Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.
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Korean J Hepatol 2009;15(3):357-361. Published online September 30, 2009
Bone is a common site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of rib metastasis from HCC treated by transcatheter arterial chemoembolization (TACE). A 55-year-old man with liver cirrhosis presented with right lower chest pain. The diagnosis was an HCC with a bone metastasis in the right eighth rib. Intra-arterial injections of doxorubicin mixed with Lipiodol and Gelfoam particles were instituted through the right eighth intercostal artery. Computed tomography and a Tc99-labeled scan performed 2 months after the third TACE revealed no viable HCC in the right eighth rib. (Korean J Hepatol 2009;15:357-361)
Background/Aims Transcatheter arterial chemoembolization (TACE) is a major modality in the treatment
of unresectable hepatocellular carcinoma. Acute renal failure (ARF) may occur after TACE because of
underlying liver cirrhosis and the presence of radiocontrast agent. However, the data available regarding this
complication are variable and limited. The aim of this study was to determine the incidence and associated risk
factors of ARF after TACE. Methods: From January 2001 to December 2004, a total of 632 procedures were
performed in 377 patients. Of these, the cases with high creatinine levels (≥ 2 mg/dL) before TACE and with
incomplete medical records were excluded, which resulted in 463 procedures in 319 patients (256 males and 63
females; age 58.7±9.9 years, mean±SD) being examined for this study. Various clinical and radiological data
before and after the procedure were reviewed retrospectively. Results: ARF occurred following 15 (3.2%) of
the 463 procedures within 7 days of TACE. Univariate analysis revealed that serum albumin levels (P=0.025),
Model for End-Stage Liver Disease score (P=0.001), the distribution of Child-Pugh class (P=0.027), and the
proportions of patients with ascites (P<0.001), using diuretics (P=0.010), and with a serum creatinine level
≥ 1.5 mg/dL (P=0.023) differed significantly between patients with or without ARF after TACE. In
multivariate analysis, the presence of ascites (P=0.005; odds ratio, 5.297) and serum creatinine level ≥ 1.5
mg/dL (P=0.007; odds ratio, 7.358) were independently associated with the development of ARF. Conclusions:
The incidence of ARF after TACE was 3.2%, and the presence of ascites and an abnormal baseline serum
creatinine level were the risk factors for ARF. (Korean J Hepatol 2008;14:168-177)
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Yong Kyun Kim, M.D., Su Eun Yu, M.D., Chang Kyun Hong, M.D., Sung Ku Lee, M.D.,
Young Chul Kim. M.D., So Young Lee, M.D., Si Hyun Bae, M.D., Je Hyun Shin, M.D.,
Byung Hun Byun, M.D., Jong Young Choi, M.D., Young Min Park, M.D., Kyu Won Chung, M.D.,
Hee Sik Sun, M.D., Doo Ho Park, M.D., Boo Sung Kim, M.D., Yeon Joo Jung, M.D.†
Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from 0% to 3.3%. Moreover, liver abscess formation in non-tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo-enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non-tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia.
(Korean J Hepatol 2001;7:189-194)
Intrahepatic biloma is one of the rare complications occurring after transcatheter arterial chemoembolization (TACE). Biloma after TACE may result from the development of peripheral bile duct necrosis caused by microvascular damage of the peribiliary capillary plexus, and intrahepatic ductal stenosis. We report a case of resection of intrahepatic biloma with hepatocellular carcinoma after TACE. (Korean J Hepatol 2002;8:331-335)
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