Zhang S, Zhong BY, Zhang L, Wang WS, Ni CF. Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition. World J Gastrointest Surg 2022; 14(6): 528-537 [PMID: 35979416 DOI: 10.4240/wjgs.v14.i6.528]
Corresponding Author of This Article
Cai-Fang Ni, MD, PhD, Chief Doctor, Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. szncf@suda.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Jun 27, 2022; 14(6): 528-537 Published online Jun 27, 2022. doi: 10.4240/wjgs.v14.i6.528
Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition
Shen Zhang, Bin-Yan Zhong, Lei Zhang, Wan-Sheng Wang, Cai-Fang Ni
Shen Zhang, Bin-Yan Zhong, Lei Zhang, Wan-Sheng Wang, Cai-Fang Ni, Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: Zhang S and Zhong BY contributed equally to drafting the manuscript; Zhang L polished the vocabulary and the grammar; Wang WS and Ni CF shared responsibility for the study concept and design; all authors contributed to reviewing and criticizing revision of the manuscript and approving the final version of the manuscript.
Supported bythe National Natural Science Foundation of China, No. 81901847; Natural Science Foundation of Jiangsu Province, No. BK20190177; and the Suzhou Science and Technology Youth Plan, No. KJXW2018003.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cai-Fang Ni, MD, PhD, Chief Doctor, Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. szncf@suda.edu.cn
Received: December 13, 2021 Peer-review started: December 13, 2021 First decision: January 27, 2022 Revised: February 8, 2022 Accepted: June 4, 2022 Article in press: June 4, 2022 Published online: June 27, 2022
Abstract
Multi-session transarterial chemoembolization (TACE) is usually needed for the treatment of intermediate-stage hepatocellular carcinoma (HCC), but it may not always have a positive influence on prognosis due to high heterogeneity of HCC. To avoid ineffective repeated TACE, the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors. The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data. To date, only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness, although the concept has been introduced and applied in many TACE-related clinical trials. This review focuses on some of the issues related to different versions of TACE failure/refractoriness, the rationality of related definitions, and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence. A suggestion to re-define TAEC failure/refractoriness is also put forward.
Core Tip: The definitions in the current concept of transarterial chemoembolization (TACE) failure/refractoriness are not capable of guiding clinical practice. A persistent viable tumor lesion is a well-accepted item of TACE failure/refractoriness, but that is not the case when it comes to new lesions, portal vein tumor thrombosis or extrahepatic spread. Patients with recurrent hepatocellular carcinoma after TACE constitute a heterogenous group and the treatment modalities need to be individualized.
