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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 8, 2015; 7(16): 2009-2019
Published online Aug 8, 2015. doi: 10.4254/wjh.v7.i16.2009
Transarterial chemoembolization: Evidences from the literature and applications in hepatocellular carcinoma patients
Antonio Facciorusso, Raffaele Licinio, Nicola Muscatiello, Alfredo Di Leo, Michele Barone
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
Raffaele Licinio, Alfredo Di Leo, Michele Barone, Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, 70126 Bari, Italy
Author contributions: Licinio R and Muscatiello N performed the bibliographic research; Facciorusso A wrote the paper; Di Leo A and Barone M revised the manuscript; all the authors contributed to the article.
Conflict-of-interest statement: None of the authors has conflicts of interest to declare.
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: Antonio Facciorusso, MD, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale L.Pinto, 1, 71100 Foggia, Italy. antonio.facciorusso@virgilio.it
Telephone: +39-08-81732154 Fax: +39-08-81732135
Received: April 18, 2015
Peer-review started: April 19, 2015
First decision: June 25, 2015
Revised: June 26, 2015
Accepted: July 23, 2015
Article in press: July 27, 2015
Published online: August 8, 2015
Abstract

Transarterial chemoembolization (TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma (HCC), preserved liver function, absence of cancer-related symptoms and no evidence of vascular invasion or extrahepatic spread (i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer staging system). The rationale for TACE is that the intra-arterial injection of a chemotherapeutic drug such as doxorubicin or cisplatin followed by embolization of the blood vessel will result in a strong cytotoxic effect enhanced by ischemia. However, TACE is a very heterogeneous operative technique and varies in terms of chemotherapeutic agents, treatment devices and schedule. In order to overcome the major drawbacks of conventional TACE (cTACE), non-resorbable drug-eluting beads (DEBs) loaded with cytotoxic drugs have been developed. DEBs are able to slowly release the drug upon injection and increase the intensity and duration of ischemia while enhancing the drug delivery to the tumor. Unfortunately, despite the theoretical advantages of this new device and the promising results of the pivotal studies, definitive data in favor of its superiority over cTACE are still lacking. The recommendation for TACE as the standard-of-care for intermediate-stage HCC is based on the demonstration of improved survival compared with best supportive care or suboptimal therapies in a meta-analysis of six randomized controlled trials, but other therapeutic options (namely, surgery and radioembolization) proved competitive in selected subsets of intermediate HCC patients. Other potential fields of application of TACE in hepato-oncology are the pre-transplant setting (as downstaging/bridging treatment) and the early stage (in patients unsuitable to curative therapy). The potential of TACE in selected advanced patients with segmental portal vein thrombosis and preserved liver function deserves further reports.

Keywords: Transarterial chemoembolization, Loco-regional treatment, Hepatocellular carcinoma, Liver cancer, Hepatocarcinoma, Radiofrequency ablation

Core tip: Transarterial chemoembolization (TACE) represents the standard of care for patients with large or multinodular hepatocellular carcinoma (HCC). However, TACE is a heterogeneous technique varying in terms of chemotherapeutic agents, devices and schedule. In order to overcome these drawbacks of conventional TACE (cTACE), drug-eluting beads have been developed. Unfortunately, despite its theoretical advantages, definitive data in favor of its superiority over cTACE are still lacking. TACE represents the standard-of-care for intermediate-stage HCC, in competition with other therapeutic options (surgery and radioembolization). Other fields of application are the pre-transplant setting and the early stage (in patients unsuitable to curative therapy).