Percutaneous therapies of hepatocellular carcinoma-an update

Percutaneous image-guided tumor therapies have proved important in the treatment of patients with primary liver cancer. The therapeutic spectrum for the management of this patient group includes ablative techniques such as ethanol ablation and radiofrequency ablation for patients with early-stage disease as well as intra-arterial approaches such as radioembolization and transarterial chemoembolization for patients with intermediate and end-stage disease. The tremendous advantage of such therapies is the reduced systemic toxicity combined with efficient local tumor control. However, specific therapeutic algorithms continue to be highly unstandardized and depend on individual experience of the operator. In this review, we will describe the rationale behind several percutaneous techniques, focusing on intra-arterial therapies of hepatocellular carcinoma (HCC) and review the available clinical evidence. We will also discuss new developments such as the combination of intra-arterial therapies with new systemically applicable drugs.