PRACTICAL CONSIDERATIONS IN THE TREATMENT OF HEPATOCELLULAR-CARCINOMA

Hepatocellular carcinoma (HCC) represents one of the most common neopl asms worldwide. To date, curative treatment options include liver tran splantation or resection. Unfortunately, most patients are detected wi th nonresectable or -transplantable HCC due to disease extension or co morbid factors, and are therefore candidates only for palliative treat ments. Palliative medical treatments, including systemic chemotherapy, immunotherapy or hormonal manipulation, have a borderline activity on HCC and cannot be recommended outside clinical trials. A high respons e rate has been reported with local therapies such as transcatheter ar terial embolisation, intra-arterial chemotherapy or percutaneous alcoh ol (ethanol) injection, but as there is no clear evidence of a surviva l advantage for these treatment modalities, further investigations are required, Multidisciplinary treatment, including preoperative cytored uction or postoperative adjuvant therapy, is currently under investiga tion, with encouraging survival results, HCC patients should be evalua ted within clinical trials, possibly randomised and with homogeneous p rognostic factors, in order that we may find the answer to all these i mportant questions.