Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.110735
Revised: June 29, 2025
Accepted: October 9, 2025
Published online: November 15, 2025
Processing time: 153 Days and 13.1 Hours
Hepatocellular carcinoma (HCC) remains one of the commonest cancers world
Core Tip: Recurrent hepatocellular carcinoma (HCC) is indeed an increasing concern, especially as the global incidence of chronic liver diseases continues to rise. The management of recurrent HCC remains complex, particularly after liver transplantation or hepatic resection, as there is no universally agreed-upon approach. Several treatment modalities are available as locoregional and systemic therapies, and each comes with its own set of advantages and challenges. As recurrent HCC becomes more prevalent, developing a clear, evidence-based treatment approach will be crucial. Further research and prospective randomized trials are essential to determine the best management strategies, establish guidelines, and improve long-term patient outcomes in this challenging clinical scenario.
- Citation: Elsayed MOK. Treatment of recurrent hepatocellular carcinoma: The current standards and future perspectives. World J Gastrointest Oncol 2025; 17(11): 110735
- URL: https://www.wjgnet.com/1948-5204/full/v17/i11/110735.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v17.i11.110735
Hepatocellular carcinoma (HCC) is among the fastest-growing malignant diseases globally[1]. HCC is highly aggressive, with a 5-year survival rate below 20% and recurrence rates reaching up to 88%[2]. Regardless of the underlying cause or initial treatment approach, HCC frequently recurs, emphasizing the need for diligent post-operative monitoring[3]. When recurrence occurs, it is crucial to reassess the disease’s progression and reevaluate treatment strategies. However, staging frameworks for recurrent HCC (RHCC) are less well-established compared to those for primary HCC[4]. RHCC differs from primary HCC due to the reduced residual liver size and diminished liver function often associated with previous interventions[5]. For patients with resectable RHCC, repeat hepatectomy (RH) is considered the treatment of choice. Unfortunately, RH is not feasible for many patients due to factors such as tumor location, size, advanced cirrhosis, or portal hypertension[6].
In cases where RH is not an option, locoregional therapies such as radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), and percutaneous ethanol injection (PEI) have been employed with curative intent[7]. More recently, salvage liver transplantation (SLT) has emerged as a potential curative treatment for intrahepatic recurrence of HCC. However, its application is limited by a shortage of cadaveric donors and the restricted availability of suitable living donors[8]. This review aims to explore the various treatment options available for managing RHCC.
The management of RHCC differs from that of primary HCC in several key aspects.
RHCC generally exhibits more aggressive behavior and is associated with a poorer prognosis. Two mechanisms of recurrence are identified, each with distinct clinicopathological characteristics: Intrahepatic metastasis and multicentric occurrence[9].
When resection is considered as a treatment option, the future liver remnant is typically smaller for RHCC compared to primary HCC, making surgery more challenging[10].
Liver function tends to be more impaired in patients with RHCC due to the cumulative effects of previous treatments and disease progression. While treatment strategies for RHCC often follow similar principles as those for primary HCC, it is essential to perform a comprehensive assessment before selecting the optimal treatment modality. This evaluation should consider factors such as the size, location, and number of recurrent lesions, and whether the recurrence is confined to the liver (intrahepatic) or involves extrahepatic sites. Additionally, patient-specific factors, including age, sex, psychological condition, prior surgical details (such as the site of surgery and involvement of major blood vessels), and baseline liver function, must be carefully evaluated.
Given the variability in recurrence patterns and available treatment options, RHCC management should be individualized. A multidisciplinary team approach is crucial, involving hepatologists, transplant and hepatobiliary surgeons, medical oncologists, interventional radiologists, and palliative care specialists. This collaborative “tumor board” app
Treatment options for RHCC can be classified into: Surgical treatment: Including both surgical resection (SR) and liver transplantation (LT). Locoregional treatment: (1) Ablative therapies [RFA, microwave ablation (MWA)]; (2) Endovascular or catheter-based therapies [transarterial bland embolization, TACE, transarterial radioembolization (TARE) and hepatic arterial infusion (HAI) chemotherapy]; (3) External beam radiation therapy (EBRT) and stereotactic body radiation therapy (SBRT); (4) Systemic treatment; and (5) Combined modalities.
In this part we will discuss both SR and LT.
