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Editorial

The evolving role of transarterial chemoembolization in the
The evolving role of transarterial chemoembolization in the
management of hepatocellular carcinoma
management of hepatocellular carcinoma

Georgios Tsoulfas
Department of Surgery, Aristoteleion University of Thessaloniki, 54622 Thessaloniki, Greece

Address for correspondence:
Dr. Georgios Tsoulfas, Department of Surgery, Aristoteleion University of Thessaloniki, 66 Tsimiski Street, 54622 Thessaloniki, Greece.
E-mail: tsoulfasg@gmail.com
Received: 26-01-2015, Accepted: 15-02-2015

Globally, hepatocellular carcinoma (HCC) is one of the most with limited stress for the patient, which has been shown
frequent causes of cancer-related mortality, being third to offer significant advantages. That is not to say that there
overall in terms of cancer-related mortality, in addition to are no side effects, as the patients after a treatment can
being the fifth most common cancer in men and seventh experience abdominal pain, fever, nausea, emesis, hepatic and
most frequent in women. It represents a complex disease, gallbladder inflammation and possible infection. However,
[1]
as it usually develops in a background of cirrhosis, which given its efficacy in different stages of the disease, the
signifies that in order to properly manage the patient, both challenge remains identifying its proper role and place in
issues must be addressed. Based on this, there is a wide range the continuum of care for these patients.
of treatments, depending on the stage and extent of the
HCC, as well as on the hepatic function and patient’s overall Transarterial embolization involves the transcatheter delivery
condition. There are curative treatments, including surgical of either solid particles or coils (transarterial embolization)
resection and orthotopic liver transplantation for tumors or chemoembolization (TACE) or chemoembolization
that fall within certain criteria, with liver transplantation using drug-eluting beads (DEB-TACE) or radioembolization
having the advantage of addressing both the HCC and the (for example with Yttrium-90 microspheres). A more recent
hepatic disease. There are also a variety of locoregional endeavor is the use of targeted radionuclide therapy, which is
[3]
treatments, such as radiofrequency ablation, microwave an elegant step towards increased targeted therapy. Overall,
ablation, irreversible electroporation and transarterial it is considered that transarterial embolization by itself is not
chemoembolization (TACE), which can potentially have a enough, as with minimal extra effort we could offer these
therapeutic role in small lesions (usually < 2 cm), or more patients much more if the chemotherapy is included. In a
frequently play a role in the management of more advanced review of available literature up to October 2013 by a Canadian
group, it was concluded that TACE does offer a survival benefit
HCC or in patients with poor functional status, either related to these patients, and that DEB-TACE (although it may have a
to their cirrhosis or to overall comorbidities. The first slightly better safety profile compared to TACE) is equivalent
experience with hepatic arterial chemoembolization was to standard TACE regarding increased overall survival. [4]
[2]
in the early 1980s. Over the years, TACE has managed to
gain a lot of attention as it represents a type of treatment Despite these encouraging results, there are several questions
that need to be taken into consideration, regarding both the
Access this article online
Quick Response Code validity of our data, as well as the evolution of our practices.
Website: Although TACE can be used in other diseases and organs as
http://www.hrjournal.net/ well, this editorial will mainly comment on its application in the
liver. Specifically, we have to understand that the success of the
method depends significantly on the technical characteristics,
DOI:
10.4103/2394-5079.153287 that is whether we are using chemotherapy or DEB or radiation
microspheres, ultimately this may affect the end-result. In

Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015 9