Bridging Therapy for HCC

Liver transplantation (LT) for hepatocellular carcinoma (HCC) has evolved from contraindication in the early 1990s to one of the common indications in today’s era. A lot of credit goes to the Milan criteria (1 lesion up to cm, 2–3 lesions up to 3 cm) for setting up this bench mark based on the seminal publication by Mazzaferro et al. nearly two decades ago [1]. LT provides a good 4-year survival rates (actuarial rate 74%) with low recurrence rates (recurrence-free survival rate of 83%) if performed for HCC within these criteria [1]. Liver transplant (LT) has a dual advantage as treatment; it is not only oncologically the best operation but it also cures the underlying cirrhosis. In view of longer wait times (due to shortage of organs) and high dropout rates (tumour progression/death), the practice of bridging (locoregional) therapy is becoming an essential part of HCC treatment. In this chapter we will discuss available evidence on the efficacy of bridging therapy for HCC. We will also discuss the current role of downstaging in the management of HCC. Towards the end we would like to highlight the role of bridging therapy in Indian scenario and also touch upon guidelines from Asian countries.