Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4614-4628
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4614
Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions
Riccardo Inchingolo, Alessandro Posa, Martin Mariappan, Stavros Spiliopoulos
Riccardo Inchingolo, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
Riccardo Inchingolo, Department of Radiology, King´s College Hospital, London SE5 9RS, United Kingdom
Alessandro Posa, Department of Radiology, IRCSS Fatebenefratelli Hospital, Roma 00186, Italy
Martin Mariappan, Interventional Radiology Department, Aberdeen Royal Infirmary Hospital, Aberdeen AB25 2ZN, United Kingdom
Stavros Spiliopoulos, 2nd Radiology Department, School of Medicine; National and Kapodistrian University of Athens, Chaidari Athens 12461, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Riccardo Inchingolo, MD, Doctor, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Via Montescaglioso, Matera 75100, Italy.
Telephone: +39-333-4601735 Fax: +39-835-253857
Received: April 30, 2019
Peer-review started: April 30, 2019
First decision: June 5, 2019
Revised: July 12, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019

Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant. The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.

Keywords: Hepatocellular carcinoma, Cirrhosis, Liver, Interventional oncology, Trans-arterial chemo embolization, Selective internal radiation therapy, Ablation

Core tip: Hepatocellular carcinoma (HCC) is the most frequently observed primary malignant liver tumors and is a major cause of worldwide mortality. Despite the advances in minimally invasive surgery, such as laparoscopic and robotic, they are reserved only in early stage patients. Thus, percutaneous locoregional treatments have now a pivotal role in HCC management; in this review, we discuss state of the art of currently available locoregional treatment for HCC and their future perspectives.