Subscribe to RSS
DOI: 10.1055/s-0037-1602709
Transarterial Chemoembolization and Radioembolization across Barcelona Clinic Liver Cancer Stages
Publication History
Publication Date:
01 June 2017 (online)
![](https://www.thieme-connect.de/media/sir/201702/lookinside/thumbnails/10-1055-s-0037-1602709_001007-1.jpg)
Abstract
Transarterial chemoembolization (TACE) is a well-established treatment for hepatocellular carcinoma (HCC). TACE has a clearly delineated role within the Barcelona Clinic Liver Cancer (BCLC) staging framework, and TACE has been shown to bridge patients to transplantation and to downsize patients' tumor burden to meet transplantation criteria. Radioembolization (RE) also has an evolving role in the treatment of HCC. RE has evidence-based applications across the range of BCLC stages ranging from segmentectomy for patients with solitary lesions not amenable to ablation to lobar therapy for patients with multifocal HCC, and to treatment of advanced disease with portal vein thrombosis. This article aims to elucidate the evidence behind these therapies and to provide a rationale for their utilization across the spectrum of BCLC stages in the treatment of HCC.
-
References
- 1 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (03) 329-338
- 2 Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 2010; 30 (01) 61-74
- 3 Yamada R, Kishi K, Sato M. , et al. Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer. World J Surg 1995; 19 (06) 795-800
- 4 Duan X, Zhou G, Han X. , et al. Radiofrequency ablation combined with transcatheter therapy in rabbit VX2 liver tumors: effects and histopathological characteristics. Acta Radiol 2015; 56 (01) 87-96
- 5 Kim JW, Shin SS, Kim JK. , et al. Radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of single hepatocellular carcinoma of 2 to 5 cm in diameter: comparison with surgical resection. Korean J Radiol 2013; 14 (04) 626-635
- 6 Kim JW, Kim JH, Won HJ. , et al. Hepatocellular carcinomas 2-3 cm in diameter: transarterial chemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone. Eur J Radiol 2012; 81 (03) e189-e193
- 7 Lammer J, Malagari K, Vogl T. , et al; PRECISION V Investigators. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010; 33 (01) 41-52
- 8 Malagari K, Pomoni M, Moschouris H. , et al. Chemoembolization of hepatocellular carcinoma with HepaSphere 30-60 μm. Safety and efficacy study. Cardiovasc Intervent Radiol 2014; 37 (01) 165-175
- 9 Han K, Kim JH. Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system. World J Gastroenterol 2015; 21 (36) 10327-10335
- 10 Burrel M, Reig M, Forner A. , et al. Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design. J Hepatol 2012; 56 (06) 1330-1335
- 11 Bouchard-Fortier A, Lapointe R, Perreault P, Bouchard L, Pomier-Layrargues G. Transcatheter arterial chemoembolization of hepatocellular carcinoma as a bridge to liver transplantation: a retrospective study. Int J Hepatol 2011; 2011: 974514
- 12 Graziadei IW, Sandmueller H, Waldenberger P. , et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 2003; 9 (06) 557-563
- 13 Kulik L. Criteria for liver transplantation in hepatocellular carcinoma. Clin Liver Dis 2015; 6 (04) 100-102
- 14 Riaz A, Gates VL, Atassi B. , et al. Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 2011; 79 (01) 163-171
- 15 Padia SA, Kwan SW, Roudsari B, Monsky WL, Coveler A, Harris WP. Superselective yttrium-90 radioembolization for hepatocellular carcinoma yields high response rates with minimal toxicity. J Vasc Interv Radiol 2014; 25 (07) 1067-1073
- 16 Vouche M, Habib A, Ward TJ. , et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology 2014; 60 (01) 192-201
- 17 Pompili M, Saviano A, de Matthaeis N. , et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. Results of a multicenter Italian survey. J Hepatol 2013; 59 (01) 89-97
- 18 Livraghi T, Meloni F, Di Stasi M. , et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?. Hepatology 2008; 47 (01) 82-89
- 19 Lencioni R, Della Pina C, Bartolozzi C. Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma. Abdom Imaging 2005; 30 (04) 401-408
- 20 Chen MH, Wei Y, Yan K. , et al. Treatment strategy to optimize radiofrequency ablation for liver malignancies. J Vasc Interv Radiol 2006; 17 (04) 671-683
- 21 Salem R, Vouche M, Habib A, Kim E, Sato KT, Hickey R, Lewandowski R. Reply: To PMID 24691943. Hepatology 2015; 61 (01) 407
- 22 Seror O, Nault JC, Nahon P, N'Kontchou G, Trinchet JC. Is segmental transarterial yttrium 90 radiation a curative option for solitary hepatocellular carcinoma ≤5 cm?. Hepatology 2015; 61 (01) 406-407
- 23 Tohme S, Sukato D, Chen HW. , et al. Yttrium-90 radioembolization as a bridge to liver transplantation: a single-institution experience. J Vasc Interv Radiol 2013; 24 (11) 1632-1638
- 24 Bruix J, Sherman M. ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (03) 1020-1022
- 25 Llovet JM, Real MI, Montaña X. , et al; Barcelona Liver Cancer Group. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359 (9319): 1734-1739
