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AIM:To report a single Australian oncology unit's experience with the management of patients with hepatocellular carcinoma (HCC), in the context of a literature review of the current management issues.METHODS:Retrospective case record review of 76 patients with diagnosis of HCC referred to the unit between 1984 and 1995.RESULTS:Sixty three patients had adequate records for analysis. Thirty six (56%) were migrants with half from Southeast Asia. Twenty-four patients had a documented viral aetiology.Nine (14%) of 51 patients with pathological confirmation of HCC had normal alpha fetoprotein levels. Median survival of the 20 patients managed palliatively was 5 weeks compared to 16 weeks for the cohort overall. Surgery in 16 patients rendered all initially disease free with a median survival of 88 weeks. Chemoembolisation induced tumor responses in 5 of the 11 patients so treated. Systemic chemotherapy and tamoxifen treatment caused tumor response in two of 12 and one of 25 respectively.CONCLUSION:Prolonged survival of patients with HCC depends on early detection of small tumors suitable for surgical resection. Other active treatments are palliative in intent and have limited success.In addition to tumor response and survival duration, the toxicities of therapies and the overall quality of life of patients need to be considered as important outcomes. Viral hepatitis prevention and screening of individuals at risk are strategies that are important for HCC management in communities where the disease is endemic.
Desmond Yip (Fri,) studied this question.