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CT of Hepatoma

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MRI of Hepatoma

Hepatoma or Hepatocellular Carcinoma

Start with some of the best medical sites on hepatoma: ASCO, the NCI, and the NCCN. liver anatomy here, ACS update

SCIENCE NEWS  June 04, 2007 A kidney cancer drug became the first medicine to extend the life of patients with advanced liver cancer in a large study, adding about three months to survival compared with a placebo, according to a data released on Monday. The trial found the biotechnology drug, Nexavar, by German drugmaker Bayer AG and its U.S. partner Onyx Pharmaceuticals Inc., extended survival by 10.7 months, compared with 7.9 months for a placebo -- a 44 percent survival benefit. Of the roughly 100 clinical trials in liver cancer in 30 years, all have been negative, according to Joseph Llovet, director of liver cancer research at Mount Sinai School of Medicine in New York, who led the trial.

Surgery is the best treatment but most patients are not candidates for curative surgery so other techniques like radiofrequency ablation,  hepatic artery chemoembolization or radiation are often used (go here and here).

Some of the recent studies using radiation are noted here , here , here and here

from the NCI: 

Hepatocellular carcinoma is a tumor that is relatively uncommon in the United States, although its incidence is rising, principally in relation to the spread of hepatitis C infection. It is the most common cancer in some parts of the world, with more than one million new cases diagnosed each year. Hepatocellular carcinoma is potentially curable by surgical resection, but surgery is the treatment of choice for only the small fraction of patients with localized disease.

Prognosis depends on the degree of local tumor replacement and the extent of liver function impairment. Therapy other than surgical resection is best administered as part of a clinical trial. Such trials evaluate the efficacy of systemic or infusional chemotherapy, hepatic artery ligation or embolization, percutaneous ethanol injection, radiofrequency ablation, cryotherapy, and radiolabeled antibodies, often in conjunction with surgical resection and/or radiation therapy. In some studies of these approaches, long remissions have been reported.  A few patients may be candidates for liver transplantation, but the limited availability of livers for transplantation restricts the use of this approach.

from the NCCN:

Surgery, including transplantation, remains the only curative modality for hepatocellular cancer. In liver transplantation recipients, 5-year survival has been reported to be as high as 75%, which exceeds survival after resection or ablation. The United Network for Organ Sharing (UNOS) criteria for liver transplant include patients who are not candidates for resection who have (1) a single tumor that is 5 cm or less in diameter, or who have 2 to 3 tumors, each 3 cm or less in diameter; (2) no macrovascular invasion; and (3) no extrahepatic spread to surrounding lymph nodes, lungs, abdominal organs, or bone. The single uniform negative prognostic finding for transplantation ishistopathologic evidence of vascular invasion.

Patients With Unresectable and Inoperable Disease or Those Who Decline Surgery. Alternative therapies for patients with unresectable disease or those who decline surgery include clinical trial, ablative therapy (eg, radiofrequency, alcohol, cryotherapy, microwave), chemoembolization, chemotherapy plus radiation in a clinical trial, conformal radiation, radiotherapeutic microspheres, supportive care, and systemic or intra-arterial chemotherapy in a clinical trial. Patients with inoperable disease are those who should not undergo surgery because of performance status, comorbidity, or extent of liver disease. Options for patients with cancer-related symptoms include clinical trial, ablative therapy (eg, radiofrequency alcohol, cryotherapy, microwave), chemoembolization (contraindicated in cases of main portal thrombosis or Child-Pugh class C score), conformal or stereotactic radiation, radiotherapeutic microspheres, and supportive care. Chemoembolization, ablation, and conformal or stereotactic radiotherapy have produced local control in some patients. All of these modalities have limitations, such as the size and number of lesions, potential toxicities, and a questionable effect on long-term survival. For patients without cancer-related symptoms, options include participation in a clinical trial or ablation of small-volume disease. Patients with metastatic disease may be offered supportive care or therapy as part of a clinical trial. Unfortunately, there is no proven advantage of single-agent or combination chemotherapy in these patients.