ABSTRACT
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third most common cause of cancer death. HCC is the most common primary liver malignancy and is one of the most common malignancies globally. The highest annual incidence rates, of up to 100 per 100,000, occur in parts of southern Africa and the Far East. HCC usually arises in a cirrhotic liver, although the cirrhosis is not always symptomatic and, indeed, the development of HCC may be the first indication of underlying chronic liver disease. HCC is a highly vascular tumour, and the elucidation of the molecular mechanisms mediating tumour angiogenesis, notably the contribution of vascular endothelial growth factor (VEGF) signalling, has provided pharmacological targets. Pre-clinical models suggest that epidermal growth factor receptor signalling is a prerequisite for angiogenesis in HCC via up-regulation of VEGF. The use of external-beam radiotherapy is significantly limited by the radiosensitivity of normal hepatocytes, with a normal tissue tolerance of 25–30 Gy.
