《Advances in managing hepatocellular carcinoma》.pdfVIP

Front．Med．2014，8(2)：175-189 D0I10．1007／sl1684．014。03324 REV|IEW Advancesinmanaginghepat0celIuIarcarcinoma MarielleReataza，DavidK．Imagawa(函) UniversityofCalifornia，lrvineMedicalCenter,Orange,CA92868,USA，2‘DivisionofHepatobiliar)，andPancreasSurgery,Departmentof Surgery,University CaliJbrnia，lrvineMedicalCenter,Orange,CA92868,USA ◎ HigherEducationPressandSpringer-VerlagBerlinHeidelberg2014 Abstract M ultiplemodalitiesfortreatmentofhepat0ceIlularcarcinomaareavailable，dependingontumorsize and number．SurgicaIresection remainsthegold standard．so long astheresidualliverfunction reserve is sumcient．Inpatientswithadvancedcirrhosis，livertransplantati0nisthepreferredoption，asthesepatientsmay nothaveadequatehepaticreserveafterresection．SaIvagelivertransplantatiOnhasalsobecomeanoptionfora selectfew patientswhorecuraftersurgicalresection．Ablativetechniqueshavebeenusedofrpalliationaswellasto eithercompletelydestroythetumor,actasanadiuncttoresection，ordownstagethetumortomeetMilancriteria suchthatapatientmaybeacandidateofrlivertranspIantati0n．Radiofrequencyablation，microwaveablation， chemoembolization，radioembolization，and irreversible electr0p0rati0n have allbeen used in thiscapacity． Currently,sorafenibistheonlyUSFoodandDrugAdministration．approvedchemotherapeuticofrhepat0cenular carcinoma．Thee硒cacy ofsorafenib，in combinationwith otheragents，transarterialchemoembolization，and surgicalresectioniscurrentlybeinginvestigated．Sunitinibandbrivanib．ytrosinekinaseinhibitors，havefafledas potentiaIfirst-orsecond。lineoptionsofrchemotherapy．Bevacizumab in combination with erlotinib isalso currently bein~ studied．Finalanalysisofr ramucirumab and axitinib arepending．Tivantinib，a selective mesenchymai—epithelialtransitionfaetor(MET)inhibitor,isalsoundergoingclinicaltrialsofrefficacyinMET- high tumors．Thisreview serv estoemphasizethecurrentandnew technologiesemergingin thetreatmentof hepatoeellul