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Chan et al. Hepatoma Research 2018;4:5                           Hepatoma Research
               DOI: 10.20517/2394-5079.2017.49


               Review                                                                        Open Access


               Treatment of high-burden hepatocellular carcinoma:
               an oncologist perspective

                             1
               Landon L. Chan , Stephen L. Chan 1,2,3,4
               1 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
               2 State Key Laboratory of Oncology in South China, Hong Kong, China.
               3 Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese
               University of Hong Kong, Hong Kong, China.
               4 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.

               Correspondence to: Dr. Stephen L. Chan, Department of Clinical Oncology, Prince of Wales Hospital, Shatin, New Territories, Hong
               Kong, China. E-mail: chanlam_stephen@cuhk.edu.hk

               How to cite this article: Chan LL, Chan SL. Treatment of high-burden hepatocellular carcinoma: an oncologist perspective. Hepatoma
               Res 2018;4:5. http://dx.doi.org/10.20517/2394-5079.2017.49

               Received: 29 Nov 2017    First Decision: 17 Jan 2018    Revised: 22 Jan 2018    Accepted: 22 Jan 2018    Published: 7 Feb 2018
               Science Editor: Guang-Wen Cao    Copy Editor: Jun-Yao Li    Production Editor: Huan-Liang Wu



               Abstract
               Hepatocellular carcinoma (HCC) is recognized as a major global healthcare burden. Although there have been
               tremendous improvements in cancer screening and treatment, HCC mortality rate remains high. Many patients
               with HCC present late to medical attention and thus are not candidates for curative treatment. They typically have
               high tumor burden at presentation showing heterogeneity in anatomical factors and biochemical profile. Despite
               the relatively poor prognosis for these patients, significant improvements can still be made in survival if the
               optimal treatment modality is chosen. Currently, there is no international consensus on how to manage this group
               of heterogeneous, high-burden HCC. In this article, we will address this question by reviewing the latest available
               evidences. Our definition of “high-burden HCC” will be based on three factors: size, number of tumors and the
               presence of macrovascular invasion. The different treatment modalities, namely surgery, intra-arterial therapy,
               radiotherapy and systemic therapy, and their respective supportive evidences, will be discussed. In the end, we will
               summarize with our views on the future direction of research priorities for the management of high-burden HCC.

               Keywords: Cancer, hepatocellular carcinoma, liver




               INTRODUCTION
               Hepatocellular carcinoma (HCC) is a major healthcare burden in the world. It represents 6% and 9% of
                                                              [1]
               the global cancer incidence and mortality respectively . It is the second most common cause of cancer-
                                    [1]
               related death worldwide . Although major advancements have been made in cancer screening, diagnosis


                           © The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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