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Semin Liver Dis 2005; 25(2): 201-211
DOI: 10.1055/s-2005-871199
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Local/Regional and Systemic Treatments of Hepatocellular Carcinoma

Michel Beaugrand1 , 2 , Giselè N'kontchou1 , Olivier Seror1 , Nathalie Ganne1 , Jean-Claude Trinchet1
  • 1Liver Unit, Hôpital Jean Verdier, Bondy France
  • 2University of Paris xiii, Paris, France
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Publication History

Publication Date:
25 May 2005 (online)

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ABSTRACT

Screening programs for patients with cirrhosis are designed to detect hepatocellular carcinoma at an early stage when effective treatment is feasible and may provide long-term survival benefits. However, only a minority of these patients will be considered candidates for liver transplantation or surgical resection and hence, most cases will be evaluated for other medical options.

While systemic therapy has never been shown to bear a relevant antitumoral activity with an impact on survival, there are several locoregional options that can achieve a high rate of objective responses (this includes complete necrosis or partial reduction in tumor burden). Percutaneous ablation by any of the available methods (ethanol injection, radiofrequency, microwave, acetic acid injection, laser) is extremely useful in patients with small solitary tumors. Results indicate that 90% of tumors < 2 cm will be completely ablated using the percutaneous approach. However, when tumor size exceeds 3 cm and/or the number of nodules is greater than 3, the rate of treatment success is significantly reduced. In patients with large/multifocal disease, the sole option that has been shown to provide treatment efficacy with moderate improvement in survival is chemoembolization.

New therapeutic agents should target biological mechanisms in a tailored strategy, and the demonstration of beneficial results for patients should be obtained by large, randomized, controled trials comparing active intervention versus no treatment.

KEYWORDS

Hepatocellular carcinoma - treatment - chemoembolization - percutaneous ablation

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 Dr.
M. Beaugrand

Head of Department of Hepato-Gastroentrol, Hôpital Jean Verdier, Avenue du 14 Juillet

93143 Bondy Cedex, France

Email: secmed.hge@jvr.ap-hop-paris.fr