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Chemoembolization for hepatocellular carcinoma: where does the truth lie?
1Division of Interventional Radiology, The Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Blalock 545, 600 North Wolfe Street, Baltimore, Maryland 21287, USA. jfg@jhmi.edu
Insights
Hepatocellular carcinoma (HCC) is a lethal cancer with limited treatments. New trials clarify the role of transcatheter arterial chemoembolization (TACE) in managing unresectable HCC, offering insights into its palliative effectiveness.
Area of Science:
- Hepatology and oncology
- Cancer research and treatment
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally, particularly in Asia and Africa.
- Rising incidence in the US is linked to hepatitis C virus (HCV) infection.
- Effective curative options like surgery and transplantation are limited to early-stage HCC.
Discussion:
- Transcatheter arterial chemoembolization (TACE) is a common palliative treatment for unresectable HCC.
- Controversy exists regarding TACE's survival benefit over supportive care.
- Previous studies yielded mixed results, with some randomized trials showing no survival advantage.
Key Insights:
- Two recent high-quality randomized trials published in Hepatology and Lancet address the efficacy of TACE.
- These trials aim to resolve the long-standing debate on TACE's impact on patient survival.
- Findings are expected to establish the definitive role of TACE in palliative care for HCC.
Outlook:
- Clarification of TACE's role will guide clinical practice for unresectable HCC.
- Potential for improved patient management and outcomes.
- Further research may explore optimizing TACE or alternative palliative strategies.
Abstract:
Hepatocellular carcinoma (HCC) remains one of the most highly lethal cancers in the world. It continues to be plagued by a shortage of effective therapeutic options and consequently is a major cause of death, especially in eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has been rapidly and steadily increasing in the past 20 years because of the concomitant epidemic rise in hepatitis C virus infection. Surgical resection and liver transplantation offer the only chance for a cure, but, unfortunately, tumors in most patients are found to be unresectable at presentation and the patients are therefore left with palliative options only. Of those, transcatheter arterial chemoembolization has been the most widely used over the years and has become the mainstay of therapy for patients with unresectable HCC. Yet, controversy has surrounded its efficacy and impact on patient survival. After a period of initial enthusiasm followed by encouraging results from retrospective and prospective studies, several randomized trials failed to show any survival advantage of chemoembolization over supportive care. So where does the truth lie? The publication this year of two separate high-quality randomized trials, one in Hepatology from Hong Kong and the other in Lancet from Spain, should help answer this question and finally establish the usefulness of chemoembolization as an effective palliative therapy against HCC.