International Journal of Hematology and Oncology 2020, Vol 30, Num 2 Page(s): 248-253
Management of Hepatocelluler Carcinoma

Yeşim YILDIRIM1, Özgür ÖZYILKAN1, Hamdi KARAKAYALI2, Mehmet HABERAL2

1Başkent Üniversitesi, Tıp Fakültesi, Tıbbi Onkoloji Bilim Dalı, ANKARA
2Başkent Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anailim Dalı, ANKARA

Keywords: Hepatocelluler carcinoma, Treatment
Hepatocelluler carcinoma is common especially in Asia and Far East where the incidence of viral hepatitis is very high. Treatment of HCC includes the treatment of underlying chronic liver disease caused by viral hepatitis and the tumor itself. Although, surgical resection is the curative treatment procedure for the disease, presence of cirrhosis hinders the resection at about 90% of patients. Besides, owing to diffuse and multiple lesions, most of the patients are not suitable for the curative resection. Liver transplantation can cure both the underlying chronic liver disease and the HCC. Liver transplantation are performed according to expanded criteria and successful results have been obtained at our center.

Local and ablative treatments are put on to the agenda in patients whom are not suitable for surgical intervention. Transarterial chemoembolisation (TACE), percutaneous alcohol injections (PAI) and radiofrequency ablation (RF) are the most common procedures that are effective in small solitary lesions.

Systemic chemotherapies are used in the case of extrahepatic dissemination or in patients with unresectable disease. Cisplatin, doxorubicin, etoposite and 5-flourouracil have been used both as a single agent and in combinations but the response rates are limited between 8 to 18%. In this group of patients although the higher response rate was achieved with the combination of cisplatin, interferon-α-2b, doxorubicin and 5-flourouracil (PIAF), no survival advantage was obtained when compared with doxorubicin. This combination has not been accepted as a standard because of its severe morbidity. Recently sorefenib, a Raf kinase intibitor, was shown to be effective in HCC. Owing to survival advantage in a phase III trial when comparing to placebo, sorefenib seems to be proming agent in HCC.