Abstract
Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). In this review, we summarize recent updates on the use of TACE for HCC. TACE can be performed using two techniques; conventional TACE (cTACE) and drug-eluting beads using TACE (DEB-TACE). The anti-tumor effect of the two has been reported to be similar; however, DEB-TACE carries a higher risk of hepatic artery and biliary injuries and a relatively lower risk of post-procedural pain than cTACE. TACE can be used for early stage HCC if other curative treatments are not feasible or as a neoadjuvant treatment before liver transplantation. TACE can also be considered for selected patients with limited portal vein thrombosis and preserved liver function. When deciding to repeat TACE, the ART (Assessment for Retreatment with TACE) score and ABCR (AFP, BCLC, Child-Pugh, and Response) score can guide the decision process, and TACE refractoriness needs to be considered. Studies on the combination therapy of TACE with other treatment modalities, such as local ablation, radiation therapy, or systemic therapy, have been actively conducted and are still ongoing. Recently, new prognostic models, including analysis of the neutrophil-lymphocyte ratio, radiomics, and deep learning, have been developed to help predict survival after TACE.
Highlights
Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide
Sorafenib plus drug-eluting beads (DEBs)-transarterial chemoembolization (TACE) did not improve progression-free survival (PFS) compared with DEB-TACE alone [94]
We reviewed the latest data on the use of TACE in treating Hepatocellular carcinoma (HCC) patients from various perspectives
Summary
Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Hepatocellular carcinoma (HCC) accounts for 75% to 95% of all primary liver cancer cases [1]. Prognosis of HCC patients is highly heterogeneous and depends on various factors such as tumor burden, baseline liver function, cancer-related symptoms represented by performance status, and treatment allocation [2,3]. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, which has been commonly used in clinical practice and endorsed by international guidelines, transarterial chemoembolization (TACE) is the treatment of choice for intermediate-stage HCC, including unresectable multinodular HCC without extrahepatic spread. The clinical situations in which TACE is indicated differ slightly depending on the various staging systems, TACE is a well-established treatment for intermediate-stage HCC [3,5]. We hope to provide updated guidance for treatment decisions
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