Skip to main content
Top
Published in: Journal of Cancer Research and Clinical Oncology 7/2006

01-07-2006 | Original Paper

Postoperative interferon α treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial

Authors: Hui-Chuan Sun, Zhao-You Tang, Lu Wang, Lun-Xiu Qin, Zeng-Chen Ma, Qin-Hai Ye, Bo-Heng Zhang, Yong-Bin Qian, Zhi-Quan Wu, Jia Fan, Xin-Da Zhou, Jian Zhou, Shuang-Jian Qiu, Yue-Fang Shen

Published in: Journal of Cancer Research and Clinical Oncology | Issue 7/2006

Login to get access

Abstract

Background/Aims: Recurrence after resection of hepatocellular carcinoma (HCC) is a frequent event. This study evaluated the effect of postoperative interferon α (IFN α) treatment on recurrence and survival in patients with hepatitis B virus (HBV)-related HCC. Method: Two hundred and thirty six patients were randomized after resection into IFN α treatment (5 mu i.m. tiw for 18 months) and control groups. Treatment was terminated if recurrence was diagnosed, and recurrence was managed the same way in both groups. Statistical analysis was based on the method of intent-to-treat. Results: The two groups were comparable in all clinicopathological parameters. The median overall survival was 63.8 months in the treatment group and 38.8 months in the control group (P=0.0003); the median disease-free survival period was 31.2 versus 17.7 months (P=0.142). Fever, leucocytopenia, and thrombocytopenia were adverse effects in the treatment group, but were mostly manageable. Conclusions: IFN α treatment improved the overall survival of patients with HBV-related HCC after curative resection, probably by postponing recurrence.
Literature
go back to reference Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F (1991) Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214:114–117PubMedCrossRef Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F (1991) Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214:114–117PubMedCrossRef
go back to reference Chung YH, Song IH, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ (2000) Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer 88:1986–1991PubMedCrossRef Chung YH, Song IH, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ (2000) Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer 88:1986–1991PubMedCrossRef
go back to reference Dupont WD, Plummer WD Jr (1990) Power and sample size calculations. A review and computer program. Control Clin Trials 11:116–128PubMedCrossRef Dupont WD, Plummer WD Jr (1990) Power and sample size calculations. A review and computer program. Control Clin Trials 11:116–128PubMedCrossRef
go back to reference van der Eijk AA, Niesters HG, Hansen BE, Heijtink RA, Janssen HL, Schalm SW, de Man RA (2006) Quantitative HBV DNA levels as an early predictor of nonresponse in chronic HBe-antigen positive hepatitis B patients treated with interferon-alpha. J Viral Hepat 13:96–103PubMedCrossRef van der Eijk AA, Niesters HG, Hansen BE, Heijtink RA, Janssen HL, Schalm SW, de Man RA (2006) Quantitative HBV DNA levels as an early predictor of nonresponse in chronic HBe-antigen positive hepatitis B patients treated with interferon-alpha. J Viral Hepat 13:96–103PubMedCrossRef
go back to reference Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M, Koide N, Adachi W, Amano J (2000) Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg 191:381–388PubMedCrossRef Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M, Koide N, Adachi W, Amano J (2000) Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg 191:381–388PubMedCrossRef
