Evolution of approaches to the treatment of hepatocellular carcinoma

This paper reviews the evolution of approaches to the treatment of hepatocellular carcinoma (HCC). The main treatments for liver cancer are discussed, including surgery, resection, and liver transplantation, as well as a number of non-invasive techniques, such as radiofrequency ablation (RFA) and transarterial chemoembolization. The treatment of HCC is a multidisciplinary and multifaceted task; at the same time, surgical treatment is currently the only method that can potentially cure the patient. Over the past two decades, the treatment of HCC has become remarkably more effective, mainly in the areas of both drug and surgical treatment. Over the past decades, the variety of HCC treatment methods has significantly increased and includes both traditional and minimally invasive surgical interventions, as well as targeted and immunotherapeutic approaches. RFA makes it possible to effectively and reproducibly control local tumors with minimal trauma in small HCC and metastasis, which makes RFA the preferred treatment at the early stages of HCC. Due to the potential of ultraselective chemoembolization for the treatment of small HCC, including hypovascular areas of tumor, this technique may replace surgical resection and RFA in selected HCC patients at the BCLC 0 and A stages. Unpredictable asymptomatic HCC progression at the time of initial diagnosis makes less than 30% of patients candidates for radical treatment. Systemic therapy is supposed to be an effective technique for treating patients with moderately progressive HCC. The complex HCC pathogenesis has inspired researchers to search for various biomolecular target therapies aimed at specific targets. Proper understanding of the molecular HCC mechanism presents a key to finding an effective target therapy. Significant clinical benefits in systemic therapy are observed when target drugs are combined with immunotherapy, while a sequential treatment with multiple drugs provides satisfactory survival in progressive HCC. The choice of treatment tactics should be individualized, taking into account the stage of the disease, the general condition of the patient, and comorbidities. Timely prevention, early diagnosis, comprehensive approach, and availability of new treatment methods remain important aspects

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