Abstract No. 163 Liver-Directed Therapy Modality-Specific Outcomes Controlling for Index Tumor Size in Early- to Intermediate-Stage Hepatocellular Carcinoma
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The Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm recommends transarterial chemoembolization (TACE) and radio/microwave ablation (MWA) for non-resectable, early- to intermediate-stage (BCLC A-B) hepatocellular carcinoma (HCC). 90Yittrium (90Y) radioembolization is recommended as a secondary treatment pathway. As clinical data has become available, some centers have begun utilizing 90Y as a primary treatment option for BCLC A-B. This study uses retrospective data from multiple centers within a single health system to compare liver-directed therapy (LDT) outcomes among TACE, MWA, and 90Y after subgrouping based on primary target tumor diameter ≤ or > 3 cm. Retrospective, single system, multi-center study included treatment naïve, non-resectable HCC with BCLC A-B and ECOG 0-1 with underlying cirrhosis Child-Pugh (CP) A5–B9 that received liver-directed therapy (LDT) as a definitive treatment approach (n = 445, 2016-2023). LDT approaches included MWA, doxorubicin-eluting embolic TACE (DEE-TACE), and 90Y. Objective response (OR) was calculated after the first treatment cycle. Target time to retreatment (tTTR) and time to BCLC-C progression (TTP) were compared among treatment approaches. Subgrouping based on target tumor diameter yielded the cohorts: ≤ 3 cm–TACE (n = 94), MWA (n = 78), 90Y (n = 87) and > 3-cm–TACE (n = 54), 90Y (n = 132). In the ≤ 3-cm cohort, the OR was similar among treatment modalities (P = 0.053)–TACE (58/91), MWA (58/72), 90Y (65/82). Median tTTR (P < 0.001) was shorter for TACE (4 months) compared to MWA (43 months) or 90Y (31 months) and resulted in a higher 1 year retreatment frequency [TACE (68%), MWA (24%), 90Y (34%)]. However, TTP were similar (P = 0.194) with 2 year progression rates of–TACE (33%), MWA (19%), and 90Y (22%). In the > 3-cm cohort, there was a similar OR between treatments (P = 0.720) - TACE (33/51), 90Y (85/122). However, there was a significance difference in tTTR (P < 0.001) with TACE having a shorter median tTTR–TACE (2 months), 90Y (8 months). At 1 year after treatment, nearly all patients receiving TACE required retreatment to the target tumor–TACE (92%), 90Y (60%); however, TTP were similar (P = 0.633) with 2 year progression rates–TACE (48%), 90Y (54%). In this single system retrospective analysis, MWA and 90Y provided a more durable treatment response compared to TACE for HCC ≤ 3 cm. For HCC > 3 cm, 90Y also yielded a more durable treatment response compared to TACE.Keywords:
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Modalities are the most prominent expressions that patient narrates to the physician during case taking. The time modality is more important than the aggravation and amelioration. It may be general modality or may affect a particular part of the body. In some repertory ailments also comes under causative modality which is key to prescription. Modality play a major role in the differentiation of the medicine as well as reaching to similimum.
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Foreword. Preface. 1. The background to hepatocellular carcinoma and the liver. 2. Premalignant lesions of hepatocellular carcinoma. 3. Pathomorphologic characteristics of early-stage small hepatocellular carcinoma. 4. Morphologic evolution of hepatocellular carcinoma: from early to advanced. 5. Angioarchitecture of hepatocellular carcinoma. 6. Advanced hepatocellular carcinoma. 7. Multicentric occurrence of hepatocellular carcinoma. 8. Combined hepatocellular carcinoma and cholangiocarcinoma. 9. Nodular lesions mimicking hepatocellular carcinoma. 10. Biopsy diagnosis of tumorous lesions of the liver. 11. Chemoprevention of hepatocellular carcinoma. Index
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Hepatocellular carcinoma is the most common malignancy among males and the 7th among female patients in the Kingdom of Saudi Arabia. This is due to the endemicity of hepatitis B and hepatitis C. Spontaneous rupture of hepatocellular carcinoma is rare. We report 4 cases of spontaneous rupture of hepatocellular carcinoma. Initial control of bleeding was achieved surgically in 3 patients and by embolization in the 4th patient. All patients had very good hepatic reserve as reflected by Child-Pugh scoring (A & B). We found that the incidence of ruptured hepatocellular carcinoma among 85 patients was 4.7%. The prognosis of this subgroup of patients is poor as reflected by the low median survival ranging from 6-16 weeks.
