Adjuvant Therapy for Hepatocellular Carcinoma after Curative Treatment

Abstract

Hepatocellular carcinoma (HCC) is a common malignancy in the world. Although resection and various locoregional therapies can achieve eradication or complete ablation of small HCC, HCC recurrence after these therapies is still common. Although candidates for medical ablation usually exhibit compensated hepatic functional status, the frequent recurrence of HCC after successful ablation contributes to short survival. Therefore, attempts to prevent HCC recurrence are essential to prolong survival. Efforts in preventing HCC recurrence after curative therapies include prevention of early recurrence by improving liver immunity and eliminating microscopic tumor foci or micrometastases, and prevention of late recurrence by reducing the hepatitis activity and using antiviral therapies based on viral suppression/eradication. In HCC with vascular invasion, adjuvant transcatheter arterial chemoembolization should be considered to provide better control. Whether the adjuvant use of sorafenib may suppress microscopic tumor foci or micrometastases may be unveiled in the near future. This review article will update the algorithms, novel medication or study drugs in the prevention of HCC after curative therapies.

Postoperative adjuvant radiotherapy is associated with improved survival in hepatocellular carcinoma with microvascular invasion

“…Various postoperative adjuvant therapies including TACE, radiotherapy, conservative and molecular targeted therapies are used to decrease HCC recurrence and thus prolong OS. However, the outcomes of these interventions are variable and no adjuvant therapy have been universally accepted as being effective in reducing recurrence after hepatectomy [ 16 – 21 ]. Moreover, studies comparing these adjuvant therapies are rare and only few studies take the MVI into consideration.…”

Diagnostics and Treatment of Hepatocellular Carcinoma in 2016: Standards and Developments

“…However, this approach has not been validated in a randomized fashion yet. Adjuvant treatment after R0 resection is not established [8]. A complication associated with surgical treatment -in addition to the usual risks as- sociated with hepatobiliary procedures -is hepatic decompensation, especially in patients with a low functional hepatic reserve.…”

Hepatocellular carcinoma: resection with adjuvant hepatic artery infusion therapy vs resection alone. A systematic review and meta‐analysis

“…These recurrences have been attributed to residual tumor satellites in the liver and microscopic intravascular tumor thrombi . Thus, an effective local adjuvant therapy that can ablate those residual elements has the potential to prevent recurrence and subsequently improve disease‐free and overall survival . Infusional therapy can be delivered directly via the hepatic artery infusion therapy (HAIT), which constitutes 90%‐100% of tumor blood supply, consequently reaching higher tumor drug concentrations with less systemic toxicity and more localized effect than standard systemic chemotherapy.…”

“…9 Thus, an effective local adjuvant therapy that can ablate those residual elements has the potential to prevent recurrence and subsequently improve disease-free and overall survival. 10 Infusional therapy can be delivered directly via the hepatic artery infusion therapy (HAIT), which constitutes 90%-100% of tumor blood supply, consequently reaching higher tumor drug concentrations with less systemic toxicity and more localized effect than standard systemic chemotherapy. Progress with implantable drug delivery systems has enabled the repeated arterial infusion of chemotherapeutic agents as cisplatin (CDDP), oxaliplatin (OX), 5fluorouracil (5-FU), doxorubicin, epirubicin, and mitomycin-C, used individually or in combination.…”