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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
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