Emerging curative-intent minimally-invasive therapies for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally. Cure can be achieved for early stage HCC, which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0. Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation (LT) also achieve curative outcomes. Traditionally, surgical resection, LT, and ablation are considered curative therapies for early HCC. However, results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC, leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC. This review is based on current evidence for curative-intent loco-regional therapies including radioembolization for early-stage HCC.

Keywords: Hepatocellular carcinoma; Loco-regional therapy; Radiation segmentectomy; Transarterial radio-embolization; Ablation; Transarterial chemo-embolization; Curative intent

Core Tip: Accepted curative modalities for early hepatocellular carcinoma (HCC) include resection, liver transplant, and loco-regional therapies. In this manuscript, we review the curative-intent loco-regional therapies including recent evidence from the LEGACY study and DOSISPHERE trial demonstrating a curative role for transarterial radio-embolization in early HCC.