Liver-directed therapy for hepatocellular carcinoma

Area of Science:

• Hepatobiliary Oncology
• Interventional Radiology
• Surgical Oncology

Background:

• Hepatocellular carcinoma (HCC) presents a high mortality rate, necessitating curative-intent treatments.
• Optimal HCC management involves multidisciplinary decisions considering tumor characteristics and liver function.
• Current first-line therapies like surgical resection have limitations in patient eligibility and recurrence rates.

Purpose of the Study:

• To review current and emerging treatment strategies for hepatocellular carcinoma (HCC).
• To evaluate the role of surgical resection, transplantation, and image-guided therapies in HCC management.
• To discuss palliative-intent therapies and future directions in curative-intent HCC treatment.

Main Methods:

• Review of established and novel therapeutic modalities for HCC.
• Analysis of treatment outcomes for surgical resection, liver transplantation, and image-guided interventions.
• Assessment of neoadjuvant and palliative treatment options, including ablation, embolization, and radiotherapy.

Main Results:

• Surgical resection offers long-term survival for selected patients but has low eligibility and high recurrence rates.
• Transplantation provides a higher cure chance, with neoadjuvant therapies crucial for maintaining eligibility.
• Image-guided therapies (ablation, embolization) are vital for curative and neoadjuvant treatment; transarterial radioembolization shows comparable survival to TACE with a better toxicity profile.

Conclusions:

• Multidisciplinary approaches are essential for optimizing HCC treatment strategies.
• Image-guided therapies play a significant role in both curative and palliative HCC management.
• Emerging techniques require further validation, while established methods like TACE and transarterial radioembolization remain important palliative options.