Published online Aug 8, 2015. doi: 10.4254/wjh.v7.i16.2009
Peer-review started: April 19, 2015
First decision: June 25, 2015
Revised: June 26, 2015
Accepted: July 23, 2015
Article in press: July 27, 2015
Published online: August 8, 2015
Processing time: 112 Days and 10.2 Hours
Transarterial chemoembolization (TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma (HCC), preserved liver function, absence of cancer-related symptoms and no evidence of vascular invasion or extrahepatic spread (i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer staging system). The rationale for TACE is that the intra-arterial injection of a chemotherapeutic drug such as doxorubicin or cisplatin followed by embolization of the blood vessel will result in a strong cytotoxic effect enhanced by ischemia. However, TACE is a very heterogeneous operative technique and varies in terms of chemotherapeutic agents, treatment devices and schedule. In order to overcome the major drawbacks of conventional TACE (cTACE), non-resorbable drug-eluting beads (DEBs) loaded with cytotoxic drugs have been developed. DEBs are able to slowly release the drug upon injection and increase the intensity and duration of ischemia while enhancing the drug delivery to the tumor. Unfortunately, despite the theoretical advantages of this new device and the promising results of the pivotal studies, definitive data in favor of its superiority over cTACE are still lacking. The recommendation for TACE as the standard-of-care for intermediate-stage HCC is based on the demonstration of improved survival compared with best supportive care or suboptimal therapies in a meta-analysis of six randomized controlled trials, but other therapeutic options (namely, surgery and radioembolization) proved competitive in selected subsets of intermediate HCC patients. Other potential fields of application of TACE in hepato-oncology are the pre-transplant setting (as downstaging/bridging treatment) and the early stage (in patients unsuitable to curative therapy). The potential of TACE in selected advanced patients with segmental portal vein thrombosis and preserved liver function deserves further reports.
Core tip: Transarterial chemoembolization (TACE) represents the standard of care for patients with large or multinodular hepatocellular carcinoma (HCC). However, TACE is a heterogeneous technique varying in terms of chemotherapeutic agents, devices and schedule. In order to overcome these drawbacks of conventional TACE (cTACE), drug-eluting beads have been developed. Unfortunately, despite its theoretical advantages, definitive data in favor of its superiority over cTACE are still lacking. TACE represents the standard-of-care for intermediate-stage HCC, in competition with other therapeutic options (surgery and radioembolization). Other fields of application are the pre-transplant setting and the early stage (in patients unsuitable to curative therapy).