Overview of treatment approaches for hepatocellular carcinoma
- Eddie K Abdalla, MD
Eddie K Abdalla, MD
- Professor of Surgery
- The Lebanese American University
- Keith E Stuart, MD
Keith E Stuart, MD
- Chairman, Department of Hematology and Oncology
- Lahey Hospital and Medical Center
- Section Editors
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Richard M Goldberg, MD
Richard M Goldberg, MD
- Section Editor — Gastrointestinal Cancer
- Director of the West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center
- Professor of Medicine
- Laurence S. & Jean J. DeLynn Chair of Oncology
Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis (see "Epidemiology and etiologic associations of hepatocellular carcinoma"). It is typically diagnosed late in its course, and the median survival following diagnosis is approximately 6 to 20 months . Although the mainstay of therapy is surgical resection, the majority of patients are not eligible because of tumor extent or underlying liver dysfunction.
Several other treatment modalities are available, including:
●Radiofrequency ablation (RFA) and microwave ablation
●Percutaneous ethanol or acetic acid ablation
- A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 1998; 28:751.
- Llovet JM, Di Bisceglie AM, Bruix J, et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008; 100:698.
- Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19:329.
- Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002; 35:519.
- Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol 2016; 22:7.
- Torzilli G, Belghiti J, Kokudo N, et al. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 2013; 257:929.
- Liu CL, Fan ST, Lo CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol 2001; 19:3725.
- Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol 2002; 20:1527.
- Henderson JM, Sherman M, Tavill A, et al. AHPBA/AJCC consensus conference on staging of hepatocellular carcinoma: consensus statement. HPB (Oxford) 2003; 5:243.
- Vauthey JN, Dixon E, Abdalla EK, et al. Pretreatment assessment of hepatocellular carcinoma: expert consensus statement. HPB (Oxford) 2010; 12:289.
- Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 2015; 16:465.
- TREATMENT ALGORITHMS FOR HCC
- TREATMENT OPTIONS
- Surgical resection
- Liver transplantation
- Radiofrequency ablation
- TACE plus RFA
- Percutaneous ethanol or acetic acid ablation
- Transarterial chemoembolization
- Radiation therapy and stereotactic body radiotherapy
- - Radioembolization
- Systemic therapy
- - Molecularly targeted therapy: Sorafenib
- - Cytotoxic chemotherapy
- INFORMATION FOR PATIENTS