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Editor's Note
September 2015

Dual-Modality Liver-Directed Therapy for Primary Liver Cancer

JAMA Oncol. 2015;1(6):765. doi:10.1001/jamaoncol.2015.2197

Hepatocellular carcinoma (HCC) is one of the most common solid tumors worldwide and continues to be a major public health problem. While there are level 1 data supporting the use of small-molecule, tyrosine kinase inhibitors against the pathways involved in angiogenesis and tumor proliferation for locally advanced or metastatic HCC, the incorporation of different liver-directed therapeutic agents continues to evolve.1 The goals of HCC treatment include a spectrum from pure palliation to serving as a bridge-to-liver transplant. The intersection of interventional radiology and radiation oncology is part of the multidisciplinary approach to primary liver cancer.2 In this issue of JAMA Oncology, Huo and Eslick3 report on a systematic review and meta-analysis comparing single-modality transcatheter arterial chemoembolization (TACE) with dual-modality TACE plus radiotherapy, with the latter approach being superior. This study would have been strengthened if recently standardized imaging guidelines of HCC, the Liver Imaging Reporting and Data System (LI-RADS) had been followed.4 This study does not tell us whether radiofrequency ablation, often used as a consolidative liver-directed approach, is equal to consolidative radiotherapy, nor does it define the impact of other predictive and prognostic factors, such as initial BCLC (Barcelona Clinic Liver Cancer) stage [EASL-EORTC 2012], variability in target delineation, treatment planning, use and type of image-guidance techniques, radiotherapy dose-fractionation, and differences between Asian and non-Asian patients.5 The analysis from Huo and Eslick3 provide some rationale for dual-modality liver-directed therapy being conducted at many centers. Nevertheless, the ill-defined therapeutic landscape for localized HCC requires the completion and reporting of well-designed prospective trials that incorporate a multidisciplinary approach and include investigators working together.

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Article Information

Conflict of Interest Disclosures: None reported.

References
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Llovet  JM, Ricci  S, Mazzaferro  V,  et al; SHARP Investigators Study Group.  Sorafenib in advanced hepatocellular carcinoma.  N Engl J Med. 2008;359(4):378-390.PubMedArticle
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Naugler  WE, Alsina  AE, Frenette  CT, Rossaro  L, Sellers  MT.  Building the multidisciplinary team for management of patients with hepatocellular carcinoma.  Clin Gastroenterol Hepatol. 2015;13(5):827-835.PubMedArticle
3.
Huo  YR, Eslick  GD.  Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma: a systematic review and meta-analysis [published online July 9, 2015].  JAMA Oncol. doi:10.1001/jamaoncol.2015.2189.
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Mitchell  DG, Bruix  J, Sherman  M, Sirlin  CB.  LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions.  Hepatology. 2015;61(3):1056-1065.PubMedArticle
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European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer.  EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.  J Hepatol. 2012;56(4):908-943.PubMedArticle
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