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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(04): 484-487
DOI: 10.4103/ijmpo.ijmpo_256_19
Editorial Commentary

Interventional Radiological Management of Hepatocellular Carcinoma

Abhishek Bansal
Department of Radiology and Interventional Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Arvind Chaturvedi
Department of Radiology and Interventional Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Hepatocellular carcinoma (HCC) is the sixth-most common cancer worldwide and the fourth-most common cause of death due to cancers.[1] Its incidence is steadily increasing, and the common etiological factors include hepatitis B and C, alcohol-induced chronic liver disease, and nonalcoholic fatty liver disease.[2],[3] Multiple staging systems have been proposed for classifying and guiding treatment decisions based on various factors which include tumor burden, background liver function, and performance status of the patients. The Barcelona Clinic Liver Cancer (BCLC) system [Figure 1] is the most widely accepted and followed worldwide.[4],[5] However, certain authors have suggested that BCLC is too conservative in treatment recommendations and thus have advocated the usage of the Hong Kong Liver Cancer system [Figure 2].[6]

Zoom Image
Figure 1 Barcelona clinic liver cancer staging system
Zoom Image
Figure 2 Hong Kong liver cancer classification

HCC recurrences are frequently seen in patients who have undergone curative treatments.[7] Moreover, many patients in our country are no longer surgical candidates at the time of presentation.[8] Hence, a multidisciplinary approach is required for the management of HCC. With the development and emergence of interventional radiological (IR) treatments, the management of HCC has changed dramatically.[9],[10] IR treatments are curative in patients with early-stage disease, while they play a major role in controlling disease, improving the quality of life, and improving survival in patients with advanced stages.[10],[11]

The following IR treatment options are available for the treatment of HCC:

  • Ablation techniques

    • Chemical

    • Thermal

    • Electrical.

  • Transarterial therapies

    • Bland embolization

    • Chemoembolization (Trans-arterial Chemoembolization [TACE]).

      • Conventional

      • Drug-Eluting Beads (DEB) based

  • Radioembolization (transarterial radioembolization [TARE]).

  • Other adjunct procedures such as portal vein embolization (PVE).



