Selecting a Treatment Regimen
����Alcohol injection and radiofrequency are equally effective for
tumors < 2 cm. However, the necrotic effect of radiofrequency
ablation (RFA) is more predictable in all tumor sizes, and
in addition its efficacy is clearly superior to that of alcohol
injection in larger tumors (I).
����Transarterial chemoembolization (TACE) is recommended as
first line noncurative therapy for nonsurgical patients with
large or multifocal HCC who do not have vascular invasion or
extrahepatic spread (I).
����Sorafenib is recommended as a first line option in patients
who have preserved liver function but cannot benefit from
resection, transplantation, ablation or TACE (I).
����Radioembolization with Yttrium-90-labeled glass beads
has been shown to induce extensive tumor necrosis with
an acceptable safety profile. However, there are no studies
demonstrating an impact on survival. Hence its value in
the clinical setting has not been established and cannot be
recommended as standard therapy for advanced HCC outside
clinical trials (II).
����Tamoxifen, anti-androgens, octreotide or hepatic artery
ligation/embolization are NOT recommended (I).
����Systemic or selective intraarterial chemotherapy is NOT
recommended and should NOT be used as standard of care (II).
Table 2. FDA-Approved Drug for HCC
Drug (Brand)
Dose
Sorafenib (NEXAVAR )
��
400 mg bid without food
