Clinical and Molecular Hepatology

"Radiation"

Editorial

Hepatic neoplasm

Exploring the mythical abscopal effect: Radiation and programmed cell death protein 1 (PD-1) blockade for hepatocellular carcinoma: Jun Won Kim, Ik Jae Lee; Clin Mol Hepatol 2021;27(1):103-106.
Published online December 14, 2020; DOI: https://doi.org/10.3350/cmh.2020.0297

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Exploiting the immune system in hepatic tumor targeting: Unleashing the potential of drugs, natural products, and nanoparticles
Chou-Yi Hsu, Mohammed Ahmed Mustafa, Ashwani Kumar, Atreyi Pramanik, Rajiv Sharma, Faraj Mohammed, Israa Abed Jawad, Imad Jasim Mohammed, Mohammad Y. Alshahrani, Noor Alhuda Mohammad Ali khalil, Ali Turki Shnishil, Munther Kadhim Abosaoda
Pathology - Research and Practice.2024; 256: 155266. CrossRef

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Review

Hepatic neoplasm

Strategic application of radiotherapy for hepatocellular carcinoma: Seo Hee Choi, Jinsil Seong; Clin Mol Hepatol 2018;24(2):114-134.
Published online February 14, 2018; DOI: https://doi.org/10.3350/cmh.2017.0073

Abstract
PDF

With increasing clinical use, radiotherapy (RT) has been considered reliable and effective method for hepatocellular carcinoma (HCC) treatment, depending on extent of disease and patient characteristics. RT for HCC can improve therapeutic outcomes through excellent local control, downstaging, conversion from unresectable to resectable status, and treatments of unresectable HCCs with vessel invasion or multiple intrahepatic metastases. In addition, further development of modern RT technologies, including image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT), and stereotactic body radiotherapy, has expanded the indication of RT. An essential feature of IGRT is that it allows image guidance therapy through in-room images obtained during radiation delivery. Compared with 3D-conformal RT, distinctions of IMRT are inverse treatment planning process and use of a large number of treatment fields or subfields, which provide high precision and exquisitely conformal dose distribution. These modern RT techniques allow more precise treatment by reducing inter- and intra-fractional errors resulting from daily changes and irradiated dose at surrounding normal tissues. More recently, particle therapy has been actively investigated to improve effectiveness of RT. This review discusses modern RT strategies for HCC, as well as optimal selection of RT in multimodal approach for HCC.

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Original Article

Hepatic neoplasm

Comparison of surgical resection versus transarterial chemoembolization with additional radiation therapy in patients with hepatocellular carcinoma with portal vein invasion: Danbi Lee, Han Chu Lee, Jihyun An, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee; Clin Mol Hepatol 2018;24(2):144-150.
Published online January 16, 2018; DOI: https://doi.org/10.3350/cmh.2017.0041

Abstract
PDF

Background/Aims
Portal vein invasion (PVI) is a poor prognostic factor in patients with hepatocellular carcinoma (HCC). We intended to compare the effects of surgical resection and transarterial chemoembolization (TACE) with additional radiation therapy (RT) in HCC patients with PVI.
Methods
The subjects comprised 43 patients who underwent surgical resection for HCC with PVI without previous treatment and another 43 patients who received TACE followed by RT (TACE+RT) as initial treatment who were matched for Child-Pugh class, tumor size, and extent of PVI. Disease progression and death after the treatment were examined, and progression-free survival (PFS) and overall survival (OS) were compared between groups. Predisposing factors affecting OS were analyzed using univariate and multivariate analyses in HCC patients with PVI.
Results
The subjects (Age [51, 24-74; median, range], Sex [81/13; male/female], Etiology [78/1/15; hepatitis B virus {HBV}/ hepatitis C virus {HCV}/non-HBV and non-HCV]) were followed for a median of 17 (2-68) months. There were no differences in clinical or tumor characteristics between the resection and TACE+RT groups. The cumulative PFS was not significantly different between groups. The median PFS was 5.6 and 4.0 months in the resection and TACE+RT groups, respectively. However, the cumulative OS was significantly longer in patients treated with resection than in those treated with TACE+RT (P=0.04). The median OS was 26.9 and 14.2 months in the resection and TACE+RT groups, respectively. Univariate and multivariate analyses revealed that surgical resection was an independent predictive factor for better survival outcome.
Conclusions
Surgical resection might be an effective treatment in HCC patients with PVI.

Citations

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Comparison of surgical resection versus transarterial chemoembolization with additional radiation therapy in patients with hepatocellular carcinoma with portal vein invasion
Jin Wook Chung
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Review

Hepatic neoplasm

Recent advances in transarterial embolotherapies in the treatment of hepatocellular carcinoma: Edward Wolfgang Lee, Sarah Khan; Clin Mol Hepatol 2017;23(4):265-272.
Published online November 8, 2017; DOI: https://doi.org/10.3350/cmh.2017.0111

Abstract
PDF

Management of hepatocellular carcinoma (HCC) can be maximized with the utilization of multiple treatment modalities including transplant, surgical resection and locoregional therapies including ablative therapies and transarterial embolotherapies. Although transplant and surgical resection offer the best clinical outcomes, a limited number of patients are amenable to these surgical treatment options due to the advanced disease at presentation. Transarterial embolotherapies including conventional transarterial chemoembolization (cTACE), bland transarterial embolization (TAE), drug-eluting beads transarterial chemoembolization (DEB-TACE) and selective internal radiation therapy (SIRT) with Yttrium 90 (⁹⁰Y) have played an increasingly important role for these patients with unresectable HCC. With a better understanding of different transarterial embolotherapies, more personalized and precise treatment should be implemented for these patients with unresectable HCC. In this review, the updated evidence on the current role of each embolotherapy in the treatment of HCC is summarized.

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Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis: Jong Ho Chung, Hyung Su Ahn, Sang Gyune Kim, Yun Nah Lee, Young Seok Kim, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Boo Sung Kim; Clin Mol Hepatol 2013;19(2):156-164.
Published online June 27, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.2.156

Abstract
PDF

Background/Aims

Several noninvasive methods have recently been developed for the evaluation of liver fibrosis. The accuracy of transient elastography (TE), acoustic-radiation-force impulse (ARFI) elastography, and real-time elastography (RTE) in predicting liver fibrosis were evaluated.

Methods

Seventy-four patients who had undergone a liver biopsy within the previous 6 months were submitted to evaluation with TE, ARFI, and RTE on the same day.

Results

There were significant correlations between fibrosis stage and liver stiffness measurement (LSM) using the three tested methods: TE, r²=0.272, P=0.0002; ARFI, r²=0.225, P=0.0017; and RTE, r²=0.228, P=0.0015. The areas under the receiver operating characteristic curves (AUROC) for the diagnosis of significant fibrosis (≥F2, Metavir stage) by TE, ARFI, RTE, TE/platelet count (PLT), velocity of shear wave (Vs)/PLT, and elasticity score (Es)/PLT were 0.727, 0.715, 0.507, 0.876, 0.874, and 0.811, respectively. The AUROC for the diagnosis of cirrhosis by TE, ARFI, RTE, TE/PLT, Vs/PLT, and Es/PLT were 0.786, 0.807, 0.767, 0.836, 0.819, and 0.838, respectively. Comparisons of AUROC between all LSMs for predicting significant fibrosis (≥F2) produced the following results: TE vs. RTE, P=0.0069; ARFI vs. RTE, P=0.0277; and TE vs. ARFI, P=0.8836. Applying PLT, the ability of each LSM to predict fibrosis stage significantly increased: TE/PLT vs. TE, P=0.0004; Vs/PLT vs. ARFI, P=0.0022; and Es/PLT vs. RTE, P<0.0001. However, the ability to predict cirrhosis was not enhanced, combining LSM and PLT.

Conclusions

TE and ARFI may be better methods for predicting significant liver fibrosis than RTE. This predictive ability increased significantly when accounting for platelet count. However, all of the measures had comparable efficacies for predicting cirrhosis.

Citations

Citations to this article as recorded by

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Concurrent Chemo - Radiation Therapy for Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Jin Suk Kim, M.D., Kwang-Hyub Han, M.D., Do Yun Lee, M.D.* , Jin-Sil Seong, M.D.† , Young Hoon Youn, M.D., Jae Youn Cheong, M.D., Sang Hoon Ahn, M.D., Chae Yoon Chon, M.D., and Young Myoung Moon, M.D.; Korean J Hepatol 2002;8(1):71-79.

Abstract
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Background/Aims
Advanced hepatocellular carcinoma with portal vein thrombosis has a poor prognosis. This study was undertaken to evaluate the therapeutic effects of concurrent chemo-radiation therapy in advanced hepatocellular carcinoma with portal vein thrombosis. Methods: A total of 54 patients with advanced hepatocellular carcinoma (TNM stage IVa) were enrolled. Nineteen patients were treated with external beam radiotherapy (4,500 cGy/ 5 weeks) and intrahepatic arterial 5-FU infusion (500 mg on 1-5 day and 30-35 day, respectively) via implanted chemoport. The others were treated with intrahepatic arterial cisplatin infusion (80 mg/m²). Results: In patients treated with concurrent chemo-radiation therapy, response rates at 2nd and 6th months were 42.1% and 26.3%, respectively. In patients treated with intrahepatic arterial cisplatin therapy, response rates at 2nd and 6th months were 2.9% and 0%, respectively. The median survival time was 11.6 months in concurrent chemo-radiation therapy and 4.8 months in intrahepatic arterial cisplatin infusion therapy. Concurrent chemo-radiation therapy produced better response rates and longer survival time than those of intrahepatic arterial cisplatin infusion therapy (p<0.05). Conclusions: Concurrent chemo-radiation therapy achieved favorable results in advanced hepatocellular carcinoma with portal vein thrombosis and can be considered as a treatment option for the management of advanced hepatocellular carcinoma.(Korean J Hepatol 2002;8:71-79)

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Reappraisal of Risk Factors Predicting Liver Complications from Radiotherapy for Hepatocellular Carcinoma: Ik Jae Lee, M.D., Jinsil Seong, M.D., Su Jung Shim, M.D., Kwang Hyub Han, M.D.1, and Chae Yoon Chon, M.D.1; Korean J Hepatol 2006;12(3):420-428.

Abstract
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Background/Aims
Determination of the optimal radiotherapeutic parameters for radiotherapy of hepatocellular carcinoma (HCC) is still under investigation. The purpose of this study is to identify the risk factors associated with radiation-related morbidity. Methods: We evaluated one hundred fifty-eight patients, who were given radiotherapy for HCC between January 1992 and March 2000. Radiation-induced liver disease (RILD) was defined as the development of nonmalignant ascites without disease progression and an anicteric elevation of the alkaline phosphatase level by at least twofold. Gastrointestinal toxicity was assessed by using the RTOG-EORTC scale. Results: Six patients (3.8%) displayed RILD. In these patients, three patients had not responded to other previous treatments. Two patients with portal vein thrombosis or huge sized mass, above 10 cm, showed liver toxicity and two other patients presented with Child-Pugh class B liver cirrhosis. Eight patients (5%) had gastro-duodenal ulcers. In one of these 8 patients, the left lobe close to the stomach was involved and two patients had been treated for gastro-duodenal ulcer. In two more patients, the radiation field, with using anterior/posterior radiation ports, covered a significant volume of the gastrointestinal tract. One of eight patients had been irradiated with a large fraction size (250 cGy). Conclusions: The efforts should be made to reduce the radiation-related complications for hepatocellular carcinoma by considering the volume and the function of remaining liver, the location of tumor, the tumor size and the severity of liver cirrhosis