Strategy for the treatment of hepatocellular carcinoma

: Hepatocellular carcinoma is a refractory cancer for the following two reasons: the tumor characteristics, including formation of tumor thrombus in the portal vein, metastasis within the liver and multicentricity of growth; and liver function disturbance due to cirrhotic change by B- or C-type viral infection. The most desirable treatment is hepatic resection, the only method producing a disease-free condition. However, there are not many cases that meet the indications for hepatic resection, since they have advanced lesions and/or liver dysfunction. If one cannot perform a hepatic resection, other suitable therapies should be selected, including transcatheter arterial embolization, percutaneous ethanol injection therapy, ligation of hepatic artery, irradiation, chemotherapy from hepatic artery via reservoir and so on. Combined therapy may sometimes be necessary for satisfactory efficacy. For long-term survival it is very important to do a close follow-up study over a long period. This encourages us to detect new lesions earlier and then perform suitable therapy again. Notifying patients of the disease and obtaining informed consent are needed for this long-term follow-up and treatment. When patients were examined who had first undergone hepatic resection and then hepatic re-resection for recurrence, we found that their survival rate was not different from that in the non-recurrent cases. This result indicates that overcoming refractory hepatocellular carcinoma requires a multidisciplinary treatment in which hepatic resection is the main means.