NON-SURGICAL TREATMENT OF PRIMARY LIVER CANCER

The majority of patients diagnosed with hepatocellular carcinoma are not able to undergo surgical resection either because of the severity of their underlying liver disease, or because the size and number of tumours precludes such an approach. Liver transplantation is also inappropriate for many patients with hepatocellular carcinoma either because of the extent of disease or limitations in access. A range of effective non-surgical treatments is available for patients of hepatocellular carcinoma, so that now an effective therapy is potentially available to all but those with terminal disease. Commonly used local ablative treatments for patients with smaller tumours include radiofrequency ablation and percutaneous alcohol injection. Transarterial chemoembolisation is most suitable for patients with intermediate stage disease, multifocal tumours without vascular invasion and those with large solitary lesions (> 3cm diameter). Recently, targeted systemic therapy with an oral multikinase inhibitor, sorafenib, has shown significant benefit in prolonging survival in patients with advanced hepatocellular carcinoma. Many other targeted drug therapies are in clinical trial development. Combination approaches with radiofrequency ablation and transarterial chemoembolisation, and with radiofrequency ablation or transarterial chemoembolisation with sorafenib or other targeted therapies, are under evaluation. It is critical that patients are staged at presentation with regard to the severity of liver disease, tumour stage and performance status, and that management is undertaken within a multidisciplinary setting to ensure the best outcomes.