Loco-regional interventional treatment of hepatocellular carcinoma: techniques, outcomes, and future prospects

Loco-regional interventional treatments continue to evolve and to play a major role in the therapeutic management of hepatocellular carcinoma (HCC). Image-guided ablation is established as the treatment of choice for patients with early-stage HCC when transplantation or resection is precluded. Recent refinements in technique have substantially increased the ability of radiofrequency ablation to achieve sustained complete response of target tumors in properly selected patients, and new alternate thermal and nonthermal methods for local tumor treatment are currently under investigation. Transarterial chemoembolization (TACE) is the standard of care for patients with multinodular disease at the intermediate stage. The introduction of drug-eluting beads--that enhance drug delivery to the tumor and reduce systemic exposure--appears to improve anticancer activity and safety profile of TACE compared with conventional regimens. Despite these advances, the long-term outcomes of patients treated with loco-regional therapies remain unsatisfactory because of the high rate of tumor recurrence. The introduction of molecular targeted therapies that inhibit tumor proliferation and angiogenesis has opened new prospects in this regard. Clinical trials focused on combining interventional treatment with systemically active drugs are ongoing. The outcomes of such studies are eagerly awaited, as they have the potential to revolutionize treatment of HCC.