Recent advances in loco-ablative therapies for liver cancers

Hepatocellular carcinoma (HCC) is the most pervasive form of liver cancer worldwide, with its incidence rising due to lifestyle trends. The majority of HCC cases cannot be treated surgically; hence, loco-ablative therapies are required. Classically, radiofrequency ablation (RFA) has been the loco-ablative therapy most often selected for nonresectable HCC. However, due to technological advances and a better understanding of HCC's pathophysiology, new loco-ablative therapies have been developed for HCC. These novel techniques offer an alternative to surgery and RFA depending on each patient's clinical presentation, such as the number and size of nodules. Moreover, they present different benefits and potential clinical complications; therefore, knowledge of available techniques is important to allow clinicians to select the most suitable therapy for their patients.

A narrative review was carried out to summarize the existing loco-ablative therapies for HCC, as well as to investigate emerging loco-ablative therapies for HCC. The benefits, drawbacks, indication for, and mechanism of each technique are outlined.

The frontier of locoregional HCC treatment is shifting toward histotripsy and combinations of existing locoregional therapies with immunotherapy. The importance of a multidisciplinary team is highlighted. Nonetheless, there remains a role for surgical resection of HCC and classical locoregional therapies such as RFA, as there is a lack of large-scale randomised controlled trials investigating the role of novel locoregional techniques for treating HCC patients.