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Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects

Hepatocellular carcinoma (HCC) is usually accompanied by chronic liver damage, which sometimes influences the selection of HCC treatment. The Barcelona Clinic Liver Cancer (BCLC) staging system, which was first introduced in 1999, is the most commonly used worldwide. Although the intermediate-stage...

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Detalles Bibliográficos
Autores principales: Torimura, Takuji, Iwamoto, Hideki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association for the Study of the Liver 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046626/
https://www.ncbi.nlm.nih.gov/pubmed/33317248
http://dx.doi.org/10.3350/cmh.2020.0204
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author Torimura, Takuji
Iwamoto, Hideki
author_facet Torimura, Takuji
Iwamoto, Hideki
author_sort Torimura, Takuji
collection PubMed
description Hepatocellular carcinoma (HCC) is usually accompanied by chronic liver damage, which sometimes influences the selection of HCC treatment. The Barcelona Clinic Liver Cancer (BCLC) staging system, which was first introduced in 1999, is the most commonly used worldwide. Although the intermediate-stage (BCLC stage B) includes the largest number and heterogeneous HCC patients, the recommended treatment option is transarterial chemoembolization (TACE) only. However, recent progress in radical treatments such as hepatic resection, liver transplantation, radiation therapy, and percutaneous therapy has made it possible to treat selected patients with BCLC stage B HCC. Radical treatments are expected to prolong survival time. To-date, TACE has also progressed. In addition to conventional TACE, balloon-occluded TACE and drug-eluting beads TACE are available. These new modalities of TACE will improve therapeutic efficacy and reduce adverse events. One of the most serious concerns of TACE is that repeated TACE reduces the treatment effect and induces liver function impairment. The decision on when TACE should be interrupted is complex. Many molecular targeted agents are now available, and immune checkpoint inhibitors will soon be available for HCC patients with Child-Pugh class A worldwide. Under these circumstances, in patients with TACE unsuitability, switching to molecular targeted agents before deterioration of liver function might improve the prognosis compared to repeated TACE. We should pay attention to stop TACE in TACE-unsuitable HCC patients as it can induce the deterioration of liver function.
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spelling pubmed-80466262021-04-22 Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects Torimura, Takuji Iwamoto, Hideki Clin Mol Hepatol Review Hepatocellular carcinoma (HCC) is usually accompanied by chronic liver damage, which sometimes influences the selection of HCC treatment. The Barcelona Clinic Liver Cancer (BCLC) staging system, which was first introduced in 1999, is the most commonly used worldwide. Although the intermediate-stage (BCLC stage B) includes the largest number and heterogeneous HCC patients, the recommended treatment option is transarterial chemoembolization (TACE) only. However, recent progress in radical treatments such as hepatic resection, liver transplantation, radiation therapy, and percutaneous therapy has made it possible to treat selected patients with BCLC stage B HCC. Radical treatments are expected to prolong survival time. To-date, TACE has also progressed. In addition to conventional TACE, balloon-occluded TACE and drug-eluting beads TACE are available. These new modalities of TACE will improve therapeutic efficacy and reduce adverse events. One of the most serious concerns of TACE is that repeated TACE reduces the treatment effect and induces liver function impairment. The decision on when TACE should be interrupted is complex. Many molecular targeted agents are now available, and immune checkpoint inhibitors will soon be available for HCC patients with Child-Pugh class A worldwide. Under these circumstances, in patients with TACE unsuitability, switching to molecular targeted agents before deterioration of liver function might improve the prognosis compared to repeated TACE. We should pay attention to stop TACE in TACE-unsuitable HCC patients as it can induce the deterioration of liver function. The Korean Association for the Study of the Liver 2021-04 2020-12-03 /pmc/articles/PMC8046626/ /pubmed/33317248 http://dx.doi.org/10.3350/cmh.2020.0204 Text en Copyright © 2021 by The Korean Association for the Study of the Liver https://creativecommons.org/licenses/by-nc/3.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Torimura, Takuji
Iwamoto, Hideki
Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title_full Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title_fullStr Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title_full_unstemmed Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title_short Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects
title_sort optimizing the management of intermediate-stage hepatocellular carcinoma: current trends and prospects
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046626/
https://www.ncbi.nlm.nih.gov/pubmed/33317248
http://dx.doi.org/10.3350/cmh.2020.0204
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