Image-guided percutaneous locoregional therapies for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the 3 rd leading cause of cancer death worldwide. Treatment options include surgical resection, liver transplantation, imageguided percutaneous locoregional options, external beam radiation therapy (EBRT) and systemic therapies.Treatment choice depends on the stage of the disease and patient's characteristics including performance status and liver function. Barcelona Clinic Liver Cancer (BCLC) staging system, with its recent 2022 update, is one of the most widely endorsed staging system. Locoregional therapies (LRT) are recommended for very early stage (BCLC-0), early stage (BCLC-A), and the two first subgroups of intermediate stage (BCLC-B). Image-guided percutaneous locoregional therapies include ablation, mainly thermal ablation with radiofrequency (RFA), microwave ablations (MWA) and cryoablation, transarterial embolization (TAE, also known as bland embolization), transarterial chemoembolization (TACE), drug-eluding beadstransarterial chemoembolization (DEB-TACE), combination of ablation with embolization, transarterial radioembolization (TARE) also known as selective internal radioembolization therapy, and hepatic artery infusion (HAI). While ablation is recognized as a curative therapy, all intra-arterial therapies are considered non-curative options. There is growing evidence that TARE, through radiation segmentectomy, can be considered a curative intent treatment in appropriate selective patients. In this article, we will review indications, complications, and outcomes of locoregional therapies for HCC.

Impact of body composition on the prognosis of hepatocellular carcinoma patients treated with transarterial chemoembolization: A systematic review and meta-analysis

“…Third, this study only focused on the TACE procedure, not involving other transcatheter intra-arterial therapies, given that the technique heterogeneity is notable in loco-regional interventional therapies. Generally, transcatheter intra-arterial therapy includes bland TAE, TACE, hepatic arterial infusion chemotherapy, and trans -arterial radioembolization (such as the use of Yttrium-90) [ 59 , 60 ]. As the investigation in this field is still at an initial stage, there are only a few studies describing each technique, and an accumulation of studies is required before comparing the combined effect of body composition on prognosis after transcatheter intra-arterial therapies.…”

Anti-Glycolytic Drugs in the Treatment of Hepatocellular Carcinoma: Systemic and Locoregional Options

“…Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the third leading cause of cancer-related death [1]. (Liver transplant, surgical resection, and ablation are among the curative treatment options [2]. However, most patients are not candidates for curative options at the time of their diagnosis.…”