Nonsurgical treatment of hepatocellular carcinoma

While surgical resection and tumor ablation are the preferred therapies for hepatocellular carcinoma (HCC), these are available or appropriate in only a minority of patients. This reflects the usual comorbidity of severe underlying liver disease that either precludes surgery or makes the surgical approach extremely dangerous. Nonetheless, regional control of HCC is highly relevant and many regional strategies have been explored, including hepatic intra-arterial chemotherapy transarterial chemoembolization, lipiodol chemoembolization, radiation therapy, cryosurgery, percutaneous ethanol injection, and radiofrequency ablation. In addition, a variety of systemic chemotherapeutic agents have been tested in HCC, including various combinations of 5-fluorouracil, doxorubicin, epirubicin, etoposide, cisplatin, and mitoxantrone, as well as interferon, tamoxifen, capecitabine, thalidomide, and octreotide. Published data regarding these regional and systemic therapies will be discussed in this review.