Combining local regional therapy and systemic therapy:Expected changes in the treatment landscape of recurrent hepatocellular carcinoma

Improvements in early screening,new diagnostic techniques,and surgical treatment have led to continuous downward trends in hepatocellular carcinoma(HCC)morbidity and mortality rates.However,high recurrence and refractory cancer after hepatectomy remain important factors affecting the long-term prognosis of HCC.The clinical characteristics and prognosis of recurrent HCC are heterogeneous,and guidelines on treatment strategies for recurrent HCC are lacking.Therapies such as surgical resection,radiofrequency ablation,and transhepatic arterial chemoembolization are effective for tumors confined to the liver,and targeted therapy is a very important treatment for unresectable recurrent HCC with systemic metastasis.With the deepening of the understanding of the immune microenvironment of HCC,blocking immune checkpoints to enhance the antitumor immune response has become a new direction for the treatment of HCC.In addition,improvements in the tumor immune microenvironment caused by local treatment may provide an opportunity to improve the therapeutic effect of HCC treatment.Ongoing and future clinical trial data of combined therapy may develop the new treatment scheme for recurrent HCC.This paper reviews the pattern of recurrent HCC and the characteristics of the immune microenvironment,demonstrates the basis for combining local treatment and systemic treatment,and reports current evidence to better understand current progress and future approaches in the treatment of recurrent HCC.

Discussion of rationality of radiosurgery therapy on pineal region germ cell tumors

Objective To discuss rationality of stereotaxic radiosurgery as the first therapy strategy on pineal region germ cell tumors. Methods To retrospectively analyze the clinical materials of 14cases which received the treatment of gamma knife or X-knife. The condition of tumor changing ,recurrence

Discussion of diagnosis and therapy strategy for pineal region tumors

Objective To define optimal diagnosis and theraputic strategy of pineal region tumors. Methods Clinicalmaterials of 154 cases with pineal region tumors were analyzed retrospectively. Results The patients with pineal region tumors often complained of increased intracranial pressure and ocular movement deficiency.

Small hepatocellular carcinoma: current status and prospects

Background: More than two decades have gone by since the early report of resection for small hepatocel- lular carcinoma (HCC), which resulted in improved prognosis of HCC. Objective: To review the past and recent data, and prospect the future in this field. Data sources: Literature and recent data from the Liver Cancer Institute of Fudan University, Shang- hai, China. Data synthesis: 1232 patients with small HCC from the institute were analyzed between 1960-1984 (n= 107) and 1985-1999 (n=1125). The increase of li- mited resection rate from 69.5 % to 82.5 % contribu- ted in part to the increase of resectability from 76.6 % to 95.5 %, decrease of operative mortality from 2.4 % to 1.2 %, and improvement of 5-year sur- vival after resection (from 53.1% to 64.0%). The 5-year survival was higher after limited resection than after lobectomy, being 64.4 % versus 55.9%. The 5-year survival after resection was superior to that after cryosurgery and other regional cancer therapies (32.8 %). However, molecular studies found that biological characteristics were only slightly better in small HCC than in large HCC. Conclusions: Resection remains the treatment choice for small HCC with compensated liver function, while regional cancer therapies and liver transplanta- tion are alternatives for patients with incompensated liver function. Biological characteristics remain the leading factor influencing prognosis of small HCC.