Abstract
Transarterial chemoembolization (TACE) is a first-line treatment for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer stage B (BCLC-B). There are two major techniques of TACE: conventional TACE (cTACE) using iodized oil and gelatin sponge particles, and TACE using drug-eluting beads (DEB-TACE). The latest randomized controlled trial proved the superiority of cTACE regarding local effects over DEB-TACE; however, cTACE also damages the liver more severely. Therefore, cTACE should be performed for localized HCCs as selectively as possible. On the other hand, DEB-TACE has less liver toxicity and is favorable for patients with an advanced age, large and/or bilobar tumors, or a poor liver function. However, some BCLC-B HCCs are TACE-resistant and the concept of TACE unsuitability (mainly up-to-7 criteria out) has been proposed by Asia-Pacific Primary Liver Cancer Expert Meeting. Systemic therapy is recommended for patients with TACE-unsuitable HCC; however, the condition of TACE-unsuitable HCC does not always rule out TACE monotherapy and some up-to-7 criteria out tumors may also be good candidates for superselective cTACE when localized in limited liver segments. The sequential therapy of an antiangiogenic and TACE is also a novel option for patients with TACE-unsuitable HCC, antiangiogenic-refractory HCC, or even down-staged HCC.
Highlights
Since the first report by Yamada et al [1], transarterial chemoembolization (TACE) has been widely performed for inoperable hepatocellular carcinoma (HCC)
With iodized oil (Lipiodol 480, Guerbet Japan, Tokyo, Japan) and gelatin sponge (GS) particles; and TACE with drug-eluting beads (DEB-TACE). conventional TACE (cTACE) has been mainly developed in Asian regions, whereas DEB-TACE has been focused in Western countries
Two major branches are arising from the terminal hepatic artery: one terminates within the portal tract supplying the bile duct, portal tract interstitium, and portal vein wall; and the other one penetrates the liver parenchyma unaccompanied by the portal vein or bile duct, named the isolated artery [7]
Summary
Since the first report by Yamada et al [1], transarterial chemoembolization (TACE) has been widely performed for inoperable hepatocellular carcinoma (HCC). Two meta-analyses proved the clinical usefulness of TACE in prolonging HCC patients’ survival [4,5]. TACE has been recognized as an effective treatment option for inoperable HCC worldwide, and as a first-line treatment for HCC in Barcelona Clinic Liver. Two major techniques of TACE have been performed: conventional TACE (cTACE). CTACE has been mainly developed in Asian regions, whereas DEB-TACE has been focused in Western countries. The concepts and rationales for both techniques, as well as adverse effects, are quite different; we should use them appropriately according to the patient and tumor condition. The purpose of this article is to describe the TACE strategy for BCLC-B HCC, mainly based on the conceptualistic position and techniques of TACE treatment in Japan
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
