Transarterial radioembolization in patients with hepatocellular carcinoma of intermediate B2 substage

  • Alberta Cappelli
  • Paloma Sangro
  • Cristina Mosconi
  • Iris Deppe
  • Eleonora Terzi
  • Jose I. Bilbao
  • Macarena Rodriguez-Fraile
  • Caterina De Benedittis
  • Jens Ricke
  • Rita GolfieriEmail author
  • Bruno SangroEmail author
Original Article



Patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B according to the Barcelona Clinic Liver Cancer classification) are a heterogeneous group with different degrees of liver function impairment and tumour burden. The recommended treatment is transarterial chemoembolization (TACE). However, patients in this group may be judged as poor candidates for TACE because the risk-benefit ratio is low. Such patients may receive transarterial radioembolization (TARE) only by entering a clinical trial. Experts have proposed that the stage could be further divided into four substages based on available evidence of treatment benefit. We report here, for the first time, the outcome in patients with BCLC-B2 substage HCC treated with TARE.


A retrospective analysis of the survival of 126 patients with BCLC-B2 substage HCC treated with TARE in three European hospitals was performed.


Overall median survival in patients with BCLC-B2 substage was not significantly different in relation to tumour characteristics; 19.35 months (95% CI 8.27–30.42 months) in patients with a single large (>7 cm) HCC, and 18.43 months (95% CI 15.08–21.77 months) in patients with multinodular HCC (p = 0.27). However, there was a higher proportion of long-term survivors at 36 months among those with a single large tumour (29%) than among those with multiple tumours (16.8%).


Given the poor efficacy of TACE in treating patients with BCLC-B2 substage HCC, TARE treatment could be a better choice, especially in those with a large tumour.


Hepatocellular carcinoma Transarterial chemoembolization Transarterial radioembolization BCLC-B subclassification 


Authors’ contributions

Alberta Cappelli, Paloma Sangro, Cristina Mosconi, Eleonora Terzi, J Jose I. Bilbao, Jens Ricke, Rita Golfieri and Bruno Sangro participated in the design of the study.

Alberta Cappelli, Paloma Sangro, Cristina Mosconi, Iris Deppe, Eleonora Terzi, Jose I. Bilbao, Macarena Rodriguez-Fraile and Caterina De Benedittis participated in data collection and manuscript preparation.

All authors participated in the elaboration and interpretation of the results and reviewed the final manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

The study was approved by the Institutional Review Board/Ethics Committee of each hospital. This article does not describe any studies with animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alberta Cappelli
    • 1
  • Paloma Sangro
    • 2
  • Cristina Mosconi
    • 1
  • Iris Deppe
    • 2
  • Eleonora Terzi
    • 3
  • Jose I. Bilbao
    • 4
  • Macarena Rodriguez-Fraile
    • 5
  • Caterina De Benedittis
    • 1
  • Jens Ricke
    • 6
  • Rita Golfieri
    • 1
    Email author
  • Bruno Sangro
    • 2
    Email author
  1. 1.Radiology Unit, Department of Diagnostic and Preventive MedicineUniversity of Bologna, Policlinico di S.OrsolaBolognaItaly
  2. 2.Liver UnitClinica Universidad de Navarra-IDISNA and CIBEREHDPamplonaSpain
  3. 3.Division of Internal Medicine, Department of Medical and Surgical SciencesUniversity of Bologna, Policlinico di S.OrsolaBolognaItaly
  4. 4.Interventional RadiologyClinica Universidad de Navarra-IDISNAPamplonaSpain
  5. 5.Nuclear MedicineClinica Universidad de Navarra-IDISNAPamplonaSpain
  6. 6.Department of Radiology and Nuclear MedicineUniversity Hospital MagdeburgMagdeburgGermany

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