Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons

Abstract

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and has an overall five-year survival rate of less than twenty percent. For patients with unresectable disease, evolving liver-directed locoregional therapies provide efficacious treatment across the spectrum of disease stages and via a variety of catheter-directed and percutaneous techniques. Goals of locoregional therapies in HCC may include curative intent in early-stage disease, bridging or downstaging to surgical resection or transplantation for early or intermediate-stage disease, and local disease control and palliation in advanced-stage disease. This review explores the outcomes of chemoembolization, bland embolization, radioembolization, and percutaneous ablative therapies. Attention is also given to prognostic factors related to each of the respective techniques, as well as future directions of locoregional therapies for HCC.

Keywords: Hepatocellular carcinoma; Bland embolization; Chemoembolization; Radioembolization; Transarterial embolization; Thermal ablation; Locoregional therapy

Core Tip: This article reviews prognostic factors and outcomes of current locoregional therapies for hepatocellular carcinoma, as well as future directions and promising new techniques. Therapies including transarterial bland embolization, chemoembolization, and radioembolization, as well as percutaneous ablation are reviewed. Prognostic considerations vary by indication but generally follow baseline disease staging and tumor quantification. Outcomes data reveal survival benefits in appropriately selected patients. New advances in precision medicine, combination therapy, and immunotherapy are being investigated.