What are neoadjuvant and adjuvant therapies?
Neoadjuvant therapy is defined as treatment with hepatic artery embolization chemotherapy and radiation therapy for unresectable hepatocellular carcinoma to shrink the tumor, reduce the tumor stage, and allow some patients to have access to surgical resection, resulting in better long-term survival.
Adjuvant therapy is defined as prophylactic treatment to prevent tumor recurrence and metastasis after radical treatment (including surgery, radiofrequency, and radiotherapy).
Adjuvant therapy to reduce recurrence and metastasis after hepatocellular carcinoma surgery
Because of the high rate of tumor recurrence and metastasis of 40% to 70% 5 years after surgical resection of hepatocellular carcinoma, which is associated with the possible presence of microscopic foci of dissemination or multicentric occurrence before surgery, all patients need to receive close follow-up after surgery.
For those at high risk of recurrence, postoperative prophylactic interventional embolization can detect and control postoperative intrahepatic microscopic residual cancer.
Patients with active hepatitis B virus replication who receive postoperative antiviral therapy with oral nucleoside analogs can reduce the postoperative recurrence rate. Antivirals are preferable to strong, low resistance drugs such as entecavir, telbivudine, or tenofovir lipid.
There are also clinical studies suggesting that interferon α may reduce recurrence and prolong survival, but it remains controversial and is currently recommended only for patients with hepatocellular carcinoma in combination with chronic hepatitis B.
At present, there is no evidence to support the place of systemic chemotherapy in neoadjuvant or adjuvant therapy.