Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3826-3842
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3826
Current management of hepatocellular carcinoma: An Eastern perspective
Hyung Joon Yim, Sang Jun Suh, Soon Ho Um
Hyung Joon Yim, Sang Jun Suh, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si 425-707, Gyeonggi-do, South Korea
Soon Ho Um, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Um SH designed the study, outlined the draft, and supervised the overall project; Yim HJ wrote and organized the manuscript; Suh SJ searched reference materials and contributed to the writing of the manuscript.
Supported by Grants from Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, South Korea, No. HI10C2020 (partly); and Korea University Research Grant (partly).
Conflict-of-interest: The authors do not have any conflicts to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Soon Ho Um, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, South Korea.
Telephone: +82-2-9205019 Fax: +82-2-9531943
Received: August 21, 2014
Peer-review started: August 23, 2014
First decision: October 29, 2014
Revised: December 11, 2014
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: April 7, 2015

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death, especially in Eastern areas. With advancements in diagnosis and treatment modalities for HCC, the survival and prognosis of HCC patients are improving. However, treatment patterns are not uniform between areas despite efforts to promote a common protocol. Although many hepatologists in Asian countries may adopt the principles of the Barcelona Clinic Liver Cancer staging system, they are also independently making an effort to expand the indications of each treatment and to combine therapies for better outcomes. Several expanded criteria for liver transplantation in HCC have been developed in Asian countries. Living donor liver transplantation is much more commonly performed in these countries than deceased donor liver transplantation, and it may be preceded by other treatments such as the down-staging of tumors. Local ablation therapies are often combined with transarterial chemoembolization (TACE) and the outcome is comparable to that of surgical resection. The indications of TACE are expanding, and there are new types of transarterial therapies. Although data on drug-eluting beads, TACE, and radioembolization in Asian countries are still relatively sparse compared with Western countries, these methods are gradually gaining popularity because of better tolerability and the possibility of improved response rates. Hepatic arterial infusion chemotherapy and radiotherapy are not included in Western guidelines, but are currently being used actively in several Asian countries. For more advanced HCCs, appropriate combinations of TACE, radiotherapy, and sorafenib can be considered, and emerging data indicate improved outcomes of combination therapies compared with single therapies. To include these paradigm shifts into newer treatment guidelines, more studies may be needed, but they are certainly in progress.

Keywords: Hepatocellular carcinoma, Eastern, Treatment, Guidelines, Combination

Core tip: This article describes the current status of the management of hepatocellular carcinoma, focusing on the changing trends of treatment modalities in Eastern countries. Newly adopted therapies as well as emerging combination strategies are discussed based on recent data.