Multimodality Therapy for Palliative Resectable Hepatocellular Carcinoma With Intrahepatic Vessels Invasion (MDTforHCC)
Recruitment status was: Recruiting
|Hepatocellular Carcinoma||Procedure: Hepatectomy Procedure: TACE combined with local regional therapies without hepatectomy||Phase 3|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Randomized Controlled Trial of Multimodality Therapy in the Treatment of Palliative Resectable Hepatocellular Carcinoma With Intrahepatic Vessels Invasion|
- Overall survival rate [ Time Frame: 1-, 3- and 5-year ]
- Quality of live [ Time Frame: 1- and 3- month ]
|Study Start Date:||October 2006|
|Estimated Study Completion Date:||July 2010|
|Estimated Primary Completion Date:||December 2009 (Final data collection date for primary outcome measure)|
Active Comparator: surgery
initial palliative hepatectomy followed by TACE and/or local regional treatment
Experimental: no surgery
TACE combined with local regional treatment without hepatectomy
Procedure: TACE combined with local regional therapies without hepatectomy
TACE combined with RFA, MCT, PEI, and so on.
Other Name: TACE combined with local regional treatment without hepatectomy
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm and the third cause of cancer-related death. At initial diagnosis, surgical resection is considered a potentially curative modality for HCC[1, 2], with the five-year survival rates for resectable patients 50-60%, however, only about 15% of patients have resectable disease and post-operative recurrence is common, remaining the main obstacle to long-term survival. On the one hand, the reason may be the multicentric genesis of HCC or the preoperatively micrometastasis that can not be resected during operation. Shi M, et al  reported that the appropriate resection margin was >= 2cm. The Liver Cancer Study Group of Japan (LCSGJ) defined: absolute curative resection included liver resection with 1 cm of free surgical margin in patients with solitary tumor <= 2cm; relative curative resection included liver resection without 1 cm of free surgical margin but with the excised tumor tissue in patients with solitary tumor <= 2cm or liver resection with 1 cm of free surgical margin in patients with tumor >= 2cm (in either instance, no tumor thrombus may remain in the portal vein, hepatic vein, or bile duct in images of the remnant liver); relative non-curative resection, in which all macroscopic tumor tissue is removed; and absolute non-curative resection, which is liver resection with part of the macroscopic tumor tissue remaining. Either overall survival rates (OS) or disease-free survival rates (DFS) of HCC patients are higher in curative resection than in non-curative resection. According to this definition, when the giant tumor located in middle liver, tumor with lymph nodes adjacent to abdominal aorta metastasis, multiple lesions (>= 3) or tumor with intrahepatic vessels invasion, the surgery will be non-curative. On the other hand, post-operative adjuvant therapy is one of the most effective treatment strategies in improving the survival rates of HCC patients. Unfortunately, only about 15 randomized controlled trials have been reported on the post-operative adjuvant therapy until now. Most of them were single center, little sample clinical trials.
Recently, a series of studies have been reported that transcatheter arterial chemoembolization (TACE) is effective in HCC[6, 7]. Best results are seen in patients with small tumors and good liver function and 1 year survival has been shown to be of 30-50%. A recent meta-analysis showed a significant benefit of chemo-embolization with improvement in two-year survival. TACE is one of most important therapy strategies on HCC. The 2007' NCCN clinical practice guidelines in oncology has included the TACE throughout the treatment guideline of unresectable HCC or resectable HCC (for some reason, hepatectomy was not carried out) or adjuvant therapy post-operative. But there are still lack of RCT studies.
In the patients with palliative resectable HCC, the presence of intrahepatic vessels invasion was usually regarded as the symbol of cancer cells hematogenous dissemination, which is associate with short-term recurrence and worse survival. For this special group patients, some authors insisted that aggressive therapy strategy-initial palliative hepatectomy followed by TACE and/or local regional treatments was most effective to prolong the survival of patients.While other authors,however,believed that too aggressive therapy was not best choice for these patients because of the suppression of immune system after palliative hepatectomy may potentially accelerate the growth of residual cancer cells. A relative conservative strategy-transcatheter hepatic arterial chemoembolization combined local regional treatments without hepatectomy should be used. The optimal therapy strategies are still in controversial.Only the multiple-center, great sample clinical RCT studies can answer this question. The purpose of this study is to compare the effects of different multimodality therapy strategies (initial hepatectomy followed by transcatheter hepatic arterial chemoembolization and/or local regional treatments compare with transcatheter hepatic arterial chemoembolization combined local regional treatments without hepatectomy)in the treatment of palliative resectable hepatocellular carcinoma with intrahepatic vessels invasion.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00501813
|Contact: shi ming, MD||86-2087343582 ext email@example.com|
|Contact: Min-Shan Chen, MD||86-2087343117 ext 86-2087343117||Chminsh@mail.sysu.edu.cn|
|Department of Hepatobilliary Surgery, Cancer Center, Sun Yat-sen University,||Recruiting|
|Guangzhou, Guangdong, China, 86-20|
|Contact: ming shi, MD 86-2087343582 ext 86-2087343582 firstname.lastname@example.org|
|Contact: Min-Shan Chen, MD 86-2087343117 ext 86-2087343117 Chminsh@mail.sysu.edu.cn|
|Principal Investigator: Rong-Ping Guo, MD|
|Principal Investigator:||Jin-Qing Li, MD||Department of Hepatobilliary Surgery, Cancer Center, Sun Yat-sen University|
|Study Director:||Rong-Ping Guo, MD||Department of Hepatobilliary Surgery, Cancer Center, Sun Yat-sen University|