Percutaneous isolated hepatic perfusion chemotherapy following debulking

hepatectomy is reportedly useful in treating patients with severe advanced HCC with tumor thrombus of major vessels.14 LIVER TRANSPLANTATION IS the best treatment method for removing metastatic foci in the liver together with the cirrhotic liver from which the cancer develops. In Japan, living-donor liver transplantation has been covered by health insurance since January 2004. According to reports published up to the end of 2009, almost all liver transplantations for HCC click here in Japan involved living donors, with 1131 transplantations from living donors and seven from deceased donors.15 As liver transplantations are taken from living donors, indications for liver transplantation in Japan only cover those patients who meet the Milan criteria (≤3 tumors with tumor diameter ≤3 cm or a single tumor ≤5 cm in diameter), but whose hepatic reserve has deteriorated severely (Child–Pugh class C),1,2 meaning that liver transplantations are regarded very differently in comparison with other countries where the majority of transplantations are from deceased donors.15 However,

because most liver transplantations are from living donors, issues of the appropriate distribution of liver grafts and waiting times involved in transplantations from deceased donors are almost non-existent. Recently, tumor markers have also been included in the criteria, and attempts are being made to extend indications beyond those of MCE the Milan criteria.16,17 In addition, donors are restricted to close relatives. BMN 673 nmr As a result, blood groups are frequently mismatched, although in almost all cases this can be managed by the preoperative administration of anti-CD20 antibodies and plasmapheresis.18 According to a report by the Japanese Liver Transplantation Society, 1-, 3-, 5- and 10-year survival rates following liver transplantation from a living donor were 84.4%, 73.9%, 68.5% and 58.8%, respectively.15 The Act on Organ Transplantation was revised in July 2010 to enable organ donation with the family’s permission even if the donor’s own intentions had not been made clear, and

since then the number of liver transplants from deceased donors has gradually been increasing. LOCAL ABLATION THERAPY constitutes the main medical therapy for HCC in Japan. According to the report of the 18th follow-up survey, local ablation therapies were used in 30.6% of cases, administrated percutaneously in approximately 90% of those cases. RFA was used in 72.1% of cases (Fig. 2).9 Radiofrequency ablation has been covered by health insurance in Japan since April 2004, and its efficacy has been demonstrated in several subsequent randomized comparative trials,19–22 making this the first choice in percutaneous local therapy today.2 Percutaneous ethanol injection therapy, the therapy previously used, is still performed in rare cases for sites where insertion of an electrode for RFA is regarded as dangerous.