go back to reference Ikeda K, Arase Y, Kobayashi M, Someya T, Hosaka T, Saitoh S, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Kumada H (2005) Hepatitis B virus-related hepatocellular carcinogenesis and its prevention. Intervirology 48:29–38PubMedCrossRef Ikeda K, Arase Y, Kobayashi M, Someya T, Hosaka T, Saitoh S, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Kumada H (2005) Hepatitis B virus-related hepatocellular carcinogenesis and its prevention. Intervirology 48:29–38PubMedCrossRef
go back to reference Ikeda K, Arase Y, Saitoh S, Kobayashi M, Suzuki Y, Suzuki F, Tsubota A, Chayama K, Murashima N, Kumada H (2000) Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor—a prospective randomized study of hepatitis C virus-related liver cancer. Hepatology 32:228–232PubMedCrossRef Ikeda K, Arase Y, Saitoh S, Kobayashi M, Suzuki Y, Suzuki F, Tsubota A, Chayama K, Murashima N, Kumada H (2000) Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor—a prospective randomized study of hepatitis C virus-related liver cancer. Hepatology 32:228–232PubMedCrossRef
go back to reference Izumi R, Shimizu K, Iyobe T, Ii T, Yagi M, Matsui O, Nonomura A, Miyazaki I (1994) Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma. Hepatology 20:295–301PubMedCrossRef Izumi R, Shimizu K, Iyobe T, Ii T, Yagi M, Matsui O, Nonomura A, Miyazaki I (1994) Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma. Hepatology 20:295–301PubMedCrossRef
go back to reference Jonasch E, Haluska FG (2001) Interferon in oncological practice: review of interferon biology, clinical applications, and toxicities. Oncologist 6:34–55PubMedCrossRef Jonasch E, Haluska FG (2001) Interferon in oncological practice: review of interferon biology, clinical applications, and toxicities. Oncologist 6:34–55PubMedCrossRef
go back to reference Kohno H, Nagasue N, Hayashi T, Yamanoi A, Uchida M, Ono T, Yukaya H, Kimura N, Nakamura T (1996) Postoperative adjuvant chemotherapy after radical hepatic resection for hepatocellular carcinoma (HCC). Hepatogastroenterology 43:1405–1409PubMed Kohno H, Nagasue N, Hayashi T, Yamanoi A, Uchida M, Ono T, Yukaya H, Kimura N, Nakamura T (1996) Postoperative adjuvant chemotherapy after radical hepatic resection for hepatocellular carcinoma (HCC). Hepatogastroenterology 43:1405–1409PubMed
go back to reference Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Kinoshita H (2002) Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy. Br J Surg 89:418–422PubMedCrossRef Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Kinoshita H (2002) Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy. Br J Surg 89:418–422PubMedCrossRef
go back to reference Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Yamazaki O, Shiomi S, Tamori A, Oka H, Igawa S et al (2001) Effects of long-term postoperative interferon-alpha therapy on intrahepatic recurrence after resection of hepatitis C virus-related hepatocellular carcinoma. A randomized, controlled trial. Ann Intern Med 134:963–967PubMed Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Yamazaki O, Shiomi S, Tamori A, Oka H, Igawa S et al (2001) Effects of long-term postoperative interferon-alpha therapy on intrahepatic recurrence after resection of hepatitis C virus-related hepatocellular carcinoma. A randomized, controlled trial. Ann Intern Med 134:963–967PubMed
go back to reference Lai EC, Lo CM, Fan ST, Liu CL, Wong J (1998) Postoperative adjuvant chemotherapy after curative resection of hepatocellular carcinoma: a randomized controlled trial. Arch Surg 133:183–188PubMedCrossRef Lai EC, Lo CM, Fan ST, Liu CL, Wong J (1998) Postoperative adjuvant chemotherapy after curative resection of hepatocellular carcinoma: a randomized controlled trial. Arch Surg 133:183–188PubMedCrossRef
go back to reference Lau GK, Piratvisuth T, Luo KX, Marcellin P, Thongsawat S, Cooksley G, Gane E, Fried MW, Chow WC, Paik SW et al (2005) Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med 352:2682–2695PubMedCrossRef Lau GK, Piratvisuth T, Luo KX, Marcellin P, Thongsawat S, Cooksley G, Gane E, Fried MW, Chow WC, Paik SW et al (2005) Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med 352:2682–2695PubMedCrossRef
go back to reference Lau WY, Leung TW, Ho SK, Chan M, Machin D, Lau J, Chan AT, Yeo W, Mok TS, Yu SC et al (1999) Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomised trial. Lancet 353:797–801PubMedCrossRef Lau WY, Leung TW, Ho SK, Chan M, Machin D, Lau J, Chan AT, Yeo W, Mok TS, Yu SC et al (1999) Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomised trial. Lancet 353:797–801PubMedCrossRef
go back to reference Leung TW, Tang AM, Zee B, Yu SC, Lai PB, Lau WY, Johnson PJ (2002) Factors predicting response and survival in 149 patients with unresectable hepatocellular carcinoma treated by combination cisplatin, interferon-alpha, doxorubicin and 5-fluorouracil chemotherapy. Cancer 94:421–427PubMedCrossRef Leung TW, Tang AM, Zee B, Yu SC, Lai PB, Lau WY, Johnson PJ (2002) Factors predicting response and survival in 149 patients with unresectable hepatocellular carcinoma treated by combination cisplatin, interferon-alpha, doxorubicin and 5-fluorouracil chemotherapy. Cancer 94:421–427PubMedCrossRef
go back to reference Liaw YF (2005) Prevention and surveillance of hepatitis B virus-related hepatocellular carcinoma. Semin Liver Dis 25 (suppl 1):40–47PubMedCrossRef Liaw YF (2005) Prevention and surveillance of hepatitis B virus-related hepatocellular carcinoma. Semin Liver Dis 25 (suppl 1):40–47PubMedCrossRef
go back to reference Lin SM, Lin CJ, Hsu CW, Tai DI, Sheen IS, Lin DY, Liaw YF (2004) Prospective randomized controlled study of interferon-alpha in preventing hepatocellular carcinoma recurrence after medical ablation therapy for primary tumors. Cancer 100:376–382PubMedCrossRef Lin SM, Lin CJ, Hsu CW, Tai DI, Sheen IS, Lin DY, Liaw YF (2004) Prospective randomized controlled study of interferon-alpha in preventing hepatocellular carcinoma recurrence after medical ablation therapy for primary tumors. Cancer 100:376–382PubMedCrossRef
go back to reference Lin ZY, Ren ZG, Xia JL, Chen Y, Wu XF, Ma ZC, Ye QH, Qin LX, Sun HC (2000) Appraisal of postoperative transcatheter arterial chemoembolization (TACE) for prevention and treatment of hepatocellular carcinoma recurrence. Zhonghua Zhongliu Zazhi 22:315–317PubMed Lin ZY, Ren ZG, Xia JL, Chen Y, Wu XF, Ma ZC, Ye QH, Qin LX, Sun HC (2000) Appraisal of postoperative transcatheter arterial chemoembolization (TACE) for prevention and treatment of hepatocellular carcinoma recurrence. Zhonghua Zhongliu Zazhi 22:315–317PubMed
go back to reference Lok AS (2004) Prevention of hepatitis B virus-related hepatocellular carcinoma. Gastroenterology 127:S303–S309PubMedCrossRef Lok AS (2004) Prevention of hepatitis B virus-related hepatocellular carcinoma. Gastroenterology 127:S303–S309PubMedCrossRef
go back to reference Mathurin P, Raynard B, Dharancy S, Kirzin S, Fallik D, Pruvot FR, Roumilhac D, Canva V, Paris JC, Chaput JC, Naveau S (2003) Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther 17:1247–1261PubMedCrossRef Mathurin P, Raynard B, Dharancy S, Kirzin S, Fallik D, Pruvot FR, Roumilhac D, Canva V, Paris JC, Chaput JC, Naveau S (2003) Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther 17:1247–1261PubMedCrossRef
go back to reference Muto Y, Moriwaki H, Ninomiya M, Adachi S, Saito A, Takasaki KT, Tanaka T, Tsurumi K, Okuno M, Tomita E et al (1996) Prevention of second primary tumors by an acyclic retinoid, polyprenoic acid, in patients with hepatocellular carcinoma. Hepatoma Prevention Study Group. N Engl J Med 334:1561–1567PubMedCrossRef Muto Y, Moriwaki H, Ninomiya M, Adachi S, Saito A, Takasaki KT, Tanaka T, Tsurumi K, Okuno M, Tomita E et al (1996) Prevention of second primary tumors by an acyclic retinoid, polyprenoic acid, in patients with hepatocellular carcinoma. Hepatoma Prevention Study Group. N Engl J Med 334:1561–1567PubMedCrossRef
