Multidisciplinary management of nonresectable hepatocellular carcinoma.
This article summarizes the consensus of an early morning workshop on the multidisciplinary management of nonresectable hepatocellular carcinoma (HCC) held on July 4, 2010, under the auspices of the 1st Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE) Scientific Advisory Committee. Important points are as follows: (1) nonresectable HCC consists of locally advanced HCC and HCC with extrahepatic spread. The grouping system for locally advanced HCC comprises the following categories: nodular, massive with intrahepatic metastases, diffuse, and disease with vascular invasion. (2) In actual clinical practice, the orchestration of multimodality treatment options is keenly needed for successful treatment of individual patients with nonresectable HCC. Physicians in charge tend to prefer maximal cytoreductive measures as long as the condition of the individual patient allows. (3) There are a few studies on the combined use of radiation therapy and transcatheter arterial chemoembolization or hepatic arterial infusion chemotherapy in the form of phase I and II trials. (4) At this stage, scientific evidence on multidisciplinary management of nonresectable HCC is lacking. Further studies on multidisciplinary management should focus on the subcategory of locally advanced HCC. (5) Further discussion is needed in the upcoming APPLE meeting to clarify the guidelines as well as to determine a practical multidisciplinary approach for nonresectable HCC patients.
Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Hee Chul
HC
Park
Jinsil
J
Seong
Masatoshi
M
Tanaka
Zhao-Chong
ZC
Zeng
Ho Yeong
HY
Lim
Sheng
S
Guan
Si Hyun
SH
Bae
Won Young
WY
Tak
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000627:therapeutic use; D000077157:Sorafenib; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib