title: Novel implications in the treatment of hepatocellular carcinoma.
abstract: Worldwide hepatocellular carcinoma remains one of the leading causes of cancer-related death, associated with a poor prognosis due to late diagnosis in the majority of cases. Physicians at care are frequently confronted with patients who are ineligible for curative treatment such as liver resection, transplantation or radiofrequency ablation. Besides established palliative locoregional therapies, such as ablation or chemoembolization, new treatment options, such as microwave ablation, drug-eluting bead transarterial chemoembolization or selective internal radiation therapy, are emerging; however, data from randomized controlled trials are still lacking. In order to achieve optimal tumor control, patients should receive tailored treatment concepts, considering their tumor burden, liver function and performance status, instead of strictly assigning patients to treatment modalities following algorithms that may be partly very restrictive. Palliative locoregional pretreatment might facilitate downstaging to ensure later curative resection or transplantation. In addition, the combined utilization of different locoregional treatment options or systemic co-treatment has been the subject of several trials. In cases where local tumor control cannot be achieved, or in the scenario of extrahepatic spread, sorafenib remains the only approved systemic therapy option. Alternative targeted therapies, such as immune checkpoint inhibitors have shown encouraging preliminary results, while data from phase III studies are pending.
authors.affiliation: Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken).
authors.forename: Jan
authors.initials: J
authors.lastname: Best
authors.affiliation: Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken).
authors.forename: Clemens
authors.initials: C
authors.lastname: Schotten
authors.affiliation: Departments of Diagnostic and Interventional Radiology and Neuroradiology (Jens M. Theysohn, Axel Wetter).
authors.forename: Jens M
authors.initials: JM
authors.lastname: Theysohn
authors.affiliation: Departments of Diagnostic and Interventional Radiology and Neuroradiology (Jens M. Theysohn, Axel Wetter).
authors.forename: Axel
authors.initials: A
authors.lastname: Wetter
authors.affiliation: Departments of Nuclear Medicine (Stefan Müller).
authors.forename: Stefan
authors.initials: S
authors.lastname: Müller
authors.affiliation: Departments of Transplant and General Surgery (Sonia Radünz, Maren Schulze), University Hospital Essen, Essen, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Radünz
authors.affiliation: Departments of Transplant and General Surgery (Sonia Radünz, Maren Schulze), University Hospital Essen, Essen, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Schulze
authors.affiliation: Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken).
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
authors.affiliation: Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken).
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.affiliation: Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken).
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
keywords: Hepatocellular carcinoma; individualized treatment concept; liver surgery; locoregional therapy; systemic therapy