Vietnamese expert consensus on the treatment of hepatocellular carcinoma with transarterial chemoembolization

Hepatocellular carcinoma (HCC) remains a major public health challenge in Vietnam and, according to GLOBOCAN 2022, accounted for 24,502 new cases in 2022, making it the second most common cancer and the leading cause of cancer-related mortality. Transarterial chemoembolization (TACE), introduced in 1977, is a pivotal treatment for unresectable HCC, delivering chemotherapeutic agents and embolic materials to induce tumor necrosis through cytotoxicity and ischemia. TACE is versatile and, in selected early-stage HCC (BCLC 0-A) treated with a highly selective approach, may achieve complete response; in intermediate-stage disease (BCLC B), it can prolong survival and enable downstaging, and in advanced-stage disease (BCLC C), it may complement systemic therapy. Despite its global use, TACE practices vary, and Vietnam lacks standardized guidelines tailored to its unique clinical landscape. The Vietnamese Society of Radiology and Nuclear Medicine and The Vietnamese Society of Interventional Radiology conducted three workshops in Da Nang, An Giang, and Can Tho between August and December 2024. These workshops engaged interventional radiologists from major hospitals and regional centers to develop consensus-based TACE recommendations. Through literature reviews, discussions, and physician voting, the recommendations cover pre-TACE diagnostic imaging, patient selection criteria, TACE techniques, choice of embolic materials and chemotherapeutic agents, intra- and post-procedure monitoring, and integration with combination therapies. This initiative aligns international standards with local needs, aiming to enhance the efficacy and consistency of TACE for HCC management in Vietnam.