Tace treatment outcome: (almost) everything is predictable

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Transarterial chemoembolisation (TACE) is an effective treatment for hepatocellular carcinoma (HCC) patients not eligible either for surgery or radio frequency ablation (RFA). Recently, Dumortier et al. [ [1] Dumortier J. Chapuis F. Borson O. Davril B. Scoazec J.Y. Poncet G. et al. Unresectable hepatocellular carcinoma: survival and prognostic factors after lipiodol chemoembolisation in 89 patients. Dig Liver Dis. 2006; 38: 125-133 PubMed Scopus (31) Google Scholar ] have reported a multivariate analysis showing that treatment outcome of patients undergoing TACE is predictable and depends on the characteristics of the tumour, such as size and type, initial Child's class, as well as on the technique (‘lipiodol capture’ after the first course). Some side-effects from TACE are also predictable based on non-selectivity of lipiodol infusion. Consistently, non-target complications include ischaemic cholecystitis, splenic infarction, gastro-intestinal mucosal lesions, pulmonary embolism and infarction, spinal cord injury and ischaemic skin lesions [ 2 Sakamoto I. Aso N. Nagaoki K. Matsuoka Y. Uetani M. Ashizawa K. et al. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics. 1998; 18: 605-619 Crossref PubMed Scopus (197) Google Scholar , 3 Kuroda C. Iwasaki M. Tanaka T. Tokunaga K. Hori S. Yoshioka H. et al. Gallbladder infarction following hepatic transcatheter arterial embolization. Angiographic study. Radiology. 1983; 149: 85-89 Crossref PubMed Scopus (78) Google Scholar , 4 Takayasu K. Moriyama N. Muramatsu Y. Shima Y. Ushio K. Yamada T. et al. Gallbladder infarction after hepatic artery embolization. AJR Am J Roentgenol. 1985; 144: 135-138 Crossref PubMed Scopus (78) Google Scholar , 5 Choi B.I. Kim T.K. Han J.K. Chung J.W. Park J.H. Han M.C. Power versus conventional color Doppler sonography: comparison in the depiction of vasculature in liver tumors. Radiology. 1996; 200: 55-58 PubMed Google Scholar , 6 Hirakawa M. Iida M. Aoyagi K. Matsui T. Akagi K. Fujishima M. Gastroduodenal lesions after transcatheter arterial chemo-embolization in patients with hepatocellular carcinoma. Am J Gastroenterol. 1988; 83: 837-840 PubMed Google Scholar , 7 Baysal T. D’Agostino H.B. Serra E.E. Valji K. Rose S.C. Kinney T.B. Supraumbilical dermal sclerosis and fat necrosis from chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 1998; 9: 645-647 Abstract Full Text PDF PubMed Scopus (14) Google Scholar , 8 Lee J.H. Chon C.Y. Ahn S.H. Moon B.S. Kim J.H. Paik Y.H. et al. An ischemic skin lesion after chemoembolization of the right internal mammary artery in a patient with hepatocellular carcinoma. Yonsei Med J. 2001; 42: 137-141 PubMed Google Scholar ]. In spite of such different clinical manifestations, vessel ischaemic damage is recognised as the only underlying biological mechanism even for the post-TACE syndrome including also the worsening of underlying liver disease [ [9] Bismuth H. Morino M. Sherlock D. Castaing D. Miglietta C. Cauquil P. et al. Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg. 1992; 163: 387-394 Abstract Full Text PDF PubMed Scopus (279) Google Scholar ].