Treatment of Hepatocellular Carcinoma

TREATMENT OF HEPATOCELLULAR CARCINOMA:
TREATMENT ACCESS
"Are there racial and ethnic differences for survival of hepatocellular carcinoma in an equal-access system?" Abstract 1432, Gui. This was a Kaiser Permanente Northern California data base analysis during 1998 and 2004. Kaiser Permanente is a well-established large HMO that has an extensive data base for health care analysis in the Northern California region. 1000 patients with a diagnosis of HCC were identified in this data analysis. The authors were able to look across Hispanics, Caucasians, Blacks and Asians, and identified either equivalent or improved survival in the Asian patients, and did not find any difference between the stage of disease in Caucasian, Asians, Hispanics or Blacks at the time of that diagnosis. In an equal-access system, there was no significant difference in the stage of disease across different ethnic groups with the diagnosis of HCC. TACE, RADIOFREQUENCY ABLATION AND OTHER ABLATIVE THERAPIES: "Transcatheter arterial chemoembolization plus radiofrequency ablation for hepatocellular carcinoma, in comparison with surgical resection". Abstract 426-IASL, Kagawa. The investigators discussed the use of radiofrequency ablation in combination with TACE compared to surgical resection. There has been a new evolution since the recent JAMA article utilizing TACE followed by RFA in a randomized control study compared to TACE alone that identified combination ablation therapy resulted in a marked improvement in survival with combination therapy resulting in more centers utilizing combination (ablation) therapy for HCC. In this AASLD abstract, TACE-RFA was evaluated in comparison to surgical resection. Overall survival was comparable between TACE with RFA compared to surgery. This abstract would support the trend towards minimally invasive ablative procedures as opposed to more complex surgical resection for the management of HCC risking liver failure, especially in those patients with more advanced disease (presence of portal hypertension). It also supports the overall trend toward using combination modalities to treat HCC rather than any single treatment alone. "Radioembolization with yttrium 90 glass microspheres for advanced hepatocellular carcinoma, results from a European pilot-based study." Abstract 1444, Hilgard. Newer ablative therapies for the treatment of HCC including embolization with radioactive microspheres, laser photo activation, cryosurgery and other methods continue to be explored in practice and clinical trials. In this study, outcomes after radioembolization with microspheres for advanced HCC was analyzed in this European phase II study. Fifty-seven patients were analyzed, and the authors demonstrated that in this small case study that radioembolization with yttrium 90 glass microspheres were safe and effective in terms of tumor response. Tumor response was defined by radiographic criteria and reduction in AFP levels. Survival rates were 98% at one month, 96% at three months, and 53% at one year, with a mean overall survival at 657 days. This data from this phase II study suggests that a phase III study with radioembolization with yttrium 90 glass microspheres would be important and a comparison to standard TACE therapy should be considered as part of this trial. "Radiofrequency ablation for hepatocellular carcinoma, progression beyond Milan criteria and implications as neoadjuvant treatment prior to transplantation." Abstract 83, Fernandes. Radiofrequency ablation has emerged as the best percutaneous ablative therapy for managing HCC. Previous data has shown that RFA is comparable to surgical resections. In this study, the authors evaluated the use of RFA for down-staging patients. RFA was effective in reducing tumor progression, especially within the first six months after initial treatment. This data will be useful to liver transplant centers who have longer waiting times, and will lend credence to further support for combination therapy, RFA therapy, RFA-TACE or RFA and multi-kinase inhibitors to further extend waiting times to allow patients to both be down-staged to fall within Milan criteria, or individuals who are within Milan criteria to extend their ability to remain on the wait list and undergo potentially curative liver transplant surgery.