Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Abdominal Radiology
Published in: Abdominal Radiology 12/2023

16-09-2023 | Hepatocellular Carcinoma | Review

Understanding the role of radiologists in complex treatment decisions for patients with hepatocellular carcinoma

Authors: Omar Kamal, Natally Horvat, Sandeep Arora, Humaira Chaudhry, Mohab Elmohr, Lokesh Khanna, Pankaj Sharma Nepal, Manida Wungjramirun, Sadhna B. Nandwana, Anuradha S. Shenoy-Bhangle, James Lee, Ania Kielar, Robert Marks, Khaled Elsayes, Alice Fung

Published in: Abdominal Radiology | Issue 12/2023

Login to get access

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and represents a significant global health burden. Management of HCC can be challenging due to multiple factors, including variable expectations for treatment outcomes. Several treatment options are available, each with specific eligibility and ineligibility criteria, and are provided by a multidisciplinary team of specialists. Radiologists should be aware of the types of treatment options available, as well as the criteria guiding the development of individualized treatment plans. This awareness enables radiologists to contribute effectively to patient-centered multidisciplinary tumor boards for HCC and play a central role in reassessing care plans when the treatment response is deemed inadequate. This comprehensive review aims to equip radiologists with an overview of HCC staging systems, treatment options, and eligibility criteria. The review also discusses the significance of imaging in HCC diagnosis, treatment planning, and monitoring treatment response. Furthermore, we highlight the crucial branch points in the treatment decision-making process that depend on radiological interpretation.

