title: Multimodal treatment of hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) represents the most common liver cancer with an increasing incidence and it accounts for the third most common cause of cancer-related death worldwide. Even though the clinical diagnosis and management of HCC improved significantly in the last decades, this malignant disease is still associated with a poor prognosis. It has to be distinguished between patients with HCCs, which developed from liver cirrhosis, and patients without underlying liver cirrhosis as classification systems, prognosis estimation and therapy recommendations differ in-between. In case of HCC in patients with liver cirrhosis in Europe, treatment allocation and prognosis estimation are mainly based on the Barcelona-Clinic Liver Cancer (BCLC) staging system. Based on this staging system different surgical, interventional radiological/sonographical and non-interventional procedures have been established for the multimodal treatment of HCC. The BCLC classification system represents a decision guidance; however because of its limitations in selected patients treatment allocation should be determined on an individualized rather than a guideline-based medicine by a multidisciplinary board in order to offer the best treatment option for each patient. This review summarizes the current management of HCC and illustrates controversial areas of therapeutic strategies.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, University Düsseldorf, Medical Faculty, Germany. Electronic address: Dirk.Graf@med.uni-duesseldorf.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Graf
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vallböhmer
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Abdurrahaman
authors.initials: A
authors.lastname: Sagir
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D006801:Humans; D006979:Hyperthermia, Induced; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008872:Microwaves; D009367:Neoplasm Staging; D011379:Prognosis
keywords: Hepatocellular carcinoma; Liver transplantation; Radiofrequency ablation; Sorafenib; Transarterial chemoembolization