go back to reference Muto Y, Moriwaki H, Saito A (1999) Prevention of second primary tumors by an acyclic retinoid in patients with hepatocellular carcinoma. N Engl J Med 340:1046–1047PubMedCrossRef Muto Y, Moriwaki H, Saito A (1999) Prevention of second primary tumors by an acyclic retinoid in patients with hepatocellular carcinoma. N Engl J Med 340:1046–1047PubMedCrossRef
go back to reference Ono T, Nagasue N, Kohno H, Hayashi T, Uchida M, Yukaya H, Yamanoi A (1997) Adjuvant chemotherapy with epirubicin and carmofur after radical resection of hepatocellular carcinoma: a prospective randomized study. Semin Oncol 24:S6-18–S16-25 Ono T, Nagasue N, Kohno H, Hayashi T, Uchida M, Yukaya H, Yamanoi A (1997) Adjuvant chemotherapy with epirubicin and carmofur after radical resection of hepatocellular carcinoma: a prospective randomized study. Semin Oncol 24:S6-18–S16-25
go back to reference Patt YZ, Hassan MM, Lozano RD, Brown TD, Vauthey JN, Curley SA, Ellis LM (2003) Phase II trial of systemic continuous fluorouracil and subcutaneous recombinant interferon Alfa-2b for treatment of hepatocellular carcinoma. J Clin Oncol 21:421–427PubMedCrossRef Patt YZ, Hassan MM, Lozano RD, Brown TD, Vauthey JN, Curley SA, Ellis LM (2003) Phase II trial of systemic continuous fluorouracil and subcutaneous recombinant interferon Alfa-2b for treatment of hepatocellular carcinoma. J Clin Oncol 21:421–427PubMedCrossRef
go back to reference Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70PubMedCrossRef Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70PubMedCrossRef
go back to reference Regimbeau JM, Abdalla EK, Vauthey JN, Lauwers GY, Durand F, Nagorney DM, Ikai I, Yamaoka Y, Belghiti J (2004) Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: results of a multicenter study. J Surg Oncol 85:36–41PubMedCrossRef Regimbeau JM, Abdalla EK, Vauthey JN, Lauwers GY, Durand F, Nagorney DM, Ikai I, Yamaoka Y, Belghiti J (2004) Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: results of a multicenter study. J Surg Oncol 85:36–41PubMedCrossRef
go back to reference Schwartz JD, Schwartz M, Mandeli J, Sung M (2002) Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials. Lancet Oncol 3:593–603PubMedCrossRef Schwartz JD, Schwartz M, Mandeli J, Sung M (2002) Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials. Lancet Oncol 3:593–603PubMedCrossRef
go back to reference Shigeno M, Nakao K, Ichikawa T, Suzuki K, Kawakami A, Abiru S, Miyazoe S, Nakagawa Y, Ishikawa H, Hamasaki K et al (2003) Interferon-alpha sensitizes human hepatoma cells to TRAIL-induced apoptosis through DR5 upregulation and NF-kappa B inactivation. Oncogene 22:1653–1662PubMedCrossRef Shigeno M, Nakao K, Ichikawa T, Suzuki K, Kawakami A, Abiru S, Miyazoe S, Nakagawa Y, Ishikawa H, Hamasaki K et al (2003) Interferon-alpha sensitizes human hepatoma cells to TRAIL-induced apoptosis through DR5 upregulation and NF-kappa B inactivation. Oncogene 22:1653–1662PubMedCrossRef
go back to reference Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356:802–807PubMedCrossRef Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356:802–807PubMedCrossRef
go back to reference Tang ZY, Yu YQ, Zhou XD, Ma ZC, Wu ZQ (1998) Progress and prospects in hepatocellular carcinoma surgery. Ann Chir 52:558–563PubMed Tang ZY, Yu YQ, Zhou XD, Ma ZC, Wu ZQ (1998) Progress and prospects in hepatocellular carcinoma surgery. Ann Chir 52:558–563PubMed
