TITLE:
Hepatocellular Carcinoma: Review of Current Treatment with a Focus on Transarterial Chemoembolization and Radiofrequency Ablation
AUTHORS:
Nikhar Chhaniwal, Cheng Li, Jiaxiang Wang, Guosheng Qiang, Tingyue Qi, Hendi Maher
KEYWORDS:
Hepatocellular Carcinoma, Tumor, Treatment, Transarterial Chemoembolization, Radiofrequency Ablation
JOURNAL NAME:
Open Journal of Radiology,
Vol.5 No.1,
March
26,
2015
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 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.