Response rate and clinical outcome of HCC after first and repeated cTACE performed “on demand”

Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

“…TACE is a potentially toxic treatment and its efficacy can be outweighed by its toxicity particularly since many of the patients treated have underlying cirrhosis [27,28] . Two recently published studies (on demand or selective sequential TACE) report comparable results in terms of survival [22,23] . Antoch et al [22] treated 124 patients with HCC graded BCLC A (32%), B (39%) and C (29%) with 4 (± 3) selective TACE sessions, repeated every 4 wk.…”

“…Unlike the earlier metaanalyses [17,18] , Oliveri et al [19] did not find any benefit for TACE, but the analysis was criticised because it included inappropriate studies [20,21] . In Europe, TACE is recommended for intermediate stage HCC (BCLC B), but this group includes a broad spectrum of tumours (encapsulated or infiltrating, unifocal or multifocal) and patients with different degrees of liver function and consequently the survival benefit is not the same, for instance, for patients classified Child-Pugh A and B [22,23] . Careful patient selection is therefore necessary, particularly since sorafenib now provides us with a solution for cases in which chemoembolization is contraindicated or ineffective [24] .…”

“…The 1 year survival rate was 79%, dropping to 51% at the 2 year time point. In a study by Terzi et al [23] , 151 patients with BCLC A (51.5%), B (40%) and C (6%) HCC were treated with on demand TACE. The complete response rate after the first TACE was 48% for the 151 patients treated; it was 57% for the 60 patients undergoing a 2 nd session and 55% for the 22 patients treated a third time.…”

“…The response rate (EASL criteria) was 61%. Mean follow-up was 19 mo [17][18][19][20][21][22][23] . The HAP score divided the patients into three groups each with a different survival time (Table 1); median survival was the same for the HAP A and HAP B groups (31 mo).…”

BCLC-B hepatocellular carcinoma treatment or when should the systemic therapy be started

“…В литературе не представлены иссле-дования, в которых были бы определены максимальные размеры опухоли, при которых возможно достигнуть полного некроза после выполнения ТАХЭ. Только в двух рандомизированных исследованиях [16,17] было пока-зано увеличение выживаемости больных ГЦР после ТАХЭ при средних размерах опухолевых узлов 5-7 см. Тотальный некроз опухоли после ТАХЭ наблюдается редко, а частота развития местных рецидивов в течение первого года достигает 60% [17].…”