Evidence-Based Treatment for a Patient with Advanced Hepatocellular Carcinoma_Chinese Journal of Evidence-Based Medicine

Authors：

FAN Kai ,  DONG Weiguo , LV Xiaoguang , LEI Xiaofei

Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

DONG Weiguo, Email: dongwg66@yahoo.com.cn

Keywords：

Hepatocellular carcinoma/Advanced; Evidence-based treatment

DOI：

10.7507/1672-2531.20110205

Video：

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Objective 　To formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma.
Methods 　The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment.
Results 　A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal.
Conclusion 　The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.

Citation： FAN Kai,DONG Weiguo,LV Xiaoguang,LEI Xiaofei. Evidence-Based Treatment for a Patient with Advanced Hepatocellular Carcinoma. Chinese Journal of Evidence-Based Medicine, 2011, 11(10): 1221-1226. doi: 10.7507/1672-2531.20110205 Copy

1.	1 Benson AB 3rd, Abrams TA, Ben-Josef E, et al . NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw , 2009, 7(4): 350-391.
2.	2 Parikh P, Malhotra H, Jelic S; ESMO Guidelines Working Group.Hepatocellular carcinoma: ESMO Clinical Recommendation for diagnosis,treatment and follow-up. Ann Oncol , 2008, 19 Suppl 2: ii27-28.
3.	3 Poon D, Anderson BO, Chen LT, et al . Management of hepatocellular carcinoma in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol , 2009, 10(11): 1111-1118.
4.	4 Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology , 2005, 42(5): 1208-1236.
5.	5 Cammà C, Schepis F, Orlando A, et al . Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Meta-Analysis of Randomized Controlled Trials. Radiology , 2002, 224(1): 47-54.
6.	6 Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology , 2003, 37(2): 429-442.
7.	7 Llovet JM, Real MI, Montana X, et al . Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet , 2002, 359(9319): 1734-1739.
8.	8 Lo CM, Ngan H, Tso WK, et al . Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology , 2002, 35(5): 1164-1171.
9.	9 Marelli L, Stigliano R, Triantos C, et al . Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol , 2007, 30(1): 6-25.
10.	10 Matsui O, Kadoya M, Yoshikawa J, et al . Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology , 1993, 188(1): 79-83.
11.	11 Nishimine K, Uchida H, Matsuo N, et al . Segmental transarterial chemoembolization with Lipiodol mixed with anticancer drugs for nonresectable hepatocellular carcinoma: follow-up CT and therapeutic results. Cancer Chemother Pharmacol , 1994, 33 Suppl: S60-68.
12.	13 Livraghi T. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. Hepatogastroenterology , 2001, 48(37): 20-24.
13.	14 Schoppmeyer K, Weis S, Mössner J, et al . Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma. Cochrane Database Syst Rev , 2009, 8(3): CD006745.
14.	16 Galandi D, Antes G. Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev , 2004, (2): CD003046.
15.	17 Cho YK, Kim JK, Kim MY, et al . Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology , 2009, 49(2): 453-459.
16.	18 Bouza C, López-Cuadrado T, Alcázar R, et al . Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol , 2009, 9(1): 31-40.
17.	19 Orlando A, Leandro G, Olivo M, et al . Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroentero , 2009, 104(2): 514-524.
18.	21 Meng MB, Cui YL, Lu Y, et al . Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol , 2009, 92(2): 184-194.
