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This review outlines the current status of the most TACE achieves partial responses in 15-55% of patients
commonly used image-guided therapeutic approaches for and significantly delays tumor progression and vascular
the management of patients with HCC. invasion. [8,12-14] For HCC invading the portal venous system,
TACE could be an effective treatment with the 1-, 3-, and
INTRA-ARTERIAL CATHETER-BASED THERAPIES 5-year survival rates of 42%, 11%, and 3%, respectively.
[15]
Although an earlier study showed that TACE could not
Embolotherapy/chemotherapy-based therapies improve the survival of the patients, survival benefits
[12]
Transarterial chemoembolization were identified by two studies on chemoembolization. [13,14]
The radiological technique for tumor devascularization Overall, the effect may be considered modest.
was developed in the 1970s. Now, it is the most widely
[7]
used primary treatment for unresectable HCC. It is also Arterial bland embolization
the most extensively used therapy for patients on the Transcatheter arterial bland embolization, which simulates
waiting list for liver transplantation. Embolization agents, arterial ligation, induces tumor ischemia by disrupting the
like gelatin, may be administered together with selective blood supply to the tumor. Advocates of this catheter-based
intra-arterial chemotherapy mixed with lipiodol (iodized therapy claim that bland embolization may be equally
oil). Doxorubicin, mitomycin, and cisplatin are commonly effective as TACE for palliative treatment of primary liver
used anti-tumor drugs. The rationale of transarterial cancer. Despite a trend toward improved survival with
[8]
[16]
chemoembolization (TACE) is as follows: cytotoxic TACE, no study to date has demonstrated a difference in
drugs achieve higher intra-tumoral concentrations when survival between the two techniques. A randomized
[17]
injected in the hepatic artery, and lipophilic or amphiphilic trial comparing embolization (without chemotherapy) vs.
anticancer drugs, when mixed with lipiodol, are thought to symptomatic treatment in patients with hepatitis C virus-
be liberated progressively inside the tumor. Lipiodol, which related liver disease and Child-Pugh class A liver function
destroys capillary beds and induces extensive necrosis in failed to demonstrate a 2-year survival advantage. [18]
HCC with abundant blood supply, can be transported in a
tumor and may remain for weeks or months, for which the Drug-eluting bead chemoembolization
absence of Kupffer cells would presumably be responsible. Drug-eluting bead (DEB)-TACE is a drug delivery system
that combines the local embolization of vasculature with
Usually, lesions that are rich in arterial blood supply can be the release of chemotherapy into adjacent tissue. [19,20] It
anticipated to undergo complete necrosis, while those that is intended for use in the treatment of hyper-vascular
lack arterial blood supply have less iodine oil deposits and tumors such as HCC. Its administration is similar to that of
need other combinative therapies. The whole procedure conventional TACE. Beads are composed of biocompatible
can be repeated monthly or longer to achieve higher degree polymers such as polyvinyl alcohol (PVA) hydrogel that have
necrosis and avoid recurrence. However, the injection of been sulfonated to enable the binding of chemotherapy.
[21]
cytotoxic drugs mixed with lipiodol but not followed by The beads occlude vasculature, causing embolization, and
embolization has not shown any substantial anti-tumor the chemotherapy is delivered locally. [22,23]
effect, suggesting that ischemia plays a key role in tumor
necrosis. Still, some authors reported that transcatheter Like conventional TACE, DEB-TACE is considered a
[9]
arterial infusion chemotherapy had a better anti-tumor palliative option for unresectable HCC. DEB-TACE may
effect than TACE. With respect to the relationship also use as an adjunctive therapy for liver resection or
[10]
[11]
between TACE and pulmonary metastasis, Lin et al. as a bridge to liver transplantation, as well as before
reported that TACE did not significantly increase the risk or after radiofrequency ablation (RFA). [24-28] There are
of pulmonary metastasis. Post-embolization syndrome currently two types of microspheres available for drug
including abdominal pain and fever is extremely frequent loading: DC Bead microspheres (Biocompatibles, UK)
and fades in a few days. Complications related to aberrant and the recently introduced superabsorbent polymer
arterial embolization, such as acute cholecystitis, stenosis (SAP) HepaSphere microspheres (BioSphere Medical,
of the biliary tract, acute pancreatitis, or gastroduodenal USA). Most of the literature involves the application of
ulcerations have also been reported. The selection of DC Bead microspheres. These microspheres are non-
candidates for TACE is a key point. The benefits of the biodegradable PVA microspheres that are approved for
procedure should not be offset by treatment-reduced liver the treatment of malignant hyper-vascular tumors and
function failure. Patients with preserved liver function loading of doxorubicin. Precision Bead (Biocompatibles,
and asymptomatic multinodular tumors without vascular UK) microspheres are the first factory-preloaded
invasion or extra-hepatic spread are indicated for TACE. (doxorubicin 37.5 mg/vial) microspheres. They can
[8]
Child-Pugh class C is considered a contraindication. be polymerized to formulate different-sized spheres,
[12]
2 Hepatoma Research | Volume 2 | Issue 1 | January 15, 2016