Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Abstract

Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant. The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.

Keywords: Hepatocellular carcinoma; Cirrhosis; Liver; Interventional oncology; Trans-arterial chemo embolization; Selective internal radiation therapy; Ablation

Core tip: Hepatocellular carcinoma (HCC) is the most frequently observed primary malignant liver tumors and is a major cause of worldwide mortality. Despite the advances in minimally invasive surgery, such as laparoscopic and robotic, they are reserved only in early stage patients. Thus, percutaneous locoregional treatments have now a pivotal role in HCC management; in this review, we discuss state of the art of currently available locoregional treatment for HCC and their future perspectives.