Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition

Table 1 Different concepts of transarterial chemoembolization failure/refractoriness

Guidelines/articles	Contents
JSH-LCSGJ criteria 2014[6]	(1) Intrahepatic lesion: Two or more consecutive insufficient responses of the treated tumor (viable lesion > 50%) even after changing the chemotherapeutic agents and/or reanalysis of the feeding artery seen on response evaluation CT/MRI at 1-3 mo after having adequately performed selective TACE; two or more consecutive progressions in the liver (tumor number increases as compared with tumor number before the previous TACE procedure) even after having changed the chemotherapeutic agents and/or reanalysis of the feeding artery seen on response evaluation CT/MRI at 1-3 mo after having adequately performed selective TACE; (2) Continuous elevation of tumor markers immediately after TACE even though a slight transient decrease is observed; (3) Appearance of vascular invasion; and (4) Appearance of extrahepatic spread
International Association for the Study of the Liver[13]	No response after 3 or more TACE procedures within a 6 mo period, to the same area.
Europe[14]	Depending on the purpose of TACE, if TACE is used as palliative therapy, stable lesions can be regarded as effective. Conversely, if TACE is used as a curative therapy, stable lesions are considered TACE-failure

JSH-LCSGJ: JSH-Liver Cancer Study Group of Japan; TACE: Transarterial chemoembolization; CT: Computed tomography; MRI: Magnetic resonance imaging.