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Erschienen in: World Journal of Surgery 5/2017

30.11.2016 | Original Scientific Report

Multi-disciplinary Concurrent Management of Recurrent Hepatocellular Therapy is Superior to Sequential Therapy

verfasst von: Tyler D. Fields, Prejesh Philips, Charles R. Scoggins, Cliff Tatum, Lawrence Kelly, Kelly M. McMasters, Robert C. G. Martin

Erschienen in: World Journal of Surgery | Ausgabe 5/2017

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Abstract

Background

Recurrent hepatocellular carcinoma after a patient’s initial therapy, whether it is transplantation, resection, or ablation, remains a challenging clinical problem. Since recurrence occurs in 70% of all initially treated disease within 5 years, optimal management to treat this recurrence is needed. Currently, a bias exists toward mono-therapy (i.e., ablation alone, hepatic arterial therapy alone, or sorafenib therapy alone) instead of concurrent sequential therapy—as is common in other primary and metastatic disease to the liver. Thus, the aim of our study was to evaluate the overall survival of recurrent HCC based on either mono-therapy or multimodality therapy.

Methods

A review of our prospective 2245 patient hepato-pancreatico-biliary database was performed for all patients who underwent treatment with curative intent for hepatocellular carcinoma and had complete recurrence treatment data from June 2002 to May 2015. Mono-therapy was defined as initiation of a solitary therapy until disease progression or intolerance. Multimodality therapy was defined as at least 2 therapies that occurred simultaneously or within 4 weeks of each therapy.

Results

A total of 281 patients underwent treatment with curative intent for hepatocellular carcinoma, in which 192 experienced recurrence. These patients were treated with either thermal ablation or liver resection (LR) (N = 51), transarterial chemoembolization (TACE) or radiation (N = 68), systemic therapy (N = 26), or multimodality therapy (N = 47). The extent of the first recurrence was similar in regard to the number of tumors (median 1), the type of radiologic HCC, gender, BMI, and percentage of liver involvement. They differed in regard to size (MMT largest, median 5.6 cm, p = 0.02), and MMT had higher Hepatitis C involvement (37% of patients, p = 0.001). In evaluation of first recurrence treatment, after a median follow-up of 24 months, multimodality therapy has a significant improvement in overall survival (median 40 months, range 8–85), when compared to LR/Ablation (27 months, range 4–75), TACE/XRT (13 months, range 4–68), and systemic (26 months, range 3–59) (p = 0.003).

