Multimodality treatment of hepatocellular carcinoma

By 1996, 2898 patients with pathologically proven hepatocellular carcinoma (HCC) had been treated at the Liver Cancer Institute of Shanghai Medical Un iversity. The 5 year survival in the entire series was 36.2%, being increas ed from 4.8% in 1958-70, 12.2% in 1971-83, to 50.5% in 1984-96 and 274 pati ents had survived more than 5 years. The increase in the survival rate coul d be attributed to the decreasing mean tumour diameter (11.7, 10.5 and 9.5 cm, respectively) and multimodality treatment. In addition to small HCC res ection (5 year survival 64.9%, n=735) and large HCC resection (5 year survi val 37.4%, n=1050), the following deserves to be mentioned. First, the 5 ye ar survival of unresectable HCC treated by palliative surgery increased fro m 0% to 7.2% to 20.0%, which was related to the increase in use of multimod ality treatment, particularly in those followed by second-stage resection. Second, cytoreduction and sequential resection is a new field with a signif icant potential in the treatment of localized unresectable HCC in a cirrhot ic liver. Cytoreduction can be achieved by surgery, such as hepatic artery ligation, cannulation, cryosurgery and their combination, and followed by i ntrahepatic arterial chemoembolization, targeting therapy or regional radio therapy. Ninety of 647 patients with unresectable HCC so treated had marked shrinkage of tumour and received second-stage resection; the 5 year surviv al was 71.4%. Third, non-surgical cytoreduction was mainly achieved by tran scatheter arterial chemoembolization (TACE); for 70 patients with second-st age resection following TACE, the 5 year survival was 56.0%. Finally, re-re section of subclinical recurrence of tumour after curative HCC resection wa s performed in 155 patients; the 5 year survival calculated fi om the first resection was 50.9%, which played an important role in increasing the 5 ye ar survival in the resection group (from 13.0% to 29.5% to 56.2%). It is co ncluded that multimodality treatment with combined and sequential use of di fferent modalities and repeated use of some modalities is of substantial be nefit for localized unresectable HCC.