Nonresectional therapies for hepatocellular carcinoma

Surgical resection is generally accepted as the first choice of treatment for hepatocellular carcinoma (HCC). However, due to its multifocal nature, association with chronic liver disease, and frequent postresectional recurrence, nonresectional therapies are important in the management of a significant proportion of patients with HCC.

A literature review was performed on the current status of different nonresectional treatment modalities commonly employed for HCC. They include direct ablation methods, systemic chemotherapy, transcatheter arterial chemoembolization, external and targeting radiotherapy, hormonal therapy, and immunotherapy. Multidisciplinary therapy resulting in preoperative cytoreduction has also been reported with improvement of therapeutic results.

Nonresectional therapies play an essential role in the treatment of inoperable HCC as they lead to satisfactory survival. Percutaneous ethanol injection and transcatheter arterial chemoembolization are the most frequently employed modalities, and they result in a 3-year survival rate of 55% to 70% and about 20%, respectively. Multidisciplinary therapy appears to be the current trend of management and improved survival is achieved especially when unresectable tumors are converted to resectable ones.