The current role of neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hepatocellular carcinoma: a systematic review.
BACKGROUND
Following curative treatment for hepatocellular carcinoma (HCC), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any neoadjuvant or adjuvant therapy, which can decrease or delay the incidence of intra-hepatic recurrence, or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant, will improve the results of liver resection. This article systematically reviewed the current evidence of neoadjuvant, adjuvant, and chemoprevention in partial hepatectomy of HCC.


METHODS
Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords "hepatocellular carcinoma", "hepatectomy", "adjuvant therapy", "neoadjuvant therapy", and "regional therapy". Additional papers and book chapters were identified by a manual search of the references from the key articles.


RESULTS
Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy+/- embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with 131I-lipiodol and adjuvant systemic interferon showed promising results. However, there were only a limited number of such studies.


CONCLUSIONS
Further randomized controlled studies need to be carried out. Currently, there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC.
Lau
Wan-Yee
WY
Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. josephlau@cuhk.edu.hk
Lai
Eric C H
EC
Lau
Stephanie H Y
SH
D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D006498:Hepatectomy; D006801:Humans; D007167:Immunotherapy; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D020360:Neoadjuvant Therapy; D016032:Randomized Controlled Trials as Topic
D016588:Anticarcinogenic Agents