Nonpercutaneous therapies of hepatocellular carcinoma.

Treatment of hepatocellular carcinoma depends largely on local resources, the stage of the disease and the presence of cirrhosis, but is limited overall by the lack of efficient chemotherapy. Hepatic resection is the treatment of choice for the few patients with hepatocellular carcinoma and normal liver. Five-year survival without recurrence in patients with a tumor of mean diameter 8 cm was 33%. Liver transplantation is the best chance for cure in patients with cirrhosis and a single small tumor, but its widespread application is limited by a number of obstacles, including cost. Tumor size and number, and liver status were common guidelines for selecting patients. Five-year survival of transplant patients was > 50%, compared to 0% in historical untreated controls. Patients with well-preserved liver function and a small tumor at the periphery could equally benefit from hepatic resection, although cirrhosis entails the risk of morbidity due to portal hypertension and development of de-novo tumors. Another major drawback of hepatic resection is the early spread of tumor cells, facilitating early tumor recurrence after operation. For patients with compensated cirrhosis and a small tumor who were hardly eligible for surgery, transcatheter arterial chemoembolization appeared to be a cost-saving and effective treatment modality. Transcatheter arterial chemoembolization has been largely employed also for the palliative treatment of patients with large tumors, but the benefits on survival are doubtful. Conventional radiotherapy with external irradiation was not effective against hepatocellular carcinoma.