Hepatocellular carcinoma, the commonest primary cancer of the liver is the sixth most common cancer in the world. According to the World Health Organization, most cases of hepatocellular carcinoma occur in Asia and Africa, however recent reports suggest that the incidence of primary liver cancer is also increasing in several developed countries, mainly in the Unites States and Europe. In Southeast Asia and Africa, hepatocellular carcinoma is predominantly associated with hepatitis B virus infection, whereas in Western countries and Japan it is associated with infection due to hepatitis C virus.
For hepatocellular carcinoma, surgery is the main form of treatment, but it is only possible for a small proportion of those afflicted. Even after curative resection, recurrence is common and is the main cause of death. Adjuvant (that is, chemotherapy after surgery) and neo-adjuvant therapy (that is, chemotherapy before surgery) are thus attempted to try to improve outcomes.
This review sets on to determine the efficacy and adverse events of different neoadjuvant therapies (drug given before) versus adjuvant therapies (drug given after) compared to surgery alone, or surgery and placebo or supportive therapy when given to improve relapse and survival rates for operable hepatocellular carcinoma. A total of 12 randomised trials were identified, totaling 843 patients. The size of the randomised clinical trials ranged from 30 to 155 patients. Nine of the twelve trials reported no survival benefit from adjuvant therapy. Two trials reported a significant difference for survival and four studies for disease-free survival for the treatment group, but the results of one of the trials on both its groups were very poor when compared to other trials. Two of the trials that did not report any absolute survival advantage reported statistically significant differences in disease-free survival. The highest toxicity rate was in a trial using oral 1-hexylcarbamoyl 5- fluorouracil which resulted in 12 out of 38 patients being withdrawn from the trial because of adverse events.
In conclusion, this review found insufficient evidence to show that adjuvant and neo-adjuvant therapy increase survival from hepatocellular carcinoma, but there is limited evidence to suggest that neoadjuvant or adjuvant therapy may be useful for disease-free survival.