[Current therapeutic strategies for hepatocellular carcinoma, 2]

Therapeutic decisions depend on the tumor stage and the functional reserve of the tumor-free liver since most HCC are found in cirrhotic livers. Prospective randomized trials are not available, as is a uniform stage-adapted therapeutic concept. The only potentially curative therapy is surgical. Only 15-30% of patients are suitable for liver resection; localized but anatomically or functionally irresectable tumors can be treated by liver transplantation. Both methods have shown a high recurrence rate; controlled studies on adjuvant therapy are missing. Percutaneous ethanol injection therapy is an alternative in early stages resulting in survival rates comparable to surgical resection. More advanced tumors can be treated by transarterial chemoembolization using Lipiodol. Chemotherapy is little successful, the standard substance Adriamycin achieving remission rates of about 20%. To improve the results of chemotherapy, a combination of cytostatic agents with Lipiodol in non-metastasized tumors has been proposed. Among new therapeutic options such as treatment with cytokines, hormone antagonists, lipiodol or antibodies coupled with radioactivity no definite results have been published so far. Therefore, all patients with HCC should be treated in prospectively controlled, randomized studies.