Tailoring of Interventional Procedures for HCC Patients-Review Article

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma (HCC). Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma (HCC) including transcatheter arterial chemoembolization (TACE) and many tumor ablation techniques, such as percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser-induced interstitial thermotherapy (LITT), cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likely that in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography (CT) and magnetic resonance imaging (MRI) have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated. In this review article, we discuss the imaging modalities and also tailoring of interventional procedures for HCC patients. Introduction Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer and due to the poor prognosis and low response rate, it consists the fourth cause of death related to cancer worldwide.1 The epidemiology and risk factors that contribute to the development of the disease govern the incidence and prevalence rate of HCC. The most prevalent risk factor of HCC development is chronic hepatitis B virus (HBV) infection regarding its endemic presence in the heavily crowded regions, for example in Sub-Saharan Africa and Southeast Asia.1 Most cases are male and between 30 and 50 years of age.2 Hepatitis B virus (HBV) infection is the main cause of chronic liver disease in Iran.3,4 “It was estimated that more than 35% of Iranians have been exposed to HBV and about 3% were chronic carriers”.5 National vaccination of infants and adolescents and intensified hepatitis B vaccination of high risk groups, surveillance of hepatitis B infected subjects and controlling the health status of our community has decreased the frequency of infection in Iran.5-12 The infection is much lower in our neighbors such as Turkey and Pakistan.13,14 The most common cause of HCC in Iran is HBV infection and at least 80% of HCC cases are positive for at least one of the markers of HBV.15-18 Management of HCC is challenging due to its ever-changing epidemiology, the difficulties due to the underlying cirrhosis and the evolving therapeutic algorithms.19 For management of patients we need collaboration between internists, gastroenterologists, oncologists, surgeons and interventional radiologists. This review provides an overview of the interventional procedures for HCC patients and methods for ablations.