New progress of non-surgical treatments for hepatocellular carcinoma

Abstract

Many non-surgical treatments of hepatocellular carcinoma (HCC) have significantly improved in the last few decades and have shown survival benefits for selected patients with HCC. Today ablation can improve survival in individuals diagnosed in early HCC and even offer a curative treatment in selected candidates. Patients with intermediate-stage HCC benefit from transarterial chemoembolization (TACE). Drug-eluting bead transarterial chemoembolization (DEB-TACE) has shown a better combined ischemic and cytotoxic effect locally and less system toxicity when compared with conventional TACE. Those diagnosed at advanced stage benefit from sorafenib. In addition to TACE and sorafenib which could improve survival for selected patients, three-dimensional conformal radiotherapy treatment (3-DCRT), selection internal radiation therapy and systemic chemotherapy have also shown anti-tumor activity in the treatment of advanced HCC, but their survival benefit have not been proven. The limited effects of single therapy suggested that the combination would enhance the overall treatment effect. Other potential non-surgical therapies like gene therapy and immunotherapy are still in testing phases, except for some small-scale clinical trials which have been reported to show some beneficial effect. Here, we review the current non-surgical treatments in HCC and the new advances in this field.

Oleuropein induces apoptosis via activation of caspases and suppression of phosphatidylinositol 3-kinase/protein kinase B pathway in HepG2 human hepatoma cell line

“…However, only 10-20% of patients with HCC are eligible for surgical resection, due to poorly preserved liver function, portal vein invasion or extrahepatic spread. Furthermore, the risk of recurrence following HCC resection is high (3,4). The available chemotherapeutic and radiotherapeutic treatment options for patients with advanced HCC are also extremely limited.…”

Hepatectomy combined with microwave ablation of the spleen for treatment of hepatocellular carcinoma complicated with splenomegaly: A retrospective study

“…To reduce surgical trauma, Cheng et al (6) preferred local treatments for HCC, such as thermal ablation and transcatheter arterial chemoembolization, albeit with certain limitations. Partial splenic embolization in conjunction with percutaneous injection of ethanolamine oleate was also performed (7,8).…”

Tamibarotene: a new hope for therapeutic efficacy in hepatocellular carcinoma patients

“…In the early stage, surgical resection remains the most effective treatment with 40-70 % 5-year survival rates; however, only 10-20 % of the subjects with HCC are eligible for surgical resection because of poorly preserved liver function, portal vein invasion or extrahepatic spread [3].…”

“…In the early stage, surgical resection remains the most effective treatment with 40-70 % 5-year survival rates; however, only 10-20 % of the subjects with HCC are eligible for surgical resection because of poorly preserved liver function, portal vein invasion or extrahepatic spread [3]. TACE is recommended as the first-line treatment for HCC patients with intermediate stage disease and for downstaging tumors that exceed the criteria for transplantation [1].…”

“…It improved the median survival time by *3 months (the median for sorafenib was 10.7 months, while the median for the placebo group was 7.9 months) in patients with advanced HCC [10]. However, there is still a lack of significant treatment efficacy according to the response evaluation criteria in solid tumors (RECIST) [3]. In addition, the application of sorafenib was limited because of severe adverse events, including skin rash, hand-foot skin reactions, diarrhea and hypertension.…”