Copyright ©The Author(s) 2021.
World J Gastroenterol. Nov 21, 2021; 27(43): 7462-7479
Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7462
Table 1 Locoregional therapy techniques, benefits, and risks
Locoregional modality
Clinical advantages
Clinical risks
TACEDrug-eluting beads or conventional deliveryProvides both local embolic and chemotherapeutic effectPES, biloma, liver abscess, liver failure
TAEParticulate or other embolic agentsAvoids radio and chemotoxicity; less expensive than other embolotherapiesPES, biloma, liver abscess, liver failure
TAREY90 microspheresMay be used in early disease with curative intent; intermediate disease can be used to increase FLV to qualify for curative intent surgery; best QoL scores of all optionsPRS, RILD, radiation-induced pneumonitis, biloma, liver abscess, liver failure
AblationRadiofrequency current, microwaves, or cryoablationEfficacious as monotherapy for early-stage disease; less morbidity than transarterial therapiesPAS, iatrogenic injury, bleeding
Table 2 Summary of primary outcomes of locoregional therapies for hepatocellular carcinoma
Locoregional technique
Primary outcomes
TACETACE provides a survival benefit compared to supportive care in unresectable disease[34]. Concomitant TACE and sorafenib is superior to standalone therapy for unresectable disease[51-53]. Comparisons of DEB-TACE versus cTACE have yet to reveal significant differences in OS and short and long-term complication rates. Further studies are needed for considerations in more specific circumstances[48,49]. When combined with PVE, TACE provides more robust FLR increase and results in better survival compared to monotherapy strategies to enhance FLR[54].
TAETAE provides a survival benefit compared to supportive care in unresectable disease[34]. Early data of chemoembolization has shown little survival benefit over TAE, but superior proximate outcomes such as TTP and tumor response compared to TAE[63,64].
TARETARE shows similar complication and survival rates to TACE, while producing higher QoL scores and longer TTP[77,78]. TARE segmentectomy for early-stage disease (tumors < 3 cm) results in a 5-year survival of 75%, which is comparable to curative intent therapies such as transplantation and surgical resection[81]. TARE lobectomy provides a significant increase in FLR and is a safe mechanism to treat tumor while inducing contralateral hypertrophy[82-86].
AblationIn early-stage patients, standalone percutaneous ablation produces comparable survival outcomes to surgical resection[113-116]. RFA and MWA techniques show similar outcomes in early-stage disease (tumor < 3 cm)[108,119]. Combination therapy using TACE and ablation (particularly MWA) provide the best outcomes for large tumors (tumor 3-5 cm)[120].