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Review
. 2022 Jul 10;14(14):3351.
doi: 10.3390/cancers14143351.

Intraarterial Therapies for the Management of Hepatocellular Carcinoma

Tushar Garg  1 , Apurva Shrigiriwar  2 , Peiman Habibollahi  3 , Mircea Cristescu  4 , Robert P Liddell  1 , Julius Chapiro  5 , Peter Inglis  6 , Juan C Camacho  7   8 , Nariman Nezami  6   9
Affiliations
Review

Intraarterial Therapies for the Management of Hepatocellular Carcinoma

Tushar Garg et al. Cancers (Basel). .

Abstract

Image-guided locoregional therapies play a crucial role in the management of patients with hepatocellular carcinoma (HCC). Transarterial therapies consist of a group of catheter-based treatments where embolic agents are delivered directly into the tumor via their supplying arteries. Some of the transarterial therapies available include bland embolization (TAE), transarterial chemoembolization (TACE), drug-eluting beads-transarterial chemoembolization (DEB-TACE), selective internal radioembolization therapy (SIRT), and hepatic artery infusion (HAI). This article provides a review of pre-procedural, intra-procedural, and post-procedural aspects of each therapy, along with a review of the literature. Newer embolotherapy options and future directions are also briefly discussed.

Keywords: bland embolization; drug-eluting beads–transarterial chemoembolization; hepatic artery infusion; hepatocellular carcinoma; selective internal radioembolization therapy; transarterial chemoembolization.

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Conflict of interest statement

T.G. serves on the editorial board of RadioGraphics and Pediatrics Oncall. T.G. receives conference travel support from Siemens Healtineers. J.C. is supported by grants from the Society of Interventional Oncology, Guerbet Pharmaceuticals, Philips Healthcare, Boston Scientific, Yale Center for Clinical Investigation, and the National Institutes of Health (R01CA206180); reports personal fees from Guerbet Pharmaceuticals, Bayer, AstraZeneca and Philips Healthcare; and reports nonfinancial support from Guerbet Pharmaceuticals outside the submitted work. N.N. is consultant to Embolx, RenovoRx, and CAPS Medical.

Figures

Figure 1
Figure 1
Transarterial therapies. (A) Bland embolization (BE). (B) Conventional transarterial chemoembolization (cTACE). (C) Drug-eluting beads–transarterial chemoembolization (DEB–TACE). (D) Radioembolization.
Figure 2
Figure 2
Indications for the use of transarterial therapies in patients with hepatocellular carcinoma (HCC).
Figure 3
Figure 3
Patient with right lobe HCC with extension into the hepatic vein causing thrombosis. Pre-procedural investigation showed 30% shunt fraction, and therefore the patient was treated with cTACE. (A) Pre-procedural coronal CT shows right lobe HCC lesion with hepatic vein thrombosis. (B) A 99mTc-MAA SPECT/CT shows a lung shunt with a lung shunt fraction of 30%. (C) Intraoperative CT showing good lipiodol uptake in the treated lesion areas. (D) Follow-up MRI showing reduced non-enhancing HCC and hepatic vein thrombus due to good response after treatment.
Figure 4
Figure 4
A patient with multifocal HCC who underwent DEB–TACE for its management. CT showing multifocal HCC involving the right (A) and left lobe (B). Common hepatic artery angiogram showing tumor blush (C), which completely disappeared after DEB–TACE (D). Follow-up CT showing good tumor response in the right (E) and left (F) lobe of the liver.
Figure 4
Figure 4
A patient with multifocal HCC who underwent DEB–TACE for its management. CT showing multifocal HCC involving the right (A) and left lobe (B). Common hepatic artery angiogram showing tumor blush (C), which completely disappeared after DEB–TACE (D). Follow-up CT showing good tumor response in the right (E) and left (F) lobe of the liver.
Figure 5
Figure 5
Radiation segmentectomy in a patient with HCC with a past surgical history of right hepatectomy. (A) CT showing a large lesion in the left lobe of the liver. (B) Left hepatic artery angiogram showing vessels supplying the tumor. (C) SPECT-CT imaging after left segment-2 sub-segmentectomy, showing good dose delivery. (D) Follow-up CT showing good response in the treated area.
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