Transarterial therapies for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is often fatal due to local growth inside the liver and its unique arterial vascularization provides the basis for transarterial therapies. Around 35% of patients are diagnosed at stages in which transarterial therapies are indicated as first-line therapy; many others are treated after recurrence or progression to surgery or percutaneous ablation. However, the scientific evidence supporting the use of transarterial therapy is heterogeneous and certainly weak for several subgroups. New developments have emerged in the last decade.

This review discusses the scientific evidence supporting the use of transarterial therapies for patients with HCC, including chemoembolization with conventional materials or drug-eluting beads, and internal radiation procedures such as the injection radioactive lipiodol or radioembolization with (90)Y-loaded microspheres. The literature on clinical development of transarterial therapies for HCC has been reviewed since 1990.

Transarterial chemoembolization has been shown to improve the survival of those patients with unresectable, mostly viral-related HCC who have a preserved liver function and low tumor burden. Recently developed devices and procedures, particularly drug-eluting beads and radioactive microspheres, may further improve the clinical outcome of patients receiving transarterial therapies. Combination with antiangiogenic agents is an appealing approach that should be explored.