Flashcards in B14. Radiotherapy, surgical and pharmacological treatment of liver tumours Deck (24):
What is the fundamental principle of treating liver tumors
-In hepatocellular carcinoma it is surgical resection.
-May present with cirrhosis indicating liver transplant for curative treatment
How are liver tumors treated if radical surgery is not suitable?
-Radiofrequency ablation (RFA)
-Percutaneous ethanol injection (PEI)
-High-intensity focused ultrasound (HIFU)
-chemotherapy given through afferent circulation of the liver (HAI)
-transarterial chemoembolisation (TACE)
In the case of metastatic cancer, chemotherapy may be given
Basic principle of surgical treatment for liver tumors
Radical resection that retains a sufficient amount of liver volume for survival and regeneration.
-liver is not cirrhotic
-sufficient remaining liver volume is 30%
-provided blood supply
-bile duct drainage are intact
How does intrahepatic bile duct tumor surgeries do not differ from hepatocellular cancer surgery? What is also required in both cases?
They are technically the same. Portal lymphadenectomy is required.
Surgery done for hilar cholangiocarcinomas (Klatskin tumors)?
Resection of bile duct system with clear surgical margins; which leads to partial hepatectomy of a liver love; the connection of the bile duct is usually reconstructed using a transplanted segment
Surgery for liver bed tumors
Resection of the liver bed wall
Surgery for liver siphon
Intraoperative frozen section analysis of the cystic stump; if it turns out positive: surgery should be extended to large bile ducts
1-2 liver segment involvement surgery
One or few nodules in liver surgery
What percent of the cases are unresectable for HCC
60-80% (majority of cases)
Resection, cryoablation, transplantation
Non surgical treatment for direct liver lesions in liver cancer
-Percutaneous ethanol injection
Non-surgical systemic treatment for liver cancers
-targeted molecular therapy
How does chemotherapy affect hepatocellular cancer?
Has little effect, rarely given in adjuvant setting or as palliative.
Intra-arterial chemotherapy (when used) for liver tumor uses cytotoxic drugs like
Anthracycline, mitomycin-C, and cisplatin
Targeted biological therapies. First line? Second line?
-First line: Sorafenib, per os multikinase inhibitor (inhibits VEGF, PDGF, RAF)
-Second line: Regorafenib (VEGFR)
Is radiotherapy used for liver tumors
The liver is highly radiosensitive organ, while its tumor (especially HCC) have low radiosensitivity. So radiotherapy is not typically used except stereotactic ablative radiotherapy (SABRT)
Clinical indication for liver transplant
-Decompoensated cirrhosis (ascites, esophageal variceal hemorrhage, spontaneous, hepatic encephalopathy, coagulopathy, progressive jaundice, severe fatigue)
-unresectable primary liver cancers
-fulminant hepatic failure
End stage liver disease with life expectancy<1 year and if no other therapy is appropriate
MELD score (model for end-stage liver disease)
6-40 points used to prioritize liver allocation
Classification system to asses the prognosis and mortality of liver disease; patient must have >7 points (Class B)
CI to a liver transplant
-Active alcohol/substance abuse
-extrahepatic malignancy within 5 year
-advanced cardiopulmonary disease
-active uncontrolled infection
Post op complications of liver transplant
-rejected liver, need new transplant
-vascular: hepatic artery or portal vein thrombosis, IVC obstruction
-biliary complication: fever, increasing bilirubin and ALP
-complications related to immunosuppression: HTN, renal disease, DM, obesity, hyperlipidemia, osteoporosis, malignancy, neurological complications, infection (leading cause of mortality following transplant)