峯 ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) 106 09 27 /
肝癌診療指引 106 105 106-1 ( AFP) 3-6 (1) (2) -2 (1)1-2 (2)>2-3 -4-4 :1 Sorafenib (Child A)(Child B ) ( AFP) (1) 1 (2) <1 (3) -1 肝癌診療指引共識 -1 1 B -2 轉介 B.C 型肝炎帶原者評估是否接受抗病毒治療 刪除 Sorafenib 治療 (Child A)(Child B, 非仿單是應, 需自費 ) 6. 癌症診療指引4
肝癌診療指引共識1-1 B C B C ( AFP) 3-6 1 <1 / / 3-6 6-2 ( AFP) 3-6 癌症診療指引5
肝癌診療指引共識2-2 ( ) -3 4 ( 1 ) * ( ) 癌症診療指引6 * : B -1
肝癌診療指引共識3-3 ICG test/ BCLC : 0 1~3 BCLC : A (RFA)/ (PEI) / (PMCT)/ (RFA)/ (PEI) / (PMCT) (TACE/TAE) ( HAIC) 2 1-3 6 B.C 癌症診療指引7
肝癌診療指引共識4-4 ICG test/ BCLC : B BCLC : C (RFA)/ (PEI) / (PMCT)/ (RFA)/ (PEI) / (PMCT) (TACE/TAE) ( HAIC) 1. 2. 3. 4. 5. 6. 1~3 2 1-3 6 B.C 癌症診療指引8 BCLC : D 1. 2.
肝癌診療指引 參考文獻 1. NCCN Clinical Practice Guidelines in Oncology Hepatobiliary Cancers. V3. 2017 2. Jordi Bruix, and Morries Sherman. Mangement of Hepatocellular Carcinoma,AASLD PRACTICE GUIDELINE. HEPATOLOGY, Vol.42, No. 5,2005 3. Francois Durand, M.D., and Dominique Valla, M.D. Assessment of Prognosis of Cirrhosis. SEMINARS IN DISEASE, 2008;Vol.28, No.1:110-122. 4. Deniela Benedeto-Stojanov, Aleksandar Nagorni, et al.the Model for the End-Stage Liver Disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding. VOJNOSANITETSKI PREGLED 2009;Vol.66:724-728. 5. Mazzaferro V, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693-9. 6. Duffy JP et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg. 2007 Sep;246(3):502-9; discussion 509-11. 7. Yamakado, K., et al., Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology 2008; 247(1):260-266. 8. Maluccio, M.A., et al., Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2008;19(6):862-869. 9. Kulik, L.M., et al., Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 2008;47(1):71-81. 10. Cardenes HR, Price TR, Perkins SM, et al. Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 2010; 12:18-225. 11. Tse RV, Hawkins M, Lockwood G, K, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008 26:657-664. 12. Hawkins MA, Dawson LA. Radiation therapy for hepatocellular carcinoma.cancer 2006;106(8):1653-1663. 癌症診療指引9
肝癌診療指引 參考文獻 13. Tse RV, Guha C, Dawson LA. Conformal radiotherapy for hepatocellular carcinoma.crit Rev Oncol/Hematol 2008;67:113-123. 14. Huang YJ, Hsu HC, Wang CY, et al. The treatment responses in cases of radiation therapy to portal vein thrombosis in advanced hepatocellular carcinomna.ijrobp 2009;73(4):1155-1163. 15. Meng MB, Cui YL, Lu Y, She B, Chen Y, Guan YS, et al. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2009; 92(2): 184-94. 16. Seong J, Park HC, Han KH, Chon CY. Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys. 2003; 55(2): 329-36. 17. Prof. M. kudo :Clinical Practice Guidelines for HCC Differ between Japan, United States,and Europe. Liver Cancer 2015;4:89-95 18. Eric C. H. et al: Spontaneous Rupture of Hepatocellular Carcinoma. ARCH SURG/VOL 141: 191-198, FEB 2006 19. Chi-leung Liu et al: Management of Spontaneous Rupture of Hepatocellular Carcinoma: Single-Center Experience. Journal of Clinical Oncology, Vol 19, No 17 (September 1): 3725-3732, 2001 20. Joon Sung Kim et al: Long-Term Survival in a Patient With Ruptured Hapatocellular Carcinoma. The Korean Journal of Internal Medicine Vol. 24, No. 1, March:63-67, 2009 21. Chiung-Yu Chen et al: Spontaneous Rupture of Hepatocellular Carcinoma A Review of 141 Taiwanese Cases and Comparison with Nonrupture Cases. 