📖 Overview
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Interventional radiology provides highly effective locoregional treatments including transarterial chemoembolization (TACE), radioembolization (Y90), and percutaneous tumour ablation. These can be used as bridge to transplantation, downstaging prior to resection, or as definitive treatment in non-surgical candidates.
At Cochin AP-HP, all cases are discussed in our hepatology multidisciplinary team (MDT) including hepatologists, liver surgeons, oncologists, and interventional radiologists. We have the Nexaris Angio-CT with photon-counting NAEOTOM Alpha.Prime scanner — unique technology for per-procedural imaging and personalised dosimetry.
🔧 Treatment options
💊 TACE / DEB-TACE
Standard of care for intermediate-stage HCC (BCLC B). Selective intra-arterial injection of chemotherapy + embolization. DEB-TACE (drug-eluting beads) reduces systemic toxicity. 70–80% objective response.
⚛️ Y90 Radioembolization (SIRT)
TheraSphere® microspheres loaded with yttrium-90. Preferred for HCC with portal vein thrombosis or large tumour burden. Personalised dosimetry. Cochin is a reference centre for Y90.
🌡️ RFA / Microwave Ablation
Curative-intent ablation for HCC ≤5 cm. Local anaesthesia + sedation or general anaesthesia. 90–95% local control for lesions ≤3 cm. Nexaris Angio-CT guidance for lesions not visible on ultrasound.
🤝 MDT & Bridge to transplantation
All cases discussed in MDT. TACE and ablation used as bridge to liver transplantation (Milan/UCSF criteria maintenance) or downstaging to transplant eligibility (UNOS criteria).