Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and results in a third of cancer deaths. Most cases are found in Asia and sub-Saharan Africa, but the incidence in the United States has drastically increased over the past two decades, in part because of the prolonged survival of cirrhotic patients, the prevalence of chronic hepatitis C, and associations with the metabolic syndrome of obesity and diabetes.1,2
Despite improved surveillance of patients with underlying liver disease, most HCCs are diagnosed at nonoperable stages. Transarterial therapies have been developed to provide local control for HCC both in a palliative setting and as an adjunct to surgery. Transarterial therapies exploit the fact that HCC derives most of its blood supply from the hepatic artery, whereas nontumorous liver receives most if its blood supply from the portal vein.3
After a catheter is directed into the hepatic artery, vasculo-occlusive (embolic) or nonembolic agents are delivered preferentially to the tumor while limiting exposure to normal hepatic parenchyma. Current available therapies include transarterial embolization (TAE), transarterial chemoembolization (TACE), and radioembolization (). In addition, transarterial techniques hold promise for the future, as they allow for the selective tumor delivery of therapy. This article is a review of the technical and clinical applications of transarterial therapies for the treatment of HCC and ends with a brief discussion of possible future directions.
Current available transarterial therapies