Thanks to the growing knowledge on biological behaviors of hepatocellular carcinomas (HCC), as well as continuous improvement in imaging techniques and experienced interpretation of imaging features of the nodules in cirrhotic liver, the detection and characterization of HCC has improved in the past decade. A number of practice guidelines for imaging diagnosis have been developed to reduce interpretation variability and standardize management of HCC, and they are constantly updated with advances in imaging techniques and evidence based data from clinical series. In this article, we strive to review the imaging techniques and the characteristic features of hepatocellular carcinoma associated with cirrhotic liver, with emphasis on the diagnostic value of advanced magnetic resonance imaging (MRI) techniques and utilization of hepatocyte-specific MRI contrast agents. We also briefly describe the concept of liver imaging reporting and data systems and discuss the consensus and controversy of major practice guidelines.
Hepatocellular carcinoma (HCC) is a common and lethal malignancy worldwide that arises within the context of a host of diseases. Surgery is the primary option for tumor treatment and is thus the most effective therapy to allow the best overall survival and recurrence-free survival for patients. One aim of this paper is to present and discuss recent advances in the surgical treatment of HCC such as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), laparoscopic hepatectomy, and robotic liver resection, and another aim of this paper is to highlight current issues in the surgical treatment of HCC such as extended indications.
Marked improvement in the prognosis for patients with liver cancer who undergo liver transplantation has been achieved as a result of advances in liver transplantation techniques. Given the current shortage of organs in China, a favorable long-term survival rate might be achieved with rigorous selection of suitable patients and therefore benefit society the most. Further study of the mechanism of cancer recurrence following liver transplantation, continuing to optimize pretreatment strategies prior to liver transplantation, and paying closer attention to the prevention and treatment of cancer recurrence following liver transplantation are important steps to improve the long-term clinical benefit of liver transplantation for patients with hepatocellular carcinoma. Perfecting the techniques of liver transplantation using a marginal donor liver is the main way to solve the current problem of an organ shortage for patients with liver cancer.
Interventional therapy for liver cancer is a new type of treatment, and its progress has been influenced by the development of the large scale imaging instrument and various therapeutic apparatus. This article, from these two aspects, discusses the status and progress of interventional treatment of liver cancer.
Transcatheter arterial chemoembolization (TACE) is a minimally invasive procedure to restrict a tumor's blood supply, and TACE has an established role in cancer therapy. An embolic material in the form of microspheres (such as drug-eluting beads) and transarterial radioembolization is effective at treating hepatocellular carcinoma (HCC). Endovascular therapy offers promise for the treatment of tumor thrombi in the portal vein. Many researchers are anticipating an era of TACE with microspheres. This review aims to provide an overview of advances in endovascular therapy to treat primary HCC.
Hepatocellular carcinoma (HCC) is a common cancer with high incidence and mortality worldwide. The main treatments for HCC include radical hepatectomy, liver transplant, locoregional therapies, and systemic therapies. Systemic treatments include targeted agent treatment, chemotherapies, antiviral therapies, and nutritional treatments. According to the results of SHARP and ORIENTAL study, sorafenib became the standard first-line therapy since 2008 because of nearly three months of survival improvement in patients with advanced HCC. Subsequent studies on targeted agents found that neither sunitinib nor brivanib were superior to sorafenib as first-line therapy. After progression or intolerance of sorafenib, brivanib did not improve the overall survival (OS) compared with placebo as second-line therapy. Randomized controlled EACH study and retrospective AGEO study for systemic chemotherapy showed that oxaliplatin-based or gemcitabine-based regimen was effective for advanced HCC patients. Randomized controlled trial for adjuvant chemotherapy in China showed that capecitabine could reduce the risk of recurrence and improve postoperative survival of HCC. Comparing sorafenib with other treatments, several retrospective studies found that other treatments were not inferior to sorafenib in terms of OS. In the systemic treatment of HCC, antiviral treatment can decrease the recurrence of HBV-related HCC postoperation and prolong the survival of patients. Based on the etiology, symptoms, complications, and treatment-related side effects, nutritional treatment is also very important for HCC patients. Systemic chemotherapy, newer targeted agents, and immune therapy are the new directions in future research.
Hepatocellular carcinoma (HCC) is the most common type of hepatic malignancies, with poor prognosis. Treatment for HCC are limited, especially for patients with advanced disease who are not eligible for curative hepatectomy or hepatic transplantation. Mechanisms of immune response during tumor development have been investigated for decades. The efficacy and safety of immunotherapy have also been tested in clinical treatment of malignancies. Here we reviewed the immunotherapy strategies for HCC, as well as the particularity of liver immune system and the immune tolerance of HCC. Vaccines, adaptive therapy, immune checkpoint blockades and cytokines are included. We hope this review will give us an integral concept on HCC immunotherapy and help the readers to understand the mechanism of immune tolerance in liver cancer.
Hepatocellular carcinoma (HCC) is the most common malignancy in the world and the most common cause of cancer-related death. Surgical resection is the standard of care for solitary liverconfined HCC and provides the best long-term survival, however, most HCCs are diagnosed at an intermediate to advanced stage, and few meaningful therapeutic options are available at this point. Stereotactic body radiation therapy (SBRT) is a type of external beam radiation therapy (EBRT) that delivers radiotherapy (RT) accurately and precisely to the tumor, more so than conventionally fractionated RT. Several series report high rates of local control and low incidence of complications in SBRT for inoperable HCC. Herein, we discuss the emerging role of SBRT as well as current indications, implementation, efficacy and toxicities after SBRT. It was noted that SBRT was a safe and effective therapeutic option for HCC lesions unsuitable for standard locoregional therapies, with acceptable local control rates and low treatment-related toxicity. The significant correlation between local control (LC) and higher doses and between LC and overall survival (OS) supports the clinical value of SBRT in these patients.