Abstract
The prevalence of hepatocellular carcinoma in Europe and the US is increasing and is currently the leading cause of death in patients with cirrhosis. Surveillance programs for patients with cirrhosis aim to detect tumors at an early stage, when the greatest therapeutic benefits can be achieved. Curative treatments for early-stage tumors include liver transplantation, resection and percutaneous ablation. Transarterial chemoembolization (TACE) and sorafenib can improve survival for patients with intermediate and advanced tumors, respectively. In clinical practice, combination therapies are often used, despite limited evidence to support this approach from randomized controlled trials. Combination therapy with radiofrequency ablation (RFA) plus percutaneous ethanol injection can, however, improve survival for selected patients compared with RFA alone. Combined treatment with TACE and RFA also improves patients' survival compared with TACE or RFA monotherapy. TACE performed before or after surgical resection, however, is not beneficial. Prevention of tumor progression in patients awaiting liver transplantation requires nonsurgical treatments; however, the real advantages of the available treatment modalities are yet to be defined. The role of sorafenib administration in combination with TACE after the use of potentially curative treatments, for the treatment of intermediate hepatocellular carcinoma, or in selective settings after liver transplantation, requires further study.
Key Points
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Hepatocellular carcinoma (HCC) is a malignancy that is difficult to treat, and is increasing in prevalence worldwide
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Curative treatment options for HCC (e.g. liver transplantation, surgical resection, percutaneous ablation) are available if the disease is diagnosed at an early stage
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Despite the use of aggressive local treatments, tumor recurrence and the development of extrahepatic metastases continue to have a significant effect on the overall survival of patients with HCC
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Combination treatment with radiofrequency ablation (RFA) plus percutaneous ethanol injection can achieve improved survival compared with the use of RFA alone in selected patients
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Combined treatment with transarterial chemoembolization and RFA improves survival compared with transarterial chemoembolization or RFA monotherapy
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Further, well-conducted, randomized controlled trials to examine the effectiveness of different multimodal approaches are urgently needed
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The authors thank Warren Blumberg for critical reading of the manuscript.
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Cabibbo, G., Latteri, F., Antonucci, M. et al. Multimodal approaches to the treatment of hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 6, 159–169 (2009). https://doi.org/10.1038/ncpgasthep1357
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DOI: https://doi.org/10.1038/ncpgasthep1357
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