The importance of liver functional reserve in the non-surgical treatment of Hepatocellular Carcinoma.
Any oncological treatment must aim at maximizing patient survival with the best quality of life and not merely at eliminating the tumor. Since the liver has a vital function, any radical treatment severely compromising liver function will result in a shortening of life expectancy, rather than a prolongation. Furthermore, even non-severe liver damage may imply the risk of impeding the opportunity to receive further effective therapies. This is particularly important in the case of hepatocellular carcinoma (HCC), since this tumor is associated with underlying cirrhosis in the majority of patients, and cirrhosis itself is not only a potentially lethal disease and independent prognostic factor in HCC, but it also makes liver function fragile. Accordingly, some information about liver dysfunction is included in most staging systems for HCC, in an attempt to suggest treatments that the functional liver reserve can adequately tolerate. Unfortunately, the prediction of functional liver damage in the case of antitumor treatments is very challenging and still suboptimal in any given specific patient. Moreover, while the assessment of the functional reserve has been sufficiently elucidated in the surgical setting to avoid postoperative liver failure, it has instead been less clarified for non-surgical therapies, despite the fact that this aspect appears to have become of particular relevance today, when several lines of effective non-surgical treatments, including systemic therapies, have become available. The present article will a) critically review the implications of the assessment of liver functional reserve in patients with HCC, b) illustrate the different available tools to assess the liver functional reserve and c) discuss the role of functional assessment in the setting of each type of non-surgical therapy for HCC.
["D'Avola|Delia|D|", 'Granito|Alessandro|A|', 'de la Torre-Aláez|Manuel|M|', 'Piscaglia|Fabio|F|']
Liver functional reserve hepatocellular carcinoma Systemic therapies Loco-regional therapies Radiotherapy