Publication History

Received: 18 December 2019

Accepted: 02 July 2020

Article published online:
17 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
    CrossrefPubMedGoogle Scholar
  • 2 Kulik L, El-Serag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology 2019; 156: 477-910
    CrossrefPubMedGoogle Scholar
  • 3 Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D. et al. Hepatocellular cancer: The impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol 2014; 60: 110-7
    CrossrefPubMedGoogle Scholar
  • 4 Cillo U, Vitale A, Grigoletto F, Farinati F, Brolese A, Zanus G. et al. Prospective validation of the Barcelona clinic liver cancer staging system. J Hepatol 2006; 44: 723-31
    CrossrefPubMedGoogle Scholar
  • 5 Marrero JA, Fontana RJ, Barrat A, Askari F, Conjeevaram HS, Su GL. et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 2005; 41: 707-16
    CrossrefPubMedGoogle Scholar
  • 6 Cheung TT, Kwok PC, Chan S, Cheung CC, Lee AS, Lee V. et al. Hong Kong consensus statements for the management of unresectable hepatocellular carcinoma. Liver Cancer 2018; 7: 40-54
    CrossrefPubMedGoogle Scholar
  • 7 Zhou Y, Sui C, Li B, Yin Z, Tan Y, Yang J. et al. Repeat hepatectomy for recurrent hepatocellular carcinoma: A local experience and a systematic review. World J Surg Oncol 2010; 8: 55
    CrossrefPubMedGoogle Scholar
  • 8 Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: A retrospective analysis of 191 cases. QJM 2008; 101: 479-85
    CrossrefPubMedGoogle Scholar
  • 9 Shrimal A, Prasanth M, Kulkarni AV. Interventional radiological treatment of hepatocellular carcinoma: An update. Indian J Surg 2012; 74: 91-9
    CrossrefPubMedGoogle Scholar
  • 10 Molla N, AlMenieir N, Simoneau E, Aljiffry M, Valenti D, Metrakos P. et al. The role of interventional radiology in the management of hepatocellular carcinoma. Curr Oncol 2014; 21: e480-92
    CrossrefPubMedGoogle Scholar
  • 11 Daher S, Massarwa M, Benson AA, Khoury T. Current and future treatment of hepatocellular carcinoma: An updated comprehensive review. J Clin Transl Hepatol 2018; 6: 69-78
    CrossrefPubMedGoogle Scholar
  • 12 Bouza C, López-Cuadrado T, Alcázar R, Saz-Parkinson Z, Amate JM. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 2009; 9: 31
    CrossrefPubMedGoogle Scholar
  • 13 Lubner MG, Brace CL, Hinshaw JL, Lee Jr FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21: S192-203
    CrossrefPubMedGoogle Scholar
  • 14 Hayashi PH, Ludkowski M, Forman LM, Osgood M, Johnson S, Kugelmas M. et al. Hepatic artery chemoembolization for hepatocellular carcinoma in patients listed for liver transplantation. Am J Transplant 2004; 4: 782-7
    CrossrefPubMedGoogle Scholar
  • 15 Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W. et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 2003; 9: 557-63
    CrossrefPubMedGoogle Scholar
  • 16 Bruix J, Sherman M. American association for the study of liver diseases. Management of hepatocellular carcinoma: An update. Hepatology 2011; 53: 1020-2
    Google Scholar
  • 17 European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol 2012; 56: 908-43
    CrossrefPubMedGoogle Scholar
  • 18 Song JE, Kim DY. Conventional vs. drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma. World J Hepatol 2017; 9: 808-14
    CrossrefPubMedGoogle Scholar
  • 19 Lencioni R, Petruzzi P, Crocetti L. Chemoembolization of hepatocellular carcinoma. Semin Intervent Radiol 2013; 30: 3-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Lencioni R, de Baere T, Burrel M, Caridi JG, Lammer J, Malagari K. et al. Transcatheter treatment of hepatocellular carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): Technical recommendations. Cardiovasc Intervent Radiol 2012; 35: 980-5
    CrossrefPubMedGoogle Scholar
  • 21 Silva JP, Berger NG, Tsai S, Christians KK, Clarke CN, Mogal H. et al. Transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis. HPB (Oxford) 2017; 19: 659-66
    CrossrefPubMedGoogle Scholar
  • 22 Facciorusso A, Licinio R, Muscatiello N, Di Leo A, Barone M. Transarterial chemoembolization: Evidences from the literature and applications in hepatocellular carcinoma patients. World J Hepatol 2015; 7: 2009-19
    CrossrefPubMedGoogle Scholar
  • 23 Sacco R, Conte C, Tumino E, Parisi G, Marceglia S, Metrangolo S. et al. Transarterial radioembolization for hepatocellular carcinoma: A review. J Hepatocell Carcinoma 2016; 3: 25-9
    CrossrefPubMedGoogle Scholar
  • 24 Gramenzi A, Golfieri R, Mosconi C, Cappelli A, Granito A, Cucchetti A. et al. Yttrium-90 radioembolization vs sorafenib for intermediate-locally advanced hepatocellular carcinoma: A cohort study with propensity score analysis. Liver Int 2015; 35: 1036-47
    CrossrefPubMedGoogle Scholar
  • 25 Liapi E, Geschwind JF. Combination of local transcatheter arterial chemoembolization and systemic anti-angiogenic therapy for unresectable hepatocellular carcinoma. Liver Cancer 2012; 1: 201-15
    CrossrefPubMedGoogle Scholar
  • 26 Meyer T, Fox R, Ma YT, Ross PJ, James MW, Sturgess R. et al. Sorafenib in combination with transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma (TACE 2): A randomised placebo-controlled, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol 2017; 2: 565-75
    CrossrefPubMedGoogle Scholar
  • 27 Yoon SM, Lim YS, Won HJ, Kim JH, Kim KM, Lee HC. et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: Long-term patient outcomes. Int J Radiat Oncol Biol Phys 2012; 82: 2004-11
    CrossrefPubMedGoogle Scholar
  • 28 Tazawa J, Maeda M, Sakai Y, Yamane M, Ohbayashi H, Kakinuma S. et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement. J Gastroenterol Hepatol 2001; 16: 660-5
    CrossrefPubMedGoogle Scholar