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Journal of the Korean Liver Cancer Study Group 2009;9(1):13-16.
Published online June 30, 2009.
Should We Treat Patients with Massive Hepatocellular Carcinoma? Cons
Han Chu Lee
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul
Correspondence:  Han Chu Lee,
Email: hch@amc.seoul.kr
Abstract
Massive hepatocellular carcinoma (HCC) is defined as a tumor(s) involving 1 segment or more, with indistinct boundary in ≥50% of margins. There have been only few studies regarding the treatment response in patients with massive HCC. Therefore, in this review, the author focused on the treatment response in HCC of ≥10 cm in size. Reported survival rates after surgical resection are 61~66% at 1 year, 38~44% at 3 years, and 28~31% at 5 years. However, surgical resection is usually performed in patients with solitary tumor and good hepatic reserve function, and without gross vascular invasion. In addition, it was reported that surgical complication rate or mortality increases in tumors of ≥10 cm. Therefore, these data do not represent the outcome after surgical resection in patients with massive HCC. Transarterial chemoembolization (TACE) can induce objective response in about 65% of patients with HCC(s) of ≥10 cm according to modified EASL criteria. However, frequent intra- and extra-hepatic metastases are unavoidable and the survival rate was 43% at 1 year and 20% at 2 years. Of note, 11% of cases suffered from serious adverse effects such as renal impairment, sepsis and/or hepatic failure after TACE. Recently, sorafenib has been shown to increase patient’s survival, but the survival benefit is not still satisfactory. Other systemic chemotherapies using various combinations of cytotoxic agents usually show 10-20% of objective response, but there has been no evidence that it can prolong overall patient’s survival. There also has been no evidence that intra-arterial chemotherapy with or without implantable drug delivery system is superior to conventional chemotherapy or can prolong patient’s survival. In summary, treatment response in large HCC(s) is not still satisfactory and treatment-related adverse effects are considerable. Therefore, treatment should be performed in well-selected patients.
Key Words: Carcinoma/Hepatocellular; Treatment Outcome
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