Current Modalities for Treatment of Intermediate and Advanced Hepatocellular Carcinoma Considering Different Staging Approaches
Ashraf M. Enite, Ehab Adel 1 and M El-Wahsh2
1Department of Diagnostic and Interventional Radiology, Al Azhar University
2Hepatobiliary & Liver Transplant Unit Al Zahraa University, Hospital, Abasia, Cairo, Egypt
Abstract: Aim: The aim of this study is to assess the outcome of intermediate and advanced hepatocellular carcinoma treatment approached through three different staging systems which are Okuda, Child-Turcotte-Pugh (CTP), and Barcelona Clinic Liver Cancer (BCLC). At the same time to predict patient prognosis and survival in each staging system. Material and methods: We retrospectively identified HCC patients from the database of the Hepato-biliary and liver transplantation Unit/General Surgery and Radiology departments, Al Zahraa University hospital, between April 2011 and July 2012. The patients included after confirmed pathology by radiologic criteria of tri-phasic CT and/or AFP level > 400 ng/ml. The data collected to stage all patients by CTP, Okuda and BCLC systems. It is included demographics, risk factors for developing HCC, performance status, cirrhosis clinical manifestations. Laboratory data, including coagulation profile, different cirrhosis parameters and AFP, were captured as well as bilirubin references. Tumor characteristics that were reported were number of lesions, diameter of largest lesion, and extent of disease, MVI and metastatic disease status. Results: We identified 56 patients with radiology and laboratory confirmed HCC. Their age ranged from 40 to 76 years and mean age is 56.6+ 6.73 years. There are 41(73%) males and 15(27%) females. All patents presented with cirrhosis, which is induced by hepatitis C virus in 49 patients, hepatitis B virus in 6 patients. One of these hepatitis B patents is addict and alcoholic. The patients divided into 3 groups. The first group included 35 patients who were treated with TACE/TAC. The second group included 17 who were treated with sequential TACE/RFA. The third group included 4 patients who were treated by symptomatic and oral chemotherapy. MVI was present in 10 (28%) patients of TACE group and the 4 (100%) patients of the oral chemotherapy group. The patients were followed for 1 year and the mean duration of follow-up in the study was 8.0 months. 19 (29.4%) patients in this study died during follow-up. The complications are Liver dysfunction in 15(26.7 %); Hepato-renal syndrome in 4 (7.1%) ; Pleural effusion in 3 (5.3%) ; inguinal hematomas; 1 (1.8%).
[Ashraf M. Enite, Ehab Adel and M El-Wahsh. Current Modalities for Treatment of Intermediate and Advanced Hepatocellular Carcinoma Considering Different Staging Approaches. J Am Sci 2012;8(10):204-212 ]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 31
Key words: Hepatocellular carcinoma staging; Treatment; Radiofrequency ablation; Trans-Arterial Chemo-Embolization. Full Text 31