Review on transarterial chemoembolization in hepatocellular carcinoma: Palliative, combined, neoadjuvant, bridging, and symptomatic indications

• Published in: European journal of radiology Vol. 72; no. 3; pp. 505 - 516
• Main Authors: Vogl, Thomas J, Naguib, Nagy N.N, Nour-Eldin, Nour-Eldin A, Rao, Pramod, Emami, Alborz Hedayati, Zangos, Stefan, Nabil, Mohamed, Abdelkader, Ahmed
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.12.2009; Elsevier
• Subjects: Antineoplastic agents; Biological and medical sciences; Carcinoma, Hepatocellular - therapy; Combined therapies; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Embolization, Therapeutic - methods; Gastroenterology. Liver. Pancreas. Abdomen; Hemostatics - therapeutic use; Hepatocellular carcinoma (HCC); Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - therapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Neoadjuvant Therapy - methods; Palliative Care - methods; Pharmacology. Drug treatments; Radiology; Review; TACE; Tumors; TACE; Combined therapies; Review; Hepatocellular carcinoma (HCC); Antineoplastic agent; Human; Indication; Instrumentation therapy; Hepatic disease; Hepatocellular carcinoma; Palliative treatment; Malignant tumor; Neoadjuvant treatment; Symptomatology; Chemotherapy; Treatment; Digestive diseases; Embolization; Combined treatment; Cancer; Chemoembolization
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2008.08.007

Abstract The current review provides an overview on the palliative, combined, neoadjuvant, bridging, and symptomatic indications of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). It is based on an analysis of the current literature and the experience of the authors on the topic. Chemoembolization combines the infusion of chemotherapeutic drugs with particle embolization. Tumor ischemia raises the drug concentration compared to infusion alone, extends the retention of the chemotherapeutic agent and reduces systemic toxicity. Palliatively, TACE is performed to control symptoms and prolong survival in HCC patients; in some indications TACE allows a local tumor control of 18–63%. For combined indications, excellent results were achieved by combined therapies, such as percutaneous ethanol injection (PEI)/TACE, radiofrequency ablation (RF)/TACE, and laser-induced thermotherapy (LITT)/TACE. As a neoadjuvant therapy prior to liver resection TACE showed 70% tumor control. Though debatable, TACE still plays a role as a bridging tool before liver transplantation. Symptomatic indication of TACE in ruptured HCC showed 83–100% control of bleeding but survival was poor. Thus, TACE represents an important therapeutic tool against HCC in general in addition to its special role in cases of unresectable HCC.