Author's objectives To assess the impact on survival of primary medical treatments for people with unresectable hepatocellular cancer. Author's conclusions Chemoembolisation improves survival in people with unresectable HCC; tamoxifen offers no survival benefits for people with advanced disease. Structured abstract from Database of Abstracts of Reviews of Effects

Author's objectives The aim of this review was to assess the efficacy and safety of radiofrequency ablation (RFA) of liver tumors. Author's conclusions Most malignant liver tumors can not be surgically removed because of their extension, systemic involvement, comorbidities or tumor size. RFA is proposed as an alternative for patients with primary hepatocellular tumors or liver metastases of colorectal cancer, when surgery is not possible. When assessing the evidence, it is observed that in all cases tumor resection is the treatment of choice. When this is not possible, RFA shows more effectiveness than most alternative treatments. However, it is worth mentioning that the differences found are mainly in the rates of local recurrence and length of hospital stay, but there are no differences in survival. In addition, complications, although not evaluated by many authors, would be fewer than in other treatment alternatives (experts suggest a complication rate of 3% to 5%), with a mortality rate lower than 1%. To use this treatment, it is recommended that a multidisciplinary team including a liver surgeon performs a patient selection and that it is performed under ultrasound or topography guidance. The requirements that must be met to use RFA in patients with liver tumor are: - not candidates for surgical tumor resection (either because there is local involvement, or because of tumor location or comorbidities) - metastases of an isolated colorectal cancer or a hepatocarcinoma - no systemic or extrahepatic disease - identification images (ultrasound or computed tomography) - tumors less than 4 cm in diameter. Those tumors of other origins which are treated with RFA or which are treated for palliative treatment are considered investigational. Structured abstract from Health Technology Assessment Database

Author's objectives The aim of this report is to assess the available information on the use of transient elastography (FibroScan) for non-invasive assessment of liver fibrosis. Author's conclusions Liver fibrosis is associated with significant morbidity and mortality. The major cause is hepatitis C, which affects 240,000 Canadians. Assessing the degree of liver fibrosis is critical to its management. Liver biopsy, an invasive procedure, is considered to be the diagnostic gold standard. FibroScan is a rapid, non-invasive technology that uses low frequency vibration and ultrasound to assess the stiffness of liver tissue. The diagnostic performance of FibroScan is good for identifying severe fibrosis or cirrhosis, but it is less accurate for milder presentations. FibroScan is a promising technology, but large multi-centre trials comparing a range of emerging non-invasive fibrosis staging technologies are required. Structure abstract from Health Technology Assessment Database

Author's objectives This study aims to summarise the currently available evidence on thymalfasin (Zadaxin) for hepatitis C virus. Author's conclusions Thymalfasin (Zadaxin, TA-1, thymosin alpha 1) is in phase III trials for the treatment of hepatitis C virus (HCV) in patients who are non-responders to prior therapy. Thymalfasin is injected subcutaneously twice a week and stimulates the production of white blood cells and enhances antigen presentation. If licensed, thymalfasin would be used in combination with pegylated interferon (peg-IFN). Results from a randomised placebo-controlled trial in combination with interferon in 109 patients with HCV found that after 26 weeks serum alanine transaminase (ALT) was reduced in 37% of patients on combination therapy, 16% of patients on IFN only and 3% on placebo. HCV RNA clearance was achieved in 37% of patients on combination treatment, compared to 19% of patients on IFN monotherapy. Three phase III, multi-centred, double blind, placebo-controlled trials are ongoing: two in combination with peg-IFN over 12 months; and 1 in combination with peg-IFN and ribavirin. Structured abstract from Health Technology Assessment Database

Author's objectives The aim of this review was to compare the safety and efficacy of radiofrequency ablation for primary hepatocellular carcinoma or metastatic colorectal liver carcinoma, in comparison to other surgical and non-surgical therapeutic techniques, on the basis of a systematic assessment of the literature. The surgical comparative techniques included resection or hepatic artery infusion chemotherapy. The nonsurgical comparative interventions included local ablative therapies such as percutaneous ethanol injection (PEI); cryotherapy; or procedures that produce local heat such as microwave coagulation therapy (MCT) or laser-induced thermotherapy (LITT). Author's conclusions On the basis of the evidence presented in this systematic review, The ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the safety and efficacy of radiofrequency ablation for the treatment of liver tumours: Evidence rating - Average Safety - At least as safe compared to comparator procedure(s) Efficacy - Efficacy cannot be determined Structured abstract from Health Technology Assessment Database

