Guidelines for SIRT in HCC An Evolution
|
|
- Kathryn Dawson
- 5 years ago
- Views:
Transcription
1 Guidelines for SIRT in HCC An Evolution 2 nd Asia Pacific Symposium on Liver- Directed Y-90 Microspheres Therapy 1st November 2014, Singapore
2 The challenge of HCC Surgery is potentially curative in early HCC But 80% are inoperable at time of diagnosis Median survival of untreated inoperable HCC 3 8 months High recurrence rates after surgical resection 2
3 LOCALLY ADVANCED HEPATOCELLULAR CARCINOMA Clinical Presentation Treatment Options Consider Clinical Trial Locally Advanced HCC Good liver function Poor liver function Present for evaluation by multi-disciplinary team - Palliative treatment - Consider Clinical Trial - Transplant within UCSF Surgical resection for carefully selected cases after multidisciplinary board evaluation LOCOREGIONAL THERAPY No Vascular Invasion* Transarterial chemoembolisation (TACE) + DC-Beads [32,33] (level 1b) Selective Internal Radiation Therapy (SIRT) [34-36] (level 2b) External beam RT (alone or as part of combined modality) Sorafenib [32-35] (level 1b) With Vascular Invasion Sorafenib [37-40] (level 1b) Selective Internal Radiation Therapy (SIRT) [34-36] (level 2b) External beam RT (alone or as part of combined modality) [41,42] (level 2a) Transplantation is a consideration for HCC within the USCF expanded criteria (single tumours < 6.5cm or 2-3 tumours < 4.5cm at the most, with a total tumour diameter < 8cm) after assessment by a multidisciplinary tumour board [43,44] (level 2b) *Sorafenib may also be considered when local regional therapy is not feasible or fails [40] (level - 2b) National Cancer Center Singapore Consensus Guidelines on Liver Cancer guideline Final Ver to upload PDF pdf
4 Main Loco-regional Therapies Trans-arterial chemo-embolisation (TACE): widely used - disease control approx 40% used mainly in HCC, NETs (includes DC Beads) Selective Internal Radiation Therapy (SIRT): higher disease control (approx 80%) SIR-Sphere, Thera-Sphere 4
5 Hepatology 2008; 47(1): 71-81
6 Guidelines for SIRT 1) ESMO Guidelines 2) NCCN Guidelines 3) APPLE Guidelines 4) National Cancer Center Guidelines 6
7 European Society of Medical Oncology 7
8 ESMO Guidelines (2010) BCLC Staging for HCC Summary of Treatment Options and Recommendations according to BCLC S. Jelic,
9 ESMO Guidelines (2010) Yttrium-90 microsphere radioembolization is a recently FDAapproved, non-surgical procedure used to treat inoperable HCC 9
10 ESMO Guidelines (2012) C.Verslype,
11 Hepatocellular carcinoma: ESMO ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up Annals of Oncology 23 (Supplement 7): vii41 vii48,
12 National Comprehensive Cancer Network 12
13 NCCN Guidelines (2009) Pierce Chow FRCS, PhD
14 NCCN Guidelines (2009) Pierce Chow FRCS, PhD randomized, controlled studies on the use of radioembolization therapy in the treatment of patients with HCC are needed..
15 NCCN Guidelines (2012)
16 NCCN Guidelines (2012) may be amenable to embolization (chemoembolization, bland embolization, radioembolization) provided that the arterial blood supply to the tumor may be isolated.
17 NCCN Guidelines (2014) 17
18 NCCN Guidelines (2014) *Arterially directed therapies include transarterial embolization (TAE), chemoembolization (transarterial chemoembolization[tace] and TACE with drug-eluting beads [DEB-TACE] )and radioembolization with yttrium-90 microspheres. 18
19 Pierce Chow FRCS, PhD Asia-Pacific Primary Liver Cancer Expert (APPLE) conference
20 Pierce Chow FRCS, PhD APPLE 2014 Consensus Workshop Apple 2014 Consensus Workshop Report 20
21 APPLE recommendations for SIRT 2014 first- line therapy in Advanced HCC with vascular invasion and/or which are liver dominant with bilirubin <2 mg/dl and which are Child-Pugh A or <B (Level B1). In this context sorafenib may be added in patients with extra-hepatic disease4. (Level B2) first-line therapy in multi-focal or bilobar HCC with high disease burden5,6. (Level B1) second-line therapy in patients with multi-focal HCC who has progressed on TACE1-3. (Level B1) bridging therapy in patients on the waiting list for cadaveric transplantation7,8. (Level B1) 21
22 90 Y microspheres in Patients with HCC and PVT
23 90 Y microspheres in Patients with HCC and PVT Data from SGH/NCC Number of SIRT administrations - single : 82.5% Khor et al 2014
24 Chow et al 2014
