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11 - Hepatocellular Carcinoma: Medical Management

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

Philip Johnson
Affiliation:
Professor of Oncology and Translational Research Director of the Clinical Trials Unit Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK
Daniel Palmer
Affiliation:
Clinician Scientist Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

THE NEED FOR SYSTEMIC THERAPIES IN HEPATOCELLULAR CARCINOMA

Recent years have seen major advances in local control of hepatocellular carcinoma (HCC), and the relevant approaches are described in detail elsewhere in this volume. Thus, although surgical resection (and orthotopic liver transplantation) has long been seen as the only approach to offer cure, or at least long-term survival, other locoregional therapies including percutaneous ethanol injection and thermal ablation now appear to be rivaling surgical resection by many criteria of efficacy. However, it is clear that all these approaches (including surgical resection) are less effective as the tumor increases in size, and conventionally, most are confined to lesions smaller than 5 cm in diameter. This probably reflects the fact that as tumors increase in size, the frequency of vascular invasion increases and with it, the likelihood of metastasis. Thus, if local treatments are applied to larger lesions then the rate of recurrence increases dramatically.

Similarly, trans-catheter approaches are recognized to cause extensive tumor necrosis, but evidence of survival improvement has been more difficult to demonstrate because disease progression and tumor re-vascularization are still the rule. Thus to complement these local measures, systemic treatment is urgently required to expand the indications for local therapies and to decrease the recurrence rate (i.e., in the adjuvant setting).

At the outset, it should be noted that, largely because of the progress in local treatment, systemic agents have moved “down the scale” so that new chemotherapeutic agents have been tried mainly in patients with advanced or even terminal disease and this necessarily limits the scope for observing effective treatments.

Type
Chapter
Information
Interventional Oncology
Principles and Practice
, pp. 115 - 120
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Hepatocellular Carcinoma: Medical Management
    • By Philip Johnson, Professor of Oncology and Translational Research Director of the Clinical Trials Unit Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK, Daniel Palmer, Clinician Scientist Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.012
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  • Hepatocellular Carcinoma: Medical Management
    • By Philip Johnson, Professor of Oncology and Translational Research Director of the Clinical Trials Unit Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK, Daniel Palmer, Clinician Scientist Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.012
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hepatocellular Carcinoma: Medical Management
    • By Philip Johnson, Professor of Oncology and Translational Research Director of the Clinical Trials Unit Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK, Daniel Palmer, Clinician Scientist Cancer Research, UK Institute for Cancer Studies University of Birmingham Birmingham, UK
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.012
Available formats
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