回答“朋友的孩子得了肝母細胞癌 懇求幫忙”帖子

Hi, xixihaha12網友:

我為你朋友還不到兩歲的孩子患肝母細胞癌感到很難過。我一位好朋友的公公（80多歲）最近在國內也不幸被診斷患肝母細胞癌。因為你在你的帖子中說：“我不懂英文,請幫忙查找相關的英文資料”，我現在就將相關英文資料發給你。這些資料分別從我工作單位的網站和公眾網站中所得，我隻是將它們作了一些編輯而已，但願對你的朋友有所幫助。你的朋友如果需要更多的英文資料，可以用肝母細胞癌的英文“hepatocellular carcinoma”在網上查詢。隻是要注意相關網站的信譽，不要心急亂投醫。

我不是臨床醫生，更不是癌症專家，隻是對癌症研究和治療有一些常識。所以，有關更加具體的癌症臨床問題需要尋找相關醫生的觀念。為你對你朋友孩子的關愛而感動。祈禱你朋友的孩子對相關治療有好效果，也祈禱他/她的相關痛苦被減少到最低程度。

珍重，

廣陵曉陽

I. Treatment for hepatocellular carcinoma may include (alone or in combination):

Surgery - surgery is the key treatment of children with hepatocellular carcinoma. Unfortunately, successful removal of the tumor or tumors is difficult in children with hepatocellular carcinoma for several reasons. One reason is that the disease may be present at multiple sites within the liver. In addition, underlying cirrhosis or scarring within the liver can make tumor removal much more difficult, and underlying metabolic problems with the liver make normal liver function after surgery marginal.


Chemotherapy - chemotherapy is a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone or in conjunction with other therapy such as radiation or surgery.
Note：There is a new drug Sorafenib which was originally used for Renal Cell Cancer that has shown promising results when used with Hepatocellular Cancer.

Radiation Therapy - using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors .

Liver Transplant - the liver of a child affected with hepatocellular carcinoma may be replaced with a liver from a donor. The child's physician will provide more information on whether this is an option for the child and the process involved.

Supportive Care - any type of treatment to prevent and treat infections, side effects of treatments, and complications, and to keep a child comfortable during treatment

Continuous Follow-Up Care - a schedule of follow-up care determined by a child's physician and other members of the care team to monitor ongoing response to treatment and possible late effects of treatment.

Other types of treatment currently being studied include: 

biological therapies - a wide range of substances that may be able to involve the body's own immune system to fight cancer or lessen harmful side effects of some treatments.
new ways of delivering chemotherapy - researchers are studying new delivery strategies, such as putting chemotherapy directly into the liver .
cryotherapy - surgeons are studying new ways of using this existing treatment, which uses extreme cold to destroy unwanted tissue) for liver cancer .

II. The long-term outlook (prognosis) for patients with hepatocellular carcinoma depends on: 
the extent of the disease
the size and location of the tumor
presence or absence of metastasis 
the tumor's response to therapy
the age and overall health of the patient
the patient’s tolerance of specific medications, procedures, or therapies 
new developments in treatment

另外一份解釋更加詳細一些的治療措施：

Treatment
Surgical resection to remove a tumor together with surrounding liver tissue while preserving enough liver remnant for normal body function. This treatment offers the best prognosis for long-term survival, but unfortunately only 10-15% of patients are suitable for surgical resection. This is often due to extensive disease or poor liver function. Resection in cirrhotic patients carries high morbidity and mortality. The expected liver remnant should be more than 25% of the total size for a non-cirrhotic liver, while that should be more than 40% of the total size for a cirrhotic liver. The overall recurrent rate after resection is 50-60%.

Liver transplantation to replace the diseased liver with a cadaveric liver or a living donor graft. Historically low survival rates (20%-36%). Recent improvement (61.1%; 1996-2001), likely related to adoption of the Milan criteria at US transplantation centers. If the liver tumor has metastasized, the immuno-suppressant post-transplant drugs decrease the chance of survival. 

Percutaneous ethanol injection (PEI) well tolerated, high RR in small (<3 cm) solitary tumors; as of 2005, no randomized trial comparing resection to percutaneous treatments; recurrence rates similar to those for postresection.

