Locoregional Therapy for Hepatocellular Carcinoma

Transplantation, resection, and ablation are recommended for the treatment of very early (single <2 cm diameter) and early (single or <3 nodules <3 cm diameter) stage hepatocellular carcinomas (HCCs) as determined using the Barcelona Clinic Liver Cancer (BCLC) staging system [1]. In addition, transarterial chemoembolization (TACE) is recommended for intermediate-stage multinodular HCCs, systemic therapy with sorafenib for advancedstage HCCs, and best supportive care for end-stage HCCs, respectively. In this issue, we review current locoregional therapeutic modalities including local ablation, TACE and arterial infusion chemotherapy. Although radiofrequency ablation (RFA) [2, 3] is the best current method for ablation, many differences exist between the techniques used in Japan and those used in other countries such as the United States and in Europe. In Japan, computed tomography is used to assess the outcome of RFA immediately after the procedure, and the technique is repeated until a sufficient ablative margin is obtained, which has been found to produce nearly a 100% tumor necrosis rate. In other words, the RFA is repeated to achieve a complete response (CR) in most cases, and this is markedly different from the RFA treatment performed in the United States and Europe, in which the outcome is usually assessed at one month after a single ablation. Consequently, necrosis rates of HCC following RFA are different between Japan and the other aforementioned countries, which is described in detail in the review articles by Drs. Kang and Rhim [4]. Furthermore, TACE, which is the representative regional therapy, has conventionally been performed by first infusing doxorubicin or epirubicin suspended in Lipiodol, followed by embolization with a gelatin sponge (conventional Lipiodol-TACE). Conversely, in the United States and Europe, drug-eluting beads TACE (DEB-TACE) with microspheres (DC beads) is frequently performed as the standard method. In addition, radioembolization with yttrium-90 for internal irradiation has also been performed proactively in recent years. We are proud of TACE, which was first developed in Japan and that has evolved markedly over the years, because the complete cure of HCC is now possible with the use of superselective or subsegmental TACE. However, conventional TACE is often ineffective, or it may even adversely affect hepatic functional reserve when used in patients with huge and/ © 2015 S. Karger AG, Basel 2235-1795/15/0043-0163$39.50/0 www.karger.com/lic Liver Cancer 2015;4:163–164