Novel Approaches for Interventional Treatment

Authors:

Riccardo Lencioni, MD (Italy)

Interventional treatments play a key role in the management of hepatocellular carcinoma (HCC). Image-guided radiofrequency ablation (RFA) is recommended in patients with early-stage HCC when surgical options are precluded. Novel thermal and non-thermal techniques for tumour ablation – including microwave ablation and irreversible electroporation – seem to be able to overcome the limitations of RFA and warrant further clinical investigation. The development of lysolipid thermally sensitive liposomes, a unique technology with a novel mechanism of action that delivers high concentrations of drug in a region targeted with the application of localised heat, is being studied in combination with heat-based local treatments with the goal to expand the effective treatment zone. Transcatheter arterial chemoembolization (TACE) is the standard of care for patients with intermediate-stage HCC. Embolic, drug-eluting microspheres seem to offer advantages over conventional regimens owing to the ability to release the drug in a controlled and sustained fashion. The available data for radioembolization with yttrium-90 suggests that this is a potential new option for patients with HCC that should be investigated in the setting of randomised trials. Despite the advances and refinements in loco-regional approaches, the long-term survival of patients managed with interventional techniques is not fully satisfactory, mainly because of the high rates of tumour recurrence. The recent addition of molecular targeted drugs 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, as they have the potential to revolutionise the treatment of HCC.