Original articleClinical practice managementACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy
Section snippets
Introduction/Background
Management of hepatic malignancy remains a challenging problem. Depending on the clinical scenario, traditional therapies, such as resection, systemic chemotherapy, and external beam radiation are either unavailable or ineffective. To help address this issue, several treatment techniques have been developed by interventional radiologists to treat hepatic malignancies. These treatments include direct tumor ablation via chemical or thermal means, and endovascular techniques, such as embolization,
Summary of Recommendations
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Management of primary and secondary hepatic malignancy remains a complex issue due to the multitude of treatment options. For this reason, a multidisciplinary approach offers the best hope for optimal treatment with respect to any individual patient.
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Resection and transplantation remain the best options for cure in properly selected patients for primary malignancy as well as secondary malignancy in some limited scenarios; however, the role of RFA and potentially SBRT as primary treatment options
References (118)
- et al.
Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience
J Am Coll Surg
(2007) - et al.
Radiation therapy for hepatocellular carcinoma
Seminars in Radiat Oncol
(2011) - et al.
Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis
J Hepatol
(2010) - et al.
Microwave coagulation therapy for hepatic tumors: review of the literature and critical analysis
Surg Oncol
(2010) - et al.
Survival with up to 10-year follow-up after combination therapy of chemoembolization and radiofrequency ablation for the treatment of hepatocellular carcinoma: single-center experience
J Vasc Interv Radiol
(2013) - et al.
Radiofrequency ablation compared to resection in early-stage hepatocellular carcinoma
HPB (Oxford)
(2013) - et al.
A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma
J Hepatol
(2012) - et al.
Radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation
HPB (Oxford)
(2011) - et al.
Stereotactic body radiotherapy for primary hepatocellular carcinoma
Int J Radiat Oncol, Biol, Phys
(2011) - et al.
Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications
Eur J Radiol
(2009)
Chemoembolization for hepatocellular carcinoma
Semin Roentgenol
Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization
Cancer Treat Rev
Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis
J Vasc Interv Radiol
Use of Yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable hepatocellular carcinoma in patients with portal vein thrombosis
J Vasc Interv Radiol
Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma
Hepatology
Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial
Lancet
Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma
J Vasc Interv Radiol
Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis
Am J Transplant
Hepatocellular carcinoma locoregional therapies for patients in the waiting list. Impact on transplantability and recurrence rate
J Hepatol
Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes
Gastroenterology
Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma
J Vasc Interv Radiol
Comparative analysis of the safety and efficacy of transcatheter arterial chemoembolization and yttrium-90 radioembolization in patients with unresectable hepatocellular carcinoma
J Vasc Interv Radiol
A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization
Am J Transplant
Phase II study of concurrent transarterial chemoembolization and sorafenib in patients with unresectable hepatocellular carcinoma
J Hepatol
Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis
J Vasc Interv Radiol
Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival
J Am Coll Surg
Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival
Surgery
Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation
Eur J Radiol
Hepatic neuroendocrine metastases: chemo- or bland embolization?
J Gastrointest Surg
Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver
J Vasc Interv Radiol
Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs. drug-eluting beads
J Hepatol
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma
J Hepatol
Management of hepatocellular carcinoma: an update
Hepatology
Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis
N Engl J Med
Systemic therapy for advanced hepatocellular carcinoma: past, present, and future
Cancer Contr: J Moffitt Cancer Center
Sorafenib in advanced hepatocellular carcinoma
N Engl J Med
Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies
Hepatology
Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials
Am J Gastroenterol
Microwave ablation of hepatic malignancy
Semin Intervent Radiol
Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma: a meta-analysis
Hepatogastroenterology
Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation
Radiology
Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis
Hepatology
Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis
Ann Surg Oncol
Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials
Eur J Gastroenterol Hepatol
A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma
Ann Surg
Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?
Hepatology
Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study
Radiology
A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria
Ann Surg
The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review
Ann Surg
Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation
Liver Transpl
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