Treatment for HCC Often Suboptimal

1
Treatment for HCC Often Suboptimal

• Proportion of patients receiving potentially
  curative therapy
• 34.0 of patients with single lesions
• 34.0 of patients with lesions lt3 cm
• 19.3 of patients with lesions gt10 cm
• 4.9 of patients with metastatic disease
• 11.5 of patients ideal for transplantation
  received it
• 14.3 of patients ideal for surgical resection
  received it

El-Serag HB, et al. J Hepatol. 200644158-166.
2
Surveillance

• Importance of early diagnosis
• Dismal prognosis in patients with large HCCs
• Smaller lesions may be cured (resection,
  transplantation)
• Surveillance
• Repeated application of screening tests in a
  high-risk subject
• Improves survival
• A randomized trial in HBV infected Chinese
  (n18,816)
• 6 monthly US and alpha feto protein versus none
• Reduction in HCC mortality by 37, despite poor
  adherence (lt60)

Zhang J Cancer Res Clin Oncol 2004 417
3
Sample HCC Imaging

• Multiple HCC lesions
• Cirrhosis

• Portal vein thrombosis

4
Guidelines for Hepatitis B

• AASLD Practice Guideline Recommendation for
  Patients with Chronic Hepatitis B
• Cirrhosis regardless of age
• Asian males 40 years
• Asian females 50 years
• HCC in first degree relative (start lt40 years)
• African 20 years
• In practice Individualize!

Bruix Hepatology. 2005421208
5
Percutaneous Ablation
Radiofrequency (RFA) Ethanol Injection
6
Ablation for Early Stage HCC
PEI percutaneous ethanol injection RFAradiofreq
uency ablation Milan Milan criteria for
transplanting HCC
Livraghi T, et al. Radiology 1999210655 Lencioni
R, et al. Radiology 2003228235 Lin SM, et al.
Gastroenterology 20042171714 Shiina S, et al.
Gastroenterology 2005129122
7
RFA for Very Early HCC

• 218 patients with single HCC 2 cm in diameter
• 97 complete response upon a median F/U time of
  31 mo

Livraghi T, et al. Hepatology. 200847429
8
Chemoembolization
9
Transarterial Chemoembolization in HCC

• Median tumor size 5 - 7 cm
• Improves 2 yr survival from 20 to 60

Llovet JM, et al. Hepatology. 2003 Feb37429
10
Improved Survival in the SHARP Trial of Sorafenib
Data from Llovet J, Ricci S, Mazzaferro V.
Sorafenib in advanced hepatocellular carcinoma. N
Engl J Med. 2008359378-390.