A small percentage (10%-30%) of patients with RHCC present with isolated extrahepatic or hepatic metastases that are considered suitable for surgical removal. For patients unfit for resection but with solitary recurrences, curative treatment using thermal ablation is an alternative option. However, it is important to note that the high recurrence rates often associated with HCC may limit the effectiveness of resection or ablation, necessitating repeated interventions[12].
In a French study by Fernandez-Sevilla et al[13], 22 out of 70 patients with RHCC underwent SR (2 with intrahepatic recurrences and 20 with extrahepatic recurrences). Their survival outcomes were significantly better compared to those who did not undergo resection (35 months vs 15 months, P < 0.001). The study concluded that HCC recurrence following LT is generally linked to poor prognosis, but resection significantly improves survival and should be considered when feasible. RH has been shown to be safe, with complication rates similar to those of the initial surgery[14]. However, the risk of further recurrence remains, particularly in patients with multinodular cirrhosis in the remaining liver tissue[15].
The largest Eastern study, conducted by Zou et al[16], analyzed 635 patients who underwent a second resection for RHCC. The median overall survival (mOS) was 54.8 months, and the 1-, 3-, and 5-year overall survival (OS) rates were 96.9%, 74.8%, and 47.8%, respectively. Post-recurrence survival rates for the same periods were 75.8%, 45.7%, and 37.6%, respectively. Over the past decade, laparoscopic liver resection (LLR) has gained wider adoption. A recent meta-analysis highlighted that while 90-day mortality rates were similar between LLR and open resection for RHCC, LLR offered advantages such as reduced in-hospital complications, less blood loss, and shorter hospital stays[17]. Further research suggests that repeat LLR is both feasible and effective for RHCC, demonstrating promising short-term outcomes[18]. Although laparoscopic repeat LLR is associated with prolonged operation times compared to open repeat liver resection (LR), it results in shorter hospital stays and comparable perioperative outcomes[19].
A meta-analysis involving 767 patients (334 undergoing repeat laparoscopic hepatectomy and 433 undergoing repeat open hepatectomy) found that laparoscopic procedures were associated with less intraoperative blood loss, fewer major complications, shorter hospital stays, and higher rates of R0 resections[20]. For RHCC, patients with intrahepatic-only recurrences demonstrated better prognoses compared to those with extrahepatic or combined intra- and extrahepatic recurrences. Additionally, patients who experienced recurrence within six months of the initial resection had worse survival outcomes[21].
Theoretically, LT is the optimal treatment for HCC within the Milan criteria because it allows for both the complete removal of the tumor and the treatment of underlying liver cirrhosis. However, routinely recommending LT for RHCC is considered logistically unfeasible due to the scarcity of donor organs and prolonged waiting periods[22]. The primary benefit of LT following the first hepatic recurrence is the treatment of cirrhosis, which reduces the likelihood of further recurrences. For patients with RHCC meeting the Milan criteria, SLT can be considered if the patient’s age and comor
In 2000, Majno et al[24] were the first to describe SLT for RHCC in carefully selected patients. Their findings indicated that OS and disease-free survival (DFS) following SLT were comparable to those achieved with primary LT (PLT). A meta-analysis by Zhu et al[25] of 14 studies conducted between 2000 and 2012 further confirmed that SLT and PLT have similar mortality rates. The pooled mortality rate across 10 studies was 6.34%, with no significant statistical differences between SLT and PLT.
SLT remains a life-saving option for patients with intrahepatic recurrences or declining liver function following primary hepatic resection[26]. Moreover, SLT has demonstrated superior outcomes compared to curative locoregional therapies in seven retrospective studies. A meta-analysis found that, compared to RH alone, SLT yielded significantly better 3- and 5-year DFS, as well as higher 5-year OS[27]. However, the limited availability of donor organs continues to pose a challenge to the feasibility of SLT.
For patients with RHCC following hepatectomy, SLT is associated with poorer OS and recurrence-free survival (RFS), along with a higher risk of recurrence and mortality, compared to PLT - especially for patients within the Milan criteria[28]. On the other hand, another study reported no significant differences in 5-year recurrence risk or actuarial survival between patients undergoing PLT and those receiving SLT for HCC recurrence following initial treatments such as LR or RFA[29].
