Review
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World J Gastroenterol. Nov 14, 2013; 19(42): 7316-7326
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7316
Multimodal treatment of hepatocellular carcinoma on cirrhosis: An update
Marco Vivarelli, Roberto Montalti, Andrea Risaliti
Marco Vivarelli, Roberto Montalti, Hepatobiliary and Abdominal Transplantation Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, 60129 Ancona, Italy
Andrea Risaliti, Department of Surgery and Transplantation, University of Udine, 33100 Udine, Italy
Author contributions: Vivarelli M conceived and designed the study; Montalti R drafted the article and acquired, analyzed and interpreted the data; Risaliti A revised the manuscript.
Correspondence to: Marco Vivarelli, MD, Hepatobiliary and Abdominal Transplantation Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, A.O.U. “Ospedali Riuniti”, Via Conca 71, 60129 Ancona, Italy. vivarelli63@libero.it
Telephone: +39-71-5965099 Fax: +39-71-5965100
Received: July 3, 2013
Revised: August 8, 2013
Accepted: September 16, 2013
Published online: November 14, 2013
Processing time: 138 Days and 10.8 Hours
Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, and overall, it is one of the most frequent cancers. The association of HCC with chronic liver disease, and cirrhosis in particular, is well known, making treatment complex and challenging. The treatment of HCC must take into account the presence and stage of chronic liver disease, with the aim of preserving hepatic function that is often already impaired, the stage of HCC and the clinical condition of the patient. The different treatment options include surgical resection, transplantation, local ablation, chemoembolization, radioembolization and molecular targeted therapies; these treatments can be combined in various ways to achieve different goals. Ideally, liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it; however, the application of this powerful tool is limited by the scarcity of donors. Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation. Several professionals, including gastroenterologists, radiologists and surgeons, are involved in the choice of the most appropriate treatment for a single case, and a multidisciplinary approach is necessary to optimize the outcome. The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages, disadvantages and rationale for their use.

Keywords: Hepatocellular carcinoma; Multimodal treatment; Locoregional treatments; Molecular targeted therapies; Liver resection; Liver transplantation

Core tip: Hepatocellular carcinoma (HCC) occurs frequently, and its association with cirrhosis makes treatment complex and challenging. The treatment of HCC must take into account the presence and stage of chronic liver disease with the aim of preserving hepatic function that is often already impaired. The different treatment options include surgical resection, transplantation, local ablation, chemoembolization, radioembolization and molecular targeted therapies. Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation. The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC.