Page 185 - ebook HCC

182 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 183
FEBRUARY 13 - 16, 2014

RESECTION FOR LARGE AND MULTIFOCAL HCC PROGRESS IN PERCUTANEOUS TREATMENT

Jigjidsuren Chinburen , Michelle Gillet , Enkhbold Chinbold 1 Jens Ricke 1
1
1
1 Hepato pancreato biliary surgery, National Cancer Center, Ulaanbaatar, Mongolia 1 University Hospital Magdeburg A.ö.R, Magdeburg, Germany
Corresponding author’s e-mail: chburen@hotmail.com Corresponding author’s e-mail: Jens.Ricke@med.ovgu.de

Introduction: Hepatocellular carcinoma (HCC) is the first leading cause of cancer-related New image guided, percutaneous techniques are available for both early as well as
mortality in both men and women in Mongolia, and its incidence is among the highest advanced stages of HCC. For image guided ablation of HCC up to 3 cm RFA has evolved
worldwide. HCC is strongly associated with liver cirrhosis and hepatitis B and C infections. as the standard application in the past years. Despite a lack of comparative data on efficacy,
Surgical resection remains the first-line therapeutic strategy for HCC despite recent microwave ablation has replaced RF treatment in many centers due to facilitated use
advancements in treatment modalities. However, underlying liver diseases significantly and shorter intervention time. Irreversible electroporation is another new local treatment
limit the number of HCC patients eligible for surgical resection. In general, only 20% to which has not yet progressed beyond the experimental stage. A single arm multicenter
30% of patients with HCC are eligible for resection because of compromised liver function trial assessing 28 HCC patients only has been presented recently, and further data on
reserve. treatment of other hepatic malignancies with IRE is equally limited. Consequently, IRE
Aims: Indications for surgical treatment of patients with large or vascular invasive use can only be supported in clinical trials today. Radiation techniques overcome intrinsic
hepatocellular carcinoma (HCC) remain controversial. According to the Barcelona Clinic problems of thermal ablation such as cooling effects, unfavorable location such as in the
Liver Cancer (BCLC) classification, hepatic resection should be performed only in patients liver hilum or liver dome, or excessive tumor size. Stereotactic body irradiation (SBRT) is
with early stage HCC (BCLC stages 0 and A), but no for patients with intermediate and limited by the number and size of lesions; however, the non-invasiveness of the technique
advanced stages (BCLC stages B and C). This study aimed to determine whether hepatic (except for the large body volume simultaneously exposed to low-dose radiation including
resection improves survival for patients with BCLC stages B and C HCC. liver parenchyma) represents a significant advantage. CT-guided brachytherapy has
proven to be effective also in very large and multiple tumors. A recent randomized study
Methodology: A retrospective review of 347 HCC patients who underwent hepatic
CLINICAL SPEAKERS ABSTRACTS conducted. Of 347 patients, 125 had BCLC stage 0/A disease, 211 had stage B disease durable local control even in multiple tumors. Finally, as percutaneous treatments only CLINICAL SPEAKERS ABSTRACTS
indicated advantages over TACE in advanced patients predominately due to much more
resection at the National Cancer Center (NCC) of Mongolia between 2008 and 2012 was
represent a fraction of the tool box available for HCC, their sequential use as well as their
and 11 had stage C disease. Mortality and survival outcomes were analyzed.
combination with other interventional techniques or systemic treatments (i.e. Sorafenib)
Results: For patients with BCLC stages 0/A, B and C disease 30-day hospital mortality
was 1.6, 2.8 and 0%, respectively. The 1-year overall survival rates were 91.2% in BCLC
bares very strong potential for improved outcomes. Data on sequential or multimodal use
of ablation techniques is hard to gather; as of today, no in-depth recommendations exist on
stage 0/A patients, 80.1% in stage B patients and 31.2% in stage C patients (p<0.001);
how to sequence the surgical, interventional and systemic toolbox for an individual patient.
and the 2-year overall survival rates were 68% in stage 0/A patients and 51.8% in stage
B patients (p=0.05). All patients with stage C disease died within 432 days after surgery.
Serum alpha-fetoprotein (AFP) level above 600 ng/ml was found to be an independent
TACE failed to proof a benefit; the TACE 2 trial with more flexibility in sequencing TACE
predictor of overall survival. The SPACE trial comparing a very strict sequence of sorafenib and TACE with placebo and
and sorafenib still is recruiting. SORAMIC, a trial randomizing patients to Y90 followed by
Conclusions: Patients with BCLC stages B and C HCC can tolerate hepatic resection sorafenib or sorafenib only has recently published an interim safety analyses with positive
with low mortality and survival benefits, especially those with serum AFP below 600 ng/ results. Data on the effectiveness of that treatment sequence can be expected by the end
ml. These results show that hepatic resection can provide survival benefit for patients of 2015.
with advanced HCC especially in resource-poor settings with limited access to adjuvant
therapy.