Surgical and Locoregional Therapy of HCC: TACE

Abstract

Transcatheter arterial chemoembolization (TACE) is performed worldwide for patients with intermediate-stage hepatocellular carcinoma (HCC). TACE has produced survival advantages in two randomized controlled trials and a meta-analysis, and is currently the mainstay of treatment for this stage of HCC. However, there are currently no global guidelines regarding the dose, choice or combination of cytotoxic agents for TACE; therefore, it is difficult to compare data from different TACE studies. In Japan, most of the TACE procedures have been based on iodized oil as conventional TACE, utilizing the microembolic and drug-carrying characteristic of iodized oil. Superselective TACE with lipiodol is the primary TACE procedure that has reported satisfactory levels of local control associated with a lower risk of complications. Conversely, TACE performed using drug-eluting beads has been widely used in western countries, and this has shown similar tumor response and median survival compared to conventional TACE. Moreover, the combination of TACE and molecular targeted agents is now ongoing to evaluate the synergistic effect. In this review, the indication, technical issues, and complications of TACE are reviewed.

Keywords: Chemoembolization; Drug eluting bead; Gelatin sponge; Hepatocellular carcinoma; Iodized oil.

Figures

Fig. 1

60-year-old woman with HCC. a CT hepatic arteriogram shows an enhancing nodule (arrow) in liver segment 5. Serum alpha-fetoprotein (αFP) level was 486 ng/ml (normal range; 0-5 ng/ml). b Hepatic digital subtraction arteriogram shows a hypervascular tumor nodule (arrow) in corresponding segments, 2-dimensional angiography shows an HCC as an enhanced lesion (arrow) complicated with right anterior/posterior hepatic arteries. c Maximal projection rendering image indicates a tumor-feeding artery from a right anterior hepatic artery to the tumor (arrow) according to the navigation imaging system by cone-beam CT. d Subsegmental catheterization into the feeding artery can be performed. Subsegmental TACE was performed with mixture of 2 ml of Lipiodol and 20 mg of epirubicin followed by gelfoam embolization. e Post-TACE plain radiograph shows better deposition of Lipiodol in the portal vein around the tumor in segment 5. f Follow-up CT scan obtained one-month later shows well-accumulated compact lipiodol retention in tumor of segment 5 without evidence of viable tumor. Serum αFP level was 32 ng/ml.