title: Nonoperative therapies for combined modality treatment of hepatocellular cancer: expert consensus statement.
abstract: Although surgical resection and liver transplantation are the only treatment modalities that enable prolonged survival in patients with hepatocellular carcinoma (HCC), the majority of HCC patients presents with advanced disease and do not undergo resective or ablative therapy. Transarterial chemoembolization (TACE) is indicated in intermediate/advanced stage unresectable HCC even in the setting of portal vein involvement (excluding main portal vein). Sorafenib has been shown to improve survival of patients with advanced HCC in two controlled randomized trials. Yttrium 90 is a safe microembolization treatment that can be used as an alternative to TACE in patients with advanced liver only disease or in case of portal vein thrombosis. External beam radiation can be helpful to provide local control in selected unresectable HCC. These different treatment modalities may be combined in the treatment strategy of HCC and also used as a bridge to resection or liver transplantation. Patients should undergo formal multidisciplinary evaluation prior to initiating any such treatment in order to individualize the best available options.
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390-8548, USA. Roderich.Schwarz@utsouthwestern.edu
authors.forename: Roderich E
authors.initials: RE
authors.lastname: Schwarz
authors.forename: Ghassan K
authors.initials: GK
authors.lastname: Abou-Alfa
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Alan P
authors.initials: AP
authors.lastname: Venook
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D016031:Liver Transplantation; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives; D018579:Patient Selection; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D011878:Radiotherapy; D000077157:Sorafenib; D016896:Treatment Outcome; D015019:Yttrium / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D019275:Radiopharmaceuticals; D009536:Niacinamide; D015019:Yttrium; D000077157:Sorafenib