Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

Abstract

Recurrence following curative-intent hepatectomy for colorectal cancer liver metastasis, hepatocellular carcinoma, or cholangiocarcinoma is unfortunately common with a reported incidence as high as 75%. Various treatment modalities can improve survival following disease recurrence. A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage liver transplantation for recurrent hepatocellular carcinoma is another option, which has been associated with a 5-year survival of 50%. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location. For patients with inoperable disease, transarterial chemoembolization, or radioembolization with Yttrium-90 are liver-directed intra-arterial therapy modalities with relatively low risks that can be utilized. Stereotactic body radiation therapy is another palliative treatment option that can provide a response and local tumor control for smaller tumors.

Combining local regional therapy and systemic therapy: Expected changes in the treatment landscape of recurrent hepatocellular carcinoma

“…SLT is considered an effective and curative treatment approach that can simultaneously resolve liver tumors, potential liver dysfunction and the original underlying diseases. For recurrent HCC, as long as patients meet the criteria, the prognosis is relatively high[ 11 , 82 , 83 ]; the 5-year survival rate is 42%-73%[ 84 ]. A systematic retrospective analysis of the prognosis of SLT and RR in the treatment of recurrent HCC showed that patients in the SLT group generally had larger liver lesions but better relapse-free survival (RFS) than those in the RR group and that the OS of the two groups was similar[ 85 ].…”

“…Consequently, the prognosis after treatment varies greatly, but overall, TACE can improve the OS of multifocal tumor patients. A number of studies have shown that the 5-year survival rate after TACE treatment for recurrent HCC is 12-56%[ 70 , 83 , 84 , 87 , 96 ]. A prospective study showed that for patients with early HCC recurrence, the 5-year survival rate after TACE treatment was 27.7%, which is lower than those for RR and RFA.…”

Radiological findings in non-surgical recurrent hepatocellular carcinoma: From locoregional treatments to immunotherapy

“…To date, the available options for RHCC were similar to naïve-HCC options and include LR, OLT, and LRT for patients with liver-only recurrence, TACE, TARE, and stereotactic ablative radiotherapy for patients with unresectable disease, and systemic therapies or enrollment in clinical trials for patients with extrahepatic disease recurrence[ 13 - 15 ].…”

“…To overcome the shortcomings of RFA, MWA has been assessed in the treatment of HCC, as it produces significantly larger areas of necrosis, faster ablation times, higher intratumor temperature, less tumor seeding risk, and less susceptibility to heat-sink effect over RFA[ 15 , 23 ] (Figure 1 ). However, there are few studies about percutaneous MWA performance in RHCC.…”

Study protocol for locoregional precision treatment of hepatocellular carcinoma with transarterial chemoembolisation (TACTida), a clinical study: idarubicin dose selection, tissue response and survival

“…The recommended therapies for intermediate-stage HCC, BCLC stage B, are intra-arterial therapies and stereotactic body radiation therapy 9 and the standard of care is transarterial chemoembolisation (TACE), which has been used worldwide since the 1980. 10 In TACE, a chemotherapeutic drug is delivered through a catheter placed in the liver artery, with or without the addition of an embolising agent ( figure 1 ).…”