Precision transarterial chemoembolization in hepatocellular carcinoma: patient selection, standardized techniques,...

Area of Science:

• Interventional Oncology
• Hepatocellular Carcinoma Treatment
• Medical Imaging

Background:

• Transarterial chemoembolization (TACE) is crucial for hepatocellular carcinoma (HCC) but shows variable outcomes.
• Lack of standardization in TACE performance affects prognostic consistency.
• Existing evidence highlights the need for precise targeting and superselective catheterization in TACE.

Purpose of the Study:

• Introduce and define "precision TACE" to enhance quality control and standardize procedures.
• Categorize precision TACE into superior (SP-TACE) and moderate (MP-TACE) approaches.
• Propose a scoring system to quantify TACE precision and evaluate effectiveness.

Main Methods:

• Defined "precision TACE" based on an international expert panel consensus (ISMIO).
• Emphasized standardized angiography, superselective catheterization/embolization, embolic agent selection, and endpoint determination.
• Established criteria for SP-TACE and MP-TACE based on HCC tumor burden, lesion characteristics, and treatment goals.

Main Results:

• Precision TACE is divided into SP-TACE (aiming for complete response) and MP-TACE (aiming for partial response or stable disease).
• SP-TACE is suitable for early HCC and intermediate HCC with moderate tumor burden.
• MP-TACE is indicated for intermediate HCC with high tumor burden and locally-advanced HCC.

Conclusions:

• Precision TACE offers a standardized framework for TACE procedures in HCC management.
• SP-TACE and MP-TACE provide tailored treatment strategies based on patient-specific factors.
• Precision TACE can be combined with other therapies, and a scoring system aids in evaluating its effectiveness.