Hepatocellular carcinoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [3]

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Overview

Patients with hepatocellular carcinoma are treated with ethanol injections, transcatheter arterial chemoembolization (TACE), sealed source radiotherapy, radiofrequency ablation (RFA), intra-arterial iodine-131-lipiodol administration, high intensity focused ultrasound (HIFU), hormonal therapy, and chemotherapy.

Medical Therapy

Medical therapy for hepatocellular carcinoma

Percutaneous ethanol injection

• Percutaneous ethanol injection (PEI) well tolerated. It's preferred in small (< 3 cm) solitary tumors.

Transcatheter arterial chemoembolization (TACE)

• Transcatheter arterial chemoembolization (TACE) is usually performed in the treatment of large tumors (larger than 3 cm and less than 4 cm in diameter), most frequently by intraarterially injecting an infusion of antineoplastic agents mixed with iodized oil (such as Lipiodol).

• Combined PEI and TACE can be used for tumors larger than 4 cm in diameter.

Sealed source radiotherapy

• Sealed source radiotherapy can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue). TheraSphere is an FDA approved treatment which has been shown in clinical trials to increase survival rate of low-risk patients. This method uses a catheter (inserted by a radiologist) to deposit radioactive particles to the area of interest.

Radiofrequency ablation (RFA)

• Radiofrequency ablation (RFA) uses high frequency radio-waves to ablate the tumour.

Intra-arterial iodine-131–lipiodol administration

• Intra-arterial iodine-131–lipiodol administration demonstrated some efficacy in unresectable tumors, especially in patients with portal vein thrombus. This treatment is also used as adjuvant therapy in resected patients. It is believed to raise the 3-year survival rate from 46 to 86%.

High intensity focused ultrasound (HIFU)

• High intensity focused ultrasound (HIFU) is a new technique which uses much very powerful ultrasound to treat the tumour. Still at a very experimental stage. Most of the work has been done in China. Some early work is being done in Oxford and London in the UK.

Hormonal therapy

• Hormonal therapy with Antiestrogen therapy and tamoxifen can be used in hepatocellular treatment.

Chemotherapy

• Chemotherapy adjuvant

• Oral synthetic retinoid for 12 months after resection/ablation maybe helpful in the treatment of hepatocellular carcinoma.

• Palliative

• Regimens that included doxorubicin, cisplatin, fluorouracil, interferon, epirubicin, or taxol, as a single agent or in combination, did not show any survival benefit (Response rate, 0%-25%); a few isolated major responses allowed patients to undergo partial hepatectomy.

Interventional radiology

• Intervention radiology may help in hepatocellular carcinoma treatment.

Contraindicated medications

Hepatocellular carcinoma is considered an absolute contraindication to the use of the following medications:

• Drospirenone and Ethinyl estradiol
• Norethindrone acetate and Ethinyl estradiol
• Norgestimate and Ethinyl estradiol
• Norgestrel and Ethinyl estradiol
• Hydroxyprogesterone caproate

Effectiveness of medical therapy

The effectiveness of medical therapy depends on the following:

• Size
• Involvement of liver vessels
• Presence of a tumor capsule
• Presence of extrahepatic metastases
• Presence of daughter nodules
• Vascularity of the tumor

References

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