[Non-surgical treatments of hepatocellular carcinoma]

Hepatocellular carcinoma has as poor prognosis. Curative surgical treatment remains the first-line treatment. However, because of the limited indications and the high recurrence rate of this cancer, nonsurgical treatments have been developed. Intraarterial chemotherapy (with or without embolization or lipiodol), although effective on tumour bulk, has not yet been demonstrated to be effective on survival in the controlled studies published to date. Ultrasound-guided percutaneous alcohol injection, which is a more recent method, is simple, inexpensive and well tolerated. The inclusion of patients into controlled therapeutic protocols remains essential for both of these methods. Outside of the context of these studies, inoperable hepatocellular carcinoma without extrahepatic metastases can be treated by chemo-embolization in the case of unilobar tumours, without portal thrombosis, or major hepatocellular insufficiency or renal failure, and by alcohol injection in the case of small tumours, limited in number, without any serious clotting disorders or abundant ascites. When these two methods are contraindicated, endocrine therapy by tamoxifen remains an alternative to symptomatic treatment. In contrast, external beam radiotherapy, systemic chemotherapy and intraarterial chemotherapy without Lipiodol or embolization are no longer indicated. Finally, internal radiotherapy by intraarterial injection of lipiodol radioactive iodine is currently under evaluation.