Locoregional therapies encompass a range of minimally invasive, liver-targeted treatments. These therapies include ablative techniques, endovascular or catheter-based approaches, and SBRT. Depending on the clinical scenario, these methods can be applied as either curative interventions or neoadjuvant therapies for HCC, as illustrated in Figure 1[29].
RFA: RFA, which can be performed via percutaneous or open approaches, is considered a safe procedure and, in selected patients, as effective as SR in achieving long-term survival. Sun et al[30] reported that for small RHCCs following SR, RFA provided OS and DFS rates comparable to repeat SR, with the added benefit of a shorter hospital stay. Similarly, a meta-analysis by Gavriilidis et al[31] showed no significant differences in 5-year OS and DFS between RFA and RH for RHCC, although morbidity was significantly lower with RFA (2% vs 17%). However, a systematic review by Thomasset et al[32] analyzing 18 studies concluded that while RFA for RHCC is associated with a very low complication rate, it is less effective than RH and should therefore be reserved for patients unable to undergo surgical resection. A case report highlighted the efficacy of percutaneous RFA, achieving 2-year DFS in a 65-year-old patient with a solitary RHCC in a grafted liver[33]. In a retrospective study, Huang et al[34] compared 15 patients with post-LT HCC recurrence treated surgically to 11 patients treated with RFA. No significant difference was observed in 5-year OS (35% vs 28%, P = 0.88), although the RFA group showed worse DFS, which was not statistically significant (16% vs 0%; P = 0.75). For RHCC after liver resection, multiprobe stereotactic RFA demonstrated low morbidity, with 1-, 3-, and 5-year OS rates of 94.0%, 70.2%, and 53.3%, respectively, and DFS rates of 52.6%, 19.7%, and 15.8%, respectively[35]. RFA has proven particularly beneficial and effective for intrahepatic RHCC, especially following LT in the absence of extrahepatic metastases. For these cases, the 1-, 3-, and 5-year OS rates were 68.5%, 40.3%, and 40.3%, respectively[36]. While RFA is associated with lower RFS compared to LT, it is considered a superior therapy for intrahepatic HCC recurrence due to its minimal invasiveness, precision, and reproducibility[37].
MWA: MWA offers several advantages over RFA, including shorter ablation times, larger ablation zones, higher intra-tumoral temperatures, and more effective coagulative necrosis[38]. Recent studies have demonstrated the efficacy, safety, and suitability of MWA as a treatment for RHCC following curative SR. MWA is particularly beneficial as a parenchyma-sparing therapy, especially for patients with reduced liver volume due to previous surgical interventions. It provides long OS and progression-free survival (PFS) without significant complications or extended hospitalization and should be considered a viable option for managing RHCC after successful initial resection[39].
MWA has also shown promise in treating HCC recurrence following[40]. Zhai et al[41] evaluated the safety and effectiveness of MWA in a cohort of 11 LT recipients with intrahepatic RHCC. The procedure was well tolerated, with only three cases of tumor progression reported within 1-7 months post-treatment. However, the 2-year survival rate was 15.3%, and the mean survival time was 17.3 months, highlighting the need for further investigation into its long-term outcomes in this context.
