Advanced hepatocellular carcinoma and sorafenib: Diagnosis, indications, clinical and radiological follow-up

Table 1 Main loco-regional therapies in advanced hepatocellular carcinoma treatment

Loco-regional therapies
TACE is the most common used loco-regional treatment in patients with unresectable HCC, without macrovascular invasion or extrahepatic spreads (BCLC stage B)
The use of TACE in advanced HCC is controversial: some authors affirm its better efficacy in term of survival benefit, than the best supportive care in HCC with extrahepatic spreads and macrovascular invasion. Some other ones recommend to be careful and suggest its use only in selected patients with Child A cirrhosis and segmental portal vein thrombosis
TACE can be a valid alternative for advanced HCC patients who are not compliant with oral therapies or have severe side effects or could not have access to sorafenib because of health authorities or high cost
In advanced HCC, TARE shows survival rates similar to sorafenib and TACE, especially in patients with portal vein thrombosis
TARE contraindication: important arterial shunt to gastrointestinal tract or lung, any contraindication to catheterization

TACE: Trans-arterial chemo-embolization; TARE: Trans-arterial Radio Embolization; HCC: Hepatocellular carcinoma; BCLC: Barcelona clinic liver cancer.