Interventional treatment for unresectable hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

Keywords: Unresectable, Hepatocellular carcinoma, Intermediate-stage, Advanced-stage, Interventional

Core tip: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Interventional treatments for intermediate-stage HCC patients such as transcatheter arterial chemoembolization (TACE), drug-eluting bead embolization, and radioembolization, continue to evolve, improving prognosis. However, advanced-stage HCC is typically treated only with sorafenib, with only a modest improvement in overall survival. More effective therapies such as combined TACE and radiotherapy, TACE with special techniques, and isolated hepatic perfusion have been studied extensively. This review summarizes data on published and important ongoing studies concerning interventional treatments for unresectable HCC and discusses technical improvements in these interventions, particularly for advanced-stage HCC.