19.	25 Mornex F, Girard N, Beziat C, et al . Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies–mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys , 2006, 66(4):1152-1158.
20.	26 Zhang XB, Wang JH, Yan ZP, et al . Hepatocellular carcinoma with main portal vein tumor thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization. Cancer , 2009, 115(6): 1245-1252.
21.	27 You CR, Jang JW, Kang SH, et al . Efficacy of transarterial chemolipiodolization with or without 3-dimensional conformal radiotherapy for huge HCC with portal vein tumor thrombosis. Korean J Hepatol , 2007, 13(3): 378-386.
22.	28 Guo WJ, Yu EX, Liu LM, et al . Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol , 2003, 9(8): 1697-1701.
23.	29 Yamada K, Izaki K, Sugimoto K, et al . Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys , 2003, 57(1): 113-119.
24.	30 Samuel M, Chow PK, Chan Shih-Yen E, et al . Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev , 2009, 1(1): CD001199.
25.	31 Söderdahl G, Bäckman L, Isoniemi H, et al . A prospective, randomized, multi-centre trial of systemic adjuvant chemotherapy versus no additional treatment in liver transplantation for hepatocellular carcinoma. Transpl Int , 2006, 19(4): 288-294.
26.	32 Bayraktar Y, Balkanci F, Kayhan B, et al . A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma. Hepatogastroenterology , 1996, 43(9): 681-687.
27.	33 Mabed M, Esmaeel M, El-Khodary T, et al . A randomized controlled trial of transcatheter arterial chemoembolization with lipiodol, doxorubicin and cisplatin versus intravenous doxorubicin for patients with unresectable hepatocellular carcinoma. Eur J Cancer Care (Engl) , 2009, 18(5): 492-499.
28.	34 Tzoracoleftherakis EE, Spiliotis JD, Kyriakopoulou T, et al . Intra-arterial versus systemic chemotherapy for non-operable hepatocellular carcinoma. Hepatogastroenterology , 1999, 46(26): 1122-1125.
29.	35 Zhang T, Ding X, Wei D, et al . Sorafenib improves the survival of patients with advanced hepatocellular carcinoma: a meta-analysis of randomized trials. Anticancer Drugs , 2010, 21(3): 326-332.
30.	36 Llovet JM, Rico S, Mazzaferro V, et al . Sorafenib in advanced hepatocellular carcinoma. New Engl J Med , 2008, 59(4): 378-390.
31.	37 Cheng AL, Kang YK, Chenz, et al . Efficacy and safety of Sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma:a phase III randomised, double-blind, Placebo-controlled trial. Lancet Onto , 2009, 10(1): 25-34.
32.	38 Zhao JD, Liu J, Ren ZG, et al . Maintenance of Sorafenib following combined therapy of three-dimensional conformal radiation therapy/intensity-modulated radiation therapy and transcatheter arterial chemoembolization in patients with locally advanced hepatocellular carcinoma: a phase I/II study. Radiat Oncol , 2010, 5(1): 12-19.
33.	39 Meng MB, Cui YL, Guan YS, et al . Traditional Chinese medicine plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma. J Altern Complement Med , 2008, 14(8): 1027-1042.
34.	40 Wu P, Dugoua JJ, Eyawo O, et al . Traditional Chinese Medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res , 2009, 28(1): 112-125.
35.	陈晓明, 罗鹏飞, 邵培坚, 等. 肝癌节段性栓塞化疗与常规栓塞化疗的比较研究. 中华放射学杂志, 2000, 34(4): 271-273.
36.	陈敏山, 李锦清, 梁惠宏, 等. 经皮射频消融与手术切除治疗小肝癌的疗效比较. 中华医学杂志, 2005, 85(2): 80-83.
37.	康春博, 许洪斌, 王世龙, 等. TACE联合RFA治疗大肝癌的研究. 中华肝胆外科杂志, 2007, 13(12): 828-830.
38.	马晴, 吕慧, 王燕, 等. 三维适形放疗联合肝动脉栓塞化疗治疗原发性肝癌疗效的Meta分析. 疑难病杂志, 2009, 8(12): 718-721.
39.	吴莉, 文小平, 黄薇. 原发性肝癌三维适形放疗联合介入治疗的临床研究. 中华放射医学与防护杂志, 2006, 26(3): 256-258.
40.	娄繁, 包永星, 牛永健. 肝动脉栓塞化疗联合三维适形放疗治疗Ⅱ期原发性肝癌疗效分析. 中华放射肿瘤学杂志, 2009, 18(6): 474-476.

