Multimodality approaches for control of hepatocellular carcinoma.

Hepatic malignancies are one of the most challenging areas in oncologic care. Cure is not usually possible due to the high frequency of intrahepatic recurrence in spite of complete resection or ablation of the initial tumor. Despite this, of liver-directed therapies can afford durable local control through vigilant monitoring and aggressive multimodality treatment regimens structured by a team of specialists in medical, surgical and interventional oncology. Ablative therapies are highly efficient in causing cell death within the effective range of the probe, but are less efficacious for larger tumors. Conversely, arterially-directed therapies can treat the entire liver, but are less efficient at killing an entire tumor. Combining regional with local therapies offers increased efficacy in tumor cell kill and in promoting local control. The impact on overall disease recurrence and survival is less well understood at present.