Hepatocarcinoma en Guatemala

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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.

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 .