Conclusion

Multimodality therapy should be considered in all patients with recurrent HCC based on tumor biology and underlying hepatic reserve. Hepatocellular cancer should be treated like other hepatic malignancies in which concurrent therapies are utilized simultaneously to optimize oncologic effects (response rates and overall survival) and minimize quality-of-life side effects. Multimodality therapy can lead to far superior overall survival and is well tolerated in the majority of recurrent HCC patients.
Literatur
1.
2.
Zurück zum Zitat European Association For The Study Of The, L., R. European Organisation For, and C. Treatment Of (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56(4):908–943CrossRef European Association For The Study Of The, L., R. European Organisation For, and C. Treatment Of (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56(4):908–943CrossRef
3.
Zurück zum Zitat Bruix J, Sherman M, D. American Association for the Study of Liver (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022CrossRefPubMedPubMedCentral Bruix J, Sherman M, D. American Association for the Study of Liver (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Martin RC 2nd et al (2015) Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer 121(20):3649–3658. doi:10.1002/cncr.29534 CrossRefPubMed Martin RC 2nd et al (2015) Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer 121(20):3649–3658. doi:10.​1002/​cncr.​29534 CrossRefPubMed
5.
Zurück zum Zitat Schiffman SC et al (2014) Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: a guide to adjuvant clinical trials. J Surg Oncol 109(2):98–103CrossRefPubMed Schiffman SC et al (2014) Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: a guide to adjuvant clinical trials. J Surg Oncol 109(2):98–103CrossRefPubMed
6.
Zurück zum Zitat Schiffman SC et al (2011) Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann Surg Oncol 18(2):431–438CrossRefPubMed Schiffman SC et al (2011) Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann Surg Oncol 18(2):431–438CrossRefPubMed
7.
Zurück zum Zitat Schiffman SC et al (2010) Hepatectomy is superior to thermal ablation for patients with a solitary colorectal liver metastasis. J Gastrointest Surg 14(12):1881–1886 (discussion 1886–1887) CrossRefPubMed Schiffman SC et al (2010) Hepatectomy is superior to thermal ablation for patients with a solitary colorectal liver metastasis. J Gastrointest Surg 14(12):1881–1886 (discussion 1886–1887) CrossRefPubMed
8.
Zurück zum Zitat Coakley FV, Schwartz LH (2001) Imaging of hepatocellular carcinoma: a practical approach. Semin Oncol 28(5):460–473CrossRefPubMed Coakley FV, Schwartz LH (2001) Imaging of hepatocellular carcinoma: a practical approach. Semin Oncol 28(5):460–473CrossRefPubMed
9.
Zurück zum Zitat Bruix J, Sherman M, A.A.f.t.S.o.L.D (2005) Practice guidelines committee, management of hepatocellular carcinoma. Hepatology 42(5):1208–1236CrossRefPubMed Bruix J, Sherman M, A.A.f.t.S.o.L.D (2005) Practice guidelines committee, management of hepatocellular carcinoma. Hepatology 42(5):1208–1236CrossRefPubMed
10.
Zurück zum Zitat Woodall CE et al (2007) Hepatic imaging characteristics predict overall survival in hepatocellular carcinoma. Ann Surg Oncol 14(10):2824–2830CrossRefPubMed Woodall CE et al (2007) Hepatic imaging characteristics predict overall survival in hepatocellular carcinoma. Ann Surg Oncol 14(10):2824–2830CrossRefPubMed
11.
Zurück zum Zitat Martin RC, Scoggins CR, McMasters KM (2007) Microwave hepatic ablation: initial experience of safety and efficacy. J Surg Oncol 96(6):481–486CrossRefPubMed Martin RC, Scoggins CR, McMasters KM (2007) Microwave hepatic ablation: initial experience of safety and efficacy. J Surg Oncol 96(6):481–486CrossRefPubMed
12.
Zurück zum Zitat Martin RC 2nd et al (2011) Hepatic arterial infusion of doxorubicin-loaded microsphere for treatment of hepatocellular cancer: a multi-institutional registry. J Am Coll Surg 213(4):493–500CrossRefPubMed Martin RC 2nd et al (2011) Hepatic arterial infusion of doxorubicin-loaded microsphere for treatment of hepatocellular cancer: a multi-institutional registry. J Am Coll Surg 213(4):493–500CrossRefPubMed
13.
Zurück zum Zitat Llovet JM et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390CrossRefPubMed Llovet JM et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390CrossRefPubMed
14.
Zurück zum Zitat Woodall CE et al (2009) Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis? J Am Coll Surg 208(3):375–382CrossRefPubMed Woodall CE et al (2009) Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis? J Am Coll Surg 208(3):375–382CrossRefPubMed
15.
Zurück zum Zitat Lencioni R et al (2012) Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 35(5):980–985CrossRefPubMed Lencioni R et al (2012) Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 35(5):980–985CrossRefPubMed
16.
Zurück zum Zitat Martin R et al (2011) Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose. Korean J Hepatol 17(1):51–60CrossRefPubMedPubMedCentral Martin R et al (2011) Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose. Korean J Hepatol 17(1):51–60CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Martin RC, Scoggins CR, McMasters KM (2010) Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 17(1):171–178CrossRefPubMed Martin RC, Scoggins CR, McMasters KM (2010) Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 17(1):171–178CrossRefPubMed
18.
Zurück zum Zitat North DA et al (2014) Microwave ablation for hepatic malignancies: a call for standard reporting and outcomes. Am J Surg 208(2):284–294CrossRefPubMed North DA et al (2014) Microwave ablation for hepatic malignancies: a call for standard reporting and outcomes. Am J Surg 208(2):284–294CrossRefPubMed
19.
Zurück zum Zitat Martin RC 2nd et al (2007) Kentucky hepatoma: epidemiologic variant or same problem in a different region? Arch Surg 142(5):431–436 (discussion 436–437) CrossRefPubMed Martin RC 2nd et al (2007) Kentucky hepatoma: epidemiologic variant or same problem in a different region? Arch Surg 142(5):431–436 (discussion 436–437) CrossRefPubMed
20.
Zurück zum Zitat Ng KK et al (2008) Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 12(1):183–191CrossRefPubMed Ng KK et al (2008) Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 12(1):183–191CrossRefPubMed
21.
Zurück zum Zitat Llovet JM et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390CrossRefPubMed Llovet JM et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390CrossRefPubMed
22.
23.
Zurück zum Zitat Sala M et al (2004) High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl 10(10):1294–1300CrossRefPubMed Sala M et al (2004) High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl 10(10):1294–1300CrossRefPubMed
24.
Zurück zum Zitat Faber W et al (2011) Repeated liver resection for recurrent hepatocellular carcinoma. J Gastroenterol Hepatol 26(7):1189–1194CrossRefPubMed Faber W et al (2011) Repeated liver resection for recurrent hepatocellular carcinoma. J Gastroenterol Hepatol 26(7):1189–1194CrossRefPubMed
25.
26.
Zurück zum Zitat Kan X et al (2015) Sorafenib combined with percutaneous radiofrequency ablation for the treatment of medium-sized hepatocellular carcinoma. Eur Rev Med Pharmacol Sci 19(2):247–255PubMed Kan X et al (2015) Sorafenib combined with percutaneous radiofrequency ablation for the treatment of medium-sized hepatocellular carcinoma. Eur Rev Med Pharmacol Sci 19(2):247–255PubMed
27.
Zurück zum Zitat Wang K et al (2015) Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: a prospective cohort study. Eur J Surg Oncol 41(2):236–242CrossRefPubMed Wang K et al (2015) Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: a prospective cohort study. Eur J Surg Oncol 41(2):236–242CrossRefPubMed
28.
Zurück zum Zitat Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60CrossRefPubMed Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60CrossRefPubMed
Metadaten
Titel
Multi-disciplinary Concurrent Management of Recurrent Hepatocellular Therapy is Superior to Sequential Therapy
verfasst von
Tyler D. Fields
Prejesh Philips
Charles R. Scoggins
Cliff Tatum
Lawrence Kelly
Kelly M. McMasters
Robert C. G. Martin
Publikationsdatum
30.11.2016
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 5/2017
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3844-z

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