Author's objectives This report focuses on whether it is useful to order a hepatitis C virus (HCV) antibody test in either the general population of asymptomatic adults or selected high-risk subpopulations who have no history of liver disease or known liver function test abnormalities. Author's conclusions Screening can detect chronic HCV infection. Antiviral treatment can successfully eradicate viremia, but data on long-term clinical outcomes are lacking. Most antiviral trials evaluated patients with more severe liver disease. Although counseling and appropriate immunizations in patients identified by screening are likely to be beneficial, studies estimating the degree of benefit are not available. Harms from antiviral treatment and work-up (liver biopsy) appear minimal, but other harms (labeling, false-positives, anxiety) are more difficult to measure. There is insufficient evidence to accurately weigh the benefits and risks of screening for HCV in the general population of otherwise healthy, asymptomatic adults. The yield from targeted screening in high-risk patients, particularly intravenous drug users, would be substantially higher. Structured abstract from Health Technology Assessment Database

Full title: Screening for hepatitis C among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice Author's objectives The aims of this report were to review the clinical effectiveness and cost-effectiveness of screening for hepatitis C virus (HCV) in injecting drug users (IDUs) and genitourinary medicine (GUM) clinic attenders in the UK. Further objectives were to determine the extent of screening for HCV in England and whether knowledge of HCV status causes behavioural changes among infected or uninfected people that may reduce the spread of HCV. Srutured abstract from Health Technology Assessment Database

Author's objectives Combination therapy, interferon alfa plus ribavirin, will probably be licensed in 1999, initially for those who have relapsed following interferon alone. Since the release of the SHPIC report in September 1998 three new randomised controlled trials (RCTs) examining the efficacy and safety of interferon alfa in combination with ribavirin in the treatment of chronic hepatitis C have been published. This update summarises the results of these three trials and should be read in conjunction with the original report. Author's conclusions There is now good evidence that interferon alfa plus ribavirin is more effective than interferon alone, at a standard dose of 3MU TIW, in those not previously treated with interferon. In patients with three or more factors predicting response 24 weeks of combination therapy is sufficient. However in those patients with two or fewer predictive factors 48 weeks treatment is worthwhile. In untreated patients, there is a case for waiting until the combination is available rather than treating now with inteferon alone. There is also good evidence that six months combination therapy is more effective than 6 months interferon monotherapy in those who have relapsed. Combination therapy has not been compared to higher doses or longer duration of interferon. Combination therapy has an acceptable safety profile but requires regular monitoring for early detection of the recognised side effects. Further trials are planned evaluating the newer types of interferon (pegylated interferon) and the role of maintenance treatment in patients who are likely to have a poor response. There is no evidence to support maintenance therapy at present. All treatment regimens are for a specified duration. Structured abstract from Health Technology Assessment Database

Author's objectives This Assessment reviews the available evidence to determine whether, compared with alternatives, radiofrequency ablation (RFA) used as the sole treatment improves the net health outcome of patients with one or a few small, but unresectable tumors. Structured abstract from Health Technology Assessment Database

Author's objectives The aim of this review was to update the original ASERNIP-S systematic review on Radiofrequency Ablation for Liver Tumours, October 2002. This review was initiated in order to assess new studies examining the safety and efficacy of radiofrequency ablation (RFA) for primary hepatocellular carcinoma or metastatic colorectal liver carcinoma, in comparison to other surgical and non-surgical therapeutic techniques, on the basis of a systematic assessment of the literature. The surgical comparative techniques included resection or hepatic artery infusion chemotherapy. The non-surgical comparative interventions included local ablative therapies such as percutaneous ethanol injection (PEI); cryotherapy; or procedures that produce local heat such as microwave coagulation therapy (MCT) or laser-induced thermotherapy (LITT). Structured abstract from Health Technology Assessment Database