Transarterial Therapies for Hepatocellular Carcinoma

Abstract

Background: The treatment of hepatocellular carcinoma (HCC) is still a major health issue because of its increasing incidence and because of the complexity of its management. Transarterial embolization (TAE) and transarterial chemoembolization (TACE) are two widely used locoregional therapies in the treatment of HCC, especially for unresectable intermediate and advanced HCCs. Summary: The modern use of TAE and TACE opens new scenarios for the treatment of unresectable HCC and has yielded interesting results. The present work describes the role of transarterial therapies for HCC and focuses on the different Western and Eastern approaches to the study of response predictors. Key Messages: Recent refinements in interventional radiology techniques and in HCC patient selection have facilitated better local control of the disease. The molecular profiling of HCC to predict the response to TACE and TAE will greatly help clinicians identify the optimum therapy.

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

“…There are several epidemiological differences in HCC across geographical regions, as well as differences in genetic mutations, especially between Western and Asian populations [31,32]. The incidence of HCC is considerably higher in Asian countries, such as China and Southeast Asia, and in Africa, compared with Europe and North America [33].…”

“…In 2012, 50% of new HCC cases occurred in China [33]. A key epidemiological difference is the fact that HCC in most Asian countries (e.g., China and Southeast Asia) primarily results from hepatitis B virus (HBV) infection, whereas in Japan and Western countries, hepatitis C virus (HCV) infection is the primary risk factor for HCC [31,32]. As HBV-related HCC may occur in patients with or without cirrhosis, a higher proportion of Asian patients are noncirrhotic.…”

“…These factors include the skill and experience of the radiologist, as well as the technique and materials (e.g., catheter size) available. Ongoing genomic and proteomic trials may also be useful for patient selection according to their molecular profile [32]; however, markers from such trials are not yet available. Other arterially directed therapies to consider include transarterial bland embolization, DEB-TACE, and transarterial radioembolization (TARE) with yttrium-90 microspheres [5].…”

Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation

“…Loco-regional therapy such as transarterial chemoembolization (TACE) has been proposed for patients with large size or multifocal, un-resectable tumour restricted to the liver while awaiting liver transplant (LT) [2]. …”

Engineering Iodine-Containing 3D-Crosslinked Methacrylic Micro-spheres for Trans arterial Embolization. Evaluation of Fluoroscopic (X-ray) Visibility in a Hospital Setting

“…TACE has now become the preferred technique for the treatment of hepatocellular carcinoma (HCC). 7,8 The newest forms of TACE in oncology use drug-eluting embolic microspheres. These particles do not only embolize part of the tumour's vascular tree, they also locally deliver a cytostatic agent (such as doxorubicin), or a low-molecular-mass multi-tyrosine kinase inhibitor such as sorafenib (also known as NexavarR) or vandetanib, in a controlled manner.9-12 Embolic microspheres are of scientific and technical interest.…”