Transcatheter arterial chemoembolization (TACE) is usually performed for unresectable tumors or as a temporary treatment while waiting for liver transplant. TACE is done by injecting an antineoplastic drug (e.g. cisplatin) mixed with a radioopaque contrast (e.g. Lipiodol) and an embolic agent (e.g. Gelfoam) into the right or left hepatic artery via the groin artery. As of 2005, multiple trials show objective tumor responses and slowed tumor progression but questionable survival benefit compared to supportive care; greatest benefit seen in patients with preserved liver function, absence of vascular invasion, and smallest tumors. TACE is not suitable for big tumors (>8 cm), presence of portal vein thrombus, tumors with portal-systemic shunt and patients with poor liver function.

Radiofrequency ablation (RFA) uses high frequency radio-waves to destroy tumor by local heating. The electrodes are inserted into the liver tumor under ultrasound image guidance using percutaneous, laparoscopic or open surgical approach. It is suitable for small tumors (<5 cm). A large randomised trial comparing surgical resection and RFA for small HCC showed similar 4 years-survival and less morbidities for patients treated with RFA.[6]

Selective internal radiation therapy can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue). There are currently two products available, SIR-Spheres and TheraSphere The latter is an FDA approved treatment for primary liver cancer (HCC) which has been shown in clinical trials to increase survival rate of low-risk patients. SIR-Spheres are FDA approved for the treatment of metastatic colorectal cancer but outside the US SIR-Spheres are approved for the treatment of any non-resectable liver cancer including primary liver cancer. This method uses a catheter (inserted by a radiologist) to deposit radioactive particles to the area of interest.

Intra-arterial iodine-131–lipiodol administration: Efficacy demonstrated in unresectable patients, those with portal vein thrombus. This treatment is also used as adjuvant therapy in resected patients (Lau at et, 1999). It is believed to raise the 3-year survival rate from 46 to 86%. This adjuvant therapy is in phase III clinical trials in Singapore and is available as a standard medical treatment to qualified patients in Hong Kong.

Combined PEI and TACE can be used for tumors larger than 4 cm in diameter, although some Italian groups have had success with larger tumours using TACE alone.

High intensity focused ultrasound (HIFU) (not to be confused with normal diagnostic ultrasound) is a new technique which uses much more powerful ultrasound to treat the tumour. Still at a very experimental stage. Most of the work has been done in China. Some early work is being done in Oxford and London in the UK.

Hormonal therapy: Antiestrogen therapy with tamoxifen studied in several trials, mixed results across studies, but generally considered ineffective Octreotide (somatostatin analogue) showed 13-month MS v 4-month MS in untreated patients in a small randomized study; results not reproduced.

Adjuvant chemotherapy: No randomized trials showing benefit of neoadjuvant or adjuvant systemic therapy in HCC; single trial showed decrease in new tumors in patients receiving oral synthetic retinoid for 12 months after resection/ablation; results not reproduced. Clinical trials have varying results.

Palliative: Regimens that included doxorubicin, cisplatin, fluorouracil, interferon, epirubicin, or taxol, as single agents or in combination, have not shown any survival benefit (RR, 0%-25%); a few isolated major responses allowed patients to undergo partial hepatectomy; no published results from any randomized trial of systemic chemotherapy.

Cryosurgery: Cryosurgery is a new technique that can destroy tumors in a variety of sites (brain, breast, kidney, prostate, liver). Cryosurgery is the destruction of abnormal tissue using sub-zero temperatures. The tumor is not removed and the destroyed cancer is left to be reabsorbed by the body. Initial results in properly selected patients with unresectable liver tumors are equivalent to those of resection. Cryosurgery involves the placement of a stainless steel probe into the center of the tumor. Liquid nitrogen is circulated through the end of this device. The tumor and a half inch margin of normal liver are frozen to -190°C for 15 minutes, which is lethal to all tissues. The area is thawed for 10 minutes and then re-frozen to -190°C for another 15 minutes. After the tumor has thawed, the probe is removed, bleeding is controlled, and the procedure is complete. The patient will spend the first post-operative night in the intensive care unit and typically is discharged in 3 – 5 days. Proper selection of patients and attention to detail in performing the cryosurgical procedure are mandatory in order to achieve good results and outcomes. Frequently, cryosurgery is used in conjunction with liver resection as some of the tumors are removed while others are treated with cryosurgery. Patients may also have insertion of a hepatic intra-arterial artery catheter for post-operative chemotherapy. As with liver resection, your surgeon should have experience with cryosurgical techniques in order to provide the best treatment possible.

[廣陵曉陽]

回複qatoday.com的評論:

新朋友，謝謝你的鼓勵。祝周末愉快！

[qatoday.com]

awesome, thanks for sharing