How to define transarterial chemoembolization failure or refractoriness: a European perspective

Area of Science:

• Hepatobiliary Oncology
• Interventional Radiology

Background:

• Trans-arterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC) in Europe.
• TACE offers a modest improvement in median overall survival for HCC patients.

Purpose of the Study:

• To propose an algorithm summarizing clinical experience with TACE for HCC.
• To guide treatment decisions regarding TACE cessation and re-treatment.

Main Methods:

• Review of clinical experience with TACE in HCC management.
• Incorporation of criteria for stopping TACE, including toxicity, disease progression, and performance status.
• Consideration of the Assessment for Re-treatment with TACE (ART) score.

Main Results:

• TACE cessation is necessary due to severe toxicity, liver function decline, or tumor progression (local, extrahepatic, vascular invasion).
• The concept of 'untreatable progression' arises from these stopping criteria.
• The ART score aids in identifying patients unlikely to benefit from repeat TACE.

Conclusions:

• An algorithm is proposed to manage TACE therapy in HCC.
• This algorithm aims to optimize TACE treatment by defining criteria for cessation and re-treatment.
• The goal is to improve outcomes for HCC patients undergoing TACE.