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Local Arterial Therapies in the Management of Unresectable Hepatocellular Carcinoma

  • Upper Gastrointestinal Cancers (L Rajdev, Section Editor)
  • Published:
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Opinion statement

Most patients with hepatocellular carcinoma present with intermediate to advanced disease, where curative therapies are no longer an option. These patients with intermediate to advanced disease represent a heterogeneous population with regard to tumor burden, liver function, and performance status. While the Barcelona Clinic Liver Cancer (BCLC) staging system offers guidelines for the management of these patients, strict adherence to these guidelines may limit treatment options for these patients. Several locoregional therapies exist for these patients, including conventional transarterial chemoembolization (cTACE), transarterial embolization (TAE), drug-eluting embolization (DEE), and radioembolization. Evidence is also emerging for the role of radiation therapy including most notably stereotactic body radiation therapy and proton therapy, although at the current time, clinical trial participation is encouraged. While cTACE is traditionally recommended for BCLC B disease, both cTACE and radioembolization are increasingly used for patients with intermediate disease, as well as in select patients with BCLC A and C disease. TAE and DEE are limited in their use currently, due to lack of clear survival benefits or clinical advantages over cTACE. While several studies have demonstrated similar OS between cTACE and radioembolization, radioembolization provides a longer time to progression and fewer toxicities compared to cTACE. This is particularly relevant in the setting of advanced BCLC B and early BCLC C disease, where patients may have limited reserve. Radioembolization also has additional roles as an alternative to ablation, inducing liver hypertrophy, treating patients with PVT, and downstaging lesions to transplant. Ongoing studies will further define the role of locoregional treatment potentially in combination with and in light of developments in systemic therapy.

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Authors and Affiliations

  1. Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, CCC-1118 Medical Center North, Nashville, TN, 37232-2675, USA

    Samdeep K. Mouli MD

  2. Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, 777 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232-6307, USA

    Laura W. Goff MD, MS

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  1. Samdeep K. Mouli MD
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  2. Laura W. Goff MD, MS
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Correspondence to Laura W. Goff MD, MS.

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Samdeep K. Mouli and Laura W. Goff declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Upper Gastrointestinal Cancers

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Mouli, S.K., Goff, L.W. Local Arterial Therapies in the Management of Unresectable Hepatocellular Carcinoma. Curr. Treat. Options in Oncol. 18, 67 (2017). https://doi.org/10.1007/s11864-017-0509-6

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