Journal of Liver Cancer

Recommendation and Guideline

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association: Yuri Cho, Jin Woo Choi, Hoon Kwon, Kun Yung Kim, Byung Chan Lee, Hee Ho Chu, Dong Hyeon Lee, Han Ah Lee, Gyoung Min Kim, Jung Suk Oh, Dongho Hyun, In Joon Lee, Hyunchul Rhim; J Liver Cancer. 2023;23(2):241-261. Published online July 14, 2023; DOI: https://doi.org/10.17998/jlc.2023.05.22

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Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

Citations

Citations to this article as recorded by

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Review Article

Transarterial Approach in Early Stage HCC: From Palliative Therapy to Curative Therapy: Jung Suk Oh, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):93-96. Published online September 30, 2012

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Abstract PDF: Early stage hepatocellular carcinoma (HCC) based on BCLC staging system can be curatively treated by liver transplantation, surgical resection or percutaneous ablation. However, transarterial approaches, including transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), are standard of care for intermediate stage HCC and can be an alternative treatment in the patients with early stage HCC which are unresectable, unsuitable for percutaneous ablation, or not eligible for liver transplantation. Many previous TACE studies in early stage HCC revealed that the overall survival rate was competitive with those of curative therapies considering their operation risks, but recurrence-free survival rate was significantly lower than curative therapies. Moreover, the histopathologic reports about TACE in early stage HCC demonstrated that only 38% of the HCC nodules were completely necrotic after TACE and only 81% of the nodules with complete response by EASL criteria showed complete necrosis. Although there is no long-term survival data about TARE in early stage HCC, a histopathologic report about TARE showed that 73% of the HCC nodules were completely necrotic after TARE and 100% of the nodules with complete response by EASL criteria showed complete necrosis. In conclusion, TACE is now limited to be categorized into a curative therapy in early stage HCC, according to the previous data about TACE. However, new recent technologies including C-arm CT, superselective embolization technique, drug-eluting bead (DEB) may sufficiently improve the survival data of TACE to prove its curative role. Considering its RFA-comparable histopathologic tumor response, TARE may prove to be a potential curative therapeutic for early stage HCC.

Case Reports

A Case of Hepatocellular Carcinoma in a 10 Year Old Child Treated with Yttrium Radioembolization and Transarterial Chemoembolization: Sung Won Lee, Hee Yeon Kim, Do Seon Song, Chung-Hwa Park, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Jung Suk Oh, Ho Jong Chun, Si Hyun Bae; Journal of the Korean Liver Cancer Study Group. 2012;12(2):137-140. Published online September 30, 2012

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4 Downloads

Abstract PDF: Hepatocellular carcinoma (HCC) in childhood is rare but is the second most common malignant liver neoplasm after hepatoblastoma in children. Surgical resectability is the foundation of curative therapy but only one third of newly diagnosed HCCs are resectable, and unresectable HCC remains largely unresponsive to systemic chemotherapy. In all reported series of HCC in children, therapeutic results are poor with overall survival less than 30%. Systemic chemotherapy is only partially effective but if preoperative downstaging can be achieved, it would result in a higher survival rate. There are scarce data regarding local ablative treatments such as transarterial chemoembolization (TACE) and therefore survival benefits are still unclear. TACE may be considered as a therapeutic alternative in cases of unresectable tumors after systemic chemotherapy or in unresectable, non-metastatic HCCs. The use of orthotopic liver transplantation in childhood HCC remains controversial. Radioembolization is a mode of treatment that aims to selectively target radiation to all liver tumors using yttrium-90 microspheres while limiting the dose to normal liver parenchyma. It may be considered as another treatment option in childhood HCC with the purpose of preoperative downstaging but further studies are required to determine the treatment benefits and safety of radioembolization treatment.

A Case of Progressive Superior Mesenteric Vein Thrombosis after Percutaneous Transhepatic Obliteration in Infiltrative Hepatocellular Carcinomaswith Portal Vein Thrombosis: Hee Yeon Kim, Chung-Hwa Park, Sung won Lee, Do Seon Song, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jung Suk Oh, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):146-150. Published online September 30, 2012

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3 Downloads

Abstract PDF: Percutaneous transhepatic obliteration of gastroesophageal varices is one of the effective emergency procedure when endoscopic therapy is not indicated or has been failed. One of the major complications of this procedure is portal thrombosis. A 53-year-old male with hepatitis B virus infection was diagnosed of infiltrative hepatocellular carcinoma with right portal vein thrombosis. On the next day after being hospitalization, the patient developed variceal bleeding. With medical management, endoscopic therapy was initially attempted, however, it ended in failure. Emergency percutaneous transhepatic obliteration of bleeding gastroesophageal varices was considered as a next option. Bleeding from gastroesophageal varices was stopped after percutaneous obliateration, however, portal thrombosis was extended to splenic vein or superior mesenteric veins.

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