22. Miyamoto M, et al: Spontaneous rupture of hepatocellular carcinoma: A review of 172 Japanese cases. Am J Gastroenterol 86:67-71, 1991 23. Paolo Sammartino et al: Prevention of Peritoneal Metastases from Colon Cancer in High-Risk Patients: Preliminary Results of Surgery plus Prophylactic HIPEC. Gastroenterology Research and PracticeVolume 2012 (2012), Article ID 141585, 7 pages 24. Jesslyn H Ding et al: Hepatocellular Carcinoma Peritoneal Metastases: Report of Three Cases and Collective Review of the Literature. Ann Acad Med Singapore 2010;39:734-37 25. AASLD 2010 HCC Update.Jordi Bruix1 and Morris Sherman2: Management of Hepatocellular Carcinoma: An Update. HEPATOLOGY, Vol. 000, No. 000, 2010 癌症診療指引10
肝癌診療指引 參考文獻 26. EASL EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma: European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. Journal of Hepatology 2012 vol. 56 j 908 943 27. Asia Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update, Masao Omata1,2 Ann-Lii Cheng3 Norihiro Kokudo4 Masatoshi Kudo5 Jeong Min Lee6 Jidong Jia7 Ryosuke Tateishi8 Kwang- Hyub Han9 Yoghesh K. Chawla10 Shuichiro Shiina11 Wasim Jafri12 Diana Alcantara Payawal13 Takamasa Ohki14 Sadahisa Ogasawara15 Pei-Jer Chen16 Cosmas Rinaldi A. Lesmana17,18 Laurentius A. Lesmana17 Rino A. Gani18 Shuntaro Obi19 A. Kadir Dokmeci20 Shiv Kumar Sarin21 癌症診療指引11
癌症診療指引12 Hepatocellular Carcinoma Sorafenib (Child-Pugh Class A [category 1] or B) mg/m 2 Sorafenib 400mg PO BID 1, 2 Progression on or after Sorafenib Regorafenib (Child-Pugh Class A only [category 1] ) mg/m 2 Regorafenib 160mg PO QD 1-21 Q4W 3 Nivolumab (Child-Pugh Class A or B7 only ) mg/m 2 Nivolumab 3 mg/kg 1-21 Q2W 4 1. Llovet J, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. New Engl J Med 2008;359(4):378-390. 2. Cheng A, Kang Y, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia Pacific region with advanced hepatocellular carcinoma: a phase III randomized,double-blind, placebo-controlled trial. Lancet Oncol 2009;10:25-34. 3. Bruix J, Qin S, Merle P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017;389:56-66. 4. EI-Khoueiry AB, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet 2017;389:2492-2502.
肝癌放射治療指引共識 癌症診療指引13 1. 2. / 36-56Gy( ) 13 (12-14 ) 23 (20-25 ) ( ) 1. 6-20Gy 2. 3-6 :, : 1. NCCN clinical practice guidelines in oncology-hepatobiliary cancers. Version 4.2017. 2. Robertson JM, et al. Treatment of primary hepatobiliary cancers with conformal radiation therapy and regional chemotherapy. J Clin Oncol 1993; 11: 1286 1293. 3. Cardenes HR, et al. Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 2010; 12: 218-225. 4. Tse RV, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic
5. Bentzen SM, Constine LS, Deasy JO, et al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. International journal of radiation oncology, biology, physics 2010; 76(3 Suppl): S3-9 cholangiocarcinoma. J Clin Oncol 2008; 26: 657-664. 肝癌放射治療指引共識 癌症診療指引14