Transarterial chemoembolization: Evidences from the literature and applications in hepatocellular carcinoma patients

Table 1 Absolute and relative contraindications to transarterial chemoembolization

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 Proposed scoring systems for hepatocellular carcinoma patients undergoing transarterial chemoembolization

Ref.	Variables considered	Aim
Lladó et al[15]	AFP (> 400 UI/L), tumor size (> 50%) and CP score	Treatment selection
Kadalayil et al[16]	Albumin < 3.6 g/L, bilirubin > 17 μmol/L, AFP > 400 ng/mL and dominant tumor size > 7 cm	Treatment selection
Sieghart et al[17]	Increase of AST by > 25% and of CP score from baseline, tumor response	Treatment repetition
Adhoute et al[18]	BCLC, AFP (> 200 ng/mL), increase in CP score by ≥ 2 from baseline and tumor response	Treatment repetition
Pinato et al[19]	Normalization of CRP and serum albumin after TACE	Treatment repetition
Hucke et al[20]	Albumin level, tumour burden (reference: up-to-7 criteria) and CRP(≥ 1 mg/dL)	Treatment selection
Xu et al[21]	PVT, tumor number, tumor capsule, AFP, AST and ICR	Treatment selection
Sciarra et al[22]	CD34 and VEGF staining1	Treatment selection

¹Assessed in tumor biopsy. AFP: Alpha-fetoprotein; CP: Child-Pugh; AST: Aspartate transaminase; BCLC: Barcelona Clinic Liver Cancer; CRP: C-reactive protein; TACE: Transarterial chemoembolization; PVT: Portal vein thrombosis; ICR: Indocyanin retention test; VEGF: Vascular endothelial growth factor.

Table 3 Studies comparing conventional and drug-eluting beads transarterial chemoembolization in hepatocellular carcinoma patients

Ref.	Arm	Drug	Sample size	Study design	Region
1Nicolini et al[38]	DEB-TACE	Doxorubicin	22	R	Italy
	cTACE	Epirubicin	16
1Frenette et al[39]	DEB-TACE	Doxorubicin	35	R	United States
	cTACE	Doxorubicin	76
Song et al[40]	DEB-TACE	Doxorubicin	60	R	South Korea
	cTACE	Doxorubicin or Epirubicin/Cisplatin	69
Sacco et al[41]	DEB-TACE	Doxorubicin	33	RCT	Italy
	cTACE	Doxorubicin	34
van Malenstein et al[42]	DEB-TACE	Doxorubicin	16	RCT	Belgium
	cTACE	Doxorubicin	14
Lammer et al[43]	DEB-TACE	Doxorubicin	93	RCT	Europe
	cTACE	Doxorubicin	108
Golfieri et al[44]	DEB-TACE	Doxorubicin	89	RCT	Italy
	cTACE	Epirubicin	88
Ferrer Puchol et al[45]	DEB-TACE	Doxorubicin	47	P	Spain
	cTACE	Doxorubicin	25
Dhanasekaran et al[46]	DEB-TACE	Doxorubicin	45	R	United States
	cTACE	Doxorubicin/Cisplatin/Mytomicin-C	26
Wiggermann et al[47]	DEB-TACE	Epirubicin	22	R	Germany
	cTACE	Cisplatin	22
Recchia et al[48]	DEB-TACE	Doxorubicin	35	P	Italy
	cTACE	Doxorubicin	70
Megìas Vericat et al[49]	DEB-TACE	Doxorubicin	30	R	Spain
	cTACE	DOxorubicin	30

¹Study conducted on transplanted patients. DEB-TACE: Drug-eluting beads transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization; R: Retrospective; RCT: Randomizes controlled trial; P: Prospective.