Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

Overview

Journal J Pers Med

Date 2022 Mar 25

PMID 35330436

Authors

Evgenia Kotsifa

Chrysovalantis Vergadis

Michael Vailas

Nikolaos Machairas

Stylianos Kykalos

Christos Damaskos

Nikolaos Garmpis

Georgios D Lianos

Dimitrios Schizas

Affiliations

Soon will be listed here.

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. It is principally associated with liver cirrhosis and chronic liver disease. The major risk factors for the development of HCC include viral infections (HBV, HCV), alcoholic liver disease (ALD,) and non-alcoholic fatty liver disease (NAFLD). The optimal treatment choice is dictated by multiple variables such as tumor burden, liver function, and patient's health status. Surgical resection, transplantation, ablation, transarterial chemoembolization (TACE), and systemic therapy are potentially useful treatment strategies. TACE is considered the first-line treatment for patients with intermediate stage HCC. The purpose of this review was to assess the indications, the optimal treatment schedule, the technical factors associated with TACE, and the overall application of TACE as a personalized treatment for HCC.

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References

Yao W, Xue M, Lu M, Wang Y, Zhao Y, Wu Y . Diffuse Recurrence of Hepatocellular Carcinoma After Liver Resection: Transarterial Chemoembolization (TACE) Combined With Sorafenib Versus TACE Monotherapy. Front Oncol. 2021; 10:574668. PMC: 7793644. DOI: 10.3389/fonc.2020.574668. View

Frager S, Schwartz J . Hepatocellular carcinoma: epidemiology, screening, and assessment of hepatic reserve. Curr Oncol. 2020; 27(Suppl 3):S138-S143. PMC: 7739519. DOI: 10.3747/co.27.7181. View

Kadalayil L, Benini R, Pallan L, OBeirne J, Marelli L, Yu D . A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol. 2013; 24(10):2565-2570. PMC: 4023407. DOI: 10.1093/annonc/mdt247. View

Hatanaka T, Arai H, Kakizaki S . Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Hepatol. 2018; 10(7):485-495. PMC: 6068849. DOI: 10.4254/wjh.v10.i7.485. View

Grandhi M, Kim A, Ronnekleiv-Kelly S, Kamel I, Ghasebeh M, Pawlik T . Hepatocellular carcinoma: From diagnosis to treatment. Surg Oncol. 2016; 25(2):74-85. DOI: 10.1016/j.suronc.2016.03.002. View

Raoul J, Forner A, Bolondi L, Cheung T, Kloeckner R, De Baere T . Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat Rev. 2018; 72:28-36. DOI: 10.1016/j.ctrv.2018.11.002. View

. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018; 69(1):182-236. DOI: 10.1016/j.jhep.2018.03.019. View

Huang Z, Li W, Li S, Gao F, Zhou Q, Wu F . Cytokine-induced killer cells in combination with transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma patients. J Immunother. 2013; 36(5):287-93. DOI: 10.1097/CJI.0b013e3182948452. View

Sieghart W, Hucke F, Peck-Radosavljevic M . Transarterial chemoembolization: modalities, indication, and patient selection. J Hepatol. 2015; 62(5):1187-95. DOI: 10.1016/j.jhep.2015.02.010. View

10.

Chang Y, Jeong S, Jang J, Kim Y . Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. Int J Mol Sci. 2020; 21(21). PMC: 7662786. DOI: 10.3390/ijms21218165. View

11.

Li X, Dai D, Song X, Liu J, Zhu L, Xu W . A meta-analysis of cytokine-induced killer cells therapy in combination with minimally invasive treatment for hepatocellular carcinoma. Clin Res Hepatol Gastroenterol. 2014; 38(5):583-91. DOI: 10.1016/j.clinre.2014.04.010. View

12.

Machairas N, Tsilimigras D, Pawlik T . State-of-the-art surgery for hepatocellular carcinoma. Langenbecks Arch Surg. 2021; 406(7):2151-2162. DOI: 10.1007/s00423-021-02298-3. View

13.

Liu C, Li T, He J, Shao H . TACE combined with microwave ablation therapy vs. TACE alone for treatment of early- and intermediate-stage hepatocellular carcinomas larger than 5 cm: a meta-analysis. Diagn Interv Radiol. 2020; 26(6):575-583. PMC: 7664747. DOI: 10.5152/dir.2020.19615. View

14.

Shiina S, Sato K, Tateishi R, Shimizu M, Ohama H, Hatanaka T . Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol. 2018; 2018:4756147. PMC: 6008833. DOI: 10.1155/2018/4756147. View

15.

Wang H, Cao C, Wei X, Shen K, Shu Y, Wan X . A comparison between drug-eluting bead-transarterial chemoembolization and conventional transarterial chemoembolization in patients with hepatocellular carcinoma: A meta-analysis of six randomized controlled trials. J Cancer Res Ther. 2020; 16(2):243-249. DOI: 10.4103/jcrt.JCRT_504_19. View

16.

Kudo M . A New Treatment Option for Intermediate-Stage Hepatocellular Carcinoma with High Tumor Burden: Initial Lenvatinib Therapy with Subsequent Selective TACE. Liver Cancer. 2019; 8(5):299-311. PMC: 6872999. DOI: 10.1159/000502905. View

17.

Shanker M, Liu H, Lee Y, Stuart K, Powell E, Wigg A . Stereotactic radiotherapy for hepatocellular carcinoma: Expanding the multidisciplinary armamentarium. J Gastroenterol Hepatol. 2020; 36(4):873-884. DOI: 10.1111/jgh.15175. View

18.

Ogasawara S, Chiba T, Ooka Y, Kanogawa N, Motoyama T, Suzuki E . A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology. 2017; 67(2):575-585. DOI: 10.1002/hep.29403. View

19.

Irie T, Kuramochi M, Takahashi N . Dense accumulation of lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure. Cardiovasc Intervent Radiol. 2012; 36(3):706-13. DOI: 10.1007/s00270-012-0476-z. View

20.

Peng Z, Zhang Y, Liang H, Lin X, Guo R, Chen M . Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial. Radiology. 2011; 262(2):689-700. DOI: 10.1148/radiol.11110637. View