Graphical abstract

Literature
1.
Konyn, P., A. Ahmed, and D. Kim, Current epidemiology in hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol, 2021. 15(11): p. 1295-1307.PubMedCrossRef
2.
Kulik, L. and H.B. El-Serag, Epidemiology and Management of Hepatocellular Carcinoma. Gastroenterology, 2019. 156(2): p. 477-491 e1.PubMedCrossRef
3.
Ayuso, C., et al., Diagnosis and staging of hepatocellular carcinoma (HCC): current guidelines. Eur J Radiol, 2018. 101: p. 72-81.PubMedCrossRef
4.
Reig, M., et al., BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol, 2022. 76(3): p. 681-693.PubMedCrossRef
5.
Amorim, J., et al., Critical review of HCC imaging in the multidisciplinary setting: treatment allocation and evaluation of response. Abdom Radiol (NY), 2020. 45(10): p. 3119-3128.PubMedCrossRef
6.
Sinn, D.H., et al., Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients. PLoS One, 2019. 14(1): p. e0210730.PubMedPubMedCentralCrossRef
7.
Shenoy-Bhangle, A.S., et al., Role of the radiologist at HCC multidisciplinary conference and use of the LR-TR algorithm for improving workflow. Abdom Radiol (NY), 2021. 46(8): p. 3558-3564.PubMedCrossRef
8.
Amin, M.B., et al., The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin, 2017. 67(2): p. 93-99.PubMedCrossRef
9.
Wiesner, R., et al., Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology, 2003. 124(1): p. 91-6.PubMedCrossRef
10.
Galle, P.R., et al., Biology and significance of alpha-fetoprotein in hepatocellular carcinoma. Liver Int, 2019. 39(12): p. 2214-2229.PubMedCrossRef
11.
Tangkijvanich, P., et al., Clinical characteristics and prognosis of hepatocellular carcinoma: analysis based on serum alpha-fetoprotein levels. J Clin Gastroenterol, 2000. 31(4): p. 302-8.PubMedCrossRef
12.
Ikai, I., et al., Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer, 2004. 101(4): p. 796-802.PubMedCrossRef
13.
Mehta, N., et al., Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database. Am J Transplant, 2018. 18(5): p. 1206-1213.PubMedCrossRef
14.
Pusceddu, C., et al., The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report. Cancers (Basel), 2022. 14(12).PubMedCrossRef
15.
Han, J., Y.C. Fan, and K. Wang, Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2020. 99(43): p. e22703.PubMedCrossRef
16.
Musick, J.R., et al., Laparoscopic microwave ablation versus percutaneous microwave ablation of hepatic malignancies: Efficacy and recurrence-free survival outcomes in patients. Surgery, 2023. 173(3): p. 598-602.PubMedCrossRef
17.
Cucchetti, A., et al., Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol, 2013. 59(2): p. 300-7.PubMedCrossRef
18.
Cho, Y.K., et al., Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology, 2010. 51(4): p. 1284-90.PubMedCrossRef
19.
Fuks, D., et al., Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology, 2012. 55(1): p. 132-40.PubMedCrossRef
20.
Berzigotti, A., et al., Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology, 2015. 61(2): p. 526-36.PubMedCrossRef
21.
Ferrer-Fabrega, J., et al., Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection. Hepatology, 2016. 63(3): p. 839-49.PubMedCrossRef
22.
Mazzaferro, V., et al., Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med, 1996. 334(11): p. 693-9.PubMedCrossRef
23.
Machicao, V.I., Model for End-Stage Liver Disease-Sodium Score: The Evolution in the Prioritization of Liver Transplantation. Clin Liver Dis, 2017. 21(2): p. 275-287.PubMedCrossRef
24.
Kloeckner, R., P.R. Galle, and J. Bruix, Local and Regional Therapies for Hepatocellular Carcinoma. Hepatology, 2021. 73 Suppl 1: p. 137-149.PubMedCrossRef
25.
Couri, T. and A. Pillai, Goals and targets for personalized therapy for HCC. Hepatol Int, 2019. 13(2): p. 125-137.PubMedCrossRef
26.
Guiu, B., et al., TARE in Hepatocellular Carcinoma: From the Right to the Left of BCLC. Cardiovasc Intervent Radiol, 2022. 45(11): p. 1599-1607.PubMedCrossRef
27.
Lewandowski, R.J., et al., A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant, 2009. 9(8): p. 1920-8.PubMedCrossRef
28.
Gabr, A., et al., Liver Transplantation Following Yttrium-90 Radioembolization: 15-Year Experience in 207-Patient Cohort. Hepatology, 2021. 73(3): p. 998-1010.PubMedCrossRef
29.
Salem, R., et al., Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology, 2016. 151(6): p. 1155-1163 e2.PubMedCrossRef
30.
Gabr, A., et al., Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nucl Med Mol Imaging, 2021. 48(2): p. 580-583.PubMedCrossRef
31.
32.
Shampain, K.L., et al., SBRT for HCC: Overview of technique and treatment response assessment. Abdom Radiol (NY), 2021. 46(8): p. 3615-3624.PubMedCrossRef
33.
Lasley, F.D., et al., Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol, 2015. 5(5): p. e443-e449.PubMedCrossRef
34.
Benson, A.B., et al., Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2021. 19(5): p. 541-565.PubMedCrossRef
35.
Cannon, R., et al., Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol, 2013. 107(5): p. 544-9.PubMedCrossRef
36.
Lu, D.S., et al., Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology, 2005. 234(3): p. 954-60.PubMedCrossRef
37.
Bhutiani, N., et al., Evaluation of tolerability and efficacy of irreversible electroporation (IRE) in treatment of Child-Pugh B (7/8) hepatocellular carcinoma (HCC). HPB (Oxford), 2016. 18(7): p. 593-9.PubMedCrossRef
38.
Zou, Y.W., et al., The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2023. 22(1): p. 54-63.PubMedCrossRef
39.
40.
Chernyak, V., et al., Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology, 2018. 289(3): p. 816-830.PubMedCrossRef
41.
Eisenbrey, J.R., et al., Contrast-enhanced ultrasound (CEUS) in HCC diagnosis and assessment of tumor response to locoregional therapies. Abdom Radiol (NY), 2021. 46(8): p. 3579-3595.PubMedCrossRef
42.
43.
Kambadakone, A.R., et al., LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY), 2018. 43(1): p. 56-74.PubMedCrossRef
44.
45.
Toniutto, P., et al., Liver Transplantation in Patients with Hepatocellular Carcinoma beyond the Milan Criteria: A Comprehensive Review. J Clin Med, 2021. 10(17).PubMedPubMedCentralCrossRef
46.
