Recurrent Adult Primary Cancer Treatment
Intrahepatic recurrence is the most common pattern of failure after curative treatment. Intrahepatic recurrence of hepatocellular carcinoma (HCC) may be the result of either intrahepatic metastasis or metachronous de novo tumor. Theoretically, intrahepatic metastasis may be associated with less favorable outcomes because it is most likely the result of concurrent hematogenous metastases. However, in clinical practice, the two causes of recurrence cannot be differentiated from each other.
Treatment options for recurrent adult primary liver cancer include the following:
- Liver transplantation.
- Surgical resection.
- Palliative therapy (transcatheter arterial chemoembolization [TACE] and sorafenib).
In regard to primary HCC, the treatment strategy for recurrent intrahepatic HCC is determined by the function of the liver and the macroscopic tumor features (e.g., number of lesions, site of recurrence, and invasion of major vessels). Using the same selection criteria that are used for primary HCC, either curative (i.e., salvage liver transplant, surgical resection, and ablation) or palliative treatments (e.g., TACE and sorafenib) can be offered for recurrent HCC.
Evidence (salvage liver transplant, resection, and ablation):
- In a retrospective study of 183 patients with intrahepatic recurrence, only 87 of the patients could be treated with curative intent (transplantation, resection, and ablation).[Level of evidence: 1A]
- The 5-year tumor-free survival rate was 57.9% for liver transplantation, 49.3% for resection, and 10.6% for radiofrequency ablation. Subgroup analysis showed that transplantation and resection led to comparable survival and that both treatments led to significantly better outcomes than did ablation (P < .001); however, selection bias was a major pitfall of this retrospective study.
- Other than the use of ablation for secondary treatment, risk factors for shorter disease-free survival were identified as alpha-fetoprotein blood levels above 400 ng/mL and recurrence within 1 year of treatment (47.5% vs. 6.7% at 5 years, P < .001).
Other studies have also suggested that most of the recurrences that appear early during follow-up are caused by tumor dissemination and have a more aggressive biological pattern than primary tumors.[3,4]
Clinical trials are appropriate and should be offered to patients with recurrent HCC whenever possible.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent adult primary liver cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Fan ST, Poon RT, Yeung C, et al.: Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg 98 (9): 1292-300, 2011. [PUBMED Abstract]
- Chan AC, Chan SC, Chok KS, et al.: Treatment strategy for recurrent hepatocellular carcinoma: salvage transplantation, repeated resection, or radiofrequency ablation? Liver Transpl 19 (4): 411-9, 2013. [PUBMED Abstract]
- Minagawa M, Makuuchi M, Takayama T, et al.: Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238 (5): 703-10, 2003. [PUBMED Abstract]
- Chen YJ, Yeh SH, Chen JT, et al.: Chromosomal changes and clonality relationship between primary and recurrent hepatocellular carcinoma. Gastroenterology 119 (2): 431-40, 2000. [PUBMED Abstract]