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Liver-Directed Therapies for Hepatocellular Carcinoma: Beyond Surgery
Published: Dec 21, 2023
For patients with hepatocellular carcinoma (HCC) who aren't candidates for surgery, several liver-directed therapies offer hope. These treatments target the tumor directly within the liver, often with less impact on the body as a whole.
Ablation Techniques
Ablation therapies destroy tumor cells using heat, cold, or electrical currents. Radiofrequency ablation (RFA) and microwave ablation (MWA) use heat, while cryoablation uses extreme cold. These are typically used for smaller tumors, usually less than 3 cm in size. The procedure is minimally invasive, often done through the skin under imaging guidance.
Embolization Procedures
Embolization cuts off the blood supply to tumors. Transarterial chemoembolization (TACE) combines this with delivering chemotherapy directly to the tumor. Radioembolization uses tiny radioactive beads instead. These treatments can be effective for larger tumors or when there are multiple tumors in the liver. They're often used when ablation isn't possible.
Radiation Therapy Options
External beam radiation therapy (EBRT) and stereotactic body radiation therapy (SBRT) use high-energy rays to kill cancer cells. These can be precisely targeted to the tumor, minimizing damage to surrounding tissue. They're sometimes used for tumors that can't be treated with other local therapies, or in combination with other treatments.
Choosing the Right Therapy
The choice of liver-directed therapy depends on several factors, including tumor size and location, liver function, and overall health. Often, a combination of therapies may be used. It's crucial to have a multidisciplinary team evaluate each case to determine the best approach. Some patients may receive these therapies as a bridge to liver transplantation.
Frequently Asked Questions
Most cause minimal discomfort and are done under local anesthesia.
It varies, but many patients need repeated treatments over time.
They can be curative for small tumors, but often control rather than cure.
Side effects vary by treatment but are generally well-tolerated.
Your healthcare team will evaluate your specific case to determine eligibility.
Expanding Treatment Options
Liver-directed therapies offer valuable options for HCC patients who can't undergo surgery, potentially extending and improving quality of life.
References
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69:182.
- Lencioni R, et al. Locoregional treatment of hepatocellular carcinoma. Hepatology 2021; 73 Suppl 1:186-197.
- Kulik L, et al. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis. Hepatology 2018; 67:381-400.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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