25 Comparative Median Survival Study AHCC (Phase II multicenter study) Asian Patients Khor 2013 (Retrospec tive study) Cheng 2009 (Prospective Study) European Patients Sangro 2011 (Retrospective study) US Patients Salem 2010 (Prospective study) Y-90 + Sorafenib Y-90 Sorafenib Placebo Y-90 Y-90 BCLC B 20.3mo 23.8mo 14.3 mo 8 mo 16.9 mo 17.2 mo BCLC C 8.6mo 11.8mo 5.6 mo 4.1 mo 10.0 mo 7.3 mo SIRSA 1 patient down-staged to transplantation, 2 to RFA
26 APPLE recommendations for SIRT 2014 first- line therapy in Advanced HCC with vascular invasion and/or which are liver dominant with bilirubin <2 mg/dl and which are Child-Pugh A or <B (Level B1). In this context sorafenib may be added in patients with extra-hepatic disease4. (Level B2) first-line therapy in multi-focal or bilobar HCC with high disease burden5,6. (Level B1) second-line therapy in patients with multi-focal HCC who has progressed on TACE1-3. (Level B1) bridging therapy in patients on the waiting list for cadaveric transplantation7,8. (Level B1) 26
27 Median Survival (months) Patient Outcomes According to Suitability for TACE in the ENRY Series No difference not reached n = 52 n = 32 n = 39 n = 55 n = 48 n = 31 (unresectable) Candidates for TACE Poor Candidates for TACE Failed TACE Sangro et al., Hepatology 2011;54:
28 Overall Survival by BCLC Stage Data from SGH/NCC Number of SIRT administrations - single : 82.5%
29 APPLE recommendations for SIRT 2014 first- line therapy in Advanced HCC with vascular invasion and/or which are liver dominant with bilirubin <2 mg/dl and which are Child-Pugh A or <B (Level B1). In this context sorafenib may be added in patients with extra-hepatic disease4. (Level B2) first-line therapy in multi-focal or bilobar HCC with high disease burden5,6. (Level B1) second-line therapy in patients with multi-focal HCC who has progressed on TACE1-3. (Level B1) bridging therapy in patients on the waiting list for cadaveric transplantation7,8. (Level B1) 29
30 Pierce Chow FRCS, PhD Downstaging for HCC: Chemoembolization VS Y90 SIRT Downstaged patients stratified according to size/distribution Table for follow-up/survivals Lewandowski,
31 Tumor size changes after 3 months T3 to T PD SD PR +32 mo +8 mo -70 Retrospective analysis of 86 UNOS T3 patients ( ; indication by MDT) TACE (43) RE (43) TACE (43) RE (43) Portal HT 77% 74% Single 53% 47% Child A 53% 56% BCLC B 85% 79% Selective Treat 56% 46% G3/4 Bil Toxicity 26% 7% MELD Pre/Post 9/9 8/9.5 Ds T3 T2 31% 58% Med. time to prog Transplanted 26% 21% RFA 23% 42% Med Surv (cens) Med Surv (uncens) Recurrence 18% 22% Lewandowski, RJ, et al. Am J Transpl. 2009;9:
32 SIR-Spheres microspheres in down-sizing primary liver cancers to resection, ablation or radiation lobectomy Investigator n Tx line # Outcomes Tumour Type(s) Whitney 44 SIR-Spheres 2 nd 4 th 4 R0 2 CCC; CRC; OeC Lau 71 SIR-Spheres 1 st 2 nd 4 R0 HCC Iñarrairaegui 72 SIR-Spheres >1 st 3 R0, 2 LT HCC of which 21 SIR-Spheres >1 st 3 R0, 2 LT, 1 RF UNOS stage T3 Chow 29 SIR-Spheres + sorafenib >1 st 2 RF, 1 LT HCC Barakat 1 SIR-Spheres 1 st 1 R0 HCC Ettorre 1 SIR-Spheres 1 st 1 LT HCC Miglioresi 4 SIR-Spheres 1 st 4 LT HCC Gramenzi 63 SIR-Spheres nr 2 LT HCC Saxena 25 SIR-Spheres >1 st 1 R0 CCC Coldwell 23 SIR-Spheres >3 rd 1 RF CCC Högberg 2 SIR-Spheres 1 st 2 R0 CCC Gaba 1 SIR-Spheres 2 nd 1 RL CCC retrospective data; SIR-Spheres microspheres; R0: complete surgical resection; LT: transplant; RF: radiofrequency ablation; RL: radiation lobectomy
33 APPLE recommendations for SIRT 2014 first- line therapy in Advanced HCC with vascular invasion and/or which are liver dominant with bilirubin <2 mg/dl and which are Child-Pugh A or <B (Level B1). In this context sorafenib may be added in patients with extra-hepatic disease4. (Level B2) first-line therapy in multi-focal or bilobar HCC with high disease burden5,6. (Level B1) second-line therapy in patients with multi-focal HCC who has progressed on TACE1-3. (Level B1) bridging therapy in patients on the waiting list for cadaveric transplantation7,8. (Level B1) 33
34 Pierce Chow FRCS, PhD APPLE 2014 Consensus Workshop Apple 2014 Consensus Workshop Report 34
35 National Cancer Center Singapore 35
