Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: A reappraisal

Abstract

Transcatheter arterial chemoembolization (TACE) improves the treatment of hepatocellular carcinoma (HCC) by causing tumour necrosis and shrinkage. Fifty-two patients with resectable large HCC (defined as a maximal tumour diameter of 10 cm or more) were prospectively randomized into two groups: group 1 comprised 24 patients who had 1-5 sessions of TACE before operation; group 2 consisted of the other 28 patients, on whom surgery was performed without delay. Tumour volume was reduced to a mean (s.d.) of 42.8 (15.3) per cent in 16 patients in group 1, but remained unchanged in four and increased in size in a further four. Patients in group 1 had a slightly longer operating time (5.5 versus 4.6 h, P = 0.09), a higher rate of concomitant resection of adjacent organs (58 versus 25 per cent, P = 0.03) and a higher rate of histological invasion to these organs (33 versus 4 per cent, P = 0.01). No difference was found between the two groups in operative blood loss, operative morbidity and mortality rates, and pathological staging. The disease-free survival rate in the two groups was similar, but the incidence of extrahepatic cancer recurrence was higher in group 1 (57 versus 23 per cent, P = 0.03). The actuarial survival rate was also significantly worse in group 1 when determined from the time of detection of the tumour (P = 0.03) or from operation (P = 0.01). It is concluded that preoperative TACE for resectable large HCC should be avoided because it does not provide complete necrosis in large tumours and results in delayed surgery and difficulty in the treatment of recurrent lesions, without any benefit.

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

“…The use of cTACE prior to resection of HCC has been examined in 3 RCTs, universally yielding negative results in terms of OS and DFS (47)(48)(49). One such study, published by Zhou et al (47) delineated the negative impact of preoperative cTACE on a range of parameters including post-cTACE complications, impairment of liver function and increased technical difficulty for future transarterial treatments.…”

Use of an oncolytic virus secreting GM-CSF as combined oncolytic and immunotherapy for treatment of colorectal and hepatic adenocarcinomas

“…Local and distant recurrences after surgical therapy for colorectal as well as hepatocellular cancer, occur as a result of microscopic disease that was not detectable at the time of resection (31). A number of conventional strategies including chemotherapy and radiation therapy have had little or no impact on improving recurrence rates and survival (32)(33)(34)(35)(36)(37)(38). Indeed, most patients have distribution of disease that is not surgically treatable, and survival for these patients even with our best palliative chemotherapy regimens, is usually measured in months(39; 40).…”

Effects of pre-operative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: Implication of circulating cancer cells by detection of α-fetoprotein mRNA

“…in these previous studies, some authors supported our results, i.e., pre-operative tacE was effective in large or stage iii-iV tumors (9)(10)(11)(12). On the other hand, two rcts showed the opposite results (20,22). however, the background of these patients differed from ours; both studies involved large tumor (≥10 cm) in hepatitis B carriers.…”