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Adult Primary Liver Cancer Treatment (PDQ®)

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Treatment Option Overview for Adult Primary Liver Cancer

There is no agreement on a single treatment strategy for patients with hepatocellular carcinoma (HCC). Selection of treatment is complex due to several factors, including:

  • Underlying liver function.
  • Extent and location of the tumor.
  • General condition of the patient.

Several treatments for HCC are associated with long-term survival, including surgical resection, liver transplantation, and ablation. There are no large, robust, randomized studies that compare treatments considered effective for early-stage disease, nor are there studies comparing these treatments with best supportive care. Often, patients with HCC are evaluated by a multidisciplinary team including hepatologists, radiologists, interventional radiologists, radiation oncologists, transplant surgeons, surgical oncologists, pathologists, and medical oncologists.

Best survivals are achieved when the HCC can be removed either by surgical resection or liver transplantation. Surgical resection is usually performed in patients with localized HCC and sufficient functional hepatic reserve.

For patients with decompensated cirrhosis and a solitary lesion (<5 cm) or early multifocal disease (≤3 lesions, ≤3 cm in diameter), the best option is liver transplantation,[1] but the limited availability of liver donors restricts the use of this approach.

Among noncurative treatments for HCC, transarterial chemoembolization and sorafenib have been shown to improve survival.[2-4]

For treatment, HCC can be divided into the following two broad categories:

  • Tumors for which potentially curative treatments are available (BCLC stages 0, A, and B).
  • Tumors for which curative options are not available (BCLC stages C and D).

Table 5 shows the standard treatment options for HCC.

Table 5. Standard Treatment Options for HCC
StageStandard Treatment Options
Stages 0, A, and BSurgical Resection
Liver Transplantation
Ablation
Stages C and DTransarterial Embolization and Transcatheter Arterial Chemoembolization
Targeted Therapy
Radiation Therapy
Recurrent StageLiver Transplantation
Surgical Resection
Ablation
Palliative Therapy

References

  1. Bruix J, Sherman M; American Association for the Study of Liver Diseases: Management of hepatocellular carcinoma: an update. Hepatology 53 (3): 1020-2, 2011. [PUBMED Abstract]
  2. Llovet JM, Ricci S, Mazzaferro V, et al.: Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359 (4): 378-90, 2008. [PUBMED Abstract]
  3. Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 37 (2): 429-42, 2003. [PUBMED Abstract]
  4. Cammà C, Schepis F, Orlando A, et al.: Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224 (1): 47-54, 2002. [PUBMED Abstract]
  • Updated: January 20, 2015