J Korean Med Assoc.  2008 May;51(5):457-474. 10.5124/jkma.2008.51.5.457.

Up-to-date Information for Hepatocellular Carcinoma Treatment

• Bae SH

• KMID: 2185877
• DOI: http://doi.org/10.5124/jkma.2008.51.5.457

Abstract

Despite therapeutic advances, the overall survival of patients with hepatocellular carcinoma (HCC) has not been significantly improved in the last two decades. In the majority of the cases, there is underlying cirrhosis, therefore the prognosis of HCC depends not only on tumor stage but also on liver function. Patients at an early stage are those who present with an asymptomatic single HCC with a maximum diameter of 5 cm or up to three nodules each less than 3 cm. They will be benefitted by curative therapies, including resection, liver transplantation (LT), and percutaneous ablation, such as destroying tumor cells via the injection of chemical substances, radiation, or heating or cooling. Patients exceeding these limits, but who are free of cancer-related symptoms and vascular invasion or extrahepatic spread may be benefitted by palliation with chemoembolization and hepatic arterial infusion chemotherapy. Recently, other treatments were developed under investigation treatments arising from technical advances in ablation and radiation. New promising image-guided therapies are continuously emerging and minimize hepatic toxicity and ultimately improve quality of life and survival of patients with HCC. The 3-dimensional conformal RT, tomotherapy, stereotatic radiosurgery, high intensity focused ultrasound, and proton beam radiotherapy will provide the opportunity for curative treatment of HCC, while avoiding critical normal tissue. New drugs, such as tyrosine kinase inhibitors and antiangiogenic agents, are currently being tested in the setting of clinical trials. These new approaches may help to address the enormous need for expanded treatment options for patients with HCC. In the future, patients with HCC will be best treated by a multidisciplinary team approach, utilizing a combination of techniques to improve the patient survival.

Keyword

Hepatocellular carcinoma; Surgery; Liver transplantation; Chemotherapy; Radiotherapy; Targeted therapy

MeSH Terms

Angiogenesis Inhibitors
Carcinoma, Hepatocellular
Fibrosis
Heating
Hot Temperature
Humans
Liver
Liver Transplantation
Prognosis
Protein-Tyrosine Kinases
Protons
Quality of Life
Radiosurgery
Angiogenesis Inhibitors
Protein-Tyrosine Kinases
Protons

Figure

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  Figure 1. Surgical resection of hepatocellular carcinoma.

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  Figure 2. Transcatheter arterial chemoembolization. (A) CT shows 5cm sized hypodense nodular mass in the angle of right hepatic lobe. (B) Schematic figure of hepatic arterial embolization. (C) Arteriogram shows a hypervascular mass with prominent feeding artery in the right hepatic lobe. (D) After TACE, CT shows a complete retention of lipiodol within the mass in the right hepatic lobe.

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  Figure 3. Photograph during the Ethanol Injection. The echogenicity of targeted mass is increased after injection of ethanol.

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  Figure 4. Radiofrequency ablation. (A) Pre?treatment sonogram shows a hypoechoic mass in the right lobe of liver. (B) The echogenicity of the tumor is increased by micro?bubbles immediately after ablation.

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  Figure 5. Implantation of arterial chemoport subcutaneously above the right inguinal area. (A) Hepatic arteriogram after catheterization at hepatic proper artery. (B) Right gastroduodenal artery was embolized with multiple microcoils. (C) Chemoport was inserted in the right inguinal area.

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  Figure 6. 3-dimensional conformal radiation threapy.

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  Figure 7. Stereotactic radiosurgery (CyberKnife) and therapeutic planning.

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  Figure 8. Radiotherapy planning in Helical tomotherapy.

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  Figure 9. High Intensiy Focused Ultrasound (HIFU).

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