Primary hepatocellular cancer--present results and future prospects

Hepatocellular cancer is an enormously difficult clinical problem. This review provides an overview of selected basic and applied aspects of the care of hepatoma patients. Important pathophysiologic and prognostic features are now recognized. Initially, chemotherapy programs focused on the use of those agents commonly employed for gastrointestinal neoplasms (fluoropyrimidines, anthracyclines and alkylators). When employed as a conventional intravenous bolus, only Adriamycin is a reproducibly effective agent. However, because of the unique dual vascular supply of the liver and tumor, the use of intraarterial (IA) infusion chemotherapy has become more popular. In this regard, of promise are the application of IA FUDR and Adriamycin, the use of totally implanted infusion systems, and hepatic artery embolization. Furthermore, combinations of whole liver irradiation with chemotherapy seem efficacious. New directions for the therapy of hepatoma patients will focus on superior drug-radiation combinations, exploration of isotopic immunoglobulin, and hormonal therapy. There is currently no standard therapy for hepatoma patients, but prospects for the future have never been so bright.