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Forthcoming Issues
Hepatocellular Carcinoma (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 14, 2023 Category: Surgery Source Type: research

Changing Epidemiology of Hepatocellular Carcinoma Within the United States and Worldwide
Globally, hepatocellular carcinoma (HCC) is a major cause of cancer-related death and a leading cause of morbidity and mortality in patients with chronic liver disease and cirrhosis. The predominant cause of HCC is shifting from viral to nonviral causes, in parallel with the high global prevalence of nonalcoholic fatty liver disease and increasing alcohol consumption in many countries. There have been promising recent advances in the treatment of all stages of HCC; however, improvements in early detection, increased utilization of HCC surveillance, and equitable access to HCC therapies are needed to curb increases in HCC m...
Source: Surgical Oncology Clinics of North America - August 31, 2023 Category: Surgery Authors: Nicole E. Rich Source Type: research

Role of Neoadjuvant Therapy Prior to Curative Resection in Hepatocellular Carcinoma
Immunotherapy has revolutionized the standard of care in multiple aspects of oncology. Given successes in the setting of unresectable hepatocellular carcinoma (HCC) and the advantages of neoadjuvant therapy, many trials are demonstrating the safety and feasibility of combination of immune checkpoint inhibitors (ICIs)/tyrosine kinases in patients with resectable HCC. Numerous clinical trials are currently investigating the role of different immune modulators either as monotherapy or as combination therapy in the neoadjuvant setting. Key questions that remain to be addressed include efficacy, safety, predictive biomarkers, a...
Source: Surgical Oncology Clinics of North America - August 31, 2023 Category: Surgery Authors: Zachary Whitham, David Hsiehchen Source Type: research

Expanding Indications for Surgical Resection in Hepatocellular Carcinoma
Hepatic resection is one of the mainstays of curative therapy for hepatocellular carcinoma (HCC). The appropriate selection of resectable candidates requires careful consideration of a multitude of factors including tumor burden (size and number of nodules, presence of vascular involvement, extrahepatic spread), patient factors (performance status, underlying liver function), and availability of other therapies (access to transplantation, interventional procedures, immunotherapies). Historically, hepatic resection for HCC has been reserved for patients with solitary tumors without vascular invasion. However, in well-select...
Source: Surgical Oncology Clinics of North America - August 29, 2023 Category: Surgery Authors: Gloria Y. Chang, Adam C. Yopp Source Type: research

Hepatocellular Carcinoma
This issue of the Surgical Oncology Clinics of North America focuses on Hepatocellular Carcinoma (HCC). HCC is the most common type of primary liver cancer, and the fourth leading cause of cancer-related deaths worldwide. Approximately 60% to 70% of HCCs develop in the setting of chronic liver disease and cirrhosis. The pathogenesis of HCC is variable, yet it is primarily based on an inflammatory process related to hepatotropic virus infections (ie, hepatitis B or C virus), ethanol consumption (ie, alcoholic cirrhosis), or fatty infiltration of the liver (ie, nonalcoholic steatohepatitis). (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 29, 2023 Category: Surgery Authors: Timothy M. Pawlik Tags: Foreword Source Type: research

Role of Stereotactic Body Radiation Therapy in Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC)is a common type of liver cancer with a poor prognosis, especially in patients with advanced stages or underlying liver disease. While surgical resection, liver transplantation, and ablation therapies have traditionally been the mainstay of treatment for HCC, radiation therapy has become increasingly recognized as an effective alternative, particularly for those who are not surgical candidates. Stereotactic Body Radiation Therapy (SBRT) is a highly precise form of radiation therapy that delivers very high doses of radiation to the tumor while sparing surrounding healthy tissue. Several studies...
Source: Surgical Oncology Clinics of North America - August 25, 2023 Category: Surgery Authors: Aseel Y. Abualnil, Ritesh Kumar, Mridula A. George, Alexander Lalos, Mihir M. Shah, Matthew P. Deek, Salma K. Jabbour Source Type: research

Evolution of Systemic Therapy in Advanced Hepatocellular Carcinoma
The recognition that hepatocellular carcinoma (HCC) is a rising problem globally dates back decades; however, the development of effective medical treatment for the disease has only led to robust improvements in patient outcomes in the recent past. As knowledge evolves and regimens are proven to be more active, the importance of multidisciplinary management in patients with all stages of HCC will become more important to optimize patient outcomes. Key to optimizing patient outcomes is an understanding of the evolution and current role of these therapies in the HCC landscape. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 12, 2023 Category: Surgery Authors: Anthony Bejjani, Richard S. Finn Source Type: research

Minimally Invasive Robotic Techniques for Hepatocellular Carcinoma Resection
The adoption of minimally invasive techniques for hepatocellular resection has progressively increased in North America. Cumulative evidence has demonstrated improved surgical outcomes in patients who undergo minimally invasive hepatectomy. In this review, the authors ’ approach and methodology to minimally invasive robotic liver resection for hepatocellular carcinoma is discussed. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 12, 2023 Category: Surgery Authors: Aradhya Nigam, Jason S. Hawksworth, Emily R. Winslow Source Type: research

