[en] The adrenal gland is a common site of extrahepatic metastases from hepatocellular carcinoma. However, it has been the subject of few studies, and the optimal treatment remains unclear. Methods previously tried for the management of adrenal gland metastasis of hepatocellular carcinoma included surgical resection, transarterial chemoembolization or percutaneous ethanol injection, on the basis of case reports. External beam radiation therapy has seldom been applied for patients with adrenal gland metastases. We retrospectively studied 22 patients with adrenal metastases from hepatocellular carcinoma who were treated with limited-field external beam radiation therapy. The radiation dose to the adrenal lesion ranged from 36 to 54 (median 50) Gy, while the intrahepatic lesions were treated with either surgical resection or transarterial chemoembolization. Among the 14 patients who had pain related to adrenal metastases, 11 (78.6%) had complete pain relief without medication that lasted until death. Two (14.3%) patients had marked pain relief, but still required analgesics. Partial responses were observed in 73% of the patients. The median survival period for all patients was 10 months. No patient died from complications related to adrenal metastasis. Adverse effects were mild. Adrenal metastases from hepatocellular carcinoma are sensitive to radiation treatment. Radiation therapy with 50 Gy for adrenal gland metastases is a good palliative therapy with reasonable safety. (author)

[en] The pharmacokinetics of radioiodinated anti-human hepatocellular carcinoma ferritin antibody (FtAb) radioimmunotherapy in 15 liver cancer patients was evaluated by isotopic tracing. The microcomputer graphics portrayal met a two compartment model for both hepatic arterial (ia) (n = 4) and intravenous(iv) (n = 11) samples. Although the elimination rate constant from the central-compartment of the ia group was lower than that of iv group, the difference of the clearance half-life time between the ia group (58.1 +-27.9 hr) and iv group (63.4 ++- 26.5 hr) was not significant (P > 0.05). Seventy percent of iodine was bound to FtAb in the circulation on day 3 after injection. No significant differences between the clearance of radioiodinated antibody administered by the ia or the iv routes could be demonstrated in this study. These results indicate that radioiodinated antibody administered hepatic artery is not cleared more rapidly than when injection intravenously

[en] The pharmacokinetics of ¹³¹I labelled anti-hepatocellular carcinoma ferritin antibody, anti-HCC Hepama-1 monoclonal Ab (Hepama-1 McAb), and anti-Hepatitis B virus X protein McAb (antiHBx McAb) were studied. In summary, this study suggests that (a) FtAb and Hepama-1 McAb show similar pharmacokinetic characters, and FtAb remains an acceptable selection for HCC targeting. (b) The Pharmacokinetics of labelled Ab may be influenced by many factors, such as the antigens to be targeted, intact Ab, Ab dose, coupling methods, the method of administration and the animal for studying

[en] Objective: To evaluate the prognosis factor and outcome of radiotherapy for patients with bone metastasis from primary liver cancer. Methods: The data of 105 patients with bone metastasis from primary liver cancer treated between Oct. 1996 and Aug. 2004 were retrospectively analyzed. All bone metastases received radio- therapy in conventional fractions with a dose of 2 Gy/Fx, with a median of 40 Gy/20Fx. The primary lesion was treated with either surgical resection or TACE (transcatheter hepatic arterial chemoembolization). Statistical analysis was done using the Package for Social Sciences, Version 12.0. Survival rates were obtained by Kaplan-Meier method, univariate analysis by Logrank, multivariate analysis by Cox regression. Results: The 1-, 2- and 3-year cumulative survival rates were 21.9%, 5.6%, 4.2%, respectively. The control of intrahepafic lesion, resection of intrahepatic lesion, serum r-GT level and AFP level of bone metastasis, soft tissue around the bone lesions, and other distant metastasis were independent prognostic factors (P < 0.05). Conclusion: Even though the long-term survival is poor in liver cancer patients with bone metastasis, its bone lesion is sensitive to EBRT (external-beam radiotherapy), which results in palliative relief of pain. (authors)

[en] ¹³¹I-Cholylglycyltyrosine (CGT) was used for the study of radiolocalization and targeting therapy in nude rats bearing human hepatocellular carcinoma (HCC) (nude rat-HCC). The nude rats were sacrificed at various intervals after intravenous injection of ¹³'1I-CGT, and radioactivity in major organs was determined. The uptake rate of ¹³¹I-CGT in tumor was remarkably higher than that of other tissues, especially on the phase of 24 hours. Tumor imaging was clearly observed 24 hours after the injection in all of the three rats. Dynamic scanning in nude rat-HCC model showed that ¹³¹I-CGT can be selectively taken up by hepatoma. and detained up to 7 days. Of the six rats treated, complete remission was observed in one rat three months later, while partial remission observed in the others

[en] Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n=136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher γ-glutamyltransferase and α-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT. (author)

[en] Objective: To investigate the regenerative capacities and proliferation related cytokines expression of normal and irradiated livers following 70% partial hepatectomy in rats. Methods: 90 male Sprague-Dawley rats were divided into 3 groups. The control group was only received 70% partial hepatectomy. The two irradiated groups were performed a single dose of 4 Gy and 8 Gy photon irradiation respectively followed 70% partial hepatectomy. The remanent liver were excised at 0.5,1.0,2.0,3.0,7.0 and 10.0 d after hepatectomy, and liver regeneration capacities in normal and irradiated rats were evaluated through remanent liver weigh, BrdU incorporation, PCNA labeling, and mitotic indices. The proliferation related cytokines expression were also compared. Results: After radiotherapy and hepatectomy 1 rats died of infection in control group, and two rats in 8 Gy group died of radiation induced enteritis. The original liver weigh is regained within 12 days in control and 4 Gy group, and proliferative speed was lower in 4 Gy group than control group. The weigh of remanent liver in 8 Gy group was significantly lower than the two groups all time points from 2d. The apex of PCNA labeling index was 80.2 ± 7.6%, 71.2 ± 6.5% and 55.3 ± 4.7% in control, 4 Gy and 8 Gy groups respectively at 2d, and 44.2 ± 5.4%, 35.3 ± 5.72% and 5.3 ± 6.9% with BrdU incorporation index. HGF mRNA expression peak of 4 Gy group was significantly lower than in control at 1 d, but no apparent peak value in 8 Gy group. TGF-β1 and TGF-β_RII level of radiation groups was apparently higher than the control group at different time points. Meanwhile the p53 protein tend to increase at 1 d then decline with high expression in irradiated groups. Conclusion: Whole radiation can significantly inhibit the regenerative capacities following partial hepatectomy in rats with dose dependent. (authors)

[en] We report our experience of diagnosing and treating hepatic angiomyolipoma (HAML), a rare benign mesenchymal tumor. We analyzed retrospectively the clinicopathologic, radiological, and operative data of 25 patients who underwent surgery for HAML at our institute between November 2001 and May 2006. Most patients (20/25) were asymptomatic and had normal liver function. Ultrasonography (US) showed a heterogeneous hyperechoic mass in 13 of 23 patients, precontrast computed tomography (CT) showed that all of 12 lesions scanned were hypodense, and magnetic resonance imaging (MRI) showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in most (5/6) lesions. Marked enhancement in the arterial phase was seen in 10 of 12 lesions on CT scans and in 6 of 6 lesions on MRI scans. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and blood vessels, and showed positive immunohistochemical staining for HMB-45. All patients underwent partial hepatectomy and there was no evidence of recurrence after a median follow-up of 43 months. The radiological features of HAML vary according to its histological components. The definitive diagnosis of HAML is challenging and depends on the presence of HMB-45-positive myoid cells. Hepatic angiomyolipoma is treated effectively with surgery and the prognosis is good. (author)

[en] Purpose: To quantify microscopic invasion of intrahepatic cholangiocarcinoma (IHC) into nontumor tissue and define the gross tumor volume (GTV)-to-clinical target volume (CTV) expansion necessary for radiotherapy. Methods and Materials: One-hundred IHC patients undergoing radical resection from January 2004 to July 2008 were enrolled in this study. Pathologic and clinical data including maximum tumor diameter, tumor boundary type, TNM stage, histologic grade, tumor markers, and liver enzymes were reviewed. The distance of microinvasion from the tumor boundary was measured by microscopy. The contraction coefficient for tumor measurements in radiographs and slide-mounted tissue was calculated. SPSS15.0 was used for statistical analysis. Results: Sixty-five patients (65%) exhibited tumor microinvasions. Microinvasions ranged from 0.4-8 mm, with 96% of patients having a microinvasion distance ≤6 mm measured on slide. The radiograph-to-slide contraction coefficient was 82.1%. The degree of microinvasion was correlated with tumor boundary type, TNM stage, histologic grade, and serum levels of carbohydrate antigen 19-9, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase and alkaline phosphatase. To define CTV accurately, we devised a scoring system based on combination of these factors. According to this system, a score ≤1.5 is associated with 96.1% sensitivity in detecting patients with a microextension ≤4.9 mm in radiographs, whereas a score ≥2 has a 95.1% sensitivity in detecting microextension ≤7.9 mm measured on radiograph. Conclusions: Patients with a score ≤1.5 and ≥2 require a radiographic GTV-to-CTV expansions of 4.9 and 7.9 mm, respectively, to encompass >95% of microinvasions.

[en] Purpose: To evaluate the degree of invasion of hepatocellular carcinoma (HCC) microscopically that will provide a potential application for gross tumor volume to clinical tumor volume (GTV-to-CTV) expansion. Methods and Materials: From January 2002 to January 2006, 149 HCC patients were selected from those who had undergone surgical resection. Pathology slides and clinical data of all patients were reviewed, including platelet counts, serum α-fetoprotein (AFP) levels, degree of liver cirrhosis, tumor size, capsular status, portal vein invasion, TNM stage, and histologic tumor grade. The distance between the tumor margin (or fibrous capsule) and the invasive lesions was measured by senior pathologists. Results: Of these 149 patients, 79 (53.0%) patients presented with tumor microinvasion between 0.5 and 4 mm. This degree of microinvasion was inversely correlated with lower platelet counts and positively correlated with higher AFP levels, larger tumor sizes, portal vein invasion, and advanced TNM stage. Microinvasion distances less than or equal to 2 mm were found in 96.1% of patients (74/77) with tumor dimensions less than or equal to 5 cm and in 94.5% of patients (85/90) with AFP levels less than 400 μg/l. Conclusions: Based on our study findings, GTV-to-CTV expansions of 4 mm for HCC are required to conceal the gross tumor and any microscopic disease with 100% accuracy. Tumor size and AFP levels are the simplest indicators for determining the GTV-to-CTV distance for HCC.