Chemoembolization for Hepatocellular Carcinoma: A Critical Review of The 2021 CIRSE Recommendations with Presentation of A Technique for A Degradable Starch Microsphere - Chemoembolization

Abstract

Transarterial chemoembolization (TACE) has been used to treat hepatocellular carcinoma (HCC) for more than 4 decades. So far, there is no consensus on which substances and which method should be used for the most effective treatment. A publication commissioned by CIRSE 2021 attempted to formulate recommendations. However, only the spectrum of currently implemented procedures is outlined. No recommendation was made as to how the various patients should be treated. In this article, therefore, basic considerations regarding the technique of chemoembolization are presented. Additionally, the authors discuss fundamental considerations about the embolism materials used, the cytostatic drugs and their dosage, as well as about pain therapy during treatment. Then, a technique is presented which used degradable starch microspheres (DSM) as an embolic agent. This technique allows multiple treatments over a longer period. The aim is to provide interventionalists with a decision-making aid for the TACE technique. A major problem when evaluating publications from different working groups is that the technology used is not adequately described and the individual studies are therefore not comparable. Therefore, a classification is presented that systematizes the possible different techniques. Future randomized trials should use this classification. Hopefully, if they are carried out on a sufficient number of patients, it will finally be possible to identify what is the best TACE procedure for individual patients. Until then the technique proposed by the authors can be applied.