Hepatocellular Carcinoma (HCC): An Update

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Semin Oncol. 2007 Apr;34S1:S12-S20.

Hepatocellular Carcinoma (HCC): An Update.

Rougier P, Mitry E, Barbare JC, Taieb J.

Service d'Hepato-gastroenterologie, Hopital Ambroise Pare, Boulogne, France.

In the absence of large randomized trials, the current treatment strategy

for hepatocellular carcinoma (HCC) remains a matter of choice depending

mostly on retrospective studies, experience of centers, and the technical

therapeutic possibilities. In fact, treatment decisions must be based on HCC

extension and liver function, which is dependent on underlying liver

disease. Cirrhosis limits therapeutic choices, life expectancy, and

tolerance to therapy. Surgical resection and/or local destruction are the

most common curative treatments. Orthotopic liver transplantation is

probably the best treatment for small HCC developed in cirrhosis because it

treats tumor, cirrhosis, and preneoplastic lesions at the same time.

However, this treatment method is feasible in fewer than 5% of cases.

Adjuvant treatments include transarterial chemoembolization, chemotherapy,

polyprenoic acid, interferon, adoptive immunotherapy, and intra-arterial

radioactive lipiodol. Results from trials warrant confirmation in larger

randomized trials to show a clear survival benefit on recurrence rate,

secondary prevention, and overall survival. Chemoembolization is the only

palliative treatment that has been proven to be active, unlike systemic

chemotherapy, immunotherapy, and hormone therapy, whose activity is largely

questionable and must all be restricted to clinical trials. Possible future

therapeutic strategies include epidermal growth factor receptor inhibitors,

antivascular endothelial growth factor therapies, cyclin D inhibitors, and

HMG-CoA reductase inhibitors.

PMID: 17449346 [PubMed - as supplied by publisher]

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