- Top of page
- Neo-adjuvant locoregional therapy for hepatocellular carcinoma
- Transarterial therapies
- Which neo-adjuvant strategy should be used?
- Downstaging for hepatocellular carcinoma beyond the Milan criteria
- Endpoints of successful downstaging before liver transplantation
- Response of the tumour markers to locoregional therapy
- Should we treat patients within Milan criteria hepatocellular carcinoma?
Because of its increasing incidence of hepatocellular carcinoma, it is now recognized as a worldwide health problem affecting mostly patients with chronic liver disease. Liver transplantation is the optimal therapy and achieves its best results in patients with small tumour burden. In an effort to prevent tumour progression and patient dropout from the transplant wait list, the concept and utilization of neo-adjuvant locoregional therapies have gained relevance in the past few years. Moreover, good and maintained response to therapy is now considered a surrogate of favourable tumour biology, therefore aiding the patient transplant selection process. Herein, we review the current role of neo-adjuvant therapies and revise concepts of tumour ‘downstaging’ or ‘bridging therapy’ in the setting of liver transplantation. In addition, we explore the debate of implementing locoregional therapy for patients with small tumours and short waiting times to liver transplantation.