Digestive Diseases and Sciences

, Volume 64, Issue 4, pp 959–967 | Cite as

HCC: Transarterial Therapies—What the Interventional Radiologist Can Offer

  • Thomas J. VoglEmail author
  • Tatjana Gruber-Rouh


With the increasing incidence of hepatocellular carcinoma (HCC) and its high mortality rates, effective treatment options are of urgent need, preferably in a multidisciplinary setting. In the management of those patients, interventional radiologists play a key role. In this article, we reviewed the current literature for regional, intraarterial treatment strategies of advanced-stage HCC including conventional transarterial chemoembolization, transarterial embolization, transarterial embolization with drug-eluting beads, and selective internal radiation therapy.


Hepatocellular carcinoma (HCC) Conventional transarterial chemoembolization (cTACE) Drugeluting bead TACE (DEB-TACE) Selective internal radiation therapy (SIRT) 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Cabibbo G, Latteri F, Antonucci M, Craxì A. Multimodal approaches to the treatment of hepatocellular carcinoma. Nat Clin Pract Gastroenterol Hepatol. 2009;6:159–169.CrossRefGoogle Scholar
  2. 2.
    Ganne-Carrié N, Chaffaut C, Bourcier V, et al. Estimate of hepatocellular carcinoma’s incidence in patients with alcoholic cirrhosis. J Hepatol. 2018;69:1274–1283.CrossRefGoogle Scholar
  3. 3.
    Streba LA, Vere CC, Rogoveanu I, Streba CT. Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: an open question. World J Gastroenterol. 2015;21:4103–4110.CrossRefGoogle Scholar
  4. 4.
    Kanda T, Matsuoka S, Yamazaki M, et al. Apoptosis and non-alcoholic fatty liver diseases. World J Gastroenterol. 2018;24:2661–2672.CrossRefGoogle Scholar
  5. 5.
    El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365:1118–1127.CrossRefGoogle Scholar
  6. 6.
    Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol. 2015;13:2140–2151.CrossRefGoogle Scholar
  7. 7.
    Thomas MB, Jaffe D, Choti MM, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute clinical trials planning meeting. J Clin Oncol. 2010;28:3994–4005.CrossRefGoogle Scholar
  8. 8.
    Rougier P, Mitry E, Barbare JC, Taieb J. Hepatocellular carcinoma (HCC): an update. Semin Oncol. 2007;34:S12–S20.CrossRefGoogle Scholar
  9. 9.
    Lencioni R. Loco-regional treatment of hepatocellular carcinoma in the era of molecular targeted therapies. Oncology. 2010;78:107–112.CrossRefGoogle Scholar
  10. 10.
    Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–1255.CrossRefGoogle Scholar
  11. 11.
    Pesapane F, Nezami N, Patella F, et al. New concepts in embolotherapy of HCC. Med Oncol. 2017;34:58.CrossRefGoogle Scholar
  12. 12.
    Molvar C, Lewandowski RJ. Intra-arterial therapies for liver masses: data distilled. Radiol Clin North Am. 2015;53:973–984.CrossRefGoogle Scholar
  13. 13.
    Geschwind JF, Kudo M, Marrero JA, et al. TACE treatment in patients with sorafenibtreated unresectable hepatocellular carcinoma in clinical practice: final analysis of GIDEON. Radiology. 2016;8:150667.Google Scholar
  14. 14.
    Trevisani F, Golfieri R. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: Where are we now? Hepatology. 2016;64:23–25.CrossRefGoogle Scholar
  15. 15.
    European Association for the Study of the Liver1; European Organisation for Research and Treatment of Cancer. EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–943.CrossRefGoogle Scholar
  16. 16.
    Ramsey DE, Kernagis LY, Soulen MC, et al. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 2002;13:S211–S221.CrossRefGoogle Scholar
  17. 17.
    Ahrar K, Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am. 2003;12:105–126.CrossRefGoogle Scholar
  18. 18.
    Massmann A, Rodt T, Marquardt S, et al. Transarterial chemoembolization (TACE) for colorectal liver metastases–current status and critical review. Langenbecks Arch Surg. 2015;400:641–659.CrossRefGoogle Scholar
  19. 19.
    Gruber-Rouh T, Naguib NN, Eichler K, et al. Transarterial chemoembolization of unresectable systemic chemotherapy-refractory liver metastases from colorectal cancer: long-term results over a 10-year period. Int J Cancer. 2014;134:1225–1231.CrossRefGoogle Scholar
