Hepatocellular carcinoma medical therapy

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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

Contraindicated medications

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

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

  • Oral synthetic retinoid for 12 months after resection/ablation maybe helpful in the treatment of hepatocellular carcinoma.[1]

Interventional radiology

Intervention radiology may help in hepatocellular carcinoma treatment.


The effectiveness of medical therapy is related to 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

  1. [1] American Society of Clinical Oncology, 2005 Annual Meeting, Abstracts on Hepatobiliary Cancer


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