Chronic inflammation induced by viral infections and their role in carcinogenesis is well recognized. Two hepatotropic viruses, hepatitis B and hepatitis C (HCV), have been linked worldwide to the development of hepatocellular carcinoma (HCC). Although orthotopic liver transplant offers the best chance for cure and long-term survival, the demand for organs far outweighs the supply. The incidence of HCC in the United States has increased over the past 3 decades. HCV-induced cirrhosis is believed to play a significant role in the rising rate of HCC. Therefore, primary measures to prevent HCC in HCV-infected patients are urgently needed. Numerous studies of the HCV HCC patient have considered primary treatment with interferon-based therapy. However, secondary prevention currently seems to carry more promise. This article evaluates and assesses various treatments for primary and secondary chemoprevention in the setting of HCV.
Meena A. Prasad and Laura M. Kulik
Orthotopic liver transplantation (OLT) offers the best chance for cure in the setting of unresectable hepatocellular carcinoma (HCC). A consensus statement recommends locoregional therapy (LRT) be considered in patients with HCC who are expected to wait more than 6 months for OLT to diminish dropout from the waiting list because of tumor progression. This article reviews LRT as a bridge to OLT in patients with HCC.