36 LOCALLY ADVANCED HEPATOCELLULAR CARCINOMA Clinical Presentation Treatment Options Consider Clinical Trial Locally Advanced HCC Good liver function Poor liver function Present for evaluation by multi-disciplinary team - Palliative treatment - Consider Clinical Trial - Transplant within UCSF Surgical resection for carefully selected cases after multidisciplinary board evaluation LOCOREGIONAL THERAPY No Vascular Invasion* Transarterial chemoembolisation (TACE) + DC-Beads [32,33] (level 1b) Selective Internal Radiation Therapy (SIRT) [34-36] (level 2b) External beam RT (alone or as part of combined modality) Sorafenib [32-35] (level 1b) With Vascular Invasion Sorafenib [37-40] (level 1b) Selective Internal Radiation Therapy (SIRT) [34-36] (level 2b) External beam RT (alone or as part of combined modality) [41,42] (level 2a) Transplantation is a consideration for HCC within the USCF expanded criteria (single tumours < 6.5cm or 2-3 tumours < 4.5cm at the most, with a total tumour diameter < 8cm) after assessment by a multidisciplinary tumour board [43,44] (level 2b) *Sorafenib may also be considered when local regional therapy is not feasible or fails [40] (level - 2b) National Cancer Center Singapore Consensus Guidelines on Liver Cancer guideline Final Ver to upload PDF pdf
37 Thank You! 37
Selection Criteria and Insertion of SIRT into HCC Treatment Guidelines
Selection Criteria and Insertion of SIRT into HCC Treatment Guidelines 2 nd Asia Pacific Symposium on Liver- Directed Y-90 Microspheres Therapy 1st November 2014, Singapore Pierce Chow FRCSE PhD SIRT in
More informationMULTI-DISCIPLINARY MANAGEMENT OF INTERMEDIATE STAGE HCC
Dr Apoorva Gogna MBBS FRCR FAMS Consultant Interventional Radiology Center Department of Diagnostic Radiology SingaporeGeneral Hospital MULTI-DISCIPLINARY MANAGEMENT OF INTERMEDIATE STAGE HCC CASE HISTORY
More informationWHAT IS THE BEST APPROACH FOR TRANS-ARTERIAL THERAPY IN HCC?
WHAT IS THE BEST APPROACH FOR TRANS-ARTERIAL THERAPY IN HCC? Dr. Alexander Kim Chief, Vascular and Interventional Radiology, Medstar Georgetown University Hospital, USA DISCLAIMER Please note: The views
More informationin Hepatocellular Carcinoma
in Hepatocellular Carcinoma The following summarises the key data supporting the use of SIR-Spheres Y-90 resin microspheres in the treatment of primary liver cancer due to hepatocellular carcinoma (HCC):
More informationLocoregional Treatments for HCC Applications in Transplant Candidates. Locoregional Treatments for HCC Applications in Transplant Candidates
Locoregional Treatments for HCC Applications in Transplant Candidates Matthew Casey, MD March 31, 2016 Locoregional Treatments for HCC Applications in Transplant Candidates *No disclosures *Off-label uses
More informationSIRT for Intermediate and Advanced HCC
Pamplona, junio de 2008 SIRT for Intermediate and Advanced HCC Bruno Sangro Clínica Universidad de Navarra. CIBERehd. Pamplona, Spain 90 Y-RE MRI SPECT FUSION 90 Y-RE = Yttrium-90 radioembolization Sangro
More informationLocoregional Therapy for Hepatoma
Locoregional Therapy for Hepatoma Robert D. Crane, MD Interventional Radiology Virginia Mason How do we know a liver mass is HCC? HCC : Bx Of pts getting liver transplant only ~ 5% had Bx to establish
More informationThe Management of Advanced Stage Hepatocellular Carcinoma
The Management of Advanced Stage Hepatocellular Carcinoma Pierce K.H Chow MD PhD Professor, Duke-NUS Graduate Medical School Singapore Senior Consultant Surgeon, National Cancer Center Singapore Senior
More information6/16/2016. Treating Hepatocellular Carcinoma: Deciphering the Clinical Data. Liver Regeneration. Liver Regeneration
Treating : Deciphering the Clinical Data Derek DuBay, MD Associate Professor of Surgery Director of Liver Transplant Liver Transplant and Hepatobiliary Surgery UAB Department of Surgery Liver Regeneration
More informationHepatocellular Carcinoma: A major global health problem. David L. Wood, MD Interventional Radiology Banner Good Samaritan Medical Center
Hepatocellular Carcinoma: A major global health problem David L. Wood, MD Interventional Radiology Banner Good Samaritan Medical Center Hepatocellular Carcinoma WORLDWIDE The #2 Cancer Killer Overall cancer
More informationHCC Imaging and Advances in Locoregional Therapy. David S. Kirsch MD Ochsner Clinic Foundation
HCC Imaging and Advances in Locoregional Therapy David S. Kirsch MD Ochsner Clinic Foundation -Nothing to disclose Hepatic Imaging Primary imaging modalities include: US CT MR Angiography Nuclear medicine
More informationSelective Internal Radiation Therapy (SIRT) in the multimodal approach to Hepatocellular Carcinoma
Selective Internal Radiation Therapy (SIRT) in the multimodal approach to Hepatocellular Carcinoma International Course on THERANOSTICS and MOLECULAR RADIOTHERAPY Brussels, 4 october 2017 Vincent Donckier
More informationHamad Alsuhaibani,MD KING FAISAL SPECIALIST HOSPITAL &RESEARCH CENTRE.
