Regional cancer chemotherapy for advanced stage hepatocellular carcinoma

The conventional treatment for hepatocellular carcinoma (HCC) has been surgical resection, typically by segmentectomy, lobectomy, or trisegmentectomy. The large majority of patients, however, cannot have their tumors resected, either because of underlying cirrhosis and liver damage, making resection hazardous, or because of the multifocal or bilobar spread of the hepatoma. In those patients with resectable tumors, the recurrence rates and survival have been found to depend mainly on stage of disease [1,2]. The best results have been with TNM stage I disease, with stage II and resectable stage III disease typically having < 30% survival at 3 years. Factors adversely influencing prognosis have included diffuse disease, multifocal primaries, vascular invasion, and lymph node involvement. Causes of Recurrence After Resection The evidence from liver transplantation specimens indicates that much clinically evident hepatoma is either multifocal or widespread. This suggests that disease that has been diagnosed by angiography, ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scan consistently underestimates the amount of spread of disease in the liver. Thus, there is a reasonable probability of undetected residual microscopic disease in the remaining liver, which would account for the high recurrence rates.