Transarterial chemoembolization for patients with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) has gained interest among the scientific community due to its increasing incidence in developed countries and the improvement of its diagnostic algorithm and therapeutic approach. Despite the universal implementation of screening programs in cirrhotics through biannual abdominal ultrasound, only 30% of HCC are diagnosed at an early stage, when radical treatments, surgical resection, liver transplantation and percutaneous ablation, are possible. Several therapies have been proposed for patients who cannot benefit from a radical approach, but only transarterial chemoembolization has demonstrated survival benefits. However, it can only be performed in patients withpreserved liver function, absence of extrahepatic spread/vascular invasion, and no significant cancer-related symptoms. Therefore, no more than 20% of the patients affected by HCC can be benefited by this therapeutic modality. The objective responses after procedure vary between 20% and 50%, with a significant rate of adverse-effects, particularly post-embolization syndrome. Further randomized controlled trials are needed to assess the best chemotherapeutic agent and the ideal re-treatment schedule.