Recent developments and prospects in locoregional therapy of hepatocellular carcinoma

This invited review discusses recent advancements and prospects in locoregional therapy (LRT) for hepatocellular carcinoma (HCC), a leading cause of cancer mortality globally. The epidemiology of HCC is shifting toward nonviral etiologies, prompting a focus on early surveillance and personalized treatment approaches. Updated international guidelines, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, American Association for Study of Liver Disease (AASLD) guideline, and European Association for the Study of the Liver (EASL) now recognize LRT-including transarterial embolization, ablation, and radiotherapy-as cornerstone therapies in curative and downstaging strategies for HCC at multiple stages. The article reviews novel transarterial and ablative technologies, including advanced dosimetry for radioembolization, innovative embolic agents, and emerging nonthermal ablation modalities like irreversible electroporation and pulsed electric field ablation, all aimed at increasing precision, local delivery, minimizing systemic exposure. Additionally, combination approaches integrating LRT with immunotherapy are highlighted, reflecting the evolving understanding of HCC's tumor-immune microenvironment. Progress in robotic guidance, fusion imaging, and imageable radioembolics is also explored. Ongoing and future clinical trials will further define the optimal use of these evolving modalities. Overall, LRT continues to expand as a minimally invasive, indispensable backbone in multidisciplinary HCC management.