Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2023; 29(11): 1669-1684
Published online Mar 21, 2023. doi: 10.3748/wjg.v29.i11.1669
Radiological findings in non-surgical recurrent hepatocellular carcinoma: From locoregional treatments to immunotherapy
Davide Ippolito, Cesare Maino, Marco Gatti, Paolo Marra, Riccardo Faletti, Francesco Cortese, Riccardo Inchingolo, Sandro Sironi
Davide Ippolito, Cesare Maino, Department of Radiology, IRCCS San Gerardo dei Tintori, Monza 20900, Italy
Davide Ippolito, Sandro Sironi, School of Medicine and Surgery, University of Milano-Bicocca, Milano 20121, Italy
Marco Gatti, Riccardo Faletti, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
Paolo Marra, Sandro Sironi, Department of Diagnostic and Interventional Radiology, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
Francesco Cortese, Riccardo Inchingolo, Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Bari 70121, Italy
Author contributions: Ippolito D and Maino C designed the research; Maino C, Gatti M, Marra P, and Cortese F performed the research; Maino C, Gatti M, Marra P, and Cortese F analyzed the data; All authors wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
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: Davide Ippolito, MD, Assistant Professor, Doctor, Department of Radiology, IRCCS San Gerardo dei Tintori, 33 Via Pergolesi, Monza 20900, Italy.
Received: November 21, 2022
Peer-review started: November 21, 2022
First decision: December 10, 2022
Revised: January 10, 2023
Accepted: March 2, 2023
Article in press: March 2, 2023
Published online: March 21, 2023
Processing time: 115 Days and 20.2 Hours

Since hepatocellular carcinoma (HCC) represents an important cause of mortality and morbidity all over the world. Currently, it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence. Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices, there is still no consensus about the treatment of recurrent HCC (RHCC). Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control, especially in the advanced stage of liver disease. Different medical treatments are now approved, and others are under investigation. On this basis, radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC. This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

Keywords: Carcinoma, Hepatocellular, Liver, Ablation, Catheter, Radio frequency ablation, Ablation techniques, Medication therapy management, RECIST

Core Tip: During the follow-up of patients affected by hepatocellular carcinoma (HCC), radiology is considered the key to the diagnosis of recurrence, by taking advantage of cross-sectional imaging with a special focus on computed tomography and magnetic resonance imaging. As in the case of active surveillance in a patient with mild to moderate risk for developing HCC, cross-section imaging can help in the quick identification of signs of recurrence. Moreover, radiology plays a key role in the evaluation of treatment response during medical therapy for HCC, recently approved in the revised version of the Barcelona Clinic Liver Cancer staging.