go back to reference Truong BX, Seo Y, Kato M, Hamano K, Ninomiya T, Katayama M, Kato H, Yano Y, Hayashi Y, Kasuga M (2005) Long-term follow-up of Japanese patients with chronic hepatitis B treated with interferon-alpha. Int J Mol Med 16:279–284PubMed Truong BX, Seo Y, Kato M, Hamano K, Ninomiya T, Katayama M, Kato H, Yano Y, Hayashi Y, Kasuga M (2005) Long-term follow-up of Japanese patients with chronic hepatitis B treated with interferon-alpha. Int J Mol Med 16:279–284PubMed
go back to reference Wang L, Tang ZY, Qin LX, Wu XF, Sun HC, Xue Q, Ye SL (2000) High-dose and long-term therapy with interferon-alfa inhibits tumor growth and recurrence in nude mice bearing human hepatocellular carcinoma xenografts with high metastatic potential. Hepatology 32:43–48PubMedCrossRef Wang L, Tang ZY, Qin LX, Wu XF, Sun HC, Xue Q, Ye SL (2000) High-dose and long-term therapy with interferon-alfa inhibits tumor growth and recurrence in nude mice bearing human hepatocellular carcinoma xenografts with high metastatic potential. Hepatology 32:43–48PubMedCrossRef
go back to reference Wang L, Wu WZ, Sun HC, Wu XF, Qin LX, Liu YK, Liu KD, Tang ZY (2003) Mechanism of interferon alpha on inhibition of metastasis and angiogenesis of hepatocellular carcinoma after curative resection in nude mice. J Gastrointest Surg 7:587–594PubMedCrossRef Wang L, Wu WZ, Sun HC, Wu XF, Qin LX, Liu YK, Liu KD, Tang ZY (2003) Mechanism of interferon alpha on inhibition of metastasis and angiogenesis of hepatocellular carcinoma after curative resection in nude mice. J Gastrointest Surg 7:587–594PubMedCrossRef
go back to reference Xiao YS, Tang ZY, Fan J, Zhou J, Wu ZQ, Sun QM, Xue Q, Zhao Y, Liu YK, Ye SL (2004) Interferon-alpha 2a up-regulated thymidine phosphorylase and enhanced antitumor effect of capecitabine on hepatocellular carcinoma in nude mice. J Cancer Res Clin Oncol 130:546–550PubMedCrossRef Xiao YS, Tang ZY, Fan J, Zhou J, Wu ZQ, Sun QM, Xue Q, Zhao Y, Liu YK, Ye SL (2004) Interferon-alpha 2a up-regulated thymidine phosphorylase and enhanced antitumor effect of capecitabine on hepatocellular carcinoma in nude mice. J Cancer Res Clin Oncol 130:546–550PubMedCrossRef
go back to reference Yano H, Iemura A, Haramaki M, Ogasawara S, Takayama A, Akiba J, Kojiro M (1999) Interferon alfa receptor expression and growth inhibition by interferon alfa in human liver cancer cell lines. Hepatology 29:1708–1717PubMedCrossRef Yano H, Iemura A, Haramaki M, Ogasawara S, Takayama A, Akiba J, Kojiro M (1999) Interferon alfa receptor expression and growth inhibition by interferon alfa in human liver cancer cell lines. Hepatology 29:1708–1717PubMedCrossRef
go back to reference Yuen MF, Hui CK, Cheng CC, Wu CH, Lai YP, Lai CL (2001) Long-term follow-up of interferon alfa treatment in Chinese patients with chronic hepatitis B infection: the effect on hepatitis B e antigen seroconversion and the development of cirrhosis-related complications. Hepatology 34:139–145PubMedCrossRef Yuen MF, Hui CK, Cheng CC, Wu CH, Lai YP, Lai CL (2001) Long-term follow-up of interferon alfa treatment in Chinese patients with chronic hepatitis B infection: the effect on hepatitis B e antigen seroconversion and the development of cirrhosis-related complications. Hepatology 34:139–145PubMedCrossRef
Metadata
Title
Postoperative interferon α treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial
Authors
Hui-Chuan Sun
Zhao-You Tang
Lu Wang
Lun-Xiu Qin
Zeng-Chen Ma
Qin-Hai Ye
Bo-Heng Zhang
Yong-Bin Qian
Zhi-Quan Wu
Jia Fan
Xin-Da Zhou
Jian Zhou
Shuang-Jian Qiu
Yue-Fang Shen
Publication date
01-07-2006
Publisher
Springer-Verlag
Published in
Journal of Cancer Research and Clinical Oncology / Issue 7/2006
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-006-0091-y

Other articles of this Issue 7/2006

Journal of Cancer Research and Clinical Oncology 7/2006 Go to the issue