Hamad Alsuhaibani,MD KING FAISAL SPECIALIST HOSPITAL &RESEARCH CENTRE. YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA EFFICACY AND SAFETY OF YTTRIUM-90 RADIO- EMBOLIZATION
More informationThe Egyptian Journal of Hospital Medicine (October 2017) Vol.69(1), Page
The Egyptian Journal of Hospital Medicine (October 2017) Vol.69(1), Page 1674-1679 Radioembolization in Treatment of Hepatocellular Carcinoma with Portal Vein Invasion Elsahhar Ahmed Hetta, Osama Mohamed
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of selective internal radiation therapy for primary liver cancer Selective internal
More informationDisclosure. Speaker name: Prof. Maciej Pech I have the following potential conflicts of interest to report:
Disclosure Speaker name: Prof. Maciej Pech I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company
More informationHepatocellular Carcinoma. Markus Heim Basel
Hepatocellular Carcinoma Markus Heim Basel Outline 1. Epidemiology 2. Surveillance 3. (Diagnosis) 4. Staging 5. Treatment Epidemiology of HCC Worldwide, liver cancer is the sixth most common cancer (749
More informationTrans-arterial radioembolisation (TARE) of unresectable HCC using Y-90 microspheres: is it dangerous in case of portal vein thrombosis?
Trans-arterial radioembolisation (TARE) of unresectable HCC using Y-90 microspheres: is it dangerous in case of portal vein thrombosis? Poster No.: C-1634 Congress: ECR 2014 Type: Authors: Keywords: DOI:
More informationManagement of HepatoCellular Carcinoma
9th Symposium GIC St Louis - 2010 Management of HepatoCellular Carcinoma Overview Pierre A. Clavien, MD, PhD Department of Surgery University Hospital Zurich Zurich, Switzerland Hepatocellular carcinoma
More informationEmbolotherapy for Cholangiocarcinoma: 2016 Update
Embolotherapy for Cholangiocarcinoma: 2016 Update Igor Lobko,MD Chief, Division Vascular and Interventional Radiology Long Island Jewish Medical Center GEST 2016 Igor Lobko, M.D. No relevant financial
More informationEASL-EORTC Guidelines
Pamplona, junio de 2008 CLINICAL PRACTICE GUIDELINES: PARADIGMS IN MANAGEMENT OF HCC EASL-EORTC Guidelines Bruno Sangro Clínica Universidad de Navarra. CIBERehd. Pamplona, Spain Levels of Evidence according
More informationRadioembolization for Primary and Metastatic Tumors of the Liver
Radioembolization for Primary and Metastatic Tumors of the Liver Policy Number: 8.01.43 Last Review: 8/2017 Origination: 8/2006 Next Review: 8/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue
More informationSEQUENCING OF HCC TREATMENT. Dr. Amit G. Singal Medical Director, UT Southwestern Medical Center, USA
SEQUENCING OF HCC TREATMENT Dr. Amit G. Singal Medical Director, UT Southwestern Medical Center, USA February 2018 DISCLAIMER Please note: The views expressed within this presentation are the personal
More informationTranscatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies. Original Policy Date
MP 8.01.09 Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date
More informationSelective internal radiation therapy using yttrium-90 resin microspheres in patients with unresectable hepatocellular carcinoma: a retrospective study
Original Article Selective internal radiation therapy using yttrium-90 resin microspheres in patients with unresectable hepatocellular carcinoma: a retrospective study Parvez S. Mantry 1, Ashwini Mehta
More informationDescription. Section: Therapy Effective Date: July 15, 2014 Subsection: Therapy Original Policy Date: June 7, 2012 Subject: Page: 1 of 23
Last Review Status/Date: June 2014 Page: 1 of 23 Description Radioembolization (RE), referred to as selective internal radiation therapy or SIRT in older literature, is the intra-arterial delivery of small
More information9/10/2018. Liver Transplant for Hepatocellular Carcinoma (HCC): What is New? DISCLOSURES
UCSF Transplant 2018: Pioneering Advances in Transplantation DISCLOSURES Liver Transplant for Hepatocellular Carcinoma (HCC): What is New? I have no relevant commercial interests or relationships to report
More informationSIRTEX Lunch Symposium, Cebu, 23 Nov Dr. Stephen L. Chan Department of Clinical Oncology The Chinese University of Hong Kong
SIRTEX Lunch Symposium, Cebu, 23 Nov 2013 Dr. Stephen L. Chan Department of Clinical Oncology The Chinese University of Hong Kong I will not talk on Mechanism of SIRT Data on efficacy of SIRT Epidemiology
More informationSubject: Radioactive Yttrium-90 Microspheres for Treatment of Liver Cancer. Revision Date(s): 5/9/2017
Subject: Radioactive Yttrium-90 Microspheres for Treatment of Liver Cancer Policy Number: MCP-181 Review Date: 12/16/15, 6/15/16, 7/10/18 MCPC Approval Date: 6/22/17, 7/10/18 Revision Date(s): 5/9/2017
More informationHepatocellular Carcinoma: Diagnosis and Management
Hepatocellular Carcinoma: Diagnosis and Management Nizar A. Mukhtar, MD Co-director, SMC Liver Tumor Board April 30, 2016 1 Objectives Review screening/surveillance guidelines Discuss diagnostic algorithm
More informationThe Role of Interventional Radiology (Locoregional
The Role of Interventional Radiology (Locoregional therapies) in HCC Richard Owen MB, MRCP, FRCR Interventional Radiology, Associate Professor University of Alberta Aldo Montana-Loza MD, FRCPC Hepatology
More informationRadioembolization for Primary and Metastatic Tumors of the Liver
Page: 1 of 28 Last Review Status/Date: September 2015 Description Radioembolization (RE), also referred to as selective internal radiotherapy (SIRT), is the intra-arterial delivery of small beads (microspheres)
More informationPRIOR AUTHORIZATION Prior authorization is required for BlueCHiP for Medicare members and recommended for Commercial products.
