Potential and future strategies for radiotherapy in hepatocellular carcinoma

Effects of mTOR-STAT3 on the migration and invasion abilities of hepatoma cell and mTOR-STAT3 expression in liver cancer

OBJECTIVE

To investigate the effects of mTOR-STAT3 pathway on the invasion and migration of hepatoma cell.

METHODS

mTOR and STAT3 expression in the hepatocellular carcinoma cell line HepG2 and normal liver cell line L02 were detected by reverse transcription PCR (RT-PCR) and western blotting. The migration and invasion abilities of cells and expression of STAT3 were detected by scratch adhesion test and transwell migration assays, after siRNA transfection blocking mTOR expression of HepG2 cells.

RESULTS

The HepG2 cells expression is higher compared with normal cells L02 expression. Western blotting assay showed the mTOR expression was blocked, while STAT3 expression was also decreased, after the siRNA transfection of HepG2 cells. The migration (scratch adhesion test) and invasion (transwell assays) abilities of HepG2 cells which the mTOR expression was blocked by siRNA interference were significantly decreased (P<0.05).

CONCLUSION

mTORSTAT3 expression in hepatoma cells HepG2 was significantly higher than that in normal liver cells. mTOR blocking can reduce the expression of STAT3, which is also closely related to the invasion and metastasis of liver cancer cells.

Does external beam radiation therapy improve survival following transarterial chemoembolization for unresectable hepatocellular carcinoma?

BACKGROUND

Transcatheter arterial chemoembolization (TACE) improves survival in patients with unresectable hepatocellular carcinoma (HCC). Partial liver radiotherapy with modern techniques has been shown to be safe. The purpose of this study was to evaluate the survival value of external beam radiation therapy (EBRT) with concurrent chemotherapy combined with TACE.

METHODS

A University of Virginia Interventional Radiology patient log was used to identify patients treated with TACE ± another modality from 1999 through 2005. During this time, 44 patients received TACE for unresectable HCC, and 7 of these received adjuvant EBRT. Univariate analysis and multivariable proportional hazards survival modeling were used to identify factors impacting survival.

RESULTS

We compared 37 patients receiving TACE alone to 7 receiving TACE and EBRT (5 with concurrent capecitabine). Unadjusted mean transplant-free survival times were TACE only = 376 days (standard error [SE] = 63 days), TACE + EBRT = 879 days (SE = 100 days). EBRT, TNM stage, and MELD score were important predictors for survival on univariate analysis (p < .10). The adjusted hazard ratio for transplant or death in the TACE + EBRT group was 0.15 (0.02-0.95, p = .026).

CONCLUSION

EBRT with concurrent chemotherapy following TACE is feasible and well tolerated with modern treatment techniques. Further research should be directed toward determining the potential overall survival benefit of adjuvant EBRT with chemotherapy following TACE for hepatocellular carcinoma.

Pathological complete remission of advanced hepatocellular carcinoma with main portal vein tumor thrombosis by hepatic arterial infusion chemotherapy

Cures for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) are rare and difficult. We report a case of pathologically confirmed complete remission of HCC induced by hepatic arterial infusion chemotherapy (HAIC). A 45-year-old male patient had a massive HCC in the right lobe of the liver and tumor thrombus in the right and main portal veins. He achieved a partial response after two cycles of HAIC with 5-fluorouracil (750 mg/m(2)) and cisplatin (25 mg/m(2)). After the completion of six cycles he received a curative partial hepatectomy, and histopathology revealed complete necrosis without any viable tumor cell. He was in good health at a 4-month follow-up. These results suggest that this regimen is a promising therapeutic modality for the treatment of advanced HCC with PVTT.

Hepatic arterial infusion chemotherapy using high-dose 5-fluorouracil and cisplatin with or without interferon-alpha for the treatment of advanced hepatocellular carcinoma with portal vein tumor thrombosis

OBJECTIVE

In this retrospective study, we assessed the efficacy of hepatic arterial infusion chemotherapy (HAIC) using high-dose 5-fluorouracil (5-FU) and cisplatin with or without interferon (IFN)-alpha for the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis.

MATERIAL AND METHODS

Fifty-two patients were included in the analysis. The patients were treated with 5-FU (750 mg/m(2)) and cisplatin (25 mg/m(2)) from Days 1 to 4. IFN-alpha was administered subcutaneously at a dose of 3 million units from Days 1 to 4, and then every other day for 24 days. Chemotherapy was repeated every 4 weeks. Thirty-one patients were treated with 5-FU, cisplatin and IFN-alpha (FPI group) and 21 were treated with 5-FU and cisplatin (FP group).

RESULTS

An objective tumor response was achieved in six patients (19.4%) in the FPI group. In the FP group, 12 patients (57.1%) achieved an objective tumor response (p = 0.015). The cumulative survival rate was higher in the FP group than the FPI group, but this difference was not statistically significant (p = 0.353). The median survival time for the 18 responders was 14 months (range 4-25 months), and their 6, 12, and 24-month cumulative survival rates were 89%, 83%, and 25%, respectively.

CONCLUSIONS

HAIC using high-dose 5-FU plus cisplatin achieved a good tumor response. Adding IFN-alpha did not show any additional beneficial effects in terms of tumor response rate or survival.