  20. 20.
    Chang J, Charalel R, Noda C, et al. Liver-dominant breast cancer metastasis: a comparative outcomes study of chemoembolization versus radioembolization. Anticancer Res. 2018;38:3063–3068.Google Scholar
  21. 21.
    Wang M, Zhang J, Ji S, Shao G, et al. Transarterial chemoembolisation for breast cancer with liver metastasis: a systematic review. Breast. 2017;36:25–30.CrossRefGoogle Scholar
  22. 22.
    Alexander ES, Soulen MC. Liver metastases from noncolorectal malignancies (neuroendocrine tumor, sarcoma, melanoma, breast). Cancer J. 2016;22:381–386.CrossRefGoogle Scholar
  23. 23.
    Topaloglu S, Ozturk MH. Chemoembolization for neuroendocrine liver metastasis. Hepatogastroenterology. 2014;61:398–404.Google Scholar
  24. 24.
    Grozinsky-Glasberg S, Kaltsas G, et al. Hepatic intra-arterial therapies in metastatic neuroendocrine tumors: lessons from clinical practice. Endocrine. 2018;60:499–509.CrossRefGoogle Scholar
  25. 25.
    Chen T, Chu ZH, Liu JP, et al. Application of adenosine triphosphate tumor chemosensitive assay system to individual chemotherapy for hepatocellular carcinoma. Aizheng. 2005;24:1018–1022. (Abstract).Google Scholar
  26. 26.
    Wu J, Song L, Zhao DY, Guo B, Liu J. Chemotherapy for transarterial chemoembolization in patients with unresectable hepatocellular carcinoma. World J Gastroenterol. 2014;20:10960–10968.CrossRefGoogle Scholar
  27. 27.
    Gruber-Rouh T, Marko C, Thalhammer A, et al. Current strategies in interventional oncology of colorectal liver metastases. Br J Radiol. 2016;26:20151060.CrossRefGoogle Scholar
  28. 28.
    Schicho A, Hellerbrand C, Krüger K, et al. Impact of different embolic agents for transarterial chemoembolization (TACE) procedures on systemic vascular endothelial growth factor (VEGF) levels. J Clin Transl Hepatol. 2016;4:288–292.CrossRefGoogle Scholar
  29. 29.
    Raoul JL, Sangro B, Forner A, et al. Evolving strategies for the managementof intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37:212–220.CrossRefGoogle Scholar
  30. 30.
    Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429–442.CrossRefGoogle Scholar
  31. 31.
    Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlledtrial. Lancet. 2002;359:1734–1739.CrossRefGoogle Scholar
  32. 32.
    Cammà C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma:meta-analysis of randomized controlled trials. Radiology. 2002;224:47–54.CrossRefGoogle Scholar
  33. 33.
    Vande Lune P, Abdel Aal AK, Klimkowski S, et al. Hepatocellular carcinoma: diagnosis, treatment algorithms, and imaging appearance after transarterial chemoembolization. J Clin Transl Hepatol. 2018;6:175–188.Google Scholar
  34. 34.
    Takeba Y, Kumai T, Matsumoto N, et al. Irinotecan activates p53 with its active metabolite, resulting in human hepatocellular carcinoma apoptosis. J Pharmacol Sci. 2007;104:232–242.CrossRefGoogle Scholar
  35. 35.
    Maluccio M, Covey AM, Gandhi R, et al. Comparison of survival rates after bland arterial embolization and ablation versus surgical resection for treating solitary hepatocellular carcinoma up to 7 cm. J Vasc Interv Radiol. 2005;16:955–961.CrossRefGoogle Scholar
  36. 36.
    Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol. 2007;46:474–481.CrossRefGoogle Scholar
  37. 37.
    Poon RT, Tso WK, Pang RW, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol. 2007;5:1100–1108.CrossRefGoogle Scholar
  38. 38.
    Nam HC, Jang B, Song MJ. Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma. World J Gastroenterol. 2016;22:8853–8861.CrossRefGoogle Scholar
  39. 39.
    Lencioni R, de Baere T, Burrel M, et al. Transcatheter treatment of hepatocellular carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol. 2012;35:980–985.CrossRefGoogle Scholar
  40. 40.
    Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2010;33:41–52.CrossRefGoogle Scholar
  41. 41.
    Malagari K. Drug-eluting particles in the treatment of HCC: chemoembolization with doxorubicin-loaded DC Bead. Expert Rev Anticancer Ther. 2008;8:1643–1650.CrossRefGoogle Scholar
  42. 42.
    Han S, Zhang X, Zou L, et al. Does drugeluting bead transcatheter arterial chemoembolization improve the management of patients with hepatocellular carcinoma? A metaanalysis. PLoS One. 2014;9:e102686.CrossRefGoogle Scholar