Medical Coverage Policy Radioembolization for Primary and Metastatic Tumors of the Liver EFFECTIVE DATE: 10 06 2009 POLICY LAST UPDATED: 08 02 2016 OVERVIEW Radioembolization (RE), referred to as selective
More informationHCC RADIOLOGIC DIAGNOSIS
UCSF Transplant 2010 THE BEFORE AND AFTER HEPATOCELLULAR CARCINOMA MANAGEMENT Francis Yao, M.D. Professor of Clinical Medicine and Surgery Medical Director, Liver Transplantation University of California,
More informationRadioembolization for Primary and Metastatic Tumors of the Liver
Radioembolization for Primary and Metastatic Tumors of the Liver Policy Number: 8.01.43 Last Review: 8/2018 Origination: 8/2006 Next Review: 8/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue
More informationClinical Aspects of SBRT in Abdominal Regions Brian D. Kavanagh, MD, MPH University of Colorado Department of Radiation Oncology
Clinical Aspects of SBRT in Abdominal Regions Brian D. Kavanagh, MD, MPH University of Colorado Department of Radiation Oncology Abdominal SBRT: Clinical Aspects Rationales for liver and pancreas SBRT
More informationHCC with Intrahepatic Portal vein Tumour Should Be Treated by Systemic Therapy Rather Than Transarterial Therapy (Pros)
HCC with Intrahepatic Portal vein Tumour Should Be Treated by Systemic Therapy Rather Than Transarterial Therapy (Pros) Yi-Hsiang Huang, MD, Ph.D. Professor, Division of Gastroenterology & Hepatology,
More informationHepatocellular Carcinoma (HCC): Who Should be Screened and How Do We Treat? Tom Vorpahl MSN, RN, ACNP-BC
Hepatocellular Carcinoma (HCC): Who Should be Screened and How Do We Treat? Tom Vorpahl MSN, RN, ACNP-BC Objectives Identify patient risk factors for hepatocellular carcinoma (HCC) Describe strategies
More informationHepatobiliary Malignancies Retrospective Study at Truman Medical Center
Hepatobiliary Malignancies 206-207 Retrospective Study at Truman Medical Center Brandon Weckbaugh MD, Prarthana Patel & Sheshadri Madhusudhana MD Introduction: Hepatobiliary malignancies are cancers which
More informationFor personal use only
Sirtex Medical Limited SARAH Clinical Study Results Investor Presentation Nigel Lange, Interim CEO Dr David N. Cade, CMO 24 April 2017 SIR-Spheres is a registered trademark of Sirtex SIR-Spheres Pty Ltd
More informationTreatment of Hepatocellular Carcinoma. Andrew J. Muir, MD MHS Division of Gastroenterology Duke University Medical Center
Treatment of Hepatocellular Carcinoma Andrew J. Muir, MD MHS Division of Gastroenterology Duke University Medical Center Epidemiology of HCC: world The 5 th most common cancer worldwide > 500, 000 new
More information100% pure beta emitter Decays to zirconium-90 Physical half-life of 64.1 hours (2.67 days) 94% of radiation delivered within 11 days
100% pure beta emitter Decays to zirconium-90 Physical half-life of 64.1 hours (2.67 days) 94% of radiation delivered within 11 days TheraSphere [US package insert]. Surrey, UK: Biocompatibles UK Ltd,
More informationUPDATE TO THE MANAGEMENT OF PATIENTS WITH HCC HCA
UPDATE TO THE MANAGEMENT OF PATIENTS WITH HCC HUSSEIN K. MOHAMED MD, FACS. Transplant and Hepato-biliary Surgery Largo Medical Center HCA DISCLOSURE I have no financial relationship(s) relevant to the
More informationLiver Directed Therapy for Hepatocellular Carcinoma
Liver Directed Therapy for Hepatocellular Carcinoma Anil K Pillai MD, FRCR, Associate Professor, Department of Radiology UT Houston Health Science Center, Houston, TX, United States. Hepatocellular cancer
More informationHepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation
Original rticle Hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation Giovanni attista Levi Sandri 1, Giuseppe Maria Ettorre 1, Marco Colasanti
More informationRADIOEMBOLIZZAZIONE NEI TUMORI EPATICI: STATO DELL ARTE. clic per modificare lo stile del sottotitolo dello schem
XII Congresso Nazionale AIMN 2015 16-19 Aprile 2015 Rimini RADIOEMBOLIZZAZIONE NEI TUMORI EPATICI: STATO DELL ARTE clic per modificare lo stile del sottotitolo dello schem Marco Maccauro Nuclear Medicine
More informationPaul Martin MD FACG. University of Miami
Paul Martin MD FACG University of Miami 1 Liver cirrhosis of any cause Chronic C o c hepatitis epat t s B Risk increases with Male gender Age Diabetes Smoking ~5% increase in HCV-related HCC between 1991-28
More informationHepatocellular Carcinoma: Transplantation, Resection or Ablation?
