**4.2 Antiviral therapy**

134 Liver Tumors

Unfortunately, there is still no universally accepted form of adjuvant therapy for preventing recurrence after hepatic resection (Lau et al., 2009). Adjuvant regional therapy and anti-viral

The preventive effect of TACE on recurrence after operation had been studied by prospective (Peng et al., 2009; Zhong et al., 2009) and retrospective series (Ren et al., 2004; Xi et al., 2007) mostly in eastern centers. The survival benefit of adjuvant TACE after hepatic resection was demonstrated in patients with high risk factors for recurrence while the effect in low risk for recurrence remains questionable. However, the quoted high risk factors for recurrence varied between studies, namely large tumor, multiple nodules, vascular invasion and presence of portal vein tumor thrombus. With the currently available evidence, the adjuvant regional chemotherapy with or without embolization or combination of systemic chemotherapy does not provide any additional benefit (Chan et al., 2000; Lau et al., 2009; Schwartz et al., 2002). Adjuvant transarterial treatments with 131I-lipiodol and adjuvant immunotherapy with interferon had demonstrated early promising results, which may have a role in preventing early intra-hepatic recurrence (Boucher et al., 2003; Ikeda et al., 2000;

therapy are the two main directions that researches on this field are working on.

Fig. 7. Algorithm protocol for treatment of recurrent HCC

**4.1 Role of adjuvant regional therapy** 

**4. Prevention** 

In Asia, chronic hepatitis B virus (HBV) infection is the major cause of HCC. The risk for HCC development is closely associated with hepatitis B e antigen (HBeAg) status and the serum HBV-DNA level. Recent studies showed that tumour recurrence after curative treatment of HCC was increased with the level of HBV-DNA and alanine aminotransferase (ALT) (Cheung et al., 2008; Huang et al., 2008). This implies that HBV viral replication may play a role in HCC development and tumour recurrence. Scattered results from perspective and retrospective studies have shown that continuous treatment with nucleotide analogue in patients with chronic hepatitis B or cirrhosis could reduce the risk of HCC development (Liaw et al., 2004; Matsumoto et al., 2005). Wong et al reviewed the results of nine cohort studies including more than 500 patients in a recent meta-analysis concluded that anti-viral therapy could significantly reduce the risk of HCC recurrence after curative treatment of HBV-related HCC (Wong et al., 2011). Furthermore, anti-viral therapy might also allow salvage therapy in case of HCC recurrence by better-preserved liver function as supported by the result of two other studies (Kuzuya et al., 2007; Piao et al., 2005). Hence, anti-viral therapy with nucleotide analogues should be considered after curative treatment of HBVrelated HCC for the potential benefit in tumor recurrence and overall survival.
