Hepatocellular Carcinoma: Review of Current Treatment with a Focus on Transarterial Chemoembolization and Radiofrequency Ablation

Abstract

Hepatocellular carcinoma (HCC) is one of the most deadly tumors and its incidence has been rising worldwide. In its various stages, several modalities of treatment and therapies have been developed. Appropriate HCC treatment needs to consider the tumor stage, underlying liver disease and patient's performance levels. Liver transplantation is an effective treatment but unreliable due to scarcity of donors, whereas surgical resection possesses the potential to achieve long-term survival. However, most tumors are not resectable due to their size, location, number and the function of the liver being compromised. Thus, resection is the first choice treatment for resectable tumors only. This prompts the rise of transarterial chemoembolization (TACE) for unresectable HCC. Progressively, radiofrequency ablation (RFA) arose though it exhibits high postoperative recurrence and cancer mortality. Notably, identifying the best-suited treatment is critical in enabling maximum long-term survival. Though HCC is an identified chemoresistant tumor, chemotherapies have been developed for advanced HCC. Among them, sorafenib, blocks tumor cell proliferation thus improving patient survival, even though costly. In comparison to RFA, TACE has been identified to have more complications and symptoms. However, it demonstrates improved survival benefits and quality of patient care more than symptomatic supportive care. Furthermore, for unresectable HCC, TACE can replace the costly and modestly effective sorafenib treatment; whereas RFA is potentially curative in treating HCC and an alternative to liver transplantation or surgical resection in the early HCC stages. It treats primary and secondary liver tumor in the very early N. Chhaniwal et al. 51 stage HCC. Its reliance on image guidance is minimally invasive and enhances its efficacy and safety, especially where surgery will not have been possible. However, skin burns, hemorrhage, hepatic abscess and pleural effusion are complications that accompany RFA prompting the need for additional treatment.

Multifunctional Shell–Core Nanoparticles for Treatment of Multidrug Resistance Hepatocellular Carcinoma

“…Hepatocellular carcinoma is one of the deadly tumors worldwide, which depends on the tumor stage and patient performance status . In the past few years, the most important treatment for middle‐late stage hepatocellular carcinoma is chemotherapy . However, multidrug resistance (MDR) to chemotherapeutic agents in hepatocellular carcinoma has become the main obstruction against the efficacy of chemotherapeutic treatment .…”