| Transarterial Approach in Early Stage HCC: From Palliative Therapy to Curative Therapy |
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Jung Suk Oh, Ho Jong Chun |
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Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea |
Correspondence:
Ho Jong Chun,
Email: chunray@catholic.ac.kr
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| Abstract |
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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. |
| Key Words:
Hepatocellular carcinoma; Early stage HCC; Transarterial chemoembolization; Transarterial radioembolization |
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