TACE: The liver receives a dual blood supply, with approximately two-thirds of the blood flow originating from the portal vein and the remaining one-third from the hepatic artery. Transarterial embolization works by selectively occluding tumor-supplying vessels via the hepatic artery, inducing tumor ischemia and necrosis. TACE adds regional chemotherapy to embolizing microparticles for enhanced therapeutic effects[42]. The efficacy of conventional TACE in treating RHCC after living donor LT was assessed by Ko et al[43]. Among 28 patients, a tumor size reduction of ≥ 25% was achieved in 67.9% (19/28). However, intrahepatic or extrahepatic metastases were observed in 92.9% of patients within the first six months after TACE. Two recent meta-analyses highlighted the benefits of adjuvant TACE, demon
TARE: TARE, also known as selective internal radiation therapy, is an emerging treatment modality that offers effective disease control with a favorable safety profile. This technique involves the intra-arterial administration of therapeutic radiation doses to liver tumors using yttrium-90-loaded resin or glass microspheres[50]. TARE can be applied using three primary techniques: Radiation lobectomy, radiation segmentectomy, and the modified radiation lobectomy approach[51]. A 2016 meta-analysis by Lobo et al[52] found that TARE has OS and complication rates similar to TACE, but the prospe
HAI: HAI is a commonly used alternative to systemic chemotherapy, as it delivers chemotherapeutic agents directly to the tumor-feeding vessels while minimizing systemic toxic side effects through the liver’s first-pass effect[61]. A recent phase-three study compared HAI using FOLFOX (a combination of fluorouracil, leucovorin, and oxaliplatin) to TACE for large, unresectable HCC without macrovascular invasion. The results demonstrated a significantly improved OS with HAI (mOS: 13.3 months) compared to TACE (mOS: 10.8 months). Infusions were administered once every three weeks for up to six courses[62]. In another study, the combination of sorafenib with FOLFOX HAI was compared to sorafenib alone. The combination of sorafenib with FOLFOX HAI group exhibited a tolerable safety profile and significantly improved efficacy, with a mOS of 13.37 months vs 7.13 months for sorafenib alone[63]. Additionally, a randomized controlled trial evaluated sorafenib combined with HAI vs sorafenib alone in patients with HCC and major portal vein tumor thrombus. The combination therapy showed superior outcomes, including improved mOS, a higher objective response rate, and longer median PFS[64]. Despite these promising results, the survival benefit of combining sorafenib with HAI has shown variability across studies, highlighting the need for further research to better define its role in treating advanced HCC.
The two main types of radiation therapy commonly used are EBRT and SBRT. In EBRT, high doses of radiation are directed at the tumor tissue (liver tumor), while lower doses are delivered to the surrounding normal liver tissue. SBRT is a more advanced form of EBRT, designed to deliver a higher ablative dose to the target tissue (liver tumor) without significantly increasing the dose to the surrounding healthy liver tissue[65]. Several studies have demonstrated the effectiveness of SBRT in treating patients with unresectable, locally advanced, or RHCC[66-68]. In patients with preserved liver function, repeated SBRT for RHCC has shown good tumor ablation results, with an acceptable safety profile and OS comparable to other ablative therapies aimed at curative treatment[69]. The American Society of Radiation Oncology recommends SBRT as a treatment option for HCC[70]. SBRT has demonstrated reasonable benefits in terms of tumor control and survival, with 3-year disease control rates ranging from 68% to 97%, and 3-year survival rates from 39% to 84%. It is particularly useful in cases where RFA is not feasible or in HCC recurrence following RFA or TACE[71].
Sorafenib: Sorafenib, a multitarget tyrosine kinase inhibitor (TKI), was the first drug approved for treating HCC patients. It is most commonly used as adjuvant therapy in patients with resected HCC and as a frontline systemic treatment for those with RHCC after LT[72]. The landmark SHARP trial established sorafenib as the first Food and Drug Administration-approved systemic therapy for advanced HCC. The trial demonstrated that sorafenib significantly improved mOS compared to a placebo (mOS: 10.7 months vs 7.9 months; hazard ratio = 0.69; 95% confidence interval: 0.55-0.87; P < 0.001)[63]. Multiple studies have shown that sorafenib, as a representative molecular targeted therapy, extends survival for patients with RHCC after LT[73-76].
Lenvatinib: After a decade, another targeted therapy, lenvatinib, was assessed for use as a first-line treatment in patients with unresectable HCC. Lenvatinib’s approval was based on the results of the phase III randomized noninferiority trial REFLECT, which compared lenvatinib to sorafenib. In the study, patients treated with lenvatinib had a mOS of 13.6 months, while those treated with sorafenib had a mOS of 12.3 months. Additionally, median PFS was significantly longer in the lenvatinib group (7.4 months) compared to the sorafenib group (3.7 months)[77].
Cabozantinib, a TKI targeting vascular endothelial growth factor receptor 2, is an effective and safe monotherapy used in third-line systemic treatment for advanced HCC[78]. As a multi-kinase inhibitor, cabozantinib is considered a promising option for advanced HCC patients who have developed tolerance to sorafenib[79]. The phase III RESORCE trial (regorafenib after sorafenib in patients with HCC) evaluated regorafenib vs placebo in 573 patients (379 receiving regorafenib, 194 receiving placebo) with HCC (Child-Pugh A) whose disease had progressed after sorafenib treatment. Based on the findings, regorafenib was approved in the United States, European Union, and Japan for patients with HCC previously treated with sorafenib[80]. The following drugs are licensed for use in the second-line setting: Regorafenib, nivolumab/ipilimumab, pembrolizumab, cabozantinib, and ramucirumab[81].