Hepatocellular Carcinoma: Transplantation, Resection or Ablation? Roberto Gedaly MD Chief, Abdominal Transplantation Transplant Service Line University of Kentucky Nothing to disclose Disclosure Objective
More informationHCC: Is it an oncological disease? - No
June 13-15, 2013 Berlin, Germany Prof. Oren Shibolet Head of the Liver Unit, Department of Gastroenterology Tel-Aviv Sourasky Medical Center and Tel-Aviv University HCC: Is it an oncological disease? -
More informationHepatocelluar Carcinoma Clinical Pathways
Hepatocelluar Carcinoma Clinical Pathways The following pathways have been developed through multidisciplinary efforts with physicians from the Mary Bird Perkins Our Lady of the Lake Cancer Center. These
More informationUnmet needs in intermediate HCC. Korea University Guro Hospital Ji Hoon Kim
Unmet needs in intermediate HCC Korea University Guro Hospital Ji Hoon Kim BCLC HCC Stage 0 PST 0, Child Pugh A Stage A C PST 0 2, Child Pugh A B Stage D PST > 2, Child Pugh C Very early stage (0) 1 HCC
More informationTranscatheter hepatic arterial chemoembolization may be considered medically necessary to
Original Issue Date (Created): July 1, 2002 Most Recent Review Date (Revised): September 24, 2013 Effective Date: November 1, 2013 I. POLICY Hepatocellular carcinoma Transcatheter hepatic arterial chemoembolization
More informationRuolo della interventistica per le secondarietà epatiche e di altre sedi
Ruolo della interventistica per le secondarietà epatiche e di altre sedi Giancarlo Bizzarri Dipartimento di Diagnostica per Immagini e Radiologia Interventistica Ospedale Regina Apostolorum, Albano Laziale
More informationRadiofrequency Ablation of Primary or Metastatic Liver Tumors
Radiofrequency Ablation of Primary or Metastatic Liver Tumors Policy Number: 7.01.91 Last Review: 9/2018 Origination: 2/1996 Next Review: 9/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC)
More informationSurveillance for Hepatocellular Carcinoma
Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April
More informationEffective Health Care Program
Comparative Effectiveness Review Number 114 Effective Health Care Program Local Therapies for Unresectable Primary Hepatocellular Carcinoma Executive Summary Introduction Background This comparative effectiveness
More informationCelsion Symposium New Paradigms in HCC Staging: HKLC vs. BCLC Staging
Celsion Symposium New Paradigms in HCC Staging: HKLC vs. BCLC Staging Ronnie T.P. Poon, MBBS, MS, PhD Chair Professor of Hepatobiliary and Pancreatic Surgery Chief of Hepatobiliary and Pancreatic Surgery
More informationTranscatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies
Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its
More informationIn- and exclusion criteria
In- and exclusion criteria Kerstin Schütte Department of Gastroenterology, Hepatology and Infectious Diseases University of Magdeburg Overview: Study population Inclusion criteria I - General criteria
More informationRadiation Therapy for Liver Malignancies
Outline Radiation Therapy for Liver Malignancies Albert J. Chang, M.D., Ph.D. Department of Radiation Oncology, UCSF March 23, 2014 Rationale for developing liver directed therapies Liver directed therapies
More informationStaging & Current treatment of HCC
Staging & Current treatment of HCC Dr.: Adel El Badrawy Badrawy; ; M.D. Staging & Current ttt of HCC Early stage HCC is typically silent. HCC is often advanced at first manifestation. The selective ttt
More informationConformal external beam radiation or selective internal radiation therapy a comparison of treatment outcomes for hepatocellular carcinoma
Original Article Conformal external beam radiation or selective internal radiation therapy a comparison of treatment outcomes for hepatocellular carcinoma Oluwadamilola T. Oladeru 1, Joseph A. Miccio 1,
More informationFirst-line therapy for unresectable HCC:
ESMO GI Cancer Preceptorship 15 November 2017 Singapore First-line therapy for unresectable HCC: an oncologist s viewpoint Chiun Hsu, MD, PhD G raduate I n stitute of Oncology, National Taiwan Univers
More informationHepatocellular carcinoma: Intra-arterial treatments
Hepatocellular carcinoma: Intra-arterial treatments Irene Bargellini U.O. Radiologia Interventistica Azienda Ospedaliero Universitaria Pisana IRENE BARGELLINI,MD UO RADIOLOGIA INTERVENTISTICA, AZIENDA
More informationSection: Medicine Last Reviewed Date: July Policy No: 140 Effective Date: October 1, 2014
Medical Policy Manual Topic: Radioembolization for Primary and Metastatic Tumors of the Liver Date of Origin: December 2, 2010 Section: Medicine Last Reviewed Date: July 2014 Policy No: 140 Effective Date:
More informationState-of-the-art minimally invasive interventions for liver tumors
William Lo, HMS MD/PhD candidate, MS III Gillian Lieberman, MD State-of-the-art minimally invasive interventions for liver tumors William Lo, HMS MD/PhD candidate, MS III Gillian Lieberman, MD
More informationLatest Developments in the Treatment of Hepatocellular Carcinoma
Latest Developments in the Treatment of Hepatocellular Carcinoma Roniel Cabrera, MD MS Associate Professor of Medicine Director of Hepatology and Medical Director of Liver Transplantation Division of Gastroenterology,
More informationOptimal management of HCC: in Asia
Optimal management of HCC: in Asia Kwang-Hyub Han, MD Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea Newly diagnosed HCC : > 70% occur
More informationHepatocellular Carcinoma HCC Updated November 2015 by: Dr. Mohammed Alghamdi (Medical Oncology Fellow, University of Calgary)
Hepatocellular Carcinoma HCC Updated November 2015 by: Dr. Mohammed Alghamdi (Medical Oncology Fellow, University of Calgary) Staff Reviewers: Dr. Yoo Joung Ko (Medical Oncologist, Sunnybrook Odette Cancer
More informationJose Ramos. Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma
Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Evolution of liver resection Better understanding
More informationHepatocellular carcinoma (HCC) is the most common
Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres: A Comprehensive Report of Long-term Outcomes RIAD SALEM,*,, ROBERT J. LEWANDOWSKI,* MARY F. MULCAHY, AHSUN RIAZ,* ROBERT K.
