Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence |
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| Affiliation: | 1. Digestive Oncology, Institut de Cancérologie de l''Ouest, Boulevard Professeur Jacques Monod, 44805 Nantes-Saint Herblain, France;2. Barcelona Clinic Liver Cancer Group, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Calle Villaroel 170, 08036 Barcelona, Spain;3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Avenida Monforte de Lemos, 28029 Madrid, Spain;4. Unit of Internal Medicine, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy;5. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road 102, Hong Kong Special Administrative Region;6. Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstraße 1, 55131 Mainz, Germany;7. Gustave Roussy-Cancer Campus, rue Edouard-Vaillant 114, 94 805 Villejuif Cedex, France;1. Department of Medical Oncology, Gustave Roussy Institut, Villejuif, France;2. Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon;1. Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan;2. Department of Radiology, Kanazawa University, Graduate School of Medical Science, Takara-machi, Kanazawa, Japan;1. Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan;2. Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan;3. Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan;4. Department of Surgery, Japanese Red Cross Himeji Hospital, Himeji, Japan;5. Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan;6. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan;7. Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan;8. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan |
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| Abstract: | Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the sixth leading cause of cancer and the third leading cause of cancer-related mortality. Patient stratification and treatment allocation are based on tumor stage, liver function, and performance status. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate stage HCC, including those with large or multinodular HCC, well-preserved liver function, and no cancer-related symptoms or evidence of vascular invasion or extrahepatic spread. Two TACE techniques have been used since 2004, conventional TACE (cTACE) and TACE with drug-eluting beads (DEB-TACE). cTACE was evidenced first to treat intermediate stage HCC patients. It combines the transcatheter delivery of chemotherapy using Lipiodol-based emulsion plus an embolizing agent to achieve strong cytotoxic and ischemic effects. Drug-eluting beads (DEBs) were developed in order to slowly release chemotherapeutic agents, and to increase ischemia intensity and duration. Recent advances allow TACE treatment of both early stage patients (i.e. those with a solitary nodule or up to 3 nodules under 3 cm) and some advanced stage patients. Here we review recent clinical evidence related to TACE treatment of patients with early, intermediate, and advanced stage HCC. Based on the 2014 TACE algorithm of Raoul et al., this international expert panel proposes an updated TACE algorithm and provides insights into TACE use for patients at any HCC stage. |
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| Keywords: | Hepatocellular carcinoma Conventional TACE DEB-TACE Algorithm decision Combined treatments |
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