title: Neoadjuvant therapy for hepatocellular carcinoma: is there an optimal approach?
abstract: Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. The incidence of hepatocellular carcinoma is increasing in the United States and worldwide. Orthotopic liver transplantation (OLT) is a viable and potentially curative option for selected patients with HCC. Locoregional therapy has been used to control HCC before transplantation because of the limited number of donor organs, to prevent tumor progression, and to decrease the incidence of dropouts from the transplant waiting list. Traditionally, multiple investigational locoregional modalities such as tumor resection, radiofrequency ablation, transarterial chemoembolization, and systemic chemotherapy have been used as "bridging" therapies. While the investigation of novel neoadjuvant treatments is justified in an effort to prevent tumor progression, the absence of randomized controlled trials leaves uncertainty about the utility of these maneuvers in improving outcome. This review summarizes the current data on the different modalities used worldwide in the neoadjuvant treatment of hepatocellular carcinoma, the rationale for these approaches, efficacy, potential complications, and future prospects.
authors.affiliation: Gastrointestinal Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Sujith
authors.initials: S
authors.lastname: Kalmadi
authors.forename: Robert
authors.initials: R
authors.lastname: Pelley
authors.forename: Richard
authors.initials: R
authors.lastname: Kim
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000627:therapeutic use; D000431:Ethanol / Q000008:administration & dosage; D006801:Humans; D020360:Neoadjuvant Therapy; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000627:therapeutic use; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000431:Ethanol; D004317:Doxorubicin; D000077157:Sorafenib