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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10327-10335
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10327
Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system
Kichang Han, Jin Hyoung Kim
Kichang Han, Jin Hyoung Kim, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 138-736, South Korea
Author contributions: Kim JH designed the study, outlined the draft, and supervised the project; and Han K carried out the literature search and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
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: Jin Hyoung Kim, MD, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, South Korea. jhkimrad@amc.seoul.kr
Telephone: +82-2-30104384 Fax: +82-2-4760090
Received: April 23, 2015
Peer-review started: April 24, 2015
First decision: May 18, 2015
Revised: June 11, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 28, 2015
Abstract

Hepatocellular carcinoma (HCC), the fifth most common cancer that predominantly occurs in liver cirrhosis patients, requires staging systems to design treatments. The barcelona clinic liver cancer staging system (BCLC) is the most commonly used HCC management guideline. For BCLC stage B (intermediate HCC), transarterial chemoembolization (TACE) is the standard treatment. Many studies support the use of TACE in early and advanced HCC patients. For BCLC stage 0 (very early HCC), TACE could be an alternative for patients unsuitable for radiofrequency ablation (RFA) or hepatic resection. In patients with BCLC stage A, TACE plus RFA provides better local tumor control than RFA alone. TACE can serve as bridge therapy for patients awaiting liver transplantation. For patients with BCLC B, TACE provides survival benefits compared with supportive care options. However, because of the substantial heterogeneity in the patient population with this stage, a better patient stratification system is needed to select the best candidates for TACE. Sorafenib represents the first line treatment in patients with BCLC C stage HCC. Sorafenib plus TACE has shown a demonstrable effect in delaying tumor progression. Additionally, TACE plus radiotherapy has yielded better survival in patients with HCC and portal venous thrombosis. Considering these observations together, TACE clearly has a critical role in the treatment of HCC as a stand-alone or combination therapy in each stage of HCC. Diverse treatment modalities should be used for patients with HCC and a better patient stratification system should be developed to select the best candidates for TACE.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Sorafenib, Radiofrequency ablation, Hepatic resection, Liver transplantation

Core tip: This article describes the role of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) according to the barcelona clinic liver cancer (BCLC) staging system. Notably, TACE is the treatment of choice in the treatment of intermediate HCC (BCLC stage B). However, in clinical practice, TACE has been used as an alternative or combination therapy in patients with early or advanced HCC. Therefore, diverse treatment modalities, including TACE, should be considered for the best interests of patients with HCC.