Seuss, C.R., et al., Comparison of MRI pulse sequences for prediction of size of hepatocellular carcinoma at explant evaluation. AJR Am J Roentgenol, 2014. 203(2): p. 300-5.PubMedCrossRef
47.
Dietrich, O., et al., Technical aspects of MR diffusion imaging of the body. European Journal of Radiology, 2010. 76(3): p. 314-322.PubMedCrossRef
48.
Jha, R.C., S.S. Khera, and A.D. Kalaria, Portal Vein Thrombosis: Imaging the Spectrum of Disease With an Emphasis on MRI Features. AJR Am J Roentgenol, 2018. 211(1): p. 14-24.PubMedCrossRef
49.
Sherman, C.B., et al., Distinguishing Tumor From Bland Portal Vein Thrombus in Liver Transplant Candidates With Hepatocellular Carcinoma: the A-VENA Criteria. Liver Transpl, 2019. 25(2): p. 207-216.PubMedPubMedCentralCrossRef
50.
Kawagishi, N., HCC with portal vein tumor thrombosis: how to manage? Hepatol Int, 2020. 14(5): p. 609-611.PubMedCrossRef
51.
Hatano, E., et al., Significance of hepatic resection and adjuvant hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombus in the first branch of portal vein and the main portal trunk: a project study for hepatic surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci, 2018. 25(9): p. 395-402.PubMedCrossRef
52.
Kokudo, T., et al., Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol, 2016. 65(5): p. 938-943.PubMedCrossRef
53.
Lau, W.Y., et al., Treatment for hepatocellular carcinoma with portal vein tumor thrombosis: the emerging role for radioembolization using yttrium-90. Oncology, 2013. 84(5): p. 311-8.PubMedCrossRef
54.
Xu, Y.C., F. Yang, and D.L. Fu, Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol, 2022. 28(19): p. 2057-2075.PubMedPubMedCentralCrossRef
55.
Entezari, P., et al., Promoting Surgical Resection through Future Liver Remnant Hypertrophy. Radiographics, 2022. 42(7): p. 2166-2183.PubMedCrossRef
56.
Lian, D., et al., CT volumetry helps predict prognosis of large hepatocellular carcinoma after resection. Clin Radiol, 2022. 77(8): p. e599-e605.PubMedCrossRef
57.
Lim, M.C., et al., CT volumetry of the liver: where does it stand in clinical practice? Clin Radiol, 2014. 69(9): p. 887-95.PubMedCrossRef
58.
Forner, A., J.M. Llovet, and J. Bruix, Hepatocellular carcinoma. Lancet, 2012. 379(9822): p. 1245-55.PubMedCrossRef
59.
Uka, K., et al., Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol, 2007. 13(3): p. 414-20.PubMedPubMedCentralCrossRef
60.
Kielar, A., et al., Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY), 2018. 43(1): p. 218-230.PubMedCrossRef
61.
Ram, R., et al., LI-RADS treatment response lexicon: review, refresh and resolve with emerging data. Abdom Radiol (NY), 2021. 46(8): p. 3549-3557.PubMedCrossRef
62.
Aslam, A., et al., Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions. World J Hepatol, 2020. 12(10): p. 738-753.PubMedPubMedCentralCrossRef
63.
Mendiratta-Lala, M., et al., Natural history of hepatocellular carcinoma after stereotactic body radiation therapy. Abdom Radiol (NY), 2020. 45(11): p. 3698-3708.PubMedCrossRef
64.
Llovet, J.M. and R. Lencioni, mRECIST for HCC: Performance and novel refinements. J Hepatol, 2020. 72(2): p. 288-306.PubMedCrossRef
65.
Ronot, M., et al., Imaging to Predict Prognosis in Hepatocellular Carcinoma: Current and Future Perspectives. Radiology, 2023. 307(3): p. e221429.PubMedCrossRef
66.
Li, X., et al., Correlations between the minimum and mean apparent diffusion coefficient values of hepatocellular carcinoma and tumor grade. J Magn Reson Imaging, 2016. 44(6): p. 1442-1447.PubMedCrossRef
67.
Witjes, C.D., et al., Histological differentiation grade and microvascular invasion of hepatocellular carcinoma predicted by dynamic contrast-enhanced MRI. J Magn Reson Imaging, 2012. 36(3): p. 641-7.PubMedCrossRef
68.
Ocal, O., et al., Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma. Br J Cancer, 2022. 126(2): p. 211-218.PubMedCrossRef
69.
Wang, W., et al., The clinical significance of microvascular invasion in the surgical planning and postoperative sequential treatment in hepatocellular carcinoma. Sci Rep, 2021. 11(1): p. 2415.PubMedPubMedCentralCrossRef
70.
Chong, H.H., et al., Multi-scale and multi-parametric radiomics of gadoxetate disodium-enhanced MRI predicts microvascular invasion and outcome in patients with solitary hepatocellular carcinoma </= 5 cm. Eur Radiol, 2021. 31(7): p. 4824-4838.PubMedPubMedCentralCrossRef
71.
Calderaro, J., et al., Molecular and histological correlations in liver cancer. J Hepatol, 2019. 71(3): p. 616-630.PubMedCrossRef
72.
Kim, G.H., et al., Emerging Trends in the Treatment of Advanced Hepatocellular Carcinoma: A Radiological Perspective. Korean J Radiol, 2021. 22(11): p. 1822-1833.PubMedPubMedCentralCrossRef
73.
Llovet, J.M., et al., Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol, 2021. 18(5): p. 293-313.PubMedCrossRef
Metadata
Title
Understanding the role of radiologists in complex treatment decisions for patients with hepatocellular carcinoma
Authors
Omar Kamal
Natally Horvat
Sandeep Arora
Humaira Chaudhry
Mohab Elmohr
Lokesh Khanna
Pankaj Sharma Nepal
Manida Wungjramirun
Sadhna B. Nandwana
Anuradha S. Shenoy-Bhangle
James Lee
Ania Kielar
Robert Marks
Khaled Elsayes
Alice Fung
Publication date
16-09-2023
Publisher
Springer US
Published in
Abdominal Radiology / Issue 12/2023
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-023-04033-6

Other articles of this Issue 12/2023

Abdominal Radiology 12/2023 Go to the issue

Correction

Correction to: PET/MRI in colorectal and anal cancers: an update

Special Section: PET/MR

Distribution of prostate specific membrane antigen (PSMA) on PET-MRI in patients with and without ovarian cancer

Editorial

Introduction to the special issue on the role of PET/MRI in the abdomen and pelvis

Letter to the Editor

Letter to the Editor regarding the article “Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease‑Focused Panel” by Sonia Lee et al.

Peritoneum

FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis: a prospective multireader pilot study

Kidneys, Ureters, Bladder, Retroperitoneum

Differentiation between renal epithelioid angiomyolipoma and clear cell renal cell carcinoma using clear cell likelihood score
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits