A review of established and new developments in local therapies for liver cancer

P. Seda; R. Abbey; L. Peng; I. Ezeaku; S.T. Laroia; H. Aziz

doi:10.1016/j.esmogo.2025.100283

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A review of established and new developments in local therapies for liver cancer

Journal article

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Peer reviewed

A review of established and new developments in local therapies for liver cancer

P. Seda, R. Abbey, L. Peng, I. Ezeaku, S.T. Laroia and H. Aziz

ESMO Gastrointestinal Oncology, Vol.11, 100283

03/2026

DOI: 10.1016/j.esmogo.2025.100283

PMCID: PMC13080930

PMID: 41994023

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Abstract

Liver cancer, especially hepatocellular carcinoma (HCC), which accounts for ∼75%-85% of primary liver cancers, remains a major global health challenge. Because of its high incidence, late diagnosis, and limited curative options, local therapies have become increasingly popular for the multidisciplinary management of HCC, especially in early and intermediate Barcelona Clinic Liver Cancer stages or in medically inoperable patients. This review examines a landscape of local treatment modalities for HCC encompassing radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, histotripsy, transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiotherapy. We also highlight their respective advantages and disadvantages, compare their survival outcomes, and identify current gaps in the literature, including the need for further comparisons between safety profiles and efficacy, and the growing landscape that is using different local therapies in a sequential or combinatorial fashion. Emphasis is placed on treatment decisions tailored to tumor burden, liver function, and patient-specific considerations. Expanding access to advanced local therapies in resource-limited settings remains a global priority. •Local therapies offer curative options for liver cancer patients ineligible for surgery.•Microwave ablation reduces tumor progression compared to RFA but shows similar survival.•Histotripsy shows high safety and precision, gaining FDA approval for inoperable HCC.•TARE and TACE have similar survival, but TARE has fewer severe adverse events.•Combining local therapies with systemic immunotherapy enhances treatment efficacy.

Liver Cancer

Radiotherapy

locoregional therapy

targeted treatment immunotherapy

Details

Title: Subtitle: A review of established and new developments in local therapies for liver cancer
Creators: P. Seda - University of Iowa
R. Abbey - Carver College of Medicine, University of Iowa, Iowa City, USA
L. Peng - Carver College of Medicine, University of Iowa, Iowa City, USA
I. Ezeaku - Gift of Hope Organ and Tissue Donor Network
S.T. Laroia - University of Iowa, Radiology
H. Aziz - Department of Surgery, University of Iowa, University of Iowa Health Care, Iowa City, USA
Resource Type: Journal article
Publication Details: ESMO Gastrointestinal Oncology, Vol.11, 100283
DOI: 10.1016/j.esmogo.2025.100283
PMID: 41994023
PMCID: PMC13080930
NLM abbreviation: ESMO Gastrointest Oncol
ISSN: 2949-8198
eISSN: 2949-8198
Publisher: Elsevier Ltd
Language: English
Electronic publication date: 01/06/2026
Date published: 03/2026
Academic Unit: Radiology; Surgery; Internal Medicine
Record Identifier: 9985116070502771

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