Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2021; 27(43): 7462-7479
Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7462
Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons
Mina S Makary, Stuart Ramsell, Eric Miller, Eliza W Beal, Joshua D Dowell
Mina S Makary, Stuart Ramsell, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Eric Miller, Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Eliza W Beal, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Joshua D Dowell, Department of Radiology, Northwest Radiology, St. Vincent Health, Indianapolis, IN 46260, United States
Author contributions: Makary MS, Ramsell S, Eric Miller E, Beal EW, and Dowell JD performed the literature review, wrote the manuscript, prepared the figures and tables, made the requested revisions, and provided final approval of the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mina S Makary, MD, Assistant Professor, Attending Doctor, Director, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, 4th Floor, Columbus, OH 43210, United States.
Received: April 23, 2021
Peer-review started: April 23, 2021
First decision: June 23, 2021
Revised: July 9, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: November 21, 2021

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.