Overview of Current Hepatocellular Carcinoma Staging Systems
Multiple hepatocellular carcinoma (HCC) staging systems have been proposed and used clinically over time. These may consider clinical, pathological, radiological, or treatment response factors, depending on the model. Given the heterogeneity of HCC treatment in its different stages and the validation of the systems in different populations, they are not universal. Likewise, the improvement in diagnostic tools, as well as novel therapeutic alternatives, have made these models more complex. Despite this, some have been modified over time in line with advances in the field, and although there is no universally accepted one, e...
Source: Surgical Oncology Clinics of North America - August 12, 2023 Category: Surgery Authors: Mariana Chavez-Villa, Ismael Dom ínguez-Rosado Source Type: research

Hepatocellular Carcinoma
Hepatocellular carcinoma is the fourth leading cause of cancer deaths worldwide and the fastest growing cause of cancer mortality in the United States. Patients diagnosed with hepatocellular carcinoma are a heterogenous group due to underlying chronic liver dysfunction and the presence of a concomitant malignancy. This heterogeneity requires a multifaceted cancer care approach, including surgical, locoregional, systemic, and supportive treatment options encompassing the specialties of surgery, radiology, oncology, hepatology, and palliative care. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 12, 2023 Category: Surgery Authors: Maria B. Majella Doyle, Adam C. Yopp Tags: Preface Source Type: research

Hepatocellular Carcinoma Surveillance
Hepatocellular carcinoma (HCC) surveillance is recommended by professional society guidelines given a consistent association with reduced HCC-related mortality. HCC surveillance should be performed using semiannual abdominal ultrasound and alpha-fetoprotein, although this combination has suboptimal sensitivity and can miss more than one-third of HCC at an early stage. There are promising emerging blood-based and imaging-based strategies, including abbreviated MRI and biomarker panels; however, these require further validation before routine use in clinical practice. HCC surveillance is underused in clinical practice due to...
Source: Surgical Oncology Clinics of North America - August 1, 2023 Category: Surgery Authors: Eden Koo, Amit G. Singal Source Type: research

Up-to-Date Role of Liver Imaging Reporting and Data System in Hepatocellular Carcinoma
This article overviews Liver Imaging Reporting and Data System (LI-RADS), a system that standardizes techniques, interpretation and reporting of imaging studies done for hepatocellular carcinoma surveillance, diagnosis, and locoregional treatment response assessment. LI-RADS includes 4 algorithms, each of which defines ordinal categories reflecting probability of the assessed outcome. The categories, in turn, guide patient management. The LI-RADS diagnostic algorithms provide diagnostic criteria for the entire spectrum of lesions found in at-risk patients. In addition, the use of LI-RADS in clinical care improves clarity o...
Source: Surgical Oncology Clinics of North America - August 1, 2023 Category: Surgery Authors: Victoria Chernyak Source Type: research

Controversies of Direct-Acting Antivirals in Hepatocellular Carcinoma
Therapy for chronic hepatitis C virus infection with direct-acting antiviral agents (DAAs) has been highly successful in achieving sustained virological response (SVR) with associated improvements in liver dysfunction, liver-related mortality, and transplant-free survival. There is a high risk of hepatocellular carcinoma (HCC) with an annual incidence of 2% to 4% in patients with cirrhosis. Following DAAs treatment and achievement of SVR, the risk of incident and recurrent HCC drops significantly over time, with risk associated with demographic and liver disease-related factors. Several risk factors have been described inc...
Source: Surgical Oncology Clinics of North America - August 1, 2023 Category: Surgery Authors: Ifrah Fatima, Neehar D. Parikh, Alisa Likhitsup Source Type: research

Management of Intermediate-Stage Hepatocellular Carcinoma
Intermediate-stage hepatocellular carcinoma (HCC) comprises a heterogeneous group of patients with varying levels of tumor burden. Transarterial chemoembolization was traditionally the mainstay of treatment for intermediate-stage HCC for almost 2  decades. New and emerging treatment options have revolutionized HCC therapy, allowing for broader application to patients with intermediate- and advanced-stage disease. Accordingly, new guidelines acknowledge these options, and intermediate stage HCC can now be treated with surgical, locoregional or systemic therapies, or a combination thereof. Patients will continue to benefit ...
Source: Surgical Oncology Clinics of North America - August 1, 2023 Category: Surgery Authors: Mikin Patel, Anjana Pillai Source Type: research

Optimal Liver Transplantation Criteria for Hepatocellular Carcinoma
Liver transplantation continues to be the optimal treatment for hepatocellular carcinoma (HCC). Given the limited organ supply, patient selection for liver transplant must carefully balance tumor progression with risk of recurrence posttransplant. There are several pretransplant selection criteria that incorporate biomarkers as well as imaging modality to risk-stratify patients as we continue to look for the optimal transplant cutoff for patients with HCC, which should be transplant-center specific, and account for organ availability and dynamic response to locoregional therapy. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 1, 2023 Category: Surgery Authors: Mignote Yilma, Neil Mehta Source Type: research