Multimodal approach to the treatment of hepatocellular carcinoma

Background. Hepatocellular carcinoma (HCC) is a malignancy of the liver associated with poor prognosis. The understanding of the prevalence of liver damage and functional status of the liver can complicate therapy in these patients and often requires non-standard treatment approach. In this context, the study of the results of radical liver resection, locoregional and systemic therapy for HCC remains of current interest. Materials and methods. We analyzed the experience in the treatment of HCC in 70 patients, who were treated between 1991 and 2015. We studied the main demographic characteristics, local prevalence and liver status at the beginning of therapy, the application of therapeutic methods, intraoperative data, postmanipulation complications, overall and recurrence-free survival. The paper presents the following treatment options: liver resection (n=27), transarterial chemoembolization - TACE (n=16), radiofrequency ablation - RFA (n=3) and systemic therapy (n=4), TACE + transplantation (n=6), TACE + resection (n=3), TACE + sorafenib (n=3), resection + sorafenib (n=1), resection + RFA + sorafenib (n=2), transarterial embolization + resection (n=1), resection + RFA (n=1), TACE + resection + sorafenib (n=1), RFA + TACE (n=1), transarterial embolization + sorafenib (n=1). Results. Median overall survival (OS) was 33 months in the liver resection group, 5-year survival rate was 49%, and median recurrence-free survival (RFS) was 9 month, 1-year RFS rate - 40%. Median survival of patients who underwent TACE in mono-regimen (n=16) was 9 months; 1-year survival rate was 44%, the disease relapse after radical treatment, included resection and RFA (n=40) was noted in 25 (59.5%) patients. Median RFS was 9 months in this group. OS was significantly lower in group of patients with relapse of HCC in comparison with the group without recurrences (p=0.004). Conclusions. Although we see recent advances of interventional and drug therapy in patients with HCC, surgical treatment remains a priority. Liver resection allows radically remove malignant lesion and achieve the most satisfactory results, nowadays. The combined approach is a promising direction and the studying of the efficacy of combined treatment protocols and the development of new options will help us to improve the prognosis of treatment of HCC severe categories patients.