New nonsurgical therapies in the treatment of hepatocellular carcinoma

The last decade has seen a rapid increase in the incidence of hepatocellular carcinoma in the United States, mostly because of the increased incidence of hepatitis C. Surgical therapy remains limited to the few patients who are surgical candidates at presentation. In addition, surgery has been plagued by high recurrence rates, which can reach 80% at 3 years. Systemic chemotherapy has been found to be ineffective, with response rates approaching 10% to 20%. Nonsurgical percutaneous therapies, including percutaneous locoregional ablative procedures (ethanol or acetic acid injection, radiofrequency ablation, microwave coagulation therapy, chemotherapy infusion, laser photocoagulation, and high-intensity ultrasound) and intra-arterial procedures (radioembolization with yttrium-90 microspheres or transcatheter intra-arterial chemoembolization) are gaining popularity because they are less invasive than surgery and can be nearly as effective in prolonging survival. Multiple studies have shown good response rates with high technical success rates, as well as significant survival advantages for nonresectable disease. Furthermore, they can be performed repeatedly without compromising liver function and at a considerably lower morbidity and cost than surgery.