Transarterial chemoembolization for hepatocellular carcinoma over three decades: current progress and perspective

Area of Science:

• Hepatobiliary Oncology
• Interventional Radiology
• Gastroenterology

Background:

• Transcatheter arterial chemoembolization (TACE) is a long-standing treatment for unresectable hepatocellular carcinoma (HCC).
• Two randomized controlled trials have recently confirmed the survival benefit of TACE, resolving prior controversies.
• TACE is widely used in Japan for both initial treatment and recurrent HCC foci.

Purpose of the Study:

• To compare the indications and outcomes of TACE based on different international guidelines (Barcelona Clinic Liver Cancer and Japanese).
• To present survival data for HCC patients treated with TACE according to the Japanese guidelines, stratified by tumor burden and liver function.
• To discuss advancements in TACE, including modified response evaluation criteria and novel therapeutic approaches.

Main Methods:

• Analysis of patient data (4966 patients) stratified by TACE recommendations from Japanese guidelines.
• Comparison of survival rates based on tumor number/size and Child-Pugh class (A/B).
• Review of recent advancements including drug-eluting beads (DEB-TACE), radioembolization, and combination therapies.

Main Results:

• Japanese and Barcelona Clinic Liver Cancer guidelines for TACE indications show similar content.
• 3-year survival rates for TACE in Child-Pugh A patients with 2-3 tumors >3cm or 4+ tumors were 55% and 46%, respectively.
• 3-year survival rates for TACE in Child-Pugh B patients with 2-3 tumors >3cm or 4+ tumors were 30% and 22%, respectively.
• Newer TACE modalities (DEB-TACE, radioembolization) demonstrate comparable tumor response and survival to conventional TACE.

Conclusions:

• TACE provides a survival benefit for unresectable HCC, with outcomes influenced by tumor burden and liver function.
• Established and emerging TACE techniques offer effective treatment options for HCC.
• Ongoing research focuses on optimizing TACE through improved response assessment and combination therapies with targeted agents.