Interventional radiology for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most frequent primary malignant tumors in the world. Hepatic resection and liver transplantation are considered optimal for potential treatment of HCC. However, only 20% of HCCs can be surgically treated. And most of surgically-noneligible patients have to receive locoregional image-guided interventional managements including intra-arterial and percutaneous ablative therapies. In this paper, we review these interventional approaches. Catheter-based therapies include embolotherapy/chemotherapy-based treatments (such as transarterial chemoembolization, bland embolization, transcatheter arterial chemoinfusion, and chemoembolization with drug-eluting beads), and radiotherapy-based treatments (such as radioembolization with yttrium-90 and injection of iodine-131-labeled lipiodol). Ablative therapeutic approaches include chemical therapies (such as ethanol or acetic acid injection), and thermal therapies (such as radiofrequency ablation, laser induced thermotherapy, microwave ablation, cryoablation, and high-intensity focused ultrasound ablation). Each method has its advantages and drawbacks. As a result of the technical development of locoregional approaches for HCC during the recent decades, the range of combined interventional therapies has been continuously extended. In this article, an evidence-based approach is used to review the current role of interventional radiology in the management of unresectable HCC.