Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.

Highlights

  • Hepatocellular carcinoma (HCC) is the most common primary liver malignancy [1]

  • Selective internal radiotherapy (SIRT) for HCC can be performed with transarterial radioembolization (TARE) [10]

  • HCC is the most common primary liver malignancy and the third leading cause of cancer-related mortality worldwide [1]. Overall survival for this complex disease has improved in recent years, prognosis is still poor for advanced and terminal-stage patients [1]

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Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy [1]. The prognosis depends on a multitude of clinical, laboratory, and radiologic parameters, but the overall 5-year survival rate for liver cancer remains below 20% [2,3,4]. Traditional management options for patients with HCC include surgical resection and orthotopic liver transplantation (OLT) [4]. In a recent comparative study of more than 8000 HCC cases worldwide, less than 10% of patients fulfilled preoperative criteria for resection [5]. Other goals of locoregional approaches include tumor cytoreduction for downstaging or “bridging” to maintain eligibility for transplantation, hypertrophy of hepatic tissue to increase liver function for future major resection, and palliation [6]. Over the past two decades, management approaches that increase overall survival and reduce adverse effects for a wide range of patients have increased with the incorporation of new image-guided techniques and enhanced targeted pharmaco- and radiotherapeutics [7,8].

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