Therapy of hepatocellular carcinoma

Abstract

A great deal of experience has been accumulated in the last few years on several therapeutic modalities for the treatment of hepatocellular carcinoma (HCC): percutaneous ethanol injection, transarterial chemoembolisation, surgical resection and liver transplant. There are, however, no conclusive data, derived from prospective randomised controlled trials, to establish the best treatment or the most suitable combination of treatments. This Report analyses the current guidelines for screening patients, early detection and staging, as well as therapeutic timing and decision. The therapeutic strategy of HCC is greatly influenced by the presence and severity of liver cirrhosis, which is associated with the neoplasm in the large majority of patients. Surgical resection is the best treatment when the neoplasm arises on a normal liver. On the other hand many controversies still exist concerning the choice of treatment for HCC developing in cirrhotic livers. It is well accepted that surgical resection and percutaneous ethanol injection are effective in improving survival of unifocal small (<5 cm) HCC in well compensated cirrhosis. Transarterial chemoembolisation seems to show a beneficial effect both in single and multiple HCC, mainly when the technique is performed at least three times over a 9-month period. However, a definite demonstration of the efficacy of this technique is still lacking. Liver transplant appears to be a rational treatment for small HCC in young patients with impaired liver function. New therapeutic modalities, such as Yag laser, radiofrequency-induced thermotherapy or transarterial injection of radionuclides, are also about to be introduced. Guidelines are defined for future investigations and for programming randomised trials in this area.