DIFFERENT MODALITIES IN MANAGEMENT OF HEPATOCELLULAR CARCINOMA

Abstract

Background:Historically, the diagnosis of HCC was almost always made when the disease was
advanced, when patients were symptomatic and presented with a variable degree of liver function
impairment (1).Today, many patients are diagnosed at an early stage when liver function is preserved
and there are no cancer related symptoms. In addition, there are several active treatments available that
will potentially have a positive impact on survival. However, to achieve the best outcomes requires the
careful selection of candidates for each treatment option and the expert application of these
treatments(2).
Methods:Thisprospectivestudy was conducted upon fifty patients with hepatocellular carcinoma
treated from March 2008 to May 2010 with exclusion of patients with extra-hepatic metastasis in
Zagazig University hospitals, AL-Azhar University hospitals and International Medical Center
(IMC).Our fifty patients were divided into two groups: Group A (Surgical Management) (30 patients
60%), Subdivided into (Subgroup 1)where Hepatic Resection was done in 15 patients (30%) and
(Subgroup 2)whereLiving Donor Liver Transplantation was done in 15 patients (30%). and Group B
(Non Surgical Management) (20 patients 40%), Subdivided into (Subgroup 3)where Radio Frequency
Ablation (RFA) was done in 10 patients (20%) and (Subgroup 4)whereTrans-Arterial Chemo-
Embolization (TACE) was done in 10 patients (20%).
Results:Regarding Liver Resection; Right hepatectomy was done for 9 patients (60%) left
hepatectomy for 2 patients (13.3%), atypical (localized) resection for 4 patients (26.6%). Regarding
LDLT Right lobe graft was done in all 15 patients. The mean time stay in ICU was 7.4 (5-10 days).
The hospitalization stay period was 20.7 (17-30 days). Regarding RFAof the 10 treated patients, 20
HCC nodules were treated in 20 sessions. 2 patients were with a single session and 8 patients with two
sessions. Regarding TACESeventeen sessions were done for these ten patients. 2 sessions were done
in the hepatic artery proper for patients suffering from bilateral hepatic lesions, 10 sessions in the right
hepatic artery and 5 sessions in the left hepatic artery for right sided & left sided hepatic tumors
respectively. Seven patients had taken two sessions. While three patients received only one session.
Conclusion: Liver Resection still plays a key role in the treatment of patients with HCC and a good
functional hepatic reserve, after accurate selection on the basis of strict criteria. Liver Transplantation
is the only treatment left for many patients with end-stage liver disease which fulfill Milan Criteria.