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Technology Insight: image-guided therapies for hepatocellular carcinoma—intra-arterial and ablative techniques

Abstract

Locoregional techniques have become the mainstay of therapy for patients with unresectable hepatocellular carcinoma (HCC). Such image-guided interventions include catheter-based approaches (transarterial chemoembolization and yttrium-90 radiotherapy) and locoregional ablative techniques, either chemical (percutaneous ethanol injection), or thermal (radiofrequency ablation, laser ablation, microwave ablation and cryoablation). These therapies are mainly utilized for palliation, but have also been used with curative intent. In selected cases, percutaneous interventional treatments have shown good results (5-year survival 40–50%), but, even when chosen as first-line treatment, have not been able to achieve the response rates and outcomes achieved by surgical options (resection or transplantation). New promising image-guided therapies are continuously emerging, as we attempt to improve tumor targeting, minimize hepatic toxicity and ultimately improve quality of life and survival of patients with HCC. With new technologies in imaging and drug delivery becoming available, it is likely that, in the future, patients with HCC will be best treated by a multidisciplinary team approach, utilizing a combination of techniques to improve patient survival. This review outlines the current status of the most commonly used image-guided locoregional interventions in the treatment of patients with HCC, and describes recent research and advances related to image-guided interventions for liver cancer.

Key Points

  • Locoregional techniques have become the mainstay of therapy for patients with unresectable hepatocellular carcinoma.

  • Such image-guided interventions include catheter-based approaches (transarterial chemoembolization, yttrium-90 radiotherapy) and locoregional ablative techniques, either chemical (percutaneous ethanol injection), or thermal (radiofrequency ablation, laser ablation, microwave ablation)

  • These therapies are mainly utilized for palliation, but also been used with curative intent. In selected cases, percutaneous interventional treatments have shown good results (5-year survival 40–50%), but have not been able to achieve the response rates and outcomes achieved by surgical options, even when chosen as first-line treatment

  • New promising image-guided therapies and imaging and drug delivery techniques are continuously emerging, to improve tumor targeting, minimize hepatic toxicity and ultimately improve quality of life and survival of patients

  • It is likely that, in the future, patients with hepatocellular carcinoma will best be treated by a multidisciplinary team approach, using a combination of techniques to improve patient survival

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Figure 1: Angiogram from a transcatheter arterial chemoembolization procedure demonstrating a hypervascular tumor with abnormal vessels (arrow), predominantly supplied by the hepatic artery in segment 6 of the right lobe of the liver.
Figure 2: Patient with hepatocellular carcinoma.

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Correspondence to Kelvin Hong.

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Competing interests

J-FH Geschwind is a consultant for MDS Nordian, Biocomptibles Int. Biospheres Medical. He receives research support from MDS Nordian.

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Hong, K., Georgiades, C. & Geschwind, JF. Technology Insight: image-guided therapies for hepatocellular carcinoma—intra-arterial and ablative techniques. Nat Rev Clin Oncol 3, 315–324 (2006). https://doi.org/10.1038/ncponc0512

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