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Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum

Burroughs, A; Hochhauser, D; Meyer, T; (2004) Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum. LANCET ONCOL , 5 (7) 409 - 418.

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Abstract

Hepatocellular carcinoma is the fifth most common malignant disorder and causes nearly 1 million deaths a year worldwide. A background of cirrhosis is the major risk factor, and in Asia and subSaharan Africa, cirrhosis is attributable mainly to endemic hepatitis B infection. In Europe and the USA the incidence of hepatocellular carcinoma is increasing as a result of the high prevalence of hepatitis C. The only curative treatments are surgical resection or liver transplantation, but only a few patients are eligible for these procedures. Local ablative treatments such as ethanol injection can lengthen survival in selected patients, and radiofrequency ablation also shows promise. Unfortunately, most patients are suitable only for palliative treatment because of the extent of their tumour or background liver disease or both. For these patients, a wide range of therapeutic interventions have been assessed, including transarterial embolisation (with or without chemotherapy), hormone therapy with antioestrogens and androgens, octreotide, interferon, and both arterial and systemic chemotherapy, of which only chemoembolisation improves survival over symptomatic care. Tamoxifen is ineffective, and there are insufficient randomised data to show the benefit of any other intervention. In this review, we focus on two ends of the therapeutic spectrum-transplantation, which is highly effective but applicable to only a few patients, and systemic chemotherapy, which is of uncertain benefit but widely applicable.

Type: Article
Title: Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum
Keywords: RANDOMIZED CONTROLLED-TRIAL, LIVING-DONOR, SURGICAL RESECTION, PROGNOSTIC FACTORS, ADJUVANT THERAPY, WAITING-LIST, PHASE-II, COMBINATION CHEMOTHERAPY, COST-EFFECTIVENESS, DECISION-ANALYSIS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Oncology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: http://discovery.ucl.ac.uk/id/eprint/7003
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