Interventional therapy options in hepatocellular carcinoma

Several types of intervention are available for the local ablation of small- to medium-sized hepatocellular carcinoma (HCC) in a cirrhotic liver, for which surgical options such as transplantation or resection do not apply. Apart from the response of HCC to these local ablative methods, survival of such patients depends particularly on the extent of hepatic failure due to the underlying disease. Percutaneous ethanol injection (PEI) is simple, safe, effective, and cheap; thus, it represents the method most frequently used worldwide. Percutaneous radio-frequency thermal ablation (RFTA) seems to be more effective in local tumor control, however, at higher cost and with slightly more frequent adverse reactions and complications. Despite the complete lack of randomized comparisons between local ablation and surgery, PEI and RFTA may be comparable to surgical resection, especially in patients with small HCC (< 3 cm) in cirrhosis. Data are quite controversial regarding the efficacy and safety of transarterial chernoembolization (TACE). However, TACE may be an option for properly selected patients (limited number and size of lesions, sufficient hepatic functional reserve) for whom PEI and RFTA do not apply. The combination of TACE and PEI (or RFTA) may be of help in individual cases with large inoperable HCCs.