Hepatocarcinoma en Guatemala


Evolution of the treatment of hepatocellular carcinoma in an developing country.  When money matters

Background  We present our data in the treatment of hepatocellular carcinoma before and after the sorafenib and the incorporation of of transarterial chemoembolization (TACE), in the Guatemalan Social Security (IGSS). for the expensive treatment,  is discussed each case in the Tumor Board  together with gastroenterologists, pathologists, surgeons of abdomen, surgeons, oncologists and medical oncologists. surprisingly, our data are best to those published, probably by the number of patients.

Patients and methods The retrospective analysis of the data was approved by the institutional review board. 28 patients with HCC according to the American Joint Committee on Cancer (AJCC) staging classification (TNM) were treated between October 2008 and April 2012. Tumor size and density were assessed on CT scans by using RECIST and Choi criteria, the latter of which classify a partial response as a 15% or more reduction in tumor density or a 10% or more reduction in tumor size.

Results:  Their main characteristics were: sex (male/female) 23/5, median age: 57 yrs, median PS 80, localized resectable 1 (3.6%), localized and locally advanced unresectable 24 (85.7%) and advanced metastatic liver cáncer 3 (10.7%), Child-Pugh (CP) class A (21) and B (7) and biopsy was performed in 96% of patients.  We identified three groups Group 1: 13 (46%), patients were treated with chemotherapy (idarubicin range 2 a 12 cycles), Group 2: 8 (29%) patients treated with sorafenib,  (the median duration of  treatment was 7.1 months) and Group 3: 7 (25%) patients underwent conventional TACE with doxorubicin (The median number of sessions per patient was 1 – 2) and sorafenib.  The  time to progression  (TTP) 4.7,  6.9 and 8.3 months, and overall survival (OS) were 10.8, 15.7 and 19.1 months, for groups 1, 2 and 3 respectively.

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Conclusion:  The early-stage patients respond better. The cases must be carefully selected, for better use of resources.TACE and sorafenib achieved a promising outcome in select patients with advanced HCC.   Although patients with HCC and CP class B liver function have poorer outcomes than those with CP class A function, data suggest that patients with CP class B liver function can tolerate treatment and may still benefit .

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