J Liver Cancer.  2023 Sep;23(2):241-261. 10.17998/jlc.2023.05.22.

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association

• Cho Y
• Choi JW
• Kwon H
• Kim KY
• Lee BC
• Chu HH
• Lee DH
• Lee HA
• Kim GM
• Oh JS
• Hyun D
• Lee IJ
• Rhim H
• Research Committee of the Korean Liver Cancer Association

• KMID: 2546407
• DOI: http://doi.org/10.17998/jlc.2023.05.22

Abstract

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.

Keyword

Carcinoma, hepatocellular; Chemoembolization; Recommendations; Guidance; Guideline

Figure

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  Figure 1. Interventional radiologist survey on the use of cone-beam computed tomography (CBCT) and microcatheter. cTACE, conventional TACE; DEB-TACE, drug-eluting bead TACE.

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  Figure 2. Extent of treatment depending on the microcatheter position in superselective transarterial chemoembolization (TACE). (A) Nonselective TACE at the right hepatic artery. (B) Superselective TACE at A7 and less selective TACE at the right anterior hepatic artery. (C) Superselective TACE at every tumor-feeding artery.

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  Figure 3. Intervenional radiologist survey on chemoembolic agents in conventional transarterial chemoembolization.

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  Figure 4. Drug-eluting bead transarterial chemoembolization (DEB-TACE) vs. conventional transarterial chemoembolization (cTACE). (A) DEBTACE: DEBs cannot reach to the intra-tumoral fine arteries in small hepatocellular carcinoma, and blood supply from the portal venule can remain after DEB-TACE. (B) cTACE: Chemoemulsion can be accumulated in the peri-tumoral portal venules as well as intra-tumoral fine arteries.

Reference

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