Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies
Abstract
:1. Introduction
2. Transarterial Embolization
2.1. Procedure
2.2. Periprocedural Management
2.3. Patient Selection
2.4. Prognostic Factors and Outcomes
3. Transarterial Chemoembolization
3.1. Procedure and Periprocedural Management
3.2. Patient Selection
3.3. Prognostic Factors and Outcomes
4. Transarterial Radioembolization
4.1. Procedure and Periprocedural Management
4.2. Patient Selection
4.3. Prognostic Factors and Outcomes
5. Ablation
5.1. Procedure and Periprocedural Management
5.2. Patient Selection
5.3. Prognostic Factors and Outcomes
6. Future Directions
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Modality | Techniques | Clinical Utility | Risks | Benefits |
---|---|---|---|---|
TAE | Particulate or liquid embolic agents | Disease control (BCLC B) and bridging/downstaging to transplant (BCLC A, B). | PES, liver failure, liver abscess/biloma | Improves OS vs. best supportive care. Avoids chemotherapy toxicity. Less expensive than TACE. |
TACE | Conventional emulsified chemotherapeutic agent (c-TACE) or drug-eluting beads (DEB-TACE) | Same as TAE. Can combine with portal vein embolization before resection. | PES, liver failure, liver abscess/biloma | Improves OS vs. best supportive care. Simultaneous embolic and chemotherapeutic effects. |
TARE | Yttrium-90 radioisotope loaded onto microspheres | Same as TAE/TACE. RS for nonsurgical early stage patients (BCLC 0, A). Can also be used in portal vein thrombosis. | RILD, radiation-induced pneumonitis, PES, liver failure, liver abscess/biloma | Higher quality of life/TTP vs. TACE. RS outcomes comparable to curative-intent treatments (e.g., resection and ablation) at 5 years |
Ablation | Microwaves, radiofrequency alternating current, laser, cooling | Early stage HCC < 2–3 cm in non-surgical candidates (BCLC 0, A). Improved outcomes for tumors 3–5 cm when combined with TACE. | PAS, bleeding, adjacent organ injury | Similar outcomes as resection for tumors < 3 cm. |
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Makary, M.S.; Khandpur, U.; Cloyd, J.M.; Mumtaz, K.; Dowell, J.D. Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies. Cancers 2020, 12, 1914. https://doi.org/10.3390/cancers12071914
Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies. Cancers. 2020; 12(7):1914. https://doi.org/10.3390/cancers12071914
Chicago/Turabian StyleMakary, Mina S., Umang Khandpur, Jordan M. Cloyd, Khalid Mumtaz, and Joshua D. Dowell. 2020. "Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies" Cancers 12, no. 7: 1914. https://doi.org/10.3390/cancers12071914