Up-to-date information for hepatocellular carcinoma treatment

Despite therapeutic advances, the overall survival of patients with hepatocellular carcinoma (HCC) has not been significantly improved in the last two decades. in the majority of the cases, there is underlying cirrhosis, therefore the prognosis of HCC depends not only on tumor stage but also on liver function. Patients at an early stage are those who present with an asymptomatic single HCC with a maximum diameter of 5 cm or up to three nodules each less than 3 cm. They will be benefitted by curative therapies, including resection, liver transplantation (LT), and percutaneous ablation, such as destroying tumor cells via the Injection of chemical substances, radiation, or heating or cooling. Patients exceeding these limits, but who are free of cancerrelated symptoms and vascular invasion or extrahepatic spread may be benefitted by palliation with chemoembollzation and hepatic arterial infusion chemotherapy. Recently, other treatments were developed under investigation treatments arising from technical advances In ablation and radiation. New promising image guided therapies are continuously emerging and minimize hepatic toxicity and ultimately improve quality of life and survival of patients with HCC. The 3 dimensional conformal RT, tomotherapy, stereotatic radiosurgery, high intensity focused ultrasound, and proton beam radiotherapy will provide the opportunity for curative treatment of HCC, while avoiding critical normal tissue. New drugs, such as tyrosine kinase inhibitors and antiangiogenic agents, are currently being tested In the setting of clinical trials. These new approaches may help to address the enormous need for expanded treatment options for patients with HCC. in the future, patients with HCC will be best treated by a multidisciplinary team approach, utilizing a combination of techniques to improve the patient survival.