What are the treatment protocols for unresectable hepatocellular carcinoma (HCC) limited to the liver?

Updated: Jun 05, 2020
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Treatment regimens for patients with limited disease confined to the liver, limited to no macrovascular invasion, and no metastatic disease, are as follows:

  • For patients with unresectable disease, liver transplantation should be offered to those who are surgical candidates and meet United Network for Organ Sharing (UNOS) criteria (ie, a single tumor ≤ 5 cm in diameter or 2-3 tumors, each ≤ 3 cm in diameter; no evidence of major vascular involvement and no extrahepatic disease) [3]
  • For patients with unresectable disease who are not surgical candidates because of their performance status, comorbidities, and failure to meet UNOS criteria, National Comprehensive Cancer Network (NCCN) guidelines recommend offering locoregional therapies before initiating systemic treatment.

  • Locoreginal therapies comprise ablation, arterially directed therapies, and radiation therapy, [2]

  • Ablative procedures include radiofrequency, cryoablation, percutaneous alcohol injection, and microwave/thermal ablation. Tumor size and location is the limiting factor in offering this approach.

  • Arterially directed therapies include bland transarterial embolization (TAE), transarterial chemoembolization (TACE), TACE with drug-eluting beads (DEB-TACE), and radioembolization (RE) with yttrium-90 microspheres. Elevated bilirubin level > 3 mg/dL is a relative contraindication to this approach.

  • Radiation therapies include intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and external-body radiation therapy (EBRT). This therapy can be offered both for treatment and palliation. 

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