More informationIMPLANTABLE BETA-EMITTING MICROSPHERES FOR TREATMENT OF MALIGNANT TUMORS
UnitedHealthcare Oxford Clinical Policy IMPLANTABLE BETA-EMITTING MICROSPHERES FOR TREATMENT OF MALIGNANT TUMORS Policy Number: CANCER 036.11 T2 Effective Date: May 1, 2018 Table of Contents Page INSTRUCTIONS
More informationUpdate EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma
Update EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma Peter R. Galle PHC 2018 - www.aphc.info Disclosure of Conflict of Interest Peter R. Galle I have the following financial
More informationInterventional Radiologic Treatment of Hepatocellular Carcinoma
Interventional Radiologic Treatment of Hepatocellular Carcinoma Fatih Boyvat Abstract The current treatment modalities for patients with hepatocellular carcinoma are discussed in this review. Hepatocellular
More informationIMPLANTABLE BETA-EMITTING MICROSPHERES FOR TREATMENT OF MALIGNANT TUMORS
UnitedHealthcare Commercial Medical Policy IMPLANTABLE BETA-EMITTING MICROSPHERES FOR TREATMENT OF MALIGNANT TUMORS Policy Number: 2018T0445O Effective Date: February 1, 2018 Table of Contents Page INSTRUCTIONS
More informationAn Update on Hepatocellular Carcinoma. Ed Gane NZ Liver Transplant Unit
An Update on Hepatocellular Carcinoma Ed Gane NZ Liver Transplant Unit Hepatocellular Carcinoma has a High Burden of Disease APSCVIR March 2018 Lung Liver Colon/Rectal Stomach Breast Cervix Uteri Esophagus
More informationRadioembolization with Yttrium-90 microspheres for patients with unresectable hepatocellular carcinoma
Original Article Radioembolization with Yttrium-90 microspheres for patients with unresectable hepatocellular carcinoma Munveer Singh Bhangoo 1, Diraj R. Karnani 1, Paul N. Hein 2, Huan Giap 3, Harry Knowles
More informationLiver Cancer: Diagnosis and Treatment Options
Liver Cancer: Diagnosis and Treatment Options Fred Poordad, MD Chief, Hepatology University Transplant Center Professor of Medicine UT Health, San Antonio VP, Academic and Clinical Affairs, Texas Liver
More informationMedical Policy. MP Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Medical Policy MP 7.01.91 BCBSA Ref. Policy: 7.01.91 Last Review: 08/20/2018 Effective Date: 08/20/2018 Section: Surgery Related Policies 7.01.75 Cryosurgical Ablation of Primary or Metastatic Liver Tumors
More information9th Paris Hepatitis Conference
9th Paris Hepatitis Conference Paris, 12 January 2016 Treatment of hepatocellular carcinoma: beyond international guidelines Massimo Colombo Chairman Department of Liver, Kidney, Lung and Bone Marrow Units
More informationTumor incidence varies significantly, depending on geographical location.
Hepatocellular carcinoma is the 5 th most common malignancy worldwide with male-to-female ratio 5:1 in Asia 2:1 in the United States Tumor incidence varies significantly, depending on geographical location.
