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  • S. Karger AG  (3)
  • 2020-2024  (3)
  • 1
    Online Resource
    Online Resource
    Liver Cancer Study Group of Japan Clinical Practice Guidelines for Intrahepatic Cholangiocarcinoma
    S. Karger AG ; 2022
    In:  Liver Cancer Vol. 11, No. 4 ( 2022), p. 290-314
    Details
    In: Liver Cancer, S. Karger AG, Vol. 11, No. 4 ( 2022), p. 290-314
    Abstract: This paper presents the first version of clinical practice guidelines for intrahepatic cholangiocarcinoma (ICC) established by the Liver Cancer Study Group of Japan. These guidelines consist of 1 treatment algorithm, 5 background statements, 16 clinical questions, and 1 clinical topic, including etiology, staging, pathology, diagnosis, and treatments. Globally, a high incidence of ICC has been reported in East and Southeast Asian countries, and the incidence has been gradually increasing in Japan and also in Western countries. Reported risk factors for ICC include cirrhosis, hepatitis B/C, alcohol consumption, diabetes, obesity, smoking, nonalcoholic steatohepatitis, and liver fluke infestation, as well as biliary diseases, such as primary sclerosing cholangitis, hepatolithiasis, congenital cholangiectasis, and Caroli disease. Chemical risk factors include thorium-232, 1,2-dichloropropane, and dichloromethane. CA19-9 and CEA are recommended as tumor markers for early detection and diagnostic of ICC. Abdominal ultrasonography, CT, and MRI are effective imaging modalities for diagnosing ICC. If bile duct invasion is suspected, imaging modalities for examining the bile ducts may be useful. In unresectable cases, tumor biopsy should be considered when deemed necessary for the differential diagnosis and drug therapy selection. The mainstay of treatment for patients with Child-Pugh class A or B liver function is surgical resection and drug therapy. If the patient has no regional lymph node metastasis (LNM) and has a single tumor, resection is the treatment of choice. If both regional LNM and multiple tumors are present, drug therapy is the first treatment of choice. If the patient has either regional LNM or multiple tumors, resection or drug therapy is selected, depending on the extent of metastasis or the number of tumors. If distant metastasis is present, drug therapy is the treatment of choice. Percutaneous ablation therapy may be considered for patients who are ineligible for surgical resection or drug therapy due to decreased hepatic functional reserve or comorbidities. For unresectable ICC without extrahepatic metastasis, stereotactic radiotherapy (tumor size ≤5 cm) or particle radiotherapy (no size restriction) may be considered. ICC is generally not indicated for liver transplantation, and palliative care is recommended for patients with Child-Pugh class C liver function.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000522403
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2666925-0
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  • 2
    Online Resource
    Online Resource
    Proton Beam Therapy for Intrahepatic Cholangiocarcinoma: A Multicenter Prospective Registry Study in Japan
    S. Karger AG ; 2023
    In:  Liver Cancer
    Details
    In: Liver Cancer, S. Karger AG
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Intrahepatic cholangiocarcinoma (ICC) can be treated with chemotherapy in unresectable cases, but outcomes are poor. Proton beam therapy (PBT) may provide an alternative treatment and has good dose concentration that may improve local control. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Fifty-nine patients who received initial PBT for ICC from May 2016 to June 2018 at nine centers were included in the study. The treatment protocol was based on the policy of the Japanese Society for Radiation Oncology. Forty patients received 72.6–76 Gy (RBE) in 20–22 fr, 13 received 74.0–76.0 Gy (RBE) in 37–38 fr, and 6 received 60–70.2 Gy (RBE) in 20–30 fr. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 59 patients (35 men, 24 women; median age: 71 years; range: 41–91 years) had PS of 0 ( 〈 i 〉 n 〈 /i 〉 = 47), 1 ( 〈 i 〉 n 〈 /i 〉 = 10), and 2 ( 〈 i 〉 n 〈 /i 〉 = 2). Nine patients had hepatitis and all 59 cases were considered inoperable. The Child-Pugh class was A ( 〈 i 〉 n 〈 /i 〉 = 46), B ( 〈 i 〉 n 〈 /i 〉 = 7), and unknown ( 〈 i 〉 n 〈 /i 〉 = 6); the median maximum tumor diameter was 5.0 cm (range 2.0–15.2 cm); and the clinical stage was I ( 〈 i 〉 n 〈 /i 〉 = 12), II ( 〈 i 〉 n 〈 /i 〉 = 19), III ( 〈 i 〉 n 〈 /i 〉 = 10), and IV ( 〈 i 〉 n 〈 /i 〉 = 18). At the last follow-up, 17 patients were alive (median follow-up: 36.7 months; range: 24.1–49.9 months) and 42 had died. The median OS was 21.7 months (95% CI: 14.8–34.4 months). At the last follow-up, 37 cases had recurrence, including 10 with local recurrence. The median PFS was 7.5 months (95% CI: 6.1–11.3 months). In multivariable analyses, Child-Pugh class was significantly associated with OS and PFS, and Child-Pugh class and hepatitis were significantly associated with local recurrence. Four patients (6.8%) had late adverse events of grade 3 or higher. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 PBT gives favorable treatment outcomes for unresectable ICC without distant metastasis and may be particularly effective in cases with large tumors.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000531376
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 2666925-0
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  • 3
    Online Resource
    Online Resource
    Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis
    S. Karger AG ; 2023
    In:  Liver Cancer Vol. 12, No. 4 ( 2023), p. 297-308
    Details
    In: Liver Cancer, S. Karger AG, Vol. 12, No. 4 ( 2023), p. 297-308
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Proton beam therapy (PBT) is known to be an effective locoregional treatment for hepatocellular carcinoma (HCC). However, few comparative studies in treatment-naïve cases have been reported. The aim of this study was to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Ninety-five consecutive patients with treatment-naïve HCC, a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8 who were treated with PBT at the University of Tsukuba Hospital between 2001 and 2013 were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. Recurrence-free survival (RFS) and overall survival (OS) were compared in 83 patient pairs after propensity score matching. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 1-year, 3-year, and 5-year RFS rates were 86.6%, 49.5%, and 35.5%, respectively, in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group ( 〈 i 〉 p 〈 /i 〉 = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group ( 〈 i 〉 p 〈 /i 〉 = 0.16). Regarding adverse effects, no grade 3 or higher adverse events were noted in the PBT; however, two grade 3 adverse events occurred within 30 days of RFA in the RFA group: one hemoperitoneum and one hemothorax. 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 After propensity score matching, PBT showed no significant difference in RFS and OS compared to RFA. PBT can be an alternative for patients with solitary treatment-naïve HCC.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000528537
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 2666925-0
    Location Call Number Limitation Availability
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    Online Resource
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