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Treatment options for nonmetastatic hepatocellular carcinoma that is not resectable at diagnosis
Source: Childhood Liver Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: January 6, 2025 · Captured 2026-09-09.
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Context: Hepatocellular Carcinoma / Treatment of Hepatocellular Carcinoma
Treatment options for nonmetastatic hepatocellular carcinoma that is not resectable at diagnosis include the following:
Chemotherapy followed by reassessment of surgical resectability. If the primary tumor is resectable, complete surgical resection.
Chemotherapy with or without transarterial radioembolization (TARE) followed by reassessment of surgical resectability. If the primary tumor remains unresectable:
Chemotherapy with or without transarterial radioembolization (TARE) followed by reassessment of surgical resectability. If the primary tumor remains unresectable:
Orthotopic liver transplant.
Chemotherapy with or without transarterial radioembolization (TARE) followed by reassessment of surgical resectability. If the primary tumor remains unresectable:
Temporizing transarterial chemoembolization (TACE) or TARE followed by complete resection or liver transplant.
Chemotherapy with or without transarterial radioembolization (TARE) followed by reassessment of surgical resectability. If the primary tumor remains unresectable:
TACE or TARE alone.
The use of neoadjuvant chemotherapy or TACE to enhance resectability or liver transplant, which may result in complete resection of tumor, is necessary for a cure.
Evidence (chemotherapy followed by surgery):
In a prospective study of 41 patients who received preoperative cisplatin/doxorubicin chemotherapy, the following was observed:[23]
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In a prospective study of 41 patients who received preoperative cisplatin/doxorubicin chemotherapy, the following was observed:[23]
Treatment resulted in a decrease in tumor size, with a decrease in alpha-fetoprotein (AFP) levels in about 50% of patients.
In a prospective study of 41 patients who received preoperative cisplatin/doxorubicin chemotherapy, the following was observed:[23]
The patients who responded to chemotherapy had a superior tumor resectability and survival rate. However, the OS rate was 28%, and only those who underwent complete resection survived.
Evidence (chemotherapy, TARE, or TACE followed by reassessment of surgical resectability; treatment options, including liver transplant, for unresectable primary tumor after chemotherapy, TARE, or TACE):
Liver transplant has been a successful therapy for children with unresectable hepatocellular carcinoma. The survival rate is about 60%, with most deaths resulting from tumor recurrence.[25,35-38]
A review of SEER data for hepatocellular carcinoma treatment in patients younger than 20 years revealed that 75% of patients underwent resection and 25% underwent liver transplant.[39]
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A review of SEER data for hepatocellular carcinoma treatment in patients younger than 20 years revealed that 75% of patients underwent resection and 25% underwent liver transplant.[39]
The 5-year OS rate was 53.4% with resection and 85.3% with transplant, suggesting that the criteria for transplant in hepatocellular carcinoma might be liberalized for overall patient benefit. This data has not been verified in a prospective clinical trial.
TACE followed by complete surgical resection of the primary tumor may be an alternative to the use of chemotherapy followed by surgical resection.
TACE followed by complete surgical resection of the primary tumor may be an alternative to the use of chemotherapy followed by surgical resection.
Studies in adults in China suggest that repeated hepatic TACE before surgery may improve the outcome of subsequent hepatectomy.[40]
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TACE followed by complete surgical resection of the primary tumor may be an alternative to the use of chemotherapy followed by surgical resection.
A meta-analysis found seven randomized trials that compared resection alone with TACE followed by resection. There was no difference in the 3-year event-free survival (EFS) and OS rates between the two groups, but the 5-year EFS and OS rates favored TACE followed by resection.[41]
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TARE has been used in the treatment of adult patients with hepatocellular carcinoma for some time. In a small number of patients, TARE has provided both a palliative benefit and a possible bridge to liver transplant.[42,43]
If the primary tumor is not resectable after chemotherapy and the patient is not a transplant candidate, alternative treatment approaches used in adults include the following:
Sorafenib.
TACE or TARE.
Cryosurgery.
Intratumoral injection of alcohol.
Radiation therapy.
There are limited data on the use of these alternative treatment approaches in children.
Limited data from a European pilot study suggest that sorafenib was well tolerated in 12 children and adolescents with newly diagnosed advanced hepatocellular carcinoma when given in combination with standard chemotherapy of cisplatin and doxorubicin.[44] Additional study is needed to define its role in the treatment of children with hepatocellular carcinoma.
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Cryosurgery, intratumoral injection of alcohol, and radiofrequency ablation can successfully treat small (<5 cm) tumors in adults with cirrhotic livers.[40,45,46] Some local approaches such as cryosurgery, radiofrequency ablation, and TACE, which suppress hepatocellular carcinoma tumor progression, are used as bridging therapy in adults to delay tumor growth while on a waiting list for cadaveric liver transplant.[47] In a pediatric study of eight patients with hepatocellular carcinoma, two patients died of progressive disease without transplant. Treatment with TACE stabilized disease in six patients, for a mean of 141 days to reach transplant.[48][Level of evidence C1] Five patients were alive at the end of the observation period, and one patient died of disease. For more information, see Primary Liver Cancer Treatment.
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Most of the information about the use of targeted therapy or immunotherapy for patients with nonresectable hepatocellular carcinoma or metastatic disease has been informed by trials in adults. To learn more about these treatments in adults, see the Treatment of Locally Advanced or Metastatic Primary Liver Cancer section in Primary Liver Cancer Treatment.
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Publication references
Read the original reference and check its publication notices.
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Preserved source evidence · Not medical advice