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Staging and Current Treatment of Hepatocellular Carcinoma¹

¹ From the Departments of Radiology (H.P.C., W.F.C., P.V.K., R.J.Z.), Internal Medicine (C.P.H.H.), and Surgery (P.S.), Wake Forest University School of Medicine, Meads Hall, 2nd Floor, Medical Center Blvd, Winston-Salem, NC 27157-1088. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received February 8, 2005; revision requested March 29 and received May 24; accepted May 31. The article discusses an investigational or unlabeled use of a commercial device or pharmaceutical that has not been approved for such purpose by the FDA. TheraSphere® (MDS Nordion, Ottawa, Ontario, Canada) has received humanitarian device exemption approval from the U.S. FDA for treatment of unresectable hepatocellular carcinoma and can be used only in an investigational capacity. SIR-Spheres® (Sirtex Medical, Lake Forest, Ill) has received premarket approval from the FDA for use in combination with hepatic arterial fluorouracil therapy to treat colorectal metastasis to the liver; its use for treatment of primary hepatic neoplastic disease is an off-label application. Likewise, intraarterial administration of cisplatin, doxorubicin, and mitomycin C for treatment of hepatocellular carcinoma constitutes off-label use of these pharmacologic products. All authors have no financial relationships to disclose. Address correspondence to H.P.C. (e-mail: hclark{at}wfubmc.edu).

Early-stage hepatocellular carcinoma (HCC) is typically clinically silent, and HCC is often advanced at first manifestation. Without treatment, the 5-year survival rate is less than 5%. The selected treatment depends on the presence of comorbidity; tumor size, location, and morphology; and the presence of metastatic disease. Complete surgical resection followed by hepatic transplantation offers the best long-term survival, but few patients are eligible for this therapy. All other therapies are palliative. Radiofrequency ablation is the preferred method for managing unresectable small HCCs that are few in number. More widespread disease is treated with percutaneous therapies such as chemoembolization and selective internal radiation therapy. Systemic administration of biologic and chemotherapeutic agents is minimally successful in slowing the growth of HCC and typically is used to control symptoms in patients with overwhelming disease. A multidisciplinary approach that includes surgery, systemic therapy, and radiation therapy and that is based on the cooperation of radiation oncologists, interventional and diagnostic radiologists, hepatologists, and pathologists may offer the best chance of a cure or at least a longer and more normal life. To participate effectively in this effort, radiologists must be familiar with staging and treatment options for HCC and with the factors that affect the choice of management method.

© RSNA, 2005

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