Effective Utilization of Conventional Transarterial Chemoembolization and Drug-eluting Bead Transarterial Chemoembolization in Hepatocellular Carcinoma: A Guide to Proper Usage

Abstract

Transarterial chemoembolization is still an effective treatment option for hepatocellular carcinoma worldwide and is categorized into conventional transarterial chemoembolization with ethiodized oil transarterial chemoembolization and transarterial chemoembolization with drug-eluting spherical material transarterial chemoembolization. Several randomized controlled trials conducted in Europe have shown the equivalent efficacy of ethiodized oil transarterial chemoembolization and drug-eluting spherical material transarterial chemoembolization. However, a recent randomized controlled trials in Japan established the superiority of ethiodized oil transarterial chemoembolization in terms of complete response rates although higher liver toxicity for ethiodized oil transarterial chemoembolization. Nevertheless, the survival advantage of ethiodized oil transarterial chemoembolization is yet to be substantiated. The adverse effects of drug-eluting spherical material transarterial chemoembolization are milder than those of ethiodized oil transarterial chemoembolization, rendering drug-eluting spherical material transarterial chemoembolization an advantageous option for patients with bilobar tumors and impaired liver function/performance status. This article aims to provide an overview of these embolization techniques and a review of recent literature.