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1.
Sustained complete response of advanced hepatocellular carcinoma with metronomic capecitabine: a report of three cases.
Brandi, G, Venturi, M, De Lorenzo, S, Garuti, F, Frega, G, Palloni, A, Garajovà, I, Abbati, F, Saccoccio, G, Golfieri, R, et al
Cancer communications (London, England). 2018;(1):41
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Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most frequent causes of cancer-related death. Sorafenib, a multitarget angiogenesis inhibitor, is an approved frontline treatment for advanced HCC in Western countries, although a complete response (CR) to treatment is infrequently reported. Capecitabine, an oral fluoropyrimidine, has been shown to be effect in both treatment-naïve patients and those previously treated with sorafenib. To date, however, only one case of sustained CR to metronomic capecitabine has been reported. CASE PRESENTATION We describe three cases of advanced HCC treated with metronomic capecitabine where a CR was obtained. In the first case, capecitabine was administered as first line therapy; in the second case, capecitabine was used after intolerance to sorafenib; while in the third case, capecitabine was administered after sorafenib failure. CONCLUSION Capecitabine is a potentially important treatment option for patients with advanced HCC and may even represent a cure in certain cases.
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2.
Significant efficacy and well safety of apatinib in an advanced liver cancer patient: a case report and literature review.
Kou, P, Zhang, Y, Shao, W, Zhu, H, Zhang, J, Wang, H, Kong, L, Yu, J
Oncotarget. 2017;(12):20510-20515
Abstract
Apatinib is a novel and highly selective tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2. Previous studies have suggested that apatinib is safe and effective in some solid tumors. We report one case with advanced hepatocellular carcinoma (HCC), who received apatinib combined with transhepatic arterial chemotherapy and embolization (TACE), and chemotherapy respectively. TACE was administered three times once a month, using lipiodol 10ml, oxaliplatin 150mg, and tegafur 1g. The dose of apatinib was 500 mg/d from day 4 to 24. After TACE, the patient received chemotherapy of regimen FOLFOX4, oxaliplatin intravenously at 85 mg/m2 on day 1, calcium levofolinate 200 mg/m2 on day 1 and 2, 5-fluorouracil 400 mg/m2 intravenously and 5-fluorouracil 600 mg/m2 intravenously pumped for 22h on day 1 and 2, cycled every two weeks for seven cycles. He took concurrently apatinib with a dose of 500mg daily from 1 to 10 days per cycle. He was confirmed as partial response (PR) by the Response Evaluation Criteria in Solid Tumors (RECIST). The level of serum alpha-fetoprotein (AFP) decreased from 60500 ng/ml to 12.7 ng/ml, and the progression free survival (PFS) time was more than eight months. It indicated that apatinib may be a superior choice for HCC patients.
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3.
Hepatocellular carcinoma in hepatitis-negative patients with thalassemia intermedia: a closer look at the role of siderosis.
Maakaron, JE, Cappellini, MD, Graziadei, G, Ayache, JB, Taher, AT
Annals of hepatology. 2013;(1):142-6
Abstract
Patients with thalassemia are often exposed to several risk factors for developing hepatocellular carcinoma (HCC) due to their repeated transfusions. However, even transfusion-independent patients with thalassemia intermedia (TI) can develop HCC, which is mainly attributed to a state of iron overload. We report here two cases and review the literature for the association between TI and HCC. Along with our cases, a total of 36 cases of HCC in thalassemic patients were reported in the literature. Of these, 22 (61%) were TI patients with 6 (27%) of them being hepatitis B and C negative. There was no consistency in their characteristics; therefore, we recommended screening thresholds for HCC in TI patients based on their total liver iron concentration (LIC).
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4.
Hepatocellular carcinoma in a noncirrhotic patient with HIV: a case report and review of the literature.
Parikh, N, Martel-Laferriere, V, Zhang, X, Dieterich, D, Fiel, MI, Perumalswami, P
Seminars in liver disease. 2012;(2):186-92
Abstract
A 59-year-old man with human immunodeficiency virus (HIV) was referred for persistently elevated liver enzyme activities. His HIV was well controlled on antiretroviral therapy and his viral load was undetectable. He had no history of chronic liver disease and had minimal alcohol intake. He was asymptomatic and his physical exam was unremarkable without any stigmata of liver disease. Beyond the elevations in alkaline phosphatase and gamma-glutamyl transferase, the rest of his laboratory work, including viral hepatitis serologies and serum α-fetoprotein, was within normal limits. A computed tomography (CT) scan revealed a mildly nodular liver but hepatic mass or ascites was not seen. He was subsequently followed every 3 to 6 months without any change in his clinical symptoms, laboratory values, or imaging tests. Two years after the original visit, the patient presented with acute onset of abdominal pain, an AFP of 15.8 ng/mL, and a 9-cm hepatic mass on imaging. Given his preserved liver function, he underwent right hepatic lobectomy. Histologic examination of the resected tissue was consistent with hepatocellular carcinoma (HCC). The uninvolved liver was noncirrhotic and unremarkable except for mild portal inflammation. As the vast majority of HIV patients who develop HCC have established chronic liver diseases such as hepatitis B and/or C along with cirrhosis, this case of HCC in an HIV patient without cirrhosis or viral hepatitis is rare. Although current screening guidelines recommend imaging only for patients with HIV and hepatitis B/C cirrhosis, closer monitoring may be important in HIV patients with even subtle liver dysfunction.
