Transarterial Embolization Therapies in Hepatocellular Carcinoma: Principles of Management
Hepatocellular carcinoma (HCC) is the sixth commonest cancer worldwide and the third commonest cause of cancer-related death. The most commonly used algorithm for the staging and treatment of patients with HCC is that of the Barcelona Clinic Liver Cancer (BCLC). Patients with BCLC stage B disease at the time of first treatment are considered to be; unresectable, untransplantable and unablatable. The treatment aim is to elicit an objective response (complete or partial) and in some cases downstage the tumour such that a curative option might be considered in the future, e.g., liver transplantation or ablation. TACE should not be given where there is complete portal vein occlusion due to the risk of significant liver ischaemia and subsequent liver decompensation and death. The overall fitness of the patient should be considered and in the main reserved for patients with Child-Pugh A cirrhosis and performance status 0.The use of tools such as HAP and ART may help identify patients unlikely to benefit from TACE. The role of the best embolic agent or the use of drug-eluting beads remains controversial and should be determined by local availability and expertise and assessment of the patient. The best strategy for first treatment nonresponders, i.e., further TACE versus alternative therapy, has yet to be evaluated and should be studied in further trials. This chapter discusses the rationale for the use of TACE.
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