title: Management strategies for hepatocellular carcinoma: old certainties and new realities.
abstract: Hepatocellular carcinoma (HCC) is a highly prevalent disease ranking among the ten most common cancers worldwide with increasing trend of incidence in most developed countries. The great healthcare costs and economic burden of HCC dictate proper preventive interventions as well as surveillance and screening programs to decrease disease incidence and allow early diagnosis. HCC treatment outcomes are affected by several variables, including liver function, patient's performance status, and tumor stage. In line with the Barcelona Clinic Liver Cancer (BCLC) staging curative treatments, such as surgery or radio-frequency ablation, are indicated in early-stage HCC (BCLC-A), and the noncurative treatments are indicated in intermediate and advanced stages of HCC (BCLC-B, C). Transarterial chemoembolization (TACE) represents the treatment of choice for intermediate-stage HCC with Child-Pugh A cirrhosis, and the long-term survival after liver transplantation is inferior to that of early-stage HCCs. In advanced-stage HCC or when complete necrosis is not achieved or early recurrence after TACE develops, individualized treatments such as systemic treatment or combined radiation therapy are indicated. The increasing knowledge of the genomic landscape of HCC and the development of molecular-targeted therapies is heading toward expanding the armamentarium for HCC management.
authors.affiliation: Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy. g.mazzoccoli@operapadrepio.it.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Mazzoccoli
authors.affiliation: Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.|Inter-company Department for Continuity Assistance, School of Medicine, University of Florence, Florence, Italy.|San Giuseppe Hospital, Empoli, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tarquini
authors.affiliation: Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.|Inter-company Department for Continuity Assistance, School of Medicine, University of Florence, Florence, Italy.|San Giuseppe Hospital, Empoli, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Valoriani
authors.affiliation: University College London (UCL) - Institute for Liver and Digestive Health, Division of Medicine, Royal Free Hospital, London, UK.
authors.forename: Jude
authors.initials: J
authors.lastname: Oben
authors.affiliation: University College London (UCL) - Institute for Liver and Digestive Health, Division of Medicine, Royal Free Hospital, London, UK.|Istituto EuroMEditerraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy.|School of Science and Technology, Nottingham Trent University, Nottingham, UK.
authors.forename: Manlio
authors.initials: M
authors.lastname: Vinciguerra
authors.affiliation: Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
mesh_terms: D055011:Ablation Techniques; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D014943:Global Health; D006801:Humans; D015994:Incidence; D013514:Surgical Procedures, Operative
keywords: Cancer; Hepatocellular; Therapy