This article summarises expert discussion on the management of patients with hepatocellular carcinoma (HCC), which took place during the 24th World Gastrointestinal Cancer Congress (WGICC) in Barcelona, July 2022. A multidisciplinary approach is mandatory to ensure an optimal diagnosis and staging of HCC, planning of curative and therapeutic options, including surgical, embolisation, ablative strategies, or systemic therapy. Furthermore, in many patients with HCC, underlying liver cirrhosis represents a challenge and influences the therapeutic options.

• Klíčová slova
• chemoembolisation, hepatocellular carcinoma, immunotherapy, liver transplantation, radioembolisation,
• MeSH
• gastrointestinální nádory * diagnóza   terapie   MeSH
• hepatocelulární karcinom * diagnóza   terapie   MeSH
• lidé MeSH
• nádory jater * diagnóza   terapie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: The annually recorded incidence of primary hepatic carcinomas has significantly increased over the past two decades accounting for over 800 thousand of annual deaths caused by hepatocellular carcinoma (HCC) alone globally. Further, secondary liver malignancies are much more widespread compared to primary hepatic carcinomas: almost all solid malignancies are able to metastasise into the liver. The primary tumours most frequently metastasising to the liver are breast followed by colorectal carcinomas. Given the increased incidence of both primary and metastatic liver cancers, a new, revised approach is needed to advance medical care based on predictive diagnostics, innovative screening programmes, targeted preventive measures, and patient stratification for treatment algorithms tailored to individualised patient profile. ADVANTAGES OF THE APPROACH TAKEN: The current pilot study took advantage of systemic alterations characteristic for liver malignancies, utilising liquid biopsy (blood samples) and specific biomarker patterns detected. Key molecular pathways relevant for pathomechanisms of liver cancers have been considered opening a perspective for both-individualised diagnostics and targeted treatment. Systemic alterations have been analysed prior to the therapy application avoiding molecular biological effects potentially diminishing predictive power of the biomarker-panel proposed. Multi-omics at DNA and protein (both expression and activity) levels has been applied. An established biomarker panel is considered as a powerful tool for individualised patient profiling and improved multi-level diagnostics-both predictive and prognostic ones. RESULTS AND CONCLUSIONS: Biomarker panels have been created for the patient stratification, prediction of a more optimal therapy and prognosis of survival based on the individualised patient profiling. Although there are some limitations of the pilot study performed, the results are encouraging, as it may be possible, through further research along these lines, to find a clinically and cost-effective means of stratifying liver cancer patients for personalised care and therapy. The benefits to the patient and society of accurate treatment stratification cannot be overemphasised.

• Klíčová slova
• Biomarker pattern, Breast cancer, Colorectal cancer, Hepatocellular carcinoma, Individual outcome, Metastatic disease, Multi-omics, Predictive preventive personalised medicine, Selective internal radiation therapy (SIRT), Survival, Transarterial chemoembolisation (TACE),
• Publikační typ
• časopisecké články MeSH

Hepatocellular carcionma (HCC) is almost exclusively associated with liver cirrhosis as a significant HCC risk marker in advanced countries. Applicable therapy depends on early diagnosis, and risk patients should be screened for the presence of HCC on a regular basis. Liver ultrasound and determination of alpha-fetoprotein serum levels (AFP) are the screening methods used. Spiral CT is the most often used method for HCC staging. Non-invasive methods may under certain circumstances replace aimed biopsy. There are 3 basic curative therapies for the early stage of HCC: liver transplantation, surgical resection and different methods of local destruction of tumour (i.e., ethanolisation, thermoablation, etc.). Patients at medium stage of HCC may profit from chemoembolisation. Current available systemic chemotherapy is ineffective. Patients with advanced HCC are treated symptomatically. Patient survival prognosis after the application of one of the above treatment methods may be similar with that for HCC free cirrhosis patients, however, prognosis for advanced HCC patients is bad, with survival period from one to nine months.

• MeSH
• hepatocelulární karcinom diagnóza   terapie   MeSH
• lidé MeSH
• nádory jater diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

PURPOSE: Point detectors are frequently used to measure patient's maximum skin dose (MSD) in fluoroscopically-guided interventional procedures (IP). However, their performance and ability to detect the actual MSD are rarely evaluated. The present study investigates the sampling uncertainty associated with the use of grids of point detectors to measure MSD in IP. METHOD: Chemoembolisation of the liver (CE), percutaneous coronary intervention (PCI) and neuroembolisation (NE) procedures were studied. Spatial dose distributions were measured with XR-RV3 Gafchromic(®) films for 176 procedures. These distributions were used to simulate measurements performed using grids of detectors such as thermoluminescence detectors, with detector spacing from 1.4 up to 10 cm. RESULTS: The sampling uncertainty was the highest in PCI and NE procedures. With 40 detectors covering the film area (36 cm × 44 cm), the maximum dose would be on average 86% and 63% of the MSD measured with Gafchromic(®) films in CE and PCI procedures, respectively. In NE procedures, with 27 detectors covering the film area (14 cm × 35 cm), the maximum dose measured would be on average 82% of the MSD obtained with the Gafchromic(®) films. CONCLUSION: Thermoluminescence detectors show good energy and dose response in clinical beam qualities. However the poor spatial resolution of such point-like dosimeters may far outweigh their good dosimetric properties. The uncertainty from the sampling procedure should be estimated when point detectors are used in IP because it may lead to strong underestimation of the MSD.

