Loco-regional treatment of hepatocellular carcinoma

Rákkutatás · Hepatocellular carcinoma

Radiofrequency ablation has shown superior anticancer effects and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta-analyses of randomized controlled trials, and is currently established as the standard method for local tumor treatment.

Loco-regional treatments play a key role in the management of hepatocellular carcinoma (HCC). Image‑guided tumor ablation is recommended in patients with nearly‑stage HCC when surgical options are precluded. Radiofrequency ablation has shown superior anticancer effects and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta‑analyses of randomized controlled trials, and is currently established as the standard method for local tumor treatment. Novel thermal and nonthermal techniques for tumour ablation—including microwave ablation, irreversible electroporation, and light‑activated drug therapy—seem to have potential to overcome the limitations of radiofrequency ablation and warrant further clinical investigation. Transcatheter arterial chemoembolisation (TACE) is the standard of care for patients with asymptomatic, non‑invasive multinodular tumours at the intermediate stage. Recent introduction of embolic microspheres that release the drug in a controlled and sustained fashion has been shown to significantly increase safety and efficacy of TACE with respect to conventional, lipiodol‑based regimens. The available data for radioembolisation with yttrium‑90 suggests that this is a potential new option for patients with HCC, which should be investigated in the setting of randomized controlled trials. Despite the advances and refinements in loco‑regional approaches, the long‑term survival outcomes of patients managed with interventional techniques are not fully satisfactory, mainly because of the high rates of tumour recurrence. The recent addition of molecular targeted drugs with anti‑angiogenic and anti‑proliferative properties to the therapeutic armamentarium for HCC has prompted the design of clinical trials aimed at investigating the synergies between loco‑regional and systemic treatments. The outcomes of these trials are eagerly awaited, because they have the potential to revolutionise the treatment of HCC.

The commentary highlights that radiofrequency ablation is currently the standard local treatment for hepatocellular carcinoma, and discusses emerging loco‑regional therapies and the need for randomized controlled trials to improve long‑term survival and reduce tumour recurrence.

Bizonyítékszint: Megerősített klinikai bizonyíték. Több vagy erősebb humán vizsgálat támogatja.

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