However, radiotherapy alone is not the optimal treatment for patients with locally advanced disease, for it yields an unsatisfactory 5-year survival rate of only approximately 50% [ 4].
In their series, major vascular invasion correlated well with early and diffuse recurrence which was rarely treatable, and thus an unsatisfactory long-term survival.
Liver transplantation (LT) offers a potential curative option for patients with small HCC, but post-operative tumor recurrence remains one of the most prevalent causes of unsatisfactory long-term survival [ 4].
Survival benefits have been demonstrated by systemic chemotherapy in patients with locally advanced or metastatic gastric carcinoma (MGC) (Pyrhonen et al, 1995; Glimelius et al, 1997); however, the results of most combination regimens have been unsatisfactory, with median survival times of 6 9 months (Webb et al, 1997; Vanhoefer et al, 2000; Ohtsu et al, 2003).
Current treatment with surgery and radiotherapy is unsatisfactory given the 50% survival at 5 years and the serious side effects.
Even with curative surgical resection in early stage, a considerable number of patients eventually recur, and their survival remains unsatisfactory (Sawabata et al, 2010; Shimizu et al, 2013).
Patients with more extensive or bulky disease however often required external beam re-irradiation, but treatment outcome with conventional radiotherapy was unsatisfactory with a poor survival rate and a high incidence of late complication [ 6, 7].
Surgical treatments in terms of hepatic resection and orthotopic liver transplantation are the potentially curative treatments for HCC, but the long-term disease-free survival remains unsatisfactory (Lo and Fan 2004; Poon and Fan 2004).
However, the long-term survival remains unsatisfactory because of a high incidence of recurrence and metastasis after hepatic resection, with a 5-year actuarial recurrence rate of 75 100% reported in the literature (Poon et al, 2000).
