Current locoregional therapies and treatment strategies in hepatocellular carcinoma.

L Cardarelli-Leite,D M Liu,A Hadjivassiliou,A Mujoomdar,J Chung,H J Lim,S G F Ho,D Klass,P T W Kim

doi:10.3747/co.27.7171

Abstract

Locoregional therapies (lrts) play an important role in the treatment of hepatocellular carcinoma (hcc), with the aim of increasing overall survival while preserving liver function. Various forms of lrt are available, and choosing the best one depends on technical aspects, liver morphology, tumour biology, and the patient's symptoms. The purpose of the present review article is to provide an overview of the current evidence relating to the use of percutaneous ablation, transarterial chemoembolization, and transarterial radioembolization for the curative or palliative treatment of hcc. Special situations are also reviewed, including the combined use of systemic therapy and lrt, indications and techniques for bridging to transplant and downstaging, and the use of lrt to treat patients with hcc and macrovascular invasion.

Highlights

Liver cancer is the 2nd leading cause of cancer-related mortality worldwide and a significant health issue[1]
A wider range of options is available for patients with a single tumour of 2–5 cm or 2–3 lesions each 3 cm or smaller: resection, liver transplantation, thermal ablation, transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiation therapy
The main approach to patients with unresectable disease restricted to the liver and without vascular invasion, who have preserved liver function and who are clinically asymptomatic, is tace

Summary

Introduction

Liver cancer is the 2nd leading cause of cancer-related mortality worldwide and a significant health issue[1]. Hepatocellular carcinoma (hcc) accounts for 90% of primary tumours of the liver, with underlying chronic liver disease and cirrhosis secondary to hepatitis B, hepatitis C, alcohol excess, and non-alcoholic steatohepatitis being well-established major risk factors[2,3]. The coexistence of hcc and liver cirrhosis significantly affects mortality, thereby posing a unique clinical challenge: the best treatment strategy has to be based on oncologic criteria, and on liver function. Locoregional therapies (lrts) play an important role at all stages of hcc, aiming to increase overall survival (os) while preserving liver function. The purpose of the present review is to provide an overview of the current evidence relating to the use of lrt strategies for the treatment of hcc

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Discussion

Conclusion