1. 1 Benson AB 3rd, Abrams TA, Ben-Josef E, et al . NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw , 2009, 7(4): 350-391.
2. 2 Parikh P, Malhotra H, Jelic S; ESMO Guidelines Working Group.Hepatocellular carcinoma: ESMO Clinical Recommendation for diagnosis,treatment and follow-up. Ann Oncol , 2008, 19 Suppl 2: ii27-28.
3. 3 Poon D, Anderson BO, Chen LT, et al . Management of hepatocellular carcinoma in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol , 2009, 10(11): 1111-1118.
4. 4 Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology , 2005, 42(5): 1208-1236.
5. 5 Cammà C, Schepis F, Orlando A, et al . Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Meta-Analysis of Randomized Controlled Trials. Radiology , 2002, 224(1): 47-54.
6. 6 Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology , 2003, 37(2): 429-442.
7. 7 Llovet JM, Real MI, Montana X, et al . Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet , 2002, 359(9319): 1734-1739.
8. 8 Lo CM, Ngan H, Tso WK, et al . Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology , 2002, 35(5): 1164-1171.
9. 9 Marelli L, Stigliano R, Triantos C, et al . Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol , 2007, 30(1): 6-25.
10. 10 Matsui O, Kadoya M, Yoshikawa J, et al . Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology , 1993, 188(1): 79-83.
11. 11 Nishimine K, Uchida H, Matsuo N, et al . Segmental transarterial chemoembolization with Lipiodol mixed with anticancer drugs for nonresectable hepatocellular carcinoma: follow-up CT and therapeutic results. Cancer Chemother Pharmacol , 1994, 33 Suppl: S60-68.
12. 13 Livraghi T. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. Hepatogastroenterology , 2001, 48(37): 20-24.
13. 14 Schoppmeyer K, Weis S, Mössner J, et al . Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma. Cochrane Database Syst Rev , 2009, 8(3): CD006745.
14. 16 Galandi D, Antes G. Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev , 2004, (2): CD003046.
15. 17 Cho YK, Kim JK, Kim MY, et al . Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology , 2009, 49(2): 453-459.
16. 18 Bouza C, López-Cuadrado T, Alcázar R, et al . Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol , 2009, 9(1): 31-40.
17. 19 Orlando A, Leandro G, Olivo M, et al . Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroentero , 2009, 104(2): 514-524.
18. 21 Meng MB, Cui YL, Lu Y, et al . Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol , 2009, 92(2): 184-194.
19. 25 Mornex F, Girard N, Beziat C, et al . Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies–mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys , 2006, 66(4):1152-1158.
20. 26 Zhang XB, Wang JH, Yan ZP, et al . Hepatocellular carcinoma with main portal vein tumor thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization. Cancer , 2009, 115(6): 1245-1252.
21. 27 You CR, Jang JW, Kang SH, et al . Efficacy of transarterial chemolipiodolization with or without 3-dimensional conformal radiotherapy for huge HCC with portal vein tumor thrombosis. Korean J Hepatol , 2007, 13(3): 378-386.
22. 28 Guo WJ, Yu EX, Liu LM, et al . Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol , 2003, 9(8): 1697-1701.
23. 29 Yamada K, Izaki K, Sugimoto K, et al . Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys , 2003, 57(1): 113-119.
24. 30 Samuel M, Chow PK, Chan Shih-Yen E, et al . Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev , 2009, 1(1): CD001199.
25. 31 Söderdahl G, Bäckman L, Isoniemi H, et al . A prospective, randomized, multi-centre trial of systemic adjuvant chemotherapy versus no additional treatment in liver transplantation for hepatocellular carcinoma. Transpl Int , 2006, 19(4): 288-294.
26. 32 Bayraktar Y, Balkanci F, Kayhan B, et al . A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma. Hepatogastroenterology , 1996, 43(9): 681-687.
27. 33 Mabed M, Esmaeel M, El-Khodary T, et al . A randomized controlled trial of transcatheter arterial chemoembolization with lipiodol, doxorubicin and cisplatin versus intravenous doxorubicin for patients with unresectable hepatocellular carcinoma. Eur J Cancer Care (Engl) , 2009, 18(5): 492-499.
28. 34 Tzoracoleftherakis EE, Spiliotis JD, Kyriakopoulou T, et al . Intra-arterial versus systemic chemotherapy for non-operable hepatocellular carcinoma. Hepatogastroenterology , 1999, 46(26): 1122-1125.
29. 35 Zhang T, Ding X, Wei D, et al . Sorafenib improves the survival of patients with advanced hepatocellular carcinoma: a meta-analysis of randomized trials. Anticancer Drugs , 2010, 21(3): 326-332.
30. 36 Llovet JM, Rico S, Mazzaferro V, et al . Sorafenib in advanced hepatocellular carcinoma. New Engl J Med , 2008, 59(4): 378-390.
31. 37 Cheng AL, Kang YK, Chenz, et al . Efficacy and safety of Sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma:a phase III randomised, double-blind, Placebo-controlled trial. Lancet Onto , 2009, 10(1): 25-34.
32. 38 Zhao JD, Liu J, Ren ZG, et al . Maintenance of Sorafenib following combined therapy of three-dimensional conformal radiation therapy/intensity-modulated radiation therapy and transcatheter arterial chemoembolization in patients with locally advanced hepatocellular carcinoma: a phase I/II study. Radiat Oncol , 2010, 5(1): 12-19.
33. 39 Meng MB, Cui YL, Guan YS, et al . Traditional Chinese medicine plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma. J Altern Complement Med , 2008, 14(8): 1027-1042.
34. 40 Wu P, Dugoua JJ, Eyawo O, et al . Traditional Chinese Medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res , 2009, 28(1): 112-125.
35. 陈晓明, 罗鹏飞, 邵培坚, 等. 肝癌节段性栓塞化疗与常规栓塞化疗的比较研究. 中华放射学杂志, 2000, 34(4): 271-273.
36. 陈敏山, 李锦清, 梁惠宏, 等. 经皮射频消融与手术切除治疗小肝癌的疗效比较. 中华医学杂志, 2005, 85(2): 80-83.
37. 康春博, 许洪斌, 王世龙, 等. TACE联合RFA治疗大肝癌的研究. 中华肝胆外科杂志, 2007, 13(12): 828-830.
38. 马晴, 吕慧, 王燕, 等. 三维适形放疗联合肝动脉栓塞化疗治疗原发性肝癌疗效的Meta分析. 疑难病杂志, 2009, 8(12): 718-721.
39. 吴莉, 文小平, 黄薇. 原发性肝癌三维适形放疗联合介入治疗的临床研究. 中华放射医学与防护杂志, 2006, 26(3): 256-258.
40. 娄繁, 包永星, 牛永健. 肝动脉栓塞化疗联合三维适形放疗治疗Ⅱ期原发性肝癌疗效分析. 中华放射肿瘤学杂志, 2009, 18(6): 474-476.

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