title: New considerations for an overall approach to treat hepatocellular carcinoma in cirrhotic patients.
abstract: BACKGROUND
  Increasing numbers of cases and organ shortage justify reconsidering the global therapeutic approach for hepatocelluar carcinoma in cirrhotic patients.
  
  
  METHODS
  Recent literature was reviewed, focused on new therapeutic technologies such as radiofrequency.
  
  
  RESULTS
  For small tumors, liver transplantation offers theoretically the best chance for cure. However, organ shortage may eliminate this advantage, because of tumor progression while waiting for a graft. For small tumors, arising on compensated cirrhosis, resection or radiofrequency ablation may provide efficient local tumor control without precluding subsequent transplantation in case of tumor recurrence and/or cirrhosis decompensation.
  
  
  CONCLUSIONS
  For small tumors and compensated cirrhosis, resection or radiofrequency could represent acceptable first line treatments. In addition to permit safe and immediate tumor control, this strategy would allow a preferential redistribution of grafts to patients with decompensated cirrhosis in whom transplantation is the only possibility.
authors.affiliation: Medicosurgical Department of Hepatogastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. vdonckie@ulb.ac.be
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Van Laethem
authors.forename: Daniel
authors.initials: D
authors.lastname: Van Gansbeke
authors.forename: Brigitte
authors.initials: B
authors.lastname: Ickx
authors.forename: Pierre
authors.initials: P
authors.lastname: Lingier
authors.forename: Jean
authors.initials: J
authors.lastname: Closset
authors.forename: Issam
authors.initials: I
authors.lastname: El Nakadi
authors.forename: Pascale
authors.initials: P
authors.lastname: Feron
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boon
authors.forename: Nadine
authors.initials: N
authors.lastname: Bourgeois
authors.forename: Michael
authors.initials: M
authors.lastname: Adler
authors.forename: Michel
authors.initials: M
authors.lastname: Gelin
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006525:Hepatitis, Viral, Human / Q000517:prevention & control; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D010166:Palliative Care