title: Treatment of intermediate-stage hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC)-closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease-is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, intermediate-stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with intermediate-stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with intermediate-stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed.
authors.affiliation: Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Forner
authors.affiliation: Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Gilabert
authors.affiliation: Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Centre for Biomedical Research Network for Hepatic and Digestive Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruix
authors.affiliation: Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Raoul
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009367:Neoplasm Staging / Q000379:methods; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D000077157:Sorafenib; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D015021:Yttrium Radioisotopes; D009536:Niacinamide; D000077157:Sorafenib
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