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5.
[Guidelines for contrast enhanced ultrasound (CEUS)--update 2008].
Correas, JM, Tranquart, F, Claudon, M
Journal de radiologie. 2009;(1 Pt 2):123-38; quiz 139-40
Abstract
These new recommendations are following the text published in 2004 by the group of experts of the EFSUMB that was augmented to reevaluate the indications of ultrasound contrast agents. Initially limited to focal liver lesions, new recommendations include the study of renal and pancreatic diseases, as well as vesico-ureteric reflux, blunt abdominal trauma and trans-cranial Doppler. Contrast-enhanced ultrasound improves the diagnosis of renal pseudo-tumors but does not allow characterization of solid focal masses. Its major contribution includes characterization of complex cystic masses, diagnosis of peripheral vascular disorders such as infarction and cortical necrosis, and radiofrequency ablation follow-up. It is also useful for the study of pancreatic masses visible at ultrasound in order to improve lesion visualization and characterization (adenocarcinoma and neuro-endocrine tumors), as well as for vascular staging.
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6.
Hepatic protection by perioperative metabolic support?
Hassanain, M, Schricker, T, Metrakos, P, Carvalho, G, Vrochides, D, Lattermann, R
Nutrition (Burbank, Los Angeles County, Calif.). 2008;(11-12):1217-9
Abstract
OBJECTIVE We report the case of a 63-y-old woman undergoing left hepatectomy for hilar cholangiocarcinoma who was at high risk of postoperative liver failure due to an atrophic right liver lobe. She participated in a randomized clinical trial investigating the effect of perioperative glucose infusion on hepatic function after major liver resection. METHODS Intravenous glucose was initiated the night before the operation at 2 mg x kg(-1) x min(-1). During and after the operation, glucose was administered with a continuous insulin infusion until the first postoperative day. Postoperative liver function was assessed by the score proposed by Schindl, evaluating total serum bilirubin and plasma lactate concentrations, prothrombin time, and the grade of encephalopathy. RESULTS The patient's liver dysfunction was classified as "mild" on postoperative day 1 and as "none" on postoperative day 2. Postoperative liver function scores were better than those observed in a control group of patients who underwent hepatic resection of similar magnitude without glucose/insulin therapy. CONCLUSION Perioperative glucose/insulin administration was associated with a surprisingly small deterioration of liver function after left lobe liver resection in the presence of an atrophic right lobe. A randomized clinical trial will have to determine whether glucose/insulin therapy can improve hepatic function after major liver resections.
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An isolated pituitary metastasis as presentation of a differentiated hepatocellular carcinoma mimicking a nonfunctioning macroadenoma.
Moreno-Perez, O, Peiró, FM, López, P, Boix, E, Meoro, A, Serna-Candel, C, Aranda, FI, Picó, AM
Journal of endocrinological investigation. 2007;(5):428-33
Abstract
The differential diagnosis of sellar masses may be complex. Metastatic disease constitutes 1% of all pituitary lesions and sometimes mimics the clinical-radiological presentation of pituitary adenoma. The definitive diagnosis usually relies on histology, but occasionally even histological features of pituitary metastasis may resemble those of adenomas. We present a patient initially diagnosed with pituitary adenoma, but whose clinical course finally revealed pituitary metastasis of a hepatocellular carcinoma. The existing literature on this topic is reviewed.
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8.
Combined treatment of vitamin K2 and angiotensin-converting enzyme inhibitor ameliorates hepatic dysplastic nodule in a patient with liver cirrhosis.
Yoshiji, H, Noguchi, R, Yamazaki, M, Ikenaka, Y, Sawai, M, Ishikawa, M, Kawaratani, H, Mashitani, T, Kitade, M, Kaji, K, et al
World journal of gastroenterology. 2007;(23):3259-61
Abstract
Although it is well known that the hepatocellular carcinoma (HCC) is an ominous complication in patients with liver cirrhosis, there has been no approved drug to prevent the development of HCC to date. We previously reported that the combined treatment of vitamin K2 (VK) and angiotensin-converting enzyme inhibitor (ACE-I) significantly suppressed the experimental hepatocarcinogenesis. A 66-year-old Japanese woman with hepatitis C virus (HCV)-related liver cirrhosis developed a dysplastic nodule in the liver detected by enhanced computed tomography along with elevation of the tumor markers, namely, alpha-fetoprotein (AFP) and lectin-reactive demarcation (AFP-L3), suggesting the presence of latent HCC. After oral administration of VK and ACE-I, the serum levels of both AFP and AFP-L3 gradually decreased without any marked alteration of the serum aminotransferase activity. After one-year treatment, not only the serum levels of AFP and AFP-L3 returned to the normal ranges, but also the dysplastic nodule disappeared. Since both VK and ACE-I are widely used without serious side effects, this combined regimen may become a new strategy for chemoprevention against HCC.
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9.
Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature.
Onishi, H, Sugimasa, Y, Kawanishi, C, Onose, M
Palliative & supportive care. 2005;(4):337-40
Abstract
OBJECTIVE Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients. METHODS In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected. RESULTS AND SIGNIFICANCE OF THE RESEARCH In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.
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10.
[Nutritional management in non surgical therapy of liver cancer].
Tsukui, M
Nihon rinsho. Japanese journal of clinical medicine. 2001;:601-4