Transarterial chemoembolization and radioembolization

Transarterial chemoembolization (TACE) and radioembolization (RE) are frequently used to treat patients with hepatocellular carcinoma who cannot receive curative therapies. Transarterial chemoembolization is a heterogeneous group of procedures; based on two positive clinical trials and three meta-analyses, conventional TACE is the standard of care for patients in the intermediate stage. Transarterial chemoembolization with drug-eluting beads has been recently introduced as a more standardized way of performing TACE with similar outcomes and less systemic effects. Radioembolization is a form of brachytherapy in which microspheres are used as a source of internal radiation. Evidence supporting the use of RE derives from consistent, large-cohort series involving patients with more advanced hepatocellular carcinoma, not suitable for TACE or for those who have failed TACE. Transarterial chemoembolization and RE should not be considered competing therapies, but rather complementary tools. The clinical indications for TACE and RE will be further refined as results of ongoing large-scale studies become available.