Hepatocellular Carcinoma: The Role of Interventional Oncology

Abstract

Background: Hepatocellular carcinoma (HCC) remains a major health issue because of its increasing incidence and because of the complexity of its management. In addition to the traditional potentially curative treatments, i.e., liver transplantation and surgical resection, other new and emerging local therapies have been applied with promising results.

Summary: Radiotherapy (RT) and interstitial treatments, such as radiofrequency ablation (RFA), microwave ablation (MWA), and irreversible electroporation (IRE), have recently opened new and interesting treatment scenarios for HCC and are associated with promising results in selected patients. Herein, we describe the emerging role of interventional oncology for the treatment of HCC and focus on the different Western and Eastern approaches.

Key messages: Modern RT and modern interstitial therapies, such as RFA, MWA, and IRE, should be considered for inclusion in HCC therapy guidelines.

Keywords: IRE for HCC; MWA for HCC; RFA for HCC; Radiotherapy for HCC.

Fig. 1

Example of a typical radiation plan for a patient with HCC and vascular invasion. The radiation plan is for an HCC patient with hepatitis C and HIV. HCC (red) with invasion to the right portal vein (yellow arrow) was treated with 35 Gy in five fractions (green line). Baseline and follow-up arterial-phase and delayed-phase CT scans demonstrate an excellent radiographic response that was mirrored by an excellent clinical response and stable liver function 1 year after SBRT. At the last follow-up, there was no active HCC and the irradiated right lobe had atrophied.