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Liver Lesions

Specific Hepatic Lesions

Hepatocellular Carcinoma

The primary treatment for hepatocellular carcinoma is resection, either segmental, or more commonly, by means of a complete hepatectomy and liver transplantation. Resection has curative potential, particularly for patients with localized disease who do not have to wait too long for their donated liver (1, 2, 3). Unfortunately only a minority of HCC patients are candidates for hepatectomy and liver transplantation, and to make matters worse, even those who are eligible may progress to inoperability, while they wait for a donated liver to become available, as the waiting time may exceed a year (2).

To address the potential for tumor progression and mortality caused by delayed transplantation in otherwise operable patients, “bridge” therapies such as radiofrequency ablation or chemoembolization, even though not typically regarded as curative, have been applied as a means to delay tumor progression until hepatectomy and transplantation may occur (11). One series reported that the use of “aggressive bridge therapies” and short time to transplantation were the two factors predictive of increased survival probability for HCC patients ( 12).

In patients where definitive resection is not possible, HCC patients have received palliative benefit and modest life extension from nonsurgical ablative therapies and local radiotherapy (10, 13, 15, 16, 17). High dose radiotherapy has created prolonged responses and some long term disease-free survivals in HCC patients (15, 16, 17), though relapse at the treated site remains common due to the often limited dose of radiation that may be safely applied, leaving room for further improvement.