Treatment Options (see the APPENDIX)
The best outcomes of therapy are achieved with liver transplantation, surgical resection, or local ablative therapies that are must effective when applied to early stage HCC.
Hepatic resection and transplantation offer the greatest chance for cure in patients with HCC3-4 using the selection criteria of 1 tumor smaller than 5 cm or up to 3 tumors smaller than 3 cm and no vascular invasion, 5-year survival rates of up to 70% and recurrence rates less than 15% have been reported.
Liver resection is the preferred treatment of HCC in all noncirrhotic patients and in cirrhotic patients with well preserved liver function who are not candidates for liver transplantation. Liver resection achieves 5-year survival rates of 30% to 50%, although in ideal candidates 5-year survival rates of 50% to 70% have been reported.
Local Modalities of Therapy
Local modalities of therapy for HCC include local ablative methods, such as percutaneous ethanol injection (PVE) and radiofrequency ablation (RFA), and locoregional therapies, including transarterial chemoemblization (TACE), transarterial radioembolization, and conformal beam radiation. 5-8
Systemic Approaches Therapy
For patients with disease that has spread beyond the liver, few eftective options are available. Chemotherapy, either as a single agent or in combination, has provided only limited benefit for patients with unresectable or metastatic HCC. Responses to doxorubicin have been approximately 10% with short median survival9 . Combination of cisplatin (Platinol), interferon, doxorubicin(Adriamicin), and fluorouracil(PIAF) has been evaluated in several trials. One clinical trial reported a 26% partial response rate and a median overall survival rate of 8.9 months.
Due to limited benefit of chemotherapy, hormonal therapy have been evaluated. Several trials showed potential benefit with tamoxifen compared with a placebo, but recent multicenter trials of tamoxifen compared with best supportive care, showed no benefit of tamoxifen10 .
Current trials are focusing on targeted or novel therapies such as antiangiogenic agents11 .
Conclusions Liver resection and transplantation for HCC have provided a potentially curative option for selected patients with localized disease. Many treatment optians are available for patients with localized HCC. Metastatic spread of HCC continues to be a therapertic challenge. Although the potential treatment options are increasing, the response rate and duration of response continue to be low. Clinical trials is still critical to making advances in this area of HCC treatment.
Table 1 Okuda Staging