- 26 Lo CM, Ngan H, Tso WK. , et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35 (05) 1164-1171
- 27 Satake M, Uchida H, Arai Y. , et al. Transcatheter arterial chemoembolization (TACE) with lipiodol to treat hepatocellular carcinoma: survey results from the TACE study group of Japan. Cardiovasc Intervent Radiol 2008; 31 (04) 756-761
- 28 Ahmadzadehfar H, Meyer C, Ezziddin S. , et al. Hepatic volume changes induced by radioembolization with 90Y resin microspheres. A single-centre study. Eur J Nucl Med Mol Imaging 2013; 40 (01) 80-90
- 29 Miyayama S, Yamashiro M, Hashimoto M. , et al. Comparison of local control in transcatheter arterial chemoembolization of hepatocellular carcinoma ≤6 cm with or without intraprocedural monitoring of the embolized area using cone-beam computed tomography. Cardiovasc Intervent Radiol 2014; 37 (02) 388-395
- 30 Iwazawa J, Ohue S, Hashimoto N, Muramoto O, Mitani T. Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma. Eur J Radiol 2012; 81 (12) 3985-3992
- 31 Lencioni R, Llovet JM, Han G. , et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: the SPACE trial. J Hepatol 2016; 64 (05) 1090-1098
- 32 Chapman WC, Majella Doyle MB, Stuart JE. , et al. Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg 2008; 248 (04) 617-625
- 33 Yao FY, Hirose R, LaBerge JM. , et al. A prospective study on downstaging of hepatocellular carcinoma prior to liver transplantation. Liver Transpl 2005; 11 (12) 1505-1514
- 34 Lewandowski RJ, Kulik LM, Riaz A. , et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 2009; 9 (08) 1920-1928
- 35 Salem R, Lewandowski RJ, Kulik L. , et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 2011; 140 (02) 497-507.e2
- 36 Iñarrairaegui M, Pardo F, Bilbao JI. , et al. Response to radioembolization with yttrium-90 resin microspheres may allow surgical treatment with curative intent and prolonged survival in previously unresectable hepatocellular carcinoma. Eur J Surg Oncol 2012; 38 (07) 594-601
- 37 Kulik LM, Atassi B, van Holsbeeck L. , et al. Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 2006; 94 (07) 572-586
- 38 Kubota K, Makuuchi M, Kusaka K. , et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997; 26 (05) 1176-1181
- 39 Shindoh J, Tzeng CW, Aloia TA. , et al. Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases. Ann Surg Oncol 2013; 20 (08) 2493-2500
- 40 Vouche M, Lewandowski RJ, Atassi R. , et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59 (05) 1029-1036
- 41 Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 2007; 94 (03) 274-286
- 42 Salem R, Mazzaferro V, Sangro B. Yttrium 90 radioembolization for the treatment of hepatocellular carcinoma: biological lessons, current challenges, and clinical perspectives. Hepatology 2013; 58 (06) 2188-2197
- 43 Gaba RC, Lewandowski RJ, Kulik LM. , et al. Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 2009; 16 (06) 1587-1596
- 44 Jakobs TF, Saleem S, Atassi B. , et al. Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90yttrium microspheres. Dig Dis Sci 2008; 53 (09) 2556-2563
- 45 Sarpel U, Spivack JH, Berger Y. , et al. The effect of locoregional therapies in patients with advanced hepatocellular carcinoma treated with sorafenib. HPB (Oxford) 2016; 18 (05) 411-418
- 46 Li X, Feng GS, Zheng CS, Zhuo CK, Liu X. Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol 2004; 10 (19) 2878-2882
- 47 Pawlik TM, Reyes DK, Cosgrove D, Kamel IR, Bhagat N, Geschwind JF. Phase II trial of sorafenib combined with concurrent transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Clin Oncol 2011; 29 (30) 3960-3967
- 48 Weintraub JL, Salem R. Treatment of hepatocellular carcinoma combining sorafenib and transarterial locoregional therapy: state of the science. J Vasc Interv Radiol 2013; 24 (08) 1123-1134
- 49 Bruix J, Raoul JL, Sherman M. , et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol 2012; 57 (04) 821-829
- 50 Llovet JM, Ricci S, Mazzaferro V. , et al; SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359 (04) 378-390
- 51 Chern MC, Chuang VP, Liang CT, Lin ZH, Kuo TM. Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein invasion: safety, efficacy, and prognostic factors. J Vasc Interv Radiol 2014; 25 (01) 32-40
- 52 Luo J, Guo RP, Lai EC. , et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol 2011; 18 (02) 413-420
- 53 Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer 1997; 79 (11) 2087-2094
- 54 Georgiades CS, Hong K, D'Angelo M, Geschwind JF. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 2005; 16 (12) 1653-1659
- 55 Kulik LM, Carr BI, Mulcahy MF. , et al. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 2008; 47 (01) 71-81
- 56 Sato K, Lewandowski RJ, Bui JT. , et al. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 2006; 29 (04) 522-529
- 57 Memon K, Kulik L, Lewandowski RJ. , et al. Radioembolization for hepatocellular carcinoma with portal vein thrombosis: impact of liver function on systemic treatment options at disease progression. J Hepatol 2013; 58 (01) 73-80
- 58 Sangro B, Salