AIM: To compare the efficacy and safety of chemoembolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy (HAIC), including oxaliplatin (OXA), 5-fluorouracil (5-FU) and folinic acid (CF), in inoperable hepatocellular carcinoma (HCC) without distant metastasis.
AIM: To investigate the relationship between contrast-enhanced ultrasound (CEUS), basic fibroblast growth factor (bFGF), endothelin-1 (ET-1), and hepatocellular carcinoma (HCC) recurrence after ablation.
Hepatocellular carcinoma (HCC), the fifth most common cancer that predominantly occurs in liver cirrhosis patients, requires staging systems to design treatments. The barcelona clinic liver cancer staging system (BCLC) is the most commonly used HCC management guideline. For BCLC stage B (intermediate HCC), transarterial chemoembolization (TACE) is the standard treatment. Many studies support the use of TACE in early and advanced HCC patients. For BCLC stage 0 (very early HCC), TACE could be an alternative for patients unsuitable for radiofrequency ablation (RFA) or hepatic resection. In patients with BCLC stage A, TACE plus RFA provides better local tumor control than RFA alone. TACE can serve as bridge therapy for patients awaiting liver transplantation. For patients with BCLC B, TACE provides survival benefits compared with supportive care options.
This two-part review discusses the current state of the art for computed tomography (CT)- and magnetic resonance (MR) imaging–based diagnosis and staging of hepatocellular carcinoma (HCC). The first article reviewed basic background material including HCC epidemiology, key concepts in hepatocarcinogenesis, CT and MR imaging technique, and the CT and MR imaging appearance of cirrhotic nodules, low-grade dysplastic nodules, and high-grade dysplastic nodules. This second article builds on these concepts and reviews in detail the diagnosis and staging of HCC using CT and MR imaging. In the article, we focus on CT and MR imaging because these currently are the most important modalities for HCC diagnosis and staging.
Purpose: To prospectively evaluate the utility of computed tomography (CT) for determination of tumor response and prediction of resectability after neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with nonmetastatic locally advanced pancreatic cancer.
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Hepatocellular carcinoma (HCC) is an epithelial tumor originating in the liver and composed of cells with characteristics similar to those of normal hepatocytes. It is the fifth most common tumor in the world, and its incidence is increasing, especially in Western nations. Cirrhosis is the most important clinical risk factor for HCC, with approximately 80% of cases of HCC developing in patients with a cirrhotic liver. In such patients, the annual incidence of HCC ranges from 2% to 8%. The exact incidence depends on the cause of cirrhosis (highest incidence in those infected with hepatitis C virus or hepatitis B virus), severity of cirrhosis (highest incidence in those with decompensated cirrhosis), geographic region (higher in Japan than in Europe or United States), and sex (higher in men than women). The risk is greater in individuals with multiple risk factors as well as in those coinfected with human immunodeficiency virus. Patients without cirrhosis also may develop HCC, especially those with long-standing chronic liver inflammation due to hepatitis B virus or hepatitis C virus infection or nonalcoholic steatohepatitis, but at a much lower rate than those with cirrhosis. Other risk factors for HCC include heavy alcohol consumption, tobacco smoking, obesity, diabetes, hereditary hemochromatosis, high dietary consumption of aflatoxins, and family history of HCC. Importantly, cirrhosis and chronic hepatitis now are recognized as risk factors for intrahepatic cholangiocarcinoma (ICC) as well as HCC; thus, many patients at risk for HCC may develop ICC instead.
Thyroid nodules are common and typically benign. While an estimated 4% of the population has a thyroid nodule detectable by palpation, ultrasonography (US) can depict nodules in 35%–68% of asymptomatic patients, and postmortem studies suggest that the true lifetime prevalence of thyroid nodules may be closer to 60%–70%. Approximately 5%–15% of thyroid nodules are malignant, but US cannot reliably differentiate cancers from benign nodules. As such, clinical guidelines recommend fine-needle aspiration (FNA) of nodules with a maximal diameter greater than 1–1.5 cm and of nodules that are smaller with US features of concern, such as taller-than-wide morphologic characteristics, solid hypoechoic echotexture, irregular border, central vascularity, microcalcifications, or abnormal cervical lymphadenopathy. The reported diagnostic yield of thyroid FNA varies from 80% to 99%, with an average of 85%.
Foot complications associated with diabetes have a prevalence of 15%–20% in all patients with diabetes and remain the most common cause of nontraumatic amputations of the lower extremity. Previous studies have shown that 45%–85% of patients can be spared amputation if appropriate revascularization is performed on the basis of a reliable early diagnosis. Surgical and endovascular revascularization remains the most important therapeutic option for limb salvage in patients with severe arterial occlusive disease, particularly those with diabetes. Because the outcome of the therapy is in large part determined by the presence of adequate pedal blood flow, precise preoperative mapping of the vascular anatomy and the location, extent, and degree of stenosis is crucial for planning stent placement or selecting a site of graft anastomosis.
It has long been recognized that body weight is a critical patient-related factor that influences vascular and parenchymal contrast medium enhancement during multi–detector row computed tomography (CT). For a certain contrast medium dose, the magnitude of enhancement decreases proportionally with increasing patient body weight, particularly relative to lean body tissue. This effect can be explained by the proportional increase in blood volume, and consequent decrease in the blood pool concentration of iodine, with increasing patient body weight.
Percutaneous thermal ablation has been proven to be an effective and safe treatment for patients with small renal tumors. In fact, the American Urologic Association consensus guidelines now include percutaneous ablation as an acceptable treatment option for high-risk surgical patients with T1a (≤4 cm) renal tumors. Historically, percutaneous ablation has been reserved for patients with small, exophytic tumors in the posterolateral kidney. However, the increased use of cryoablation and displacement techniques have significantly expanded the number of renal tumors that can be successfully treated percutaneously, including larger tumors, central tumors, and tumors in less accessible locations within the kidney. This extended application, however, has been accompanied by an increase in complications, particularly bleeding complications, compared with ablation of smaller, less complex renal masses.
In February 2013, three articles published in the New England Journal of Medicine concluded that endovascular treatment (EVT) of acute ischemic stroke provided no benefit over standard of care. In 2015, five articles published in the New England Journal of Medicine concluded that EVT of acute ischemic stroke provides tremendous benefit over standard of care, doubling the likelihood of returning a patient to independence. How could the truth have changed so much in 2 years?
Purpose: To determine the clinical outcomes of polytetrafluoroethylene covered balloon expandable stents (CBESs) in occlusive lesions of the aortic bifurcation in a kissing stent configuration.
Objectives: To investigate the incidence and outcomes of acute lower gastrointestinal bleeding (ALGIB) in a population-based setting and examine the role of drugs potentially associated with GIB.
The current management therapies for hepatocellular carcinoma (HCC) patients are discussed in this review. Despite the development of new therapies, HCC remains a “difficult to treat” cancer because HCC typically occurs in advanced liver disease or hepatic cirrhosis. The progression of multistep and multicentric HCC hampers the prevention of the recurrence of HCC. Many HCC patients are treated with surgical resection and radiofrequency ablation (RFA), although these modalities should be considered in only selected cases with a certain HCC number and size. Although there is a shortage of grafts, liver transplantation has the highest survival rates for HCC. Several modalities are salvage treatments; however, intensive care in combination with other modalities or in combination with surgical resection or RFA might offer a better prognosis. Sorafenib is useful for patients with advanced HCC. In the near future, HCC treatment will include stronger molecular targeted drugs, which will have greater potency and fewer adverse events. Further studies will be ongoing.
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