A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Abstract

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related deaths. Hepatic resection and liver transplantation are considered to be the preferred treatment for HCC. However, as novel therapeutic options such as image-guided locoregional therapies have emerged and been refined, the manner in which HCC is treated has changed dramatically compared with what it was considered just 2 decades earlier. Summary: This study reviews the current results of various image-guided locoregional therapies for treating HCC, especially focusing on thermal ablative and transarterial techniques. Key Message: Advances in image-guided locoregional therapies, including local ablative therapy and transarterial therapy, have led to a major breakthrough in the management of HCC. Both survival rates and cure rates of patients with HCC have improved markedly since the introduction of these techniques. Practical Implications: Radiofrequency ablation is currently considered as an alternative to surgical resection for patients with early-stage HCC. A newer technique of ablation such as microwave ablation is increasingly being used, especially for large HCC. Transarterial chemoembolization has become a standard care for asymptomatic patients with multinodular tumors in intermediate-stage disease, and transarterial radioembolization has become the method of choice in HCC cases with portal vein thrombosis. Moreover, combination treatment modalities, such as thermal-based ablation combined with transarterial chemoembolization or ¹²⁵I seed implant brachytherapy, may further broaden their clinical indications for HCC. Moreover, use of localized radiation in combination with thermal ablation has been reported to improve tumor control and long-term survival.

Survival differences among patients with hepatocellular carcinoma based on the stage of disease and therapy received: pre and post sorafenib era

“…This could be secondary to aggressive screening and clinical surveillance protocols of individuals with known risk factors for HCC, with better access to health care (16,17). Local tumordirected therapies have emerged showing promising results recently (18). Our analysis confirms the survival improvement in early stage HCC patients, who received tumor-directed loco regional therapies.…”

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

“…Since advances of technology, such as multiple electrode radiofrequency system, multi-modality-ultrasound fusion imaging, new computed-tomography techniques, magnetic navigation system, and thermal-based ablation combined with 125 I seed implant brachytherapy [8][9][10], variety of minimally invasive techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), and percutaneous ethanol injection (PEI), have been shown to be safe and effective in HCC patients [11]. In patients with early-stage HCC, RFA can be a curative choice.…”

Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study

“…After evaluating 485 consecutive BCLC-B patients from the ITA.LI.CA database retrospectively, it was concluded that in “everyday practice TACE represents the first-line therapy in a half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion”. 32 , 33 Therefore the conclusion of Shiand and Zhai 34 seems reasonable. In their recent review on advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma, they stated that “combination treatment modalities, such as thermal-based ablation combined with TACE or 125 I seed implant brachytherapy, may further broaden their clinical indications for HCC”.…”

“…In their recent review on advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma, they stated that “combination treatment modalities, such as thermal-based ablation combined with TACE or 125 I seed implant brachytherapy, may further broaden their clinical indications for HCC”. 34 …”