Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. It is principally associated with liver cirrhosis and chronic liver disease. The major risk factors for the development of HCC include viral infections (HBV, HCV), alcoholic liver disease (ALD,) and non-alcoholic fatty liver disease (NAFLD). The optimal treatment choice is dictated by multiple variables such as tumor burden, liver function, and patient’s health status. Surgical resection, transplantation, ablation, transarterial chemoembolization (TACE), and systemic therapy are potentially useful treatment strategies. TACE is considered the first-line treatment for patients with intermediate stage HCC. The purpose of this review was to assess the indications, the optimal treatment schedule, the technical factors associated with TACE, and the overall application of TACE as a personalized treatment for HCC.

A Case Report of Excessive Inflammation After TACE That Mimicked Tumor Invasion of Adjacent Tissues

“…4 Percutaneous catheter drainage is recommended for liver abscess that occurs after TACE. 3,4 Based on this case report, spillage of the embolizing material along the tract of drainage and resulting reactive fibrosis mimicked tumor invasion of the structures along that tract. We submit that HCC patients that developed liver abscess treated with percutaneious drainage post TACE should not be taken off transplant list if there is suspicion tumor invasion after the drainage.…”

“…Common complications associated with TACE include post embolization syndrome, which is usually mild. 3 Occasionally, liver abscesses have been observed after TACE. 4 Percutaneous catheter drainage is recommended for liver abscess that occurs after TACE.…”

Sorafenib and nitazoxanide disrupt mitochondrial function and inhibit regrowth capacity in three-dimensional models of hepatocellular and colorectal carcinoma

“…Hypoxia enhances tumor aggressiveness and chemoresistance by interfering with many biological processes in HCC 43 – 45 . Moreover, in Transarterial chemoembolization (TACE), which is considered the first-line treatment for patients with intermediate stage HCC 46 hypoxia is inherent to the procedure and thought to limit the efficacy of the intervention 47 , 48 . Thus, the findings presented here may be of value for developing new TACE treatment protocols.…”

A novel nomogram to predict survival of patients with hepatocellular carcinoma after transarterial chemoembolization: a tool for retreatment decision making

“…Based on these predictors, several prognostic models such as the Assessment for Retreatment with TACE (ART) score, AFP level BCLC stage, Child-Pugh class, Response after TACE (ABCR) score, Tumor Size and Number, baseline AFP, Child-Pugh and Objective radiological Response (SNACOR) score and the post-TACE-Predict Model (15)(16)(17)(18), have been established to help clinicians decide whether to continue TACE or transition to systemic treatment. However, the predictive power and applicability of these models are limited in practice (19).…”