  43. 43.
    Molvar C, Lewandowski RJ. Intra-arterial therapies for liver masses: data distilled. Radiol Clin North Am. 2015;53:973–984.CrossRefGoogle Scholar
  44. 44.
    Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010;52:762–773.CrossRefGoogle Scholar
  45. 45.
    Salem R, Gordon AC, Mouli S, et al. Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2016;151:1155–1163.CrossRefGoogle Scholar
  46. 46.
    Dezarn WA, Cessna JT, DeWerd LA, et al. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys. 2011;38:4824–4845.CrossRefGoogle Scholar
  47. 47.
    Aubé C, Bouvier A, Lebigot J, et al. Radiological treatment of HCC: interventional radiology at the heart of management. Diagn Interv Imaging. 2015;96:625–636.CrossRefGoogle Scholar
  48. 48.
    Vente MA, Wondergem M, van der Tweel I, et al. Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol. 2009;19:951–959.CrossRefGoogle Scholar
  49. 49.
    Fiorentini G, Aliberti C, Tilli M, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012;32:1387–1395.Google Scholar
  50. 50.
    Mazzaferro V, Sposito C, Bhoori S, et al. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology. 2013;57:1826–1837.CrossRefGoogle Scholar
  51. 51.
    Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140:497–507.CrossRefGoogle Scholar
  52. 52.
    Sangro B, Iñarrairaegui M, Bilbao JI. Radioembolization for hepatocellular carcinoma. J Hepatol. 2012;56:464–473.CrossRefGoogle Scholar
  53. 53.
    Golfieri R, Bilbao JI, Carpanese L, et al. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol. 2013;59:753–761.CrossRefGoogle Scholar
  54. 54.
    Hatanaka T, Arai H, Shibasaki M, et al. Factors predicting overall response and overall survival in hepatocellular carcinoma patients undergoing balloon-occluded transcatheter arterial chemoembolization: a retrospective cohort study. Hepatol Res. 2018;48:165–175.CrossRefGoogle Scholar
  55. 55.
    Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164–1171.CrossRefGoogle Scholar
  56. 56.
    Gruber-Rouh T, Kamal A, Eichler K, et al. Transarterial chemoembolization (TACE) using mitomycin with or without irinotecan for hepatocellular carcinoma in european patients. Oncol Res Treat. 2018;41:438–442.CrossRefGoogle Scholar
  57. 57.
    Yamakado K, Miyayama S, Hirota S, et al. Hepatic arterial embolization for unresectable hepatocellular carcinomas: Do technical factors affect prognosis? Jpn J Radiol. 2012;30:560–566.CrossRefGoogle Scholar
  58. 58.
    Takaki S, Sakaguchi H, Anai H, et al. Long-term outcome of transcatheter subsegmental and segmental arterial chemoemobolization using lipiodol for hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2012;35:544–554.CrossRefGoogle Scholar
  59. 59.
    Golfieri R, Giampalma E, Renzulli M, et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer. 2014;111:255–264.CrossRefGoogle Scholar
  60. 60.
    Facciorusso A, Di Maso M, Muscatiello N. Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: a meta-analysis. Dig Liver Dis. 2016;48:571–577.CrossRefGoogle Scholar
  61. 61.
    Mantry PS, Mehta A, Madani B, et al. Selective internal radiation therapy using yttrium-90 resin microspheres in patients with unresectable hepatocellular carcinoma: a retrospective study. J Gastrointest Oncol. 2017;8:799–807.CrossRefGoogle Scholar
  62. 62.
    Kim DY, Park BJ, Kim YH, et al. Radioembolization with Yttrium-90 resin microspheres in hepatocellular carcinoma: a multicenter prospective study. Am J Clin Oncol. 2015;38:495–501.CrossRefGoogle Scholar
  63. 63.
    Kolligs FT, Bilbao JI, Jakobs T, et al. Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int.. 2015;35:1715–1721.CrossRefGoogle Scholar
  64. 64.
    Gramenzi A, Pettinato C, Cappelli A, et al. Reply to: “Sorafenib or (90) Y loaded resin microsphere radioembolization for locally-advanced hepatocellular carcinoma, what should we trust?”. Liver Int. 2015;35:1780–1781.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute for Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurt am MainGermany

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