Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update

Area of Science:

• Hepatology
• Oncology
• Interventional Radiology

Background:

• The 2010 Japan Society of Hepatology (JSH) guidelines defined transarterial chemoembolization (TACE) failure based on lipiodol deposition indicating necrosis.
• This definition was not universally accepted and became outdated with the introduction of non-lipiodol embolic agents.

Framework:

• Revised JSH guidelines now define TACE failure by treatment response and lesion changes, not solely lipiodol deposition.
• TACE failure is characterized by insufficient response after ≥2 procedures or new/increased lesions.

Implementation:

• Response evaluation uses computed tomography or magnetic resonance imaging 1-3 months post-TACE.
• Criteria include assessing tumor markers, vascular invasion, and extrahepatic spread.

Implications:

• Updated TACE failure definitions align with international standards and modern embolic materials.
• The revised criteria were approved by over 85% of hepatocellular carcinoma experts, indicating consensus on improved management strategies.