This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Corey, K. E. Articles by Pratt, D. S. Search for Related Content Social Bookmarking                   What's this?

Review: Current status of therapy for hepatocellular carcinoma

Massachusetts General Hospital, GI Unit, Boston, MA, USA

Daniel S. Pratt

Massachusetts General Hospital, GI Unit, Boston, MA, USA, dspratt{at}partners.org

The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multidisciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient's overall functional status. Curative therapies include surgical resection, liver transplantation (LT), transarterial chemoembolization, and radiofrequency ablation (RFA). Surgical resection, either primary resection or LT, is the treatment most likely to result in cure of HCC. Which option to pursue is based on multiple factors. LT has the potential benefit of treating both HCC and the underlying cirrhosis; however, long wait times incur the risk of tumor progression. Firm recommendations regarding the role of living donor LT for HCC are not yet possible because of conflicting data. HCC recurrence after LT is 8—11% and several adjuvant therapies have been investigated to reduce this. Bridging therapy and tumor downsizing are techniques that also may be considered to deal with long waiting periods and qualification for LT, respectively. If neither LT nor primary resection is possible, loco-regional therapies such as RFA and TACE should be considered. Systemic chemotherapies have proved disappointing for the treatment of HCC; however, newer targeted therapies such as sorafenib and cetuximab have provided new hope for the future.

Key Words: hepatocellular carcinoma • ultrasound • resection • liver transplantation • transarterial chemoembolization • radiofrequency ablation • cirrhosis • sorafenib • cetuximab

Therapeutic Advances in Gastroenterology, Vol. 2, No. 1, 45-57 (2009)
DOI: 10.1177/1756283X08100328


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?