New considerations for an overall approach to treat hepatocellular carcinoma in cirrhotic patients.
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.
Donckier
Vincent
V
Medicosurgical Department of Hepatogastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. vdonckie@ulb.ac.be
Van Laethem
Jean Luc
JL
Van Gansbeke
Daniel
D
Ickx
Brigitte
B
Lingier
Pierre
P
Closset
Jean
J
El Nakadi
Issam
I
Feron
Pascale
P
Boon
Nathalie
N
Bourgeois
Nadine
N
Adler
Michael
M
Gelin
Michel
M
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