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target and block key immune checkpoint proteins such as programmed cell death protein-1 (PD-1), programmed cell death ligand-1 (PD-L1), and cytotoxic T lymphocyte-associated antigen-4. This blockade enhances T-cell function and boosts the immune response against tumor cells[82]. Atezolizumab is an ICI that targets PD-L1, while bevacizumab is an antibody against vascular endothelial growth factor A. In a phase Ib trial, the combination of atezolizumab and bevacizumab showed safety and promising preliminary activity in patients with advanced HCC[83]. Subsequently, an open-label, phase 3 trial comparing atezolizumab-bevacizumab to sorafenib in patients with previously untreated advanced HCC demonstrated superior outcomes. The study, which included 336 patients in the atezolizumab-bevacizumab group and 165 patients in the sorafenib group, found that the combination therapy resulted in better OS and PFS in patients with unresectable HCC[84].
Recently, a combination therapy strategy has been used to achieve better outcome than single modality of treatment. Different combination modalities have been used to treat HCC with favourable outcomes.
RFA combined with TACE has been shown to provide the best survival outcomes for patients who are not candidates for RH. This combined treatment demonstrates a survival benefit, particularly in patients with RHCC and 2-3 tumors[85]. In comparison to SR, the combination of TACE and RFA offers comparable one- and three-year OS rates, as well as a one-year RFS rate. However, the three-year RFS rate is significantly lower in the TACE-RFA group compared to SR. On the other hand, the TACE-RFA approach is associated with a lower risk of major complications compared to SR[86].
Choi et al[87] reported positive perioperative results and long-term survival in a cohort of 53 patients who underwent combined hepatectomy and RFA for multifocal HCC. This approach demonstrated promising outcomes for patients with multiple tumors. SR combined with intraoperative RFA has been shown to provide better OS and PFS compared to TACE for patients with intermediate-stage (Barcelona Clinic Liver Cancer B) HCC[88]. Furthermore, Zhou et al[89] demon
According to Ryu et al[90], for selected patients with multifocal HCC, a combination of hepatectomy and MWA offers good long-term results with minimal complication rates. This combination approach is considered safe and practical, especially for individuals with multifocal HCC. For patients who are otherwise ineligible for hepatectomy, the combi
The combination of TACE and PEI has been shown to improve survival compared to TACE alone. A study revealed a statistically significant improvement in survival for HCC patients at Okuda stage I. Additionally, the side effects of this combination therapy were minimal, and the treatment did not substantially prolong the duration of hospitalization[91]. This suggests that combining TACE and PEI could be an effective and well-tolerated treatment option for HCC patients in the early stages, offering improved survival outcomes without significant additional risks or extended recovery times.
The combination of TACE with sorafenib has shown significantly better outcomes than TACE alone in patients with HCC. This combination therapy is associated with prolonged PFS, improved OS, and a significantly higher tumor response rate. These findings suggest that combining TACE with sorafenib not only enhances the effectiveness of treatment but also provides a controllable safety profile, demonstrating its potential as a promising therapeutic approach for managing HCC[92].