More informationLiver transplantation: Hepatocellular carcinoma
Liver transplantation: Hepatocellular carcinoma Alejandro Forner BCLC Group. Liver Unit. Hospital Clínic. University of Barcelona 18 de marzo 2015 3r Curso Práctico de Transplante de Órganos Sólidos Barcelona
More informationSIR- RFS Journal Primer
Comparison of Combina-on Therapies in the Management of Hepatocellular Carcinoma: Transarterial Chemoemboliza-on with Radiofrequency Abla-on versus Microwave Abla-on SIR- RFS Journal Primer Quick Summary
More informationDescription. Section: Surgery Effective Date: October 15, 2014 Subsection: Surgery Original Policy Date: December 7, 2011 Subject:
Last Review Status/Date: September 2014 Page: 1 of 20 Description In radiofrequency ablation (RFA), a probe is inserted into the center of a tumor and the noninsulated electrodes, which are shaped like
More informationTRANSEARTERIAL CHEMO- EMBOLIZATION FOR HEPATIC METASTASES FROM NEURO-ENDOCINE NEOPLASIA AND HEPATOMA DR SAMIA AHMAD
UNIVERSITY OF PRETORIA STEVE BIKO ACADEMIC HOSPITAL SOUTH AFRICA TRANSEARTERIAL CHEMO- EMBOLIZATION FOR HEPATIC METASTASES FROM NEURO-ENDOCINE NEOPLASIA AND HEPATOMA DR SAMIA AHMAD 1 INTRODUCTION Hepatic
More informationPortal Vein Invasion and the Role of Liver Directed Therapy. Matthew S Johnson MD FSIR Indiana University May 6, 2016
Portal Vein Invasion and the Role of Liver Directed Therapy Matthew S Johnson MD FSIR Indiana University May 6, 2016 Matthew Johnson, M.D., FSIR Stock: Endoshape Consultant/Advisory Board: Bayer, BTG,
More informationCorporate Medical Policy
Corporate Medical Policy Cryosurgical Ablation of Primary or Metastatic Liver Tumors File Name: Origination: Last CAP Review: Next CAP Review: Last Review: cryosurgical_ablation_of_primary_or_metastatic_liver_tumors
More informationRESEARCH ARTICLE. Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy
DOI:http://dx.doi.org/10.7314/APJCP.2015.16.16.6929 Real-Life HCC Treatment - Influence on Outcome of Deviation from Therapy Guidelines RESEARCH ARTICLE Real Life Treatment of Hepatocellular Carcinoma:
More informationLiver resection for HCC
8 th LIVER INTEREST GROUP Annual Meeting Cape Town 2017 Liver resection for HCC Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre The liver is almost unique in that treatment of the
More informationCurrent Standards of Care of Hepatocellular Carcinoma? Prof. Mohsen Mokhtar M.D Cairo Univ.
Current Standards of Care of Hepatocellular Carcinoma? Prof. Mohsen Mokhtar M.D Cairo Univ. Disclosures Honoraria Received : Amgen, Astra Zeneca, Bohrengier, Hikma,Hospira, GSK, Lilly, Merck, MSD, Novartis,
More informationSIRT in the Management of Metastatic Neuroendocrine Tumors
SIRT in the Management of Metastatic Neuroendocrine Tumors Navesh K. Sharma, DO, PhD Assistant Professor, Departments of Radiation Oncology, Diagnostic Radiology and Nuclear Medicine Medical Director,
More informationResection leads to cure in selected patients with hepatocellular
Overview: Where Does Radiation Therapy Fit in the Spectrum of Liver Cancer Local-Regional Therapies? Laura A. Dawson, MD*, Experience with radiation therapy for the treatment of hepatocellular carcinoma
More informationHepatocellular carcinoma: from guidelines to individualized treatment
AISF 2012 Rome, 22-24 February 2012 Hepatocellular carcinoma: from guidelines to individualized treatment A.D. 1088 Luigi Bolondi Professor of Medicine, Chairman Department of Digestive Diseases and Internal
More informationRadioembolization with Lipiodol for the Treatment of Hepatocellular Carcinoma and Liver Metastases
Radioembolization with Lipiodol for the Treatment of Hepatocellular Carcinoma and Liver Metastases Pr Francesco Giammarile CHLS Lyon Faculté de Lyon Sud «Aut tace aut loquere meliora silentio» Malignant
More informationStereotactic Body Radiotherapy (SBRT) For HCC T A R E K S H O U M A N P R O F. R A D I A T I O N O N C O L O G Y N C I, C A I R O U N I V.
Stereotactic Body Radiotherapy (SBRT) For HCC T A R E K S H O U M A N P R O F. R A D I A T I O N O N C O L O G Y N C I, C A I R O U N I V. Hepatocellular carcinoma (HCC), is a major health problem worldwide.
More informationUPDATE OF EASL CLINICAL PRACTICE GUIDELINES: MANAGEMENT OF HEPATOCELLULAR CARCINOMA*
UPDATE OF EASL CLINICAL PRACTICE GUIDELINES: MANAGEMENT OF HEPATOCELLULAR CARCINOMA* Dr. Catherine Frenette Medical Director of Liver Transplantation, Scripps Green Hospital, La Jolla, CA, USA May 2018
More informationRegional Therapy for Metastatic Neuroendocrine Tumors. Janette Durham, MD Professor of Radiology University of Colorado School of Medicine
Regional Therapy for Metastatic Neuroendocrine Tumors Janette Durham, MD Professor of Radiology University of Colorado School of Medicine Introduce regional therapy for mnet Arterial therapies Injection
More informationTranscatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies Policy Number: 8.01.11 Last Review: 6/2018 Origination: 8/2005 Next Review: 6/2019 Policy Blue Cross and Blue
More informationIntra-arterial Therapy in Management of HCC: ctace, DEB-TACE, and Y90 Radioembolization
Intra-arterial Therapy in Management of HCC: ctace, DEB-TACE, and Y90 Radioembolization Department of Radiology, National Cancer Center In Joon Lee Contents Conventional TACE Role of TACE in management
More informationReconsidering Liver Transplantation for HCC in a Era of Organ shortage
Reconsidering Liver Transplantation for HCC in a Era of Organ shortage Professor Didier Samuel Centre Hépatobiliaire Inserm-Paris Sud Research Unit 1193 Departement Hospitalo Universitaire Hepatinov Hôpital
More information