Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system

Table 1 Subclassification system for intermediate hepatocellular carcinoma proposed by Bolondi et al[43]

BCLC substage	B1	B2	B3	B4
Child-Pugh Score	5-6-7	5-6	7	8-9
Beyond Milan and Within Ut-7	In	Out	Out	Any
ECOG-PS	0	0	0	0-1
PVT	No	No	No	No
1st option	TACE	TACE or TARE		BSC
Alternative	LT, TACE + ablation	SOR	Research trialsTACE, SOR	LT

TACE: Transarterial chemoembolization; LT: Liver transplantation.

Table 2 Potential role of transarterial chemoembolization in the treatment of hepatocellular carcinoma

Stage	Potential role of TACE
BCLC 0	TACE may be considered a viable alternative treatment to RFA for treating single HCCs measuring 2 cm or smaller when RFA is not feasible
BCLC A	1: The combination of TACE and RFA is safe and provides better local tumor control than RFA alone in the treatment of medium sized HCC (3-5 cm)
	2: For a large solitary HCC (> 5 cm), HR provides better overall survival than HCC, but TACE could be considered as an alternative initial treatment when HR is not feasible
	3: TACE can be used to downstage the tumor within the Milan criteria before LT or serve as a bridge to LT
BCLC B	1: TACE is the standard of care for this stratum of patients
	2: Combination with other therapies such as RFA and sorafenib may provide better patient survival or local tumor control
BCLC C	1: Repeated TACE showed significant survival benefits in patients with advanced HCC compared with supportive care
	2: Sorafenib plus TACE has a demonstrable effect in delaying tumor progression
	3: Combination with radiotherapy has resulted in better survival in patients with HCC and PVT

TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation; HCC: Hepatocellular carcinoma; HR: Hepatic resection; LT: Liver transplantation.