Advances in managing hepatocellular carcinoma

doi:10.1007/s11684-014-0332-4

Front. Med.

2014, Vol. 8

Issue (2) : 175-189 https://doi.org/10.1007/s11684-014-0332-4

REVIEW

Advances in managing hepatocellular carcinoma

Marielle Reataza¹, David K. Imagawa²(

)

¹. University of California, Irvine Medical Center, Orange, CA 92868, USA
². Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA

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Abstract

Multiple modalities for treatment of hepatocellular carcinoma are available, depending on tumor size and number. Surgical resection remains the gold standard, so long as the residual liver function reserve is sufficient. In patients with advanced cirrhosis, liver transplantation is the preferred option, as these patients may not have adequate hepatic reserve after resection. Salvage liver transplantation has also become an option for a select few patients who recur after surgical resection. Ablative techniques have been used for palliation as well as to either completely destroy the tumor, act as an adjunct to resection, or downstage the tumor to meet Milan criteria such that a patient may be a candidate for liver transplantation. Radiofrequency ablation, microwave ablation, chemoembolization, radioembolization, and irreversible electroporation have all been used in this capacity. Currently, sorafenib is the only US Food and Drug Administration-approved chemotherapeutic for hepatocellular carcinoma. The efficacy of sorafenib, in combination with other agents, transarterial chemoembolization, and surgical resection is currently being investigated. Sunitinib and brivanib, tyrosine kinase inhibitors, have failed as potential first- or second-line options for chemotherapy. Bevacizumab in combination with erlotinib is also currently being studied. Final analysis for ramucirumab and axitinib are pending. Tivantinib, a selective mesenchymal-epithelial transition factor (MET) inhibitor, is also undergoing clinical trials for efficacy in MET-high tumors. This review serves to emphasize the current and new technologies emerging in the treatment of hepatocellular carcinoma.

Keywords hepatocellular carcinoma radiofrequency ablation microwave ablation chemoembolization radioembolization sorafenib irreversible electroporation

Corresponding Author(s): David K. Imagawa

Issue Date: 21 May 2014

Cite this article:

Marielle Reataza,David K. Imagawa. Advances in managing hepatocellular carcinoma[J]. Front. Med., 2014, 8(2): 175-189.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-014-0332-4
https://academic.hep.com.cn/fmd/EN/Y2014/V8/I2/175

Tab.1 Comparison of overall survival rates between surgical resection and radiofrequency ablation

Tab.2 Comparison of recurrence-free survival rates between surgical resection and radiofrequency ablation

Tab.3 Comparison of overall survival rates of liver transplantation

Tab.4 Comparison of recurrence-free survival rates after liver transplantation

Tab.5 Survival rates for chemoembolization as demonstrated in randomized clinical trials

Fig.1 Molecular pathways involved in chemotherapy used to treat hepatocellular carcinoma.

Fig.2 MRI of liver tumor before and after 15?months of sorafenib. (A) Original lesion was measured at 10.4?cm × 10.0?cm× 10.0?cm. (B) The lesion is now at 4.2?cm× 4.0?cm× 3.8?cm. Biopsy shows no viable tumor.

Fig.3 (A) MRI of liver tumor prior to treatment. (B) CT of tumor at post-operative day 1 after treatment with NanoKnife® ablation. (C) CT of tumor at post-operative day 30 after treatment with NanoKnife® ablation. (D) CT of tumor at post-operative day 90 after treatment with NanoKnife® ablation.

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