Ongoing research in the discipline of image-guided interventional oncology for hepatic malignancies seeks to discover and implement novel and effective therapeutic approaches in order to benefit patients with unresectable liver cancer. Research in this area incorporates advancements in the knowledge of liver cancer biology, new concepts in targeting liver cancer, development of novel drugs, improvement of intra-arterial drug delivery and technological advances of imaging systems.
This chapter is an overview of the most recent knowledge in liver cancer biology, new locoregional therapies for liver cancer and new imaging concepts for monitoring locoregional treatment response.
NEW CONCEPTS IN TARGETING LIVER CANCER
The fundamental role of angiogenesis in tumor progression was first suggested by Folkman et al. in a classic study describing that tumors cannot grow beyond 1 mm or 2 mm without the formation of new blood vessels (1). This complex process facilitates tumor progression and, eventually, tumor metastatic spread (1, 2). Several factors, including tumor hypoxia, growth factors, cytokines, oncogene activation and other mutations interact to stimulate angiogenesis (2, 3). Therefore, targeted inhibition of angiogenesis can be achieved at any of the aforementioned different levels, with treatments including the neutralization of growth factors with monoclonal antibodies (mAbs), the inhibition of downstream signaling from tyrosine kinase receptors and interference with the interaction between proliferating endothelial cells and matrix components.
Hepatocellular carcinoma (HCC) is one of the most vascular solid cancers, associated with a high propensity for vascular invasion.