Drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma: Current state of the art

Table 1 Absolute and relative contraindications to transarterial chemoembolization

Contraindications
Absolute contraindications	Decompensated cirrhosis (Child-Pugh ≥ B8) Extensive tumor with massive replacement of both entire lobes Severely reduced portal vein flow Technical impediments to hepatic intra-arterial treatment
Relative contraindications	Kidney failure Severe cardiopulmonary comorbidities Tumor size ≥ 10 cm Untreated varices at high risk of bleeding Bile-duct occlusion

Table 2 Clinical studies comparing drug-eluting beads and conventional transarterial chemombolization

Ref.	Arm	Sample size	Study design	Region	CP(A/B/C)	BCLC(A/B/C)	1-yr survival
Lammer et al[40] 2010	DEB-TACE	93	RCT	Europe	77/16/0	24/69/0	NA
	cTACE	108			89/19/0	29/79/0
Song et al[43] 2012	DEB-TACE	60	R	South Korea	56/4/0	27/33/0	88%
	cTACE	69			62/6/0	28/41/0	67%
Sacco et al[41] 2011	DEB-TACE	33	RCT	Italy	29/4/0	22/11/0	94.10%
	cTACE	34			25/9/0	22/12/0	90%
Van Malenstein et al[44] 2011	DEB-TACE	16	RCT	Belgium	14/2/0	9/5/2002	NA
	cTACE	14			14/0/0	10/3/2001
Golfieri et al[42] 2014	DEB-TACE	89	RCT	Italy	75/14/0	41/26/22	86.20%
	cTACE	88			77/11/0	41/23/24	83.50%
Ferrer et al[45] 2011	DEB-TACE	47	P	Spain	NA	NA	88%
	cTACE	25			NA	NA	90%
Dhanasekaran et al[46] 2010	DEB-TACE	45	R	United States	11/12/2022	NA	58%
	cTACE	26			11/4/2011	NA	31%
Wiggermann et al[47] 2011	DEB-TACE	22	R	Germany	22/0/0	1/17/3	70%
	cTACE	22			22/0/0	4/15/2	55%
Recchia et al[48] 2012	DEB-TACE	35	P	Italy	NA	NA	63.40%
	cTACE	70			NA	NA	49.30%
Facciorusso et al[49] 2015	DEB-TACE	145	R	Italy	129/16/0	58/81/6	85%
	cTACE	104			93/11/0	41/63/0	92%
Arabi et al[50] 2015	DEB-TACE	35	R	Saudi Arabia	24/11/0	NA	72.70%
	cTACE	19			17/2/0	NA	74.50%
Kloeckner et al[51] 2015	DEB-TACE	76	R	Germany	51/22/3	8/34/34	45%
	cTACE	174			103/64/7	30/59/85	52%
Megias et al[52] 2015	DEB-TACE	30	R	Spain	46.7%a	NA	68%
	cTACE	30			63.3%a		58%
Liu et al[53] 2015	DEB-TACE	53	R	Taiwan	53/0/0	0/53/0	NA
	cTACE	64			64/0/0	6/58/0
Scartozzi et al[54] 2010	DEB-TACE	64	R	Italy	57.1%a	NA	74%
	cTACE	87			58.6%a		93%

Percentage of CP A patients. CP: Child-Pugh; BCLC: Barcelona clinic liver cancer; DEB-TACE: Drug-eluting beads transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization; RCT: Randomized controlled trial; P: Prospective non-randomized study; R: Retrospective study,

^aP < 0.05.