Management of hepatocellular carcinoma

This article reviews the recent advances in the management of hepatocellular carcinoma (HCC). Partial hepatectomy still remains the mainstay of therapy for early HCC. The limits of liver resection have been extended with the use of a multi-modality approach, and neoadjuvant/adjuvant treatment has improved the results of liver resection. Orthotopic liver transplantation works better than partial hepatectomy in a subgroup of patients with poor liver function and with early HCC. For locally advanced HCC, which is still confined to the liver, debulking surgery gives excellent palliation and prolongs patient survival. Non-operative local ablative therapy shows encouraging results. Hepatic artery chemoembolisation has been shown, by systemic review or meta-analysis, to have no significant impact on patient survival. Initial results with transarterial radioembolisation are promising. For patients with advanced HCC, systemic chemotherapy has little clinical benefit. The results of systemic immunotherapy or systemic tamoxifen on HCC are controversial and need further evaluation. Early results of chemoimmunotherapy are encouraging.