Intraarterial therapies for primary liver cancer: state of the art

Abstract

Image-guided intraarterial therapies play an important role in the treatment of patients with hepatic malignancies. These therapies provide the dual benefit of reduced systemic toxicity and effective local tumor control. As a result, procedures such as transarterial chemoembolization have been included in the official treatment guidelines for hepatocellular carcinoma (HCC) and are fully accepted for the treatment of patients with intermediate stage disease. In this review, we will describe the scientific rationale for intraarterial therapies and discuss the available clinical evidence for primary liver cancer. Finally, we will touch on the current trends consisting of combining intraarterial approaches with systemically administered targeted agents.

Keywords::

• carcinoma
• cholangiocarcinoma
• DEB-TACE
• hepatocellular
• intraarterial therapy
• liver cancer
• radioembolization
• sorafenib
• TACE

Financial & competing interests disclosure

J Chapiro has no potential conflicts of interest to disclose. V Tacher has no financial activities related to the present article. V Tacher has received an individual grant from the SFR (Sociçtç Française de Radiologie). J-F Geschwind has no financial activities related to the present article. Financial activities not related to the present article for J-F Geschwind include paid consultant to Nordion, Biocompatibles/BTG, Bayer HealthCare, and Guerbet; the institution has grants/grants pending from NIH, DOD, Biocompatibles/BTG, Bayer HealthCare, Philips Medical, Nordion, Context Vision, SIR and the RSNA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript .

Key issues

• • Image-guided intraarterial therapies play an increasingly important role in the treatment of patients with primary and secondary hepatic malignancies.

• • Intraarterial therapies are safe and gained multidisciplinary acceptance. As a result, procedures such as transarterial chemoembolization (TACE) have been included in the official treatment guidelines for hepatocellular carcinoma (HCC).

• • To this day, conventional TACE remains the only therapy that provides significant survival benefit in selected HCC patients through level one evidence.

• • Drug-eluting bead-TACE (DEB-TACE) is better tolerated than cTACE with a clearly better toxicity profile.

• • Radioembolization appears to be superior to TACE in terms of patient quality of life, however, more studies are needed on the road to full clinical validation.

• • The combination of sorafenib and TACE in patients with unresectable HCC is safe and appears to be well tolerated. However, the efficacy of this combination therapy has yet to be confirmed.

• • The lack of standardized protocols for the different modalities makes these procedures highly dependent on individual experience and center expertise.

• • To answer the innumerous open questions, more prospective and comparative trials are needed.