Clinical Options for Treatment of Hepatocellular Carcinoma

  • Matteo Virdis
  • Michela Monteleone
  • Michele Droz dit Busset
  • Vincenzo Mazzaferro
Chapter

Abstract

Management of HCC depends on tumor stage, liver function, and patient performance status (BCLC stage) and requires a multidisciplinary approach for optimal treatment. Hepatic resection, liver transplantation, and local ablation of HCC up to 3 cm are curative options in the early stage of disease. There have been significant advances in transarterial embolotherapies (TACE and TARE) in intermediate/advanced stages. Drug-eluting beads have improved the efficacy and safety of conventional TACE, and radioembolization has set a new standard of treatment that delivers the radiation effect to tumor location without compromising the surrounding fragile liver tissue. Molecular studies on HCC have identified aberrant activation of several signaling pathways, which may represent key targets for novel molecular therapies. Immunotherapy is emerging as an additional option in properly selected patients.

Keywords

Hepatocellular carcinoma (HCC) Hepatic resection Liver transplantation Transarterial embolotherapies (TACE and TARE) Radioembolization Immunotherapy 

Abbreviations

AFP

Alpha-fetoprotein

BCLC

Barcelona Clinic Liver Cancer

CT

Computed tomography

DAA

Direct-acting antiviral

DEB

Drug-eluting beads

DFS

Disease-free survival

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HDV

Hepatitis D virus

LA

Laser ablation

LDLT

Living donor liver transplantation

LR

Liver resection

LT

Liver transplantation

MDCT

Multiple detector computed tomography

MELD

Model for end-stage liver disease

MRI

Magnetic resonance imaging

MW

Microwave

NAFLD

Non-alcoholic fatty liver disease

OS

Overall survival

PEI

Percutaneous ethanol injection

PS

Performance status

PVT

Portal vein thrombosis

RFA

Radiofrequency ablation

TACE

Transarterial chemoembolization

TARE

Transarterial radioembolization

UCSF

University of California at San Francisco

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Matteo Virdis
    • 1
  • Michela Monteleone
    • 1
  • Michele Droz dit Busset
    • 1
  • Vincenzo Mazzaferro
    • 1
    • 2
  1. 1.Hepato-Oncology Group, Surgical OncologyHPB and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute) IRCCS FoundationMilanItaly
  2. 2.University of MilanMilanItaly

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