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Review
. 2023 Aug 6;15(15):3988.
doi: 10.3390/cancers15153988.

Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives

Roberto Iezzi  1   2 , Alessandro Posa  1 , Andrea Contegiacomo  1 , In Joon Lee  3 , Reto Bale  4 , Alessandro Tanzilli  5 , Lorenzo Tenore  1 , Felice Giuliante  2   6 , Antonio Gasbarrini  2   7 , Shraga Nahum Goldberg  8 , Tobias Jakobs  9 , Maurizio Pompili  2   7 , Irene Bargellini  10 , Evis Sala  1   2 , Hyo-Cheol Kim  11
Affiliations
Review

Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives

Roberto Iezzi et al. Cancers (Basel). .

Abstract

Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the actual treatment is usually discussed by a multidisciplinary tumor board in a personalized manner, leading to potential treatment differences based on Western and Eastern perspectives. The aim of this paper is to integrate literature evidence with the eminent experiences collected during a focused session at the Mediterranean Interventional Oncology (MIO) Live Congress 2023.

Keywords: ablation; chemoembolization; hepatocellular carcinoma; interventional oncology; locoregional treatments; radioembolization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Contrast-enhanced axial MRI showing a 2.5 × 2 cm HCC lesion in the IV hepatic segment (arrow). (B) CT-guided RFA was performed with one electrode. (C) Immediate post-procedural contrast-enhanced CT examination showing the ablation area without complications. (D) Post-treatment axial MRI showing complete response (arrow).
Figure 2
Figure 2
A 73-year-old male with cirrhosis and histologically verified multifocal HCC (segments II, III, Iva, and IVb) with a maximum diameter of 10.4 cm. Previous TACE treatment with a partial response. Due to portal hypertension and a hepatic venous pressure gradient (HVPG) of 10 mmHg, the patient was deemed unsuitable for surgical resection. (A–C) Pre-stereotactic RFA axial contrast-enhanced CT scans showing the large multifocal HCC (white arrows). (D–F) Post-treatment contrast-enhanced axial CT scans show a good ablation zone. 14 coaxial needles were used, for a total of 33 RFA probe positionings and an ablation time of 132 min (4 min per probe position).
Figure 3
Figure 3
(A,B) Axial and coronal contrast-enhanced MRI images showing a 9 cm dishomogenously hypointense lesion in the right hepatic lobe in a BCLC-B patient. (C) Pre-treatment diagnostic angiography showing tumor-feeding arteries. (D) CBCT coronal VR reconstruction showing target volume and color-coded tumor-feeding arteries. (E,F) Axial and coronal contrast-enhanced MRI images showing 3-month post-DEB-TACE results with great tumor necrosis.
Figure 4
Figure 4
(A) Contrast-enhanced axial CT examination showing a 5 cm HCC lesion in the IV hepatic segment. (B) Angiography examination showing tumor staining of the HCC lesion prior to TARE. (C) Post-treatment contrast-enhanced axial CT examination showing the complete necrosis of the HCC lesion.
See this image and copyright information in PMC

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