Interventional Radiology in the Management of Primary Liver Malignancies

Area of Science:

• Oncology
• Interventional Radiology
• Hepatobiliary Malignancies

Background:

• Primary liver cancers, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined HCC-ICC, are significant global health burdens.
• Despite advances in systemic therapies, outcomes are often limited by intrahepatic tumor progression, liver failure, and portal hypertension.

Purpose of the Study:

• To review the current evidence and technical aspects of major image-guided locoregional therapies (LRTs) used in interventional radiology for primary liver malignancies.
• To discuss the role of interventional radiology in preoperative liver optimization and the integration of LRTs with systemic treatments and immunotherapy.

Main Methods:

• This narrative review synthesizes current literature on various LRTs, including ablation techniques (radiofrequency, microwave, cryoablation), transarterial therapies (chemoembolization, radioembolization), and other modalities (SBRT, IRE, histotripsy, HIFU, HAIC, brachytherapy).
• The review also covers LRTs for liver optimization (portal vein embolization, liver venous deprivation, lobar radioembolization) and their application in HCC, ICC, and combined HCC-ICC.
• The potential immunomodulatory effects of LRTs and their combination with systemic therapies are discussed.

Main Results:

• Locoregional therapies provide local tumor control, downstaging, bridging to transplant, palliation, and potential survival benefits for primary liver cancers.
• For HCC, ablation and transarterial therapies are integral to stage-based treatment, offering curative potential in select cases.
• For ICC and combined HCC-ICC, LRTs offer disease control and survival prolongation, especially when combined with systemic agents, though treatment for combined tumors is individualized.

Conclusions:

• Interventional radiology is crucial in the multidisciplinary management of primary liver cancer, offering diverse image-guided locoregional therapies.
• LRTs can modulate the tumor immune microenvironment, supporting combination strategies with immunotherapy and targeted agents.
• Future advancements depend on patient selection, technique optimization, biomarker integration, and collaborative care.