Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association

Abstract

Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

Combination treatment of transcatheter arterial chemoembolization, intensity-modulated radiotherapy, and sorafenib for hepatocellular carcinoma with macrovascular invasion

“…[24] Additionally, previous studies had demonstrated that the combination of sorafenib with local tumor treatments, such as TACE or EBRT, could achieve superior therapeutic effects in HCC patients with PVTT, compared to sorafenib alone. [25][26][27] A pivotal phase III clinical trial contrasted the efficacy of sorafenib monotherapy (s-m group) with sorafenib plus local treatment (including intra-arterial chemotherapy and radiation therapy, referred to as the s-lrts group) in advanced HCC patients. [28] Among the 290 patients in this trial, those in the s-lrts group experienced both a median PFS of 5.3 months and a median OS of 8.5 months, exceeding the outcomes in the s-m group.…”

Modular multimodal hospital-home chain physical activity rehabilitation programme (3M2H-PARP) in liver cancer: a protocol for a randomised controlled trial

“…TACE is often recommended for patients with large or multiple HCC and is commonly used as a salvage treatment for recurrent cases after radical treatment, as well as an initial treatment for HCC. 10 TACE often leads to postembolisation syndrome, characterised by symptoms such as fever, nausea, vomiting, abdominal pain and liver damage. 10 Moreover, patients undergoing TACE treatment are typically advised to rest.…”

“… 10 TACE often leads to postembolisation syndrome, characterised by symptoms such as fever, nausea, vomiting, abdominal pain and liver damage. 10 Moreover, patients undergoing TACE treatment are typically advised to rest. According to Kortebein et al , 11 significant skeletal muscle loss can occur due to 10 days of bed rest.…”

Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma?

“…Microwave ablation, cryoablation, or external radiation therapy may be more effective than radiofrequency ablation when the tumor abutts the large vessels [ 3 ]. Deep-seated tumors in the Spiegel lobe may be challenging for percutaneous ablation but can be easily treated with superselective chemoembolization or radioembolization with cone-beam computed tomography guidance [ 4 ]. A tumor just below the heart may be more suitable for intra-arterial than for percutaneous therapy.…”