Hong Kong has a high incidence rate of hepatocellular carcinoma (HCC). The annual age adjusted incidence rate of HCC is about 50 per 100,000. At the Prince of Wales Hospital, we see around 500 new cases each year. The treatment of HCC is challenging. Only about 10% are suitable for surgical resection and such patients remain at a very high risk of recurrence. Currently there is no proven benefit from any post-operative adjuvant treatment nor is there any standard treatment for those with inoperable disease. Conventional systemic chemotherapy and intra-arterial treatment can only benefit a small proportion of patients. In order to discover new forms of treatment we have undertaken several phase II trials for inoperable HCC as well as postoperative treatment for patients with a high risk of development of HCC. All HCC patients referred to our hospital are seen in the Joint Hepatoma Clinic by a combined team of hepatologists, oncologists, interventional radiologists and surgical oncologists. This ensures patients are treated promptly according to agreed protocols and entered into appropriate clinical trials. The Joint Hepatoma Clinic also holds bi-weekly hepatoma meetings with the pathologists and radiologists to discuss difficult cases for management decision.

In terms of publications, we have shown that the post-operative treatment with lipiodol-iodine-131 after surgical resection is successful in a prospective randomized trial and these results were published in The Lancet (353:797-801, 1999). Secondly, the prospect of an effective systemic treatment (PIAF combination) capable of delivering complete pathological remission seems to be becoming a reality (Clinical Cancer Research, 5:1676-1681, 1999). We also completed phase I and II studies in the use of intra-arterial yttrium-90 microspheres in treatment of unresectable hepatocellular carcinoma (British Journal of Cancer, 70:994-999, 1994. International Journal of Radiation Oncology, Biology, Physics, 33:4, 919-924, 1995). With both PIAF and yttrium-90 the concept of neoadjuvant therapy to convert inoperable to operable lesions has now been established (Annals of Surgery 233(2): 236-241, 2001). Supported by the Health Services Research Committee, we have also completed a cost and quality of life study on palliative strategies in HCC patients (Pharmacoeconomics, in-press 2001). Through another support from the Hong Kong Cancer Fund, we also finished accrual of over 1000 high-risk patients for hepatocellular carcinoma into an early detection and screening program and the results recently presented in ASCO 2001 (Proceedings of ASCO 2001, abstract #672).