The combination of atezolizumab and cabozantinib was tested in the COSMIC-312 phase III randomized trial. This trial showed an improvement in median PFS, increasing from 4.2 months in the sorafenib group to 6.8 months in the combination group (hazard ratio = 0.63; 99% confidence interval: 0.44-0.91, P = 0.0012). However, despite this improvement in PFS, the study did not show a significant benefit in OS at the interim analysis[93]. The HIMALAYA trial evaluated the combination of anti-PD-L1 durvalumab and anti-cytotoxic T lymphocyte-associated antigen-4 tre
Many trials are under investigations to find out an effective second-line agents. The anti-PD-1 monoclonal antibody tislelizumab demonstrated efficacy in the treatment of advanced HCC in the RATIONALE-301 trial. In this noninferiority study, 674 patients were randomized to receive either 200 mg of tislelizumab every three weeks or 400 mg of sorafenib twice daily. The final analysis revealed that patients treated with tislelizumab had a mOS of 15.9 months, compared to 14.1 months in the sorafenib group[97]. In the second-line setting, additional ICIs are under investigation. One such combination involves apatinib and the anti-PD-1 antibody camrelizumab, which is being tested in patients with advanced HCC, gastric cancer, or esophagogastric junction cancer[98]. Camrelizumab (administered at 3 mg/kg intravenously every two to three weeks) was evaluated in a multicenter, open-label, randomized, phase II trial in China for patients with advanced HCC who had progressed on or were intolerant to prior systemic therapy[99]. Another anti-PD-1 mono
In addition to ICIs, cytokine-induced killing (CIK) cell-based immunotherapy has emerged as a promising adjuvant therapy for HCC. Several clinical trials have indicated that CIK cell therapy improves RFS in HCC patients who undergo SR[101,102]. A meta-analysis of 22 studies involving 3756 HCC patients who received dendritic cell-based vaccines and/or CIK-based adoptive therapy after interventional treatments showed prolonged OS at 6 months, 1 year, 3 years, and 5 years. The therapy also reduced mortality and recurrence at 1, 2, and 3 years, but not at 5 years[103].
Moreover, immunological studies have highlighted promising results, including the generation of circulating multiclonal neoantigen-specific T-cell responses, activation of neoantigen-specific immunity, and an upregulated immune stimulatory signature. In 70% of patients, these responses were linked to improved DFS. Notably, 71.4% of these patients remained relapse-free for 2 years following curative treatment. However, evidence of immune evasion was also noted in recurrent tumors compared to primary tumors, suggesting that immunological therapy may lead to immunoediting and resistance[104].
Artificial intelligence (AI) has emerged as a potential alternative biomarker for predicting cancer recurrence following treatment, showing promising performance when compared to traditional clinical and pathological indicators. By leveraging computer technology, AI can extract advanced, detailed information from medical imaging modalities such as computed tomography[105], magnetic resonance imaging[106], and ultrasound[107], incorporating techniques like radiomics and deep learning[108].
A recent study conducted in Australia and Hong Kong employed AI to create and evaluate a high-performing predictive model for HCC recurrence after curative SR. The researchers concluded that applying AI to extensive clinical, biochemical, and tumor-related data allowed for accurate identification of risk factors linked to HCC recurrence following surgery[109]. A systematic review and meta-analysis highlighted the broad applicability of AI in predicting recurrence following a single first-line treatment for liver cancer, yielding favorable outcomes. These findings suggest that AI holds significant potential for clinical implementation in forecasting liver cancer recurrence[110].
In view of this systematic review and after reviewing all the available treatment options, I have proposed an algorithm for the treatment of RHCC. This algorithm will help those who need to make a decision in choosing the modality of treatment for RHCC (Figure 2).
The treatment of RHCC following LT or hepatic resection is indeed a challenging aspect of HCC management. The lack of international guidelines for RHCC treatment underscores the complexity of these cases, as treatment strategies are highly individualized based on a variety of factors such as hepatic reserve, tumor staging, and previous treatments. For patients with RHCC following resection, RH is the most commonly considered approach, provided the patient maintains adequate liver function and there is no significant underlying liver disease. However, for patients who are ineligible for reoperation or for those with recurrence after LT, SLT is emerging as a promising option, offering new hope for those with RHCC post-transplant.
Locoregional therapies such as TACE, RFA, and selective internal radiation therapy remain important treatment options for patients who are not candidates for resection or transplantation. The use of combination therapy - combining different treatment modalities - has shown promise in improving therapeutic efficacy, reducing complications, and potentially prolonging survival. By combining surgery, ablation techniques, or locoregional therapies with systemic treatments like sorafenib, lenvatinib, or ICIs, clinicians aim to optimize the treatment approach for RHCC. Although ongoing and completed clinical trials are beginning to expand systemic therapy options for advanced HCC and specific patient populations, there remains a need for more rigorous prospective randomized controlled studies. These studies are essential to develop evidence-based guidelines for managing RHCC, refine therapeutic strategies, and optimize outcomes for this challenging clinical scenario. In summary, although treatment options for RHCC are constantly advancing, a personalized approach remains key to obtaining the best results. The use of new therapies and combination methods, together with continuous clinical research, holds promise for better management of RHCC going forward.
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