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Interventional radiology therapies for liver cancer

Romaric Loffroy, Louis Estivalet, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson,
Jean-Pierre Cercueil, Denis Krausé

Department of Vascular, Oncologic and Interventional Radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine,
Bocage Teaching Hospital, 21079 Dijon Cedex, France

ABSTRACT
Hepatocellular carcinoma (HCC) is the fifth most frequently found primary malignant tumor in the world. Hepatic
surgery and liver transplantation are considered optimal for the curative treatment of HCC. However, only 15-20%
of HCCs may be surgically treated. Most of the surgically-non-eligible patients have to receive locoregional image-
guided interventional treatments including intra-arterial and percutaneous ablative therapies. The goal of this paper
is to review these interventional oncology approaches. Ablative therapeutic approaches include chemical therapies
(such as ethanol or acetic acid injection), and thermal therapies (such as radiofrequency ablation, laser-induced
thermotherapy, microwave ablation, cryoablation, and high-intensity focused ultrasound ablation). Catheter-based
therapies include embolotherapy/chemotherapy-based treatments (such as transcatheter arterial chemoembolization,
bland embolization, transcatheter arterial chemoinfusion, and chemoembolization with drug-eluting beads), and
radiotherapy-based treatments (such as radioembolization with yttrium-90 and injection of iodine-131-labeled lipiodol).
As a result of the technical development of locoregional approaches for HCC during the recent decades, the range
of combined interventional therapies has been continuously extended. In this article, an evidence-based approach
will be used to review the current role of interventional radiology therapies in the management of unresectable HCC.

Key words: Hepatocellular carcinoma; local ablative therapy; radioembolization; transarterial chemoembolization

Address for correspondence:
Prof. Romaric Loffroy, Department of Vascular, Oncologic and Interventional Radiology, Le2i UMR CNRS 6306, University of Dijon School of
Medicine, Bocage Teaching Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon Cedex, France. E-mail: romaric.loffroy@chu-dijon.fr
Received: 25-02-2015, Accepted: 06-09-2015

INTRODUCTION patients with single small HCC (≤ 5 cm) or up to three
lesions ≤ 3 cm are indicated for surgery. [5,6] When surgery
Hepatocellular carcinoma (HCC) ranks the fifth in overall is precluded, interventional treatments can be used to
frequency and fourth in annual tumor mortality. improve the prognosis of the patients. Such therapies,
[1]
Surgical treatments including hepatic resection and which rely on imaging guidance for tumor targeting and
liver transplantation are considered the most effective
treatments of HCC. However, less than 20% of HCC can response assessment, include various catheter-based
be treated surgically because of multifocal diseases, and percutaneous ablative techniques. These minimally
proximity of the tumor to key vascular or biliary strictures invasive therapies have been used mainly for palliation
precluding a margin-negative resection and inadequate but have also increasingly been used with curative intent.
functional hepatic reserve with cirrhosis. [2-4] Usually,
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How to cite this article: Loffroy R, Estivalet L, Favelier S, Pottecher P,
DOI: Genson PY, Cercueil JP, Krausé D. Interventional radiology therapies
10.4103/2394-5079.167439 for liver cancer. Hepatoma Res 2016;2:1-9.

© 2016 Hepatoma Research | Published by OAE Publishing Inc. 1