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In our center, we believe that a PD modality should not be arbitrarily assigned by the dialysis facility. Rather, the choice of PD modality should be made based on the individual child's treatment requirements and PET results as well as the family's strengths, challenges, and desires (Harmon et al., 2000). The family has the choice whether to use CCPD or CAPD. Families and children who are able to switch back and forth between the two modalities as needed are the most flexible and most successful because they can build their therapy around their lifestyle and not the other way around (Hislop & Lansing, 1983).
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The problem and approaches to the treatment of hepatocellular carcinoma as seen in Japan are reported. Current Japanese methods for the detection of hepatocellular carcinoma and the methods used to treat hepatocellular carcinoma are described. Included in the latter discussion is a description of the untoward effects of each treatment. Finally an alogorithm for the treatment of hepatocellular carcinoma is presented based upon the Japanese experience.
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Intended for use in courses where various clinically oriented techniques and methods are presented. Not a modality cookbook, but a presentation for the basis of use for each modality which allows the therapists to make their own decisions in a given situation. All therapists use some type of modalities from a simple ice pack to electrical current stimulations, and this title features comprehensive coverage of all the therapeutic modalities used in a clinical settings. In addition, strong textbook aids such as chapter objectives, lab activities and case studies help clarify and reinforce the material presented.
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The aim of this study was to determine the characteristics of hepatocellular carcinoma at a major health center in southern Turkey. Computed tomography was compared to the combination of ultrasonography and serum alpha-fetoprotein determination in the diagnosis of hepatocellular carcinoma.Of 226 patients with liver cirrhosis, 35 were diagnosed with hepatocellular carcinoma on first admission or during follow-up in the period between 1999 and 2002. The features investigated were, age at time of hepatocellular carcinoma diagnosis, etiology of cirrhosis, severity of cirrhosis at presentation, tumor pattern, stage of hepatocellular carcinoma, serum alpha-fetoprotein level, and dynamic computed tomography findings. Results were compared to previous findings in Turkey and elsewhere.In the hepatocellular carcinoma patients, the male:female ratio was 4:1 and the mean age at presentation was 61 years. Chronic hepatitis B virus infection (65.7%) and chronic hepatitis C virus infection (28.6%) were the most frequently identified risk factors for hepatocellular carcinoma. Forty percent of the patients had Child-Pugh A cirrhosis when they were diagnosed with hepatocellular carcinoma. Sixty-seven percent of patients had fewer than three hepatocellular carcinoma nodules in the liver at the time of diagnosis. Only three of the hepatocellular carcinoma cases were Okuda stage I. The combination of ultrasonography and serum alpha-fetoprotein >20 ng/ml identified hepatocellular carcinoma in 32 of the 35 total cases.The results indicate that hepatitis B virus infection in patients with cirrhosis is still the leading risk factor for the development of hepatocellular carcinoma. Also, early-stage hepatocellular carcinoma is rarely diagnosed in cirrhosis patients from this region of Turkey. Surveillance with computed tomography for early diagnosis of hepatocellular carcinoma seems not to be mandatory.
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End-stage renal disease treatment expenditures have increased greatly in recent years. Modality of treatment is a very important factor in determining costs as well as outcome and quality of life. Using quarterly observations on treatments received by ESRD patients, this paper presents a definition of modality based on type of treatment received and setting in which treatment is received. This paper also documents the magnitude of switching among defined modalities. Because many patients switch modality, selection of one modality is really a selection of a probable course of treatment by several modalities. The careful definition of modality and recognition that switching occurs are important first steps in conducting cost-effectiveness type analyses of ESRD treatment.
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Objective To evaluate serum AFP levels and their influence factors in patients with hepatocellular carcinoma.Methods From January 1995 to December 1999,140 patients were subjected to hepatectomy in our hospital,AFP levels of the patients were evaluated.The data of the patients were analyzed by nonconditional logistic regression with SPSS10.0.Results The positive rate of AFP was 62.9% in patients with hepatocellular carcinoma.The positive rate of AFP of small hepatocellular carcinoma(52.0%) was significantly higher than that of large hepatocellular carcinoma (73.9%) ( P 0.05).It was showed that the AFP levels were related to tumor size and cirrhosis through logistic regression( P 0.05).Conclusion Sensitivity of AFP in hepatocellular carcinoma diagnosis,especially in small hepatocellular cancer was lower.It was notably increased when combined with other diagnostic methods.
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