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Review
. 2022 Dec 5;14(23):5997.
doi: 10.3390/cancers14235997.

Selecting the Best Approach for the Treatment of Multiple Non-Metastatic Hepatocellular Carcinoma

Gianluca Cassese  1   2 , Ho-Seong Han  1 , Jai Young Cho  1 , Hae-Won Lee  1 , Boram Lee  1 , Roberto Ivan Troisi  2
Affiliations
Review

Selecting the Best Approach for the Treatment of Multiple Non-Metastatic Hepatocellular Carcinoma

Gianluca Cassese et al. Cancers (Basel). .

Abstract

According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the optimal strategy for patients with multiple HCC within the Milan Criteria is liver transplantation (LT). However, LT cannot be offered to all the patients due to organ shortages and long waiting lists, as well as because of the advanced disease carrying a high risk of poor outcomes. For early stages, liver resection (LR) or thermal ablation (TA) can be proposed, while trans-arterial chemoembolization (TACE) still remains the treatment of choice for intermediate stages (BCLC-B). Asian guidelines and the National Comprehensive Cancer Network suggest LR for resectable multinodular HCCs, even beyond Milan criteria. In this scenario, a growing body of evidence shows better outcomes after surgical resection when compared with TACE. Trans-arterial radioembolization (TARE) and stereotaxic body radiation therapy (SBRT) can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) specifically for patients with multiple HCC is still not clear. This review aims to summarize current knowledge about the best therapeutical strategy for multiple HCC while focusing on the role of minimally invasive surgery and on the most attractive future perspectives.

Keywords: laparoscopic liver resection; multinodular hepatocellular carcinoma; multiple hepatocellular carcinoma; radiotherapy; thermal ablations; transarterial chemo-embolization.

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Conflict of interest statement

Han H.-S. and Cassese G. serve as guest editors for the special issue “selecting the best approach for single and multiple liver tumors”.

Figures

Figure 1
Figure 1
Proposed treatment algorithm for multiple non-metastatic HCC. + All patients need to be evaluated and discussed in a multidisciplinary team approach, and treatment must be tailored to every specific case. * Laparoscopic approaches should be preferred in centers with adequate expertise and in cirrhotic patients. FLR: future liver remnant; SBRT: stereotactic body radiation therapy; TARE: trans-arterial radio-embolization; TACE: trans-arterial chemo-embolization; HCC: hepatocellular carcinoma.
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References

    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71:209–249. doi: 10.3322/caac.21660. - DOI - PubMed
    1. Llovet J.M., Kelley R.K., Villanueva A., Singal A.G., Pikarsky E., Roayaie S., Lencioni R., Koike K., Zucman-Rossi J., Finn R.S. Hepatocellular carcinoma. Nat. Rev. Dis. Primer. 2021;7:6. doi: 10.1038/s41572-020-00240-3. - DOI - PubMed
    1. Graf D., Vallböhmer D., Knoefel W.T., Kröpil P., Antoch G., Sagir A., Häussinger D. Multimodal treatment of hepatocellular carcinoma. Eur. J. Intern. Med. 2014;25:430–437. doi: 10.1016/j.ejim.2014.03.001. - DOI - PubMed
    1. Tribillon E., Barbier L., Goumard C., Irtan S., Perdigao-Cotta F., Durand F., Paradis V., Belghiti J., Scatton O., Soubrane O. When Should We Propose Liver Transplant After Resection of Hepatocellular Carcinoma? A Comparison of Salvage and De Principe Strategies. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2016;20:66–76. doi: 10.1007/s11605-015-3018-6. discussion 76. - DOI - PubMed
    1. Heimbach J.K., Kulik L.M., Finn R.S., Sirlin C.B., Abecassis M.M., Roberts L.R., Zhu A.X., Murad M.H., Marrero J.A. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–380. doi: 10.1002/hep.29086. - DOI - PubMed