First-Line Treatment for Hepatocellular Carcinoma: Resection or Transplantation?

Gastroenterology, Liver Surgery and Transplantation Unit, Istituto Nazionale Tumori, Foundation IRCCS, Milan, Italy.
Transplantation Proceedings (Impact Factor: 0.98). 10/2007; 39(7):2271-3. DOI: 10.1016/j.transproceed.2007.06.015
Source: PubMed
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    ABSTRACT: There are only few malignant tumours where organ transplantation is the treatment of choice. Transplantation can be considered individually in certain lung carcinomas, unresectable heart tumours, cholangiocellular carcinoma and Klatskin tumour. It is acceptable in unresectable chemosensitive hepatoblastoma, epitheloid haemangioendothelioma, liver metastasis of neuroendocrine tumours and as the most common indication, the early hepatocellular carcinoma (HCC) in cirrhotic liver. Results of liver transplantation (LT) for HCC according to Milan criteria as a “gold standard” are excellent. Time of LT has a great influence on the results. While patients are on waiting list, locoregional therapies may help prevent tumour progress. Living donor LT is an acceptable treatment of HCC. The greatest experience with this procedure is in Asia. Despite the favourable results, LT as the treatment of HCC is debated and raises several questions: regarding indication and expectable outcome. Milan criteria seem to answer this questions although they are too strict. The number and size of HCC foci per se is not sufficient predictor of eligibility to transplantation and for prognosis. Majority of the prognostic factors can be evaluated only after transplantation with pathological examination of HCC. Aim of the present research is to find prognostic factors that are characteristic of biological behaviour of HCC, which can be detected before LT in order to select patients who have the greatest benefit from LT. Re-definition of eligibility criteria is an actual question; an international consensus based on additional prospective studies is required for the “new” recommendation. KeywordsBridging therapy–Bronchioloalveolar carcinoma–Des-gamma-carboxy prothrombin–Extended criteria–Heart sarcomas–Hepatocellular carcinoma–Living donor liver transplantation–Liver transplantation–Milan criteria–Proliferation signal inhibitor
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    ABSTRACT: The solution of the global controllability problem is obtained for a class of the triangular systems of O.D.E. that are not feedback linearizable. The introduced class is a generalization of the classes of triangular systems investigated before. The solution of the problem is based on the approach proposed in another work [18] devoted to the triangular systems of the Volterra equations and written jointly with W.H. Schmidt by the current authors. This yields the same properties of the considered class of triangular systems as those established in [18] for the Volterra systems. As well as in [18], for the current class of triangular systems, it is proven that there exists a family of continuous controls that solve the global controllability problem for the considered class and continuously depend on the initial and the terminal states. As well as in [18], this implies the global controllability of the bounded perturbations of the current class. In contrast with [18], to prove the existence of the desired family of open-loop controls, we construct a family of closed-loop ones each of which steers the corresponding initial state into an appropriate neighborhood of an appropriate terminal point.
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