[Transarterial chemoembolization and conformal radiotherapy for hepatocellular carcinoma]

Hepatocellular carcinoma is a poor prognosis tumour. The potential curative therapeutic options are orthotopic liver transplantation, surgical resection and radiofrequency ablation. Unfortunately, only a minority of patients (around 20%) are eligible for these techniques. Thus, patients can benefit from palliative options, such as transarterial chemoembolization (TACE) or sorafenib that bring only modest benefit on survival. Conformal radiotherapy allows delivering high dose radiation within a precise tumour volume while sparing the surrounding liver parenchyma. As employed in monotherapy, conformal radiotherapy is highly efficient for small size hepatocellular carcinoma (<5 cm). Above 5 cm, its efficacy is more limited but its association with TACE gives spectacular rates of complete responses. Controlled phase 2 or 3 trials are urgently warranted to define its indications in the therapeutic algorithm of hepatocellular carcinoma.