• Klíčová slova
• Fluoroscopically-guided procedures, Maximum skin dose, Point detectors, Sampling uncertainty, TLD,
• MeSH
• chemoembolizace metody   MeSH
• dávka záření * MeSH
• fluoroskopie MeSH
• koronární angioplastika metody   MeSH
• kůže účinky záření   MeSH
• nejistota MeSH
• termoluminiscenční dozimetrie MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Hepatocelullar carcinoma (HCC) is the fifth most common cancer in the world. It mostly occurs in patients with cirrhosis. In the Czech Republic, about 250 new cases are reported per year. Surgery, i.e. liver resection or transplantation, as the only potentially curable method is possible in 15-20% of them. For the rest, palliative treatment is indicated. This includes ablative methods (radiofrequency ablation, alcoholization), transarterial chemoembolization (TACE), systemic chemotherapy or biological treatment by sorafenib. TACE is method of choice in patients unsuitable for surgery and ablative treatment. Another indication is embolization of HCC before liver transplantation to prevent tumour progression. In combination with other methods, down staging of the tumour and curable treatment afterward is possible. AIMS: To assess the outcome of transarterial chemoembolisation in patients with hepatocellular carcinoma. METHODS: Between 2004-2008 we performed 30 TACE. Of that number, 28 TACE were performed in 20 patients with HCC. We super selectively catheterized the tumour via arteria femoralis and used Doxorubicin with Lipiodol as embolic material. In follow up, we carried out laboratory studies and CT. RESULTS: We have not noticed any major complications. Post-embolization syndrome with fever, nausea and right upper quadrant pain occurred after 10 TACE (33%). One-, two- and three years survival of the patients was 53%, 40% a 20%. CONCLUSION: TACE is safe method prolonging patients' survival with unresectable HCC. For the correct treatment of HCC, its concentration to cancer centres and the cooperation between multiple specialists is necessary.

• MeSH
• chemoembolizace * MeSH
• doxorubicin aplikace a dávkování   MeSH
• hepatocelulární karcinom mortalita   terapie   MeSH
• lidé MeSH
• míra přežití MeSH
• nádory jater mortalita   terapie   MeSH
• paliativní péče MeSH
• protinádorová antibiotika aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• doxorubicin MeSH
• protinádorová antibiotika MeSH

Hepatocellular carcinoma (HCC) is one of the major complications of chronic liver disease, mostly of liver cirrhosis. Liver diseases from different causes differ in the risks of HCC development. Different mechanisms of carcinogenesis are involved in HCC development in different liver diseases as well. Generally, two main pathways are distinguished: the cause of liver disease itself (e.g. viral infections, accumulation of heavy metals etc.) and chronic liver inflammation and fibrogenesis, including mechanisms of oxidative stress. Rare cases of HCC in liver without underlying cirrhosis are likely the consequences of the mechanisms directly linked with particular etiological factor (e.g. protein X in chronic hepatitis B virus (HBV) infection). The key approach which can lead to significantly better results of any treatment used in HCC cases is HCC screening and surveillance. The appropriate method of HCC surveillance is abdominal ultrasonography in 6-month intervals. There is still one question to be solved: the correct definition of target population which should undergo this method of surveillance. Currently, the target population in the developed world is defined as all patients with liver cirrhosis. Unfortunately, the only method of primary prevention of HCC is available: universal HBV vaccination. Antiviral treatment of hepatitis B or C is considered as a method of secondary prevention. Adjuvant therapy of HCC after its primary therapy (antiviral therapy after HCC resection etc.) and other measures able to reduce HCC recurrence risk are usually mentioned as tertiary prevention approach. The BCLC staging system is the most common system used in Europe for the classification of HCC at the dia-gnosis. This classification combines the stage of HCC itself with other parameters, such as liver disease severity (Child - Pugh classification), portal hypertension etc. BCLC is a system which guides the physicians to optimal treatment options in every HCC stage. The only potentially curable approaches are surgical resection or liver transplantation. These options may be used in 1/3 of all HCC patients. Unfortunately, the vast majority of HCC patients can be treated only by palliative treatment options with transarterial chemoembolisation being the most common one.

• Klíčová slova
• chronic hepatitis B, chronic hepatitis C, hepatocellular carcinoma, non-alcoholic steatohepatitis,
• MeSH
• gastroenterologové psychologie   normy   MeSH
• hepatocelulární karcinom diagnóza   terapie   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• nádory jater diagnóza   terapie   MeSH
• směrnice pro lékařskou praxi jako téma normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH