[Transarterial ablation of hepatocellular carcinoma. Status and developments]
Related Experiment Video
Updated: May 25, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
B A Radeleff1, U Stampfl, C M Sommer
1Abt. Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Boris.radeleff@med.uni-heidelberg.de
Insights
Transvascular ablation offers palliative options for hepatocellular carcinoma (HCC). Conventional transarterial chemoembolization (cTACE) and drug-eluting bead TACE (DEB-TACE) are key methods, with DEB-TACE potentially reducing systemic toxicity.
Area of Science:
- Oncology
- Interventional Radiology
- Hepatobiliary Medicine
Context:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally, particularly in patients with liver cirrhosis.
- Curative treatments are only suitable for 30-40% of HCC patients, necessitating local-regional and palliative therapies for the majority.
- Transvascular ablation leverages the hepatic artery's blood supply to HCC tumors.
Purpose:
- To review and compare transvascular ablation techniques for HCC management.
- To discuss the different regimens within transvascular ablation: conventional TACE (cTACE), bland embolization (TAE), TACE with drug-eluting beads (DEB-TACE), and selective internal radiation therapy (SIRT).
- To highlight the lack of standardization in cTACE and explore the potential benefits of DEB-TACE.
Summary:
- Transvascular ablation encompasses cTACE, TAE, DEB-TACE, and SIRT.
- cTACE, the most common method, involves chemotherapy and embolization but lacks standardized protocols.
- DEB-TACE combines chemotherapy and embolization using drug-loaded beads, aiming for increased intratumoral efficacy and reduced systemic toxicity compared to cTACE.
Impact:
- Identifies areas of non-standardization in cTACE, suggesting avenues for future research and clinical guidelines.
- Proposes DEB-TACE as a potentially more effective and safer alternative by localizing chemotherapy delivery.
- Contributes to understanding palliative treatment strategies for unresectable HCC.
Abstract:
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and represents the main cause of death among European patients with liver cirrhosis. Only 30-40% of patients diagnosed with HCC are candidates for curative treatment options (e.g. surgical resection, liver transplantation or ablation). The remaining majority of patients must undergo local regional and palliative therapies. Transvascular ablation of HCC takes advantage of the fact that the hypervascularized HCC receives most of its blood supply from the hepatic artery. In this context transvascular ablation describes different therapy regimens which can be assigned to four groups: cTACE (conventional transarterial chemoembolization), bland embolization (transarterial embolization TAE), DEB-TACE (TACE with drug-eluting beads, DEB) and SIRT (selective internal radiation therapy, radioembolization). Conventional TACE is the most common type of transvascular ablation and represents a combination of intra-arterial chemotherapy and embolization with occlusion of the arterial blood supply. However, there is no standardized regimen with respect to the chemotherapeutic drug, the embolic agent, the usage of lipiodol and the interval between the TACE procedures. Even the exact course of a cTACE procedure (order of chemotherapy or embolization) is not standardized. It remains unclear whether or not intra-arterial chemotherapy is definitely required as bland embolization using very small, tightly calibrated spherical particles (without intra-arterial administration of a chemotherapeutic drug) shows tumor necrosis comparable to cTACE. For DEB-TACE microparticles loaded with a chemotherapeutic drug combine the advantages of cTACE and bland embolization. Thereby, a continuing chemotherapeutic effect within the tumor might cause a further increase in intratumoral cytotoxicity and at the same time a decrease in systemic toxicity.
