Abstract
Treatment of HCC is complicated by its highly variable biologic behavior and the frequent coexistence of chronic liver disease and cirrhosis in affected patients. While surgery remains the most frequently employed treatment modality, curative resection is only possible for a minority of patients. More often, treatment goals are palliative and draw on the expertise of a range of medical specialists. This chapter aims to place current treatment strategies within the framework of a multidisciplinary approach with special emphasis on pretreatment evaluation, staging, and the selection of an appropriate treatment strategy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Parkin DM, Bray F, Ferlay J et al (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94:153–156
Vauthey JN, Lauwers GY, Esnaola NF et al (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20:1527–1536
Takayasu K, Arii S, Ikai I et al (2006) Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 131:461–469
Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457
Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916
Teh SH, Christein J, Donohue J et al (2005) Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: model of end-stage liver disease (MELD) score predicts perioperative mortality. J Gastrointest Surg 9:1207–1215
Cucchetti A, Ercolani G, Vivarelli M et al (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971
Capussotti L, Ferrero A, Vigano L et al (2006) Portal hypertension: contraindication to liver surgery? World J Surg 30:992–999
Iannaccone R, Laghi A, Catalano C et al (2005) Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology 234:460–467
Laghi A, Iannaccone R, Rossi P et al (2003) Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 226:543–549
Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336
Burrel M, Llovet JM, Ayuso C et al (2003) MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 38:1034–1042
Kim HJ, Kim KW, Byun JH et al (2006) Comparison of mangafodipir trisodium- and ferucarbotran-enhanced MRI for detection and characterization of hepatic metastases in colorectal cancer patients. AJR Am J Roentgenol 186:1059–1066
Frericks BB, Loddenkemper C, Huppertz A et al (2009) Qualitative and quantitative evaluation of hepatocellular carcinoma and cirrhotic liver enhancement using Gd-EOB-DTPA. AJR Am J Roentgenol 193:1053–1060
Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467
Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet, 362:1907–1917
Jung G, Breuer J, Poll LW et al (2006) Imaging characteristics of hepatocellular carcinoma using the hepatobiliary contrast agent Gd-EOB-DTPA. Acta Radiol 47:15–23
Bhartia B, Ward J, Guthrie JA et al (2003) Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. AJR Am J Roentgenol 180:577–584
Lee VS, Hecht EM, Taouli B et al (2007) Body and cardiovascular MR imaging at 3.0 T. Radiology 244:692–705
Mannelli L, Kim S, Hajdu CH et al (2009) Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. AJR Am J Roentgenol 193:1044–1052
Huwart L, Sempoux C, Vicaut E et al (2008) Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 135:32–40
Hagiwara M, Rusinek H, Lee VS et al (2008) Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging—initial experience. Radiology 246:926–934
Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104
DuBay D, Sandroussi C, Sandhu L et al (2011) Liver transplantation for advanced hepatocellular carcinoma using poor tumor differentiation on biopsy as an exclusion criterion. Ann Surg 253:166–172
Vauthey JN, Dixon E, Abdalla EK et al (2010) Pretreatment assessment of hepatocellular carcinoma: expert consensus statement. HPB (Oxford) 12:289–299
Llovet JM, Di Bisceglie AM, Bruix J et al (2008) Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 100:698–711
Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338
Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390
Cillo U, Bassanello M, Vitale A et al (2004) The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available? J Hepatol 40:124–131
Cillo U, Vitale A, Grigoletto F et al (2006) Prospective validation of the Barcelona clinic liver cancer staging system. J Hepatol 44:723–731
Jonas S, Al-Abadi H, Benckert C et al (2009) Prognostic significance of the DNA-index in liver transplantation for hepatocellular carcinoma in cirrhosis. Ann Surg 250:1008–1013
Poon RT, Lau C, Pang R et al (2007) High serum vascular endothelial growth factor levels predict poor prognosis after radiofrequency ablation of hepatocellular carcinoma: importance of tumor biomarker in ablative therapies. Ann Surg Oncol 14:1835–1845
Kaseb AO, Abbruzzese JL, Vauthey JN et al (2011) I-CLIP: improved stratification of advanced hepatocellular carcinoma patients by integrating plasma IGF-1 into CLIP score. Oncology 80:373–381
Prasad KR, Young RS, Burra P et al (2011) Summary of candidate selection and expanded criteria for liver transplantation for hepatocellular carcinoma: a review and consensus statement. Liver Transpl 17(Suppl 2):S81–89
Belghiti J (2009) Resection and liver transplantation for HCC. J Gastroenterol 44(Suppl 19):132–135
Cherqui D, Laurent A, Mocellin N et al (2009) Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 250:738–746
Otsuka Y, Duffy JP, Saab S et al (2007) Postresection hepatic failure: successful treatment with liver transplantation. Liver Transpl 13:672–679
Scatton O, Zalinski S, Terris B et al (2008) Hepatocellular carcinoma developed on compensated cirrhosis: resection as a selection tool for liver transplantation. Liver Transpl 14:779–788
Kulik LM, Atassi B, van Holsbeeck L et al (2006) Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 94:572–586
Lewandowski RJ, Kulik LM, Riaz A et al (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9:1920–1928
Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739
A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. N Engl J Med (1995) 332:1256–1261
Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171
Schwarz RE, Abou-Alfa GK, Geschwind JF et al (2010) Nonoperative therapies for combined modality treatment of hepatocellular cancer: expert consensus statement. HPB (Oxford) 12:313–320
Krishnan S, Dawson LA, Seong J et al (2008) Radiotherapy for hepatocellular carcinoma: an overview. Ann Surg Oncol 15:1015–1024
Hawkins MA, Dawson LA (2006) Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer 106:1653–1663
Chiba T, Tokuuye K, Matsuzaki Y et al (2005) Proton beam therapy for hepatocellular carcinoma: a retrospective review of 162 patients. Clin Cancer Res 11:3799–3805
Kawashima M, Furuse J, Nishio T et al (2005) Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma. J Clin Oncol 23:1839–1846
Yasuda S, Ito H, Yoshikawa M et al (1999) Radiotherapy for large hepatocellular carcinoma combined with transcatheter arterial embolization and percutaneous ethanol injection therapy. Int J Oncol 15:467–473
Seong J, Keum KC, Han KH et al (1999) Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 43:393–397
Guo WJ, Yu EX (2000) Evaluation of combined therapy with chemoembolization and irradiation for large hepatocellular carcinoma. Br J Radiol 73:1091–1097
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Kaseb, A.O., Abaza, Y.M., Roses, R.E. (2013). Multidisciplinary Management of Hepatocellular Carcinoma. In: Vauthey, JN., Brouquet, A. (eds) Multidisciplinary Treatment of Hepatocellular Carcinoma. Recent Results in Cancer Research, vol 190. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16037-0_16
Download citation
DOI: https://doi.org/10.1007/978-3-642-16037-0_16
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-16036-3
Online ISBN: 978-3-642-16037-0
eBook Packages: MedicineMedicine (R0)