Therapeutic Strategies in Primary and Metastatic Liver Cancer

Primary and metastasizing malignant carcinoma of the liv er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques tion is whether modem diagnostic methods and new thera peutic concepts can help to improve the prospects of treat ment. Of particular interest is the role played by therapeu tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys temic therapy and organ-related therapeutic methods, in cluding surgical resection, changes in the blood supply, re gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top ics covered.

Klappentext

Primary and metastasizing malignant carcinoma of the liv­ er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques­ tion is whether modem diagnostic methods and new thera­ peutic concepts can help to improve the prospects of treat­ ment. Of particular interest is the role played by therapeu­ tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys­ temic therapy and organ-related therapeutic methods, in­ cluding surgical resection, changes in the blood supply, re­ gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan­ dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top­ ics covered.

Inhalt
Tumor Biology.- Pathogenesis of Primary Liver Tumors Induced by Chemicals.- Radiation-Induced Primary Liver Tumors in Thorotrast Patients.- Mechanisms of Metastatic Spread to Liver.- Prevention of Liver Metastases of Colorectal Carcinoma.- Diagnosis and Staging.- The Role of the Pathologist in the Clinical Management of Malignant Liver Tumors.- Significance and Limitations for Diagnostics and Follow-up.- Pathological Changes in the Liver and Computed Tomography.- Tumour Markers in the Diagnosis and Management of Patients with Hepatocellular Carcinoma.- Cancer Detection by Immunoscintigraphy, Selection, and Clinical Application of Monoclonal Anti-CEA Antibodies and Their F (ab?)2 or Fab Fragments.- Proposal for Staging Liver Metastases.- The Staging of Hepatic Metastases Arising from Colorectal Cancer.- Systemic Chemotherapy.- Indications for Treatment and Determination of Treatment Effects with Primary and Secondary Liver Tumors.- Application and Results of Different Chemotherapy Regimens in Primary Liver Malignancies.- Systemic Therapies for Patients with Liver Tumors: Prospects for the Future.- Biochemical Basis for Improving Chemotherapeutic Regimens in Liver Malignancies.- Enhancement of the Effects of 5-Fluorouracil.- Systemic Infusional Chemotherapy for Liver Metastasis: An Improved Schedule for 5-Fluorouracil.- Locoregional Chemotherapy.- Pharmacologic Rationale for Hepatic Arterial Therapy.- Experiments on the Toxicity of Locoregional Liver Chemotherapy with 5-Fluoro-2?-deoxyuridine and 5-Fluorouracil in an Animal Model.- Phase II Study of Hepatic Artery Infusion with 5-Fluorouracil, Adriamycin, and Mitomycin C (FAM) in Liver Metastases from Colorectal Carcinoma.- Indication and Rationale for the Use of Implantable Devices for Arterial RegionalChemotherapy.- Preliminary Results of a Randomized Study of Intrahepatic Infusion Versus Systemic Infusion of 5-Fluoro-2?-deoxyuridine for Metastatic Colorectal Carcinoma.- Surgical Treatment.- Surgical Anatomy of the Liver.- Concepts of Liver Resection for Primary and Secondary Tumors.- Surgical Treatment of Primary Liver Cell Carcinoma in China.- Surgical Therapy of Primary Liver Tumors.- Typical and Atypical Resection Techniques of Hepatic Metastases.- Liver Transplantation for Liver Tumors.- Requirements and Results of Liver Perfusion.- Intraarterial Chemotherapy for Colorectal Liver Metastases and Hepatomas Using a Totally Implantable Drug Infusion Pump.- Vascular Access to Liver Tumors.- Vascular Patterns of Liver Tumors and Their Consequences for Different Therapeutic Approaches.- Changes of Vascular Pattern of Tumors and Surrounding Tissue During Different Phases of Metastatic Growth.- Permanent Hepatic Artery Ligation Versus Temporary Dearterialization in the Treatment of Hepatic Tumors.- Hepatic Arterial Ligation and Portal Vein Infusion: A Clinical Trial by the Gastrointestinal Tract Cancer Group of the European Organization for Research and Treatment of Cancer.- Indications and Therapeutic Possibilities Using Degradable Microspheres in Liver Malignancies.- Radiotherapy and Additional Locoregional Treatment Modalities.- Therapeutic Strategies in Primary and Metastatic Liver Cancer: Indication and Results of External Radiation Therapy.- Combined Use of Drugs and Radiation in the Treatment of Liver Metastases.- Radiolabeled Antibody in the Treatment of Primary and Metastatic Liver Malignancies.- Thermochemotherapy for Unresectable Hepatic Cancer.- Monoclonal Antibody Infusion in Gastrointestinal Cancer Patients.