Role of interventional radiology in the management of hepatocellular carcinoma: current status

The treatment of patients with hepatocellular carcinoma requires a careful balance of adequate oncologic control and the preservation of both liver function and performance status. Over the last few decades, the emerging field of interventional oncology has introduced a variety of minimally invasive, safe and effective therapies, expanding the armament of available treatment options. The Barcelona Clinic Liver Cancer staging system is the most widely adopted treatment classification which aims to match patients with the therapies that will yield the best outcomes based on these factors. Radiofrequency ablation has been recommended by this system for patients with very early stage disease and trans-arterial chemoembolization has been recommended as the gold standard therapy for patients with intermediate grade disease. Technical innovation brings newer ablative and embolotherapy techniques into practice, while clinical innovation continues to expand the indications of these treatments outside of the formal paradigm. This article will provide an overview of the varied interventional procedures being used in clinical practice and will review how they can be used to cure very early and early stage disease, to facilitate surgical resection, to bridge or downstage tumors for liver transplantation, and extend survival as palliative interventions in patients with intermediate or advanced disease.