Locoregional Transarterial Therapies for Hepatocellular Carcinoma: Transarterial Chemoembolization and Radioembolization

Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third most common cause of cancer-related mortality. Despite the widespread implementation of surveillance programs, more than half of the patients with HCC are diagnosed at late stages, when curative treatments (resection or liver transplantation) cannot be applied. For patients presenting with unresectable, non-transplantable HCC and a relatively preserved liver function, locoregional transarterial therapies are the main therapeutic options. Therefore, locoregional transarterial treatments play a key role in the management of HCC. The concept of catheter transarterial therapies is to selectively deliver anticancer treatments to liver tumors. This is possible due to the unique double irrigation of the liver and the predominantly arterial irrigation of liver tumors. Method: An exhaustive analysis of the literature, focused mainly on the last 25 years, has been carried out. Results: This review discusses the scientific evidence supporting the use of transarterial therapies for patients with HCC, including chemoembolization with conventional materials or drug-eluting beads, and internal radiation procedures such as the injection of radiation-loaded microspheres. Conclusion: Transarterial chemoembolization has been shown to improve the survival of those patients with unresectable HCC who have a preserved liver function and a low tumor burden. Recently developed devices and procedures, particularly drug-eluting beads and radioactive microspheres, may further improve the clinical outcome of patients receiving transarterial therapies. The combination with antiangiogenic agents is an appealing approach that should be explored.