoma Ahmed O Kaseb and Melanie B Thomas 369 24 Follow-Up and Salvage Therapy ... India, and Africa Genotypes B and C are common in China, Japan, and Southeast Asia Genotype D is common in Mediterranean areas and in the Middle East [16] Genotypes E–G are common in Central and...

Ngày tải lên: 07/07/2014, 09:20

... Arachidonic acid Prostaglandin COX-2 Fig 1.2 Steps in hepatocarcinogenesis, modified from Xu et al [90] and Bensinger and Tontonoz [91] On the other hand, the association between obesity and HCC is hammered ... (mycotoxins) produced by Aspergillus flavus and A parasiticus There are four AF compounds: B1 , B2 , G1 , and G2 [55] The most common and most toxic AF is AFB1 , and the most important target organ is ... by Reddy and colleagues [97] from Mayo Clinic who assessed the association between hypothyroidism and HCC among 54 HCC patients of unknown etiology and 116 HCC patients related to HCV and alcohol...

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... including DNA level, RNA level and protein level, with regard to chromosomal imbalance and genetic instability, epigenetic alteration, gene expression and gene regulation and translation [1] Whatever ... proteins, genes and miRNAs in biological pathways Furthermore, significant and complex cross talks among the different pathways exist and are involved in different aspects of HCC development and progression ... overexpression, ligand-independent signalling through structural alteration of receptors and alterations in components of the downstream cytoplasmic circuitry that receives and processes the signals...

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... clinicopathological factors such as proliferation, vascular invasion and tumour multiplicity and was reported to associate with not only invasion and metastasis of HCC but also postoperative recurrence [29] ... telomere shortening influences stem cell function, aging and carcinogenesis These mice exhibit an impaired maintenance and function of adult stem cells and reduced regenerative reserve in response to ... regeneration and sometimes in neoplastic transformation [59, 60] This relationship to fat metabolism appears to be important both in NAFLD-related cancer and in HCV, where steatosis, steatohepatitis and...

Ngày tải lên: 07/07/2014, 09:20

... subtypes, frequently found simultaneously, are trabecular, pseudoglandular (acinar), compact, and scirrhous The trabecular and acinar patterns are commonly observed in well to moderately differentiated ... of all cases) These tumors occur at a young age and are not associated with common risk factors such as chronic hepatitis and cirrhosis [35–38] and thus are frequently amenable to surgical resection ... inclusions, and fibrinogen containing pale bodies, presenting as pale ground-glass cytoplasmic inclusions [24, 36, 41] Combined Hepatocellular Carcinoma and Cholangiocarcinoma Combined HCC and cholangiocarcinomas...

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... demonstrated in up to 96% of HCC [65] Polyclonal CEA and CD10 Both polyclonal CEA and CD10 (neprilysin) antibodies have cross-reactivity with glycoprotein I and exhibit a canalicular distribution pattern ... be negative, and occasional metastatic adenocarcinomas have been reported to be immunoreactive [76] Cytokeratin Low molecular weight keratins, including CAM 5.2 and cytokeratins and 18, usually ... adenomatous hyperplasia, and HCC [62, 77, 78] Diffuse CD34 sinusoidal reactivity would support a diagnosis of HCC [79] and can help differentiate dysplastic nodules and early HCCs from macroregenerative...

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... and patients with chronic HCV infection who have cirrhosis stand a very high risk of developing HCC [19] In Japan, HCV infection spread throughout the country mainly in the 1950s and 1960s, and ... their design and in the characteristics of the targeted patients in terms of, for example, disease etiology and severity of background liver diseases Moreover, the reported specificity and sensitivity ... noninvasive Although both the ribs and the air in the lungs and gastrointestinal tract surround the liver and potentially hinder imaging, newer ultrasound devices and techniques have improved hepatic...

Ngày tải lên: 07/07/2014, 09:20

... systems may serve to guide choice of therapy, aid in patient counseling, allow comparisons of the end results of therapy, and facilitate patient selection and randomization for research protocols ... patients, a minority (10%) of whom underwent surgical resection and a majority (58%) of whom received only supportive care and no locoregional therapy [6] This staging system builds on the AJCC 5th edition ... P, Albertini A, Decarli A et al (2002) Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women Am J Epidemiol 155:323–331 24 Kuper H,...

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... system (and related JIS score) may, however, have particular advantages in patients with early HCC As the therapeutic modalities available for HCC and the indications for aggressive therapy expand, ... carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre Gut 54:411–418 Chapter Multidisciplinary Care of the Hepatocellular Carcinoma ... Carcinoma Patient Carlo M Contreras, Jean-Nicolas Vauthey, and Kelly M McMasters Keywords HCC care · Hepatocellular carcinoma · Multidisciplinary care · HCC treatment Introduction Hepatocellular carcinoma...

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... including liver resection and liver transplantation, percutaneous ablation therapy as represented by radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI), and transcatheter arterial ... the results of liver resection and PEI when the degree of liver damage was B and the tumor was solitary and no more than cm in diameter, percutaneous ablation therapy is also recommended Although ... Study Group of Japan, and replies were 94 K Hasegawa and N Kokudo obtained from 843 (37%) of them Of those who replied, 55.4% were hepatologists and 38% were liver surgeons, and more than 70% of...

Ngày tải lên: 07/07/2014, 09:20