title: Treating hepatocellular carcinoma without liver transplantation.
abstract: Hepatocellular carcinoma, a significant health problem throughout the world, generally occurs in the setting of cirrhosis. Choice of treatment depends on the size and location of the tumor and hepatic reserve. Liver transplantation provides the best chance for long-term survival and can be performed regardless of hepatic reserve, but it requires small tumor sizes and is available to only a few patients. All other treatments require adequate hepatic reserve. Surgical resection, percutaneous ethanol injection, and radiofrequency ablation are effective treatments for patients with good hepatic reserve and small tumors isolated to the liver. For larger and multinodular tumors, chemoembolization is the best choice. With metastasis, portal vein invasion, or large bilobar disease and intact hepatic function, modest improvements in survival have occurred with the use of sorafenib, a recently approved targeted chemotherapy agent. Patients with poor hepatic function or low performance status should receive only supportive care.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, 3635 Vista @ Grand FDT 9S, St. Louis, MO 63110, USA.
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Gogia
authors.forename: Alex S
authors.initials: AS
authors.lastname: Befeler
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D017410:Practice Guidelines as Topic; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D000077157:Sorafenib
chemical_list: D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib