Interventional Treatment Strategies for Hepatocellular Carcinoma

Interventional radiology has become central to the management of hepatocellular carcinoma, offering minimally invasive locoregional therapies that preserve healthy liver tissue and prolong survival. The principal modalities include transarterial chemoembolization, which combines targeted delivery of cytotoxic agents with arterial occlusion; percutaneous thermal ablation techniques such as radiofrequency and microwave ablation, which induce tumour coagulation by heating; and bland embolisation, which deprives the lesion of blood supply without chemotherapy. Patient selection relies on established staging systems, notably the Barcelona Clinic Liver Cancer classification, and multidisciplinary tumour boards guide decisions on monotherapy or combined approaches. Combination protocols—such as embolisation followed by ablation—extend the therapeutic window for lesions that would be suboptimal for single-modality treatment, facilitate downstaging or bridging to transplantation and can improve local control. Advances in catheter technology, image guidance and ablation probes have refined procedural safety and consistency, enabling tailored strategies for early, intermediate and selected advanced cases around the world.

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Interventional Treatment Strategies for Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in interventional treatment strategies for hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Transarterial chemoembolization (TACE): Injection of chemotherapeutic agents and embolic particles into hepatic arteries supplying a tumour to induce ischaemia and deliver cytotoxic drugs.
Radiofrequency ablation (RFA): Percutaneous delivery of high-frequency alternating current to generate thermal coagulation and destroy tumour tissue.
Microwave ablation (MWA): Use of electromagnetic microwaves to produce rapid heating and coagulative necrosis in targeted hepatic lesions.
Transarterial embolization (TAE): Delivery of embolic material into tumour vessels to obstruct blood flow without chemotherapeutic agents.
Bridging and downstaging: Pre-transplant interventions to control tumour growth or reduce lesion size and number to meet transplantation criteria.
Milan criteria: Selection guidelines for liver transplantation in HCC based on maximum tumour size (≤5 cm) and number (≤3 nodules).

References

1. Combined transarterial chemoembolization and thermal ablation in candidates to liver transplantation with hepatocellular carcinoma: pathological findings and post-transplant outcome. La radiologia medica (2024).
2. Combination Therapy of Bland Transarterial Embolization and Microwave Ablation for Hepatocellular Carcinoma within the Milan Criteria Leads to Significantly Higher Overall Survival. Cancers (2023).
3. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3–. International Journal of Hyperthermia (2021).