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World J Hepatol. Mar 27, 2015; 7(3): 521-531
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.521
Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?
Xavier Adhoute, Guillaume Penaranda, Paul Castellani, Herve Perrier, Marc Bourliere
Xavier Adhoute, Paul Castellani, Herve Perrier, Marc Bourliere, Department of Hepatology, Hopital Saint-Joseph, 13285 Marseille, France
Guillaume Penaranda, Laboratoire Alphabio, Hôpital Européen, 13003 Marseille, France
Author contributions: Adhoute X and Perrier H collected data; Penaranda G performed statistical analyzes; Adhoute X, Bourliere M, Castellani P and Penaranda G analyzed data; Adhoute X and Bourliere M wrote the manuscript.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Xavier Adhoute, Department of Hepatology, Hopital Saint-Joseph, 26 boulevard Louvain, 13285 Marseille, France. adhoute.xavier@neuf.fr
Telephone: +33 6-10-152948 Fax: +33 4-91-806912
Received: August 27, 2014
Peer-review started: August 28, 2014
First decision: September 19, 2014
Revised: October 2, 2014
Accepted: November 27, 2014
Article in press: November 27, 2014
Published online: March 27, 2015
Abstract

Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of country-specific treatment strategies are also proposed. The barcelona - clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Barcelona Clinic Liver Cancer, Prognostic scoring systems

Core tip: Despite its widespread use in hepatocellular carcinoma, the indications for Transarterial chemoembolization are still debated. There are no rules about the treatment modalities or strategy to follow. To overcome these difficulties, a simple scoring system, including prognostic variables, designed as a decision support, would be useful. Deciding when we have to move from a loco-regional treatment to a systemic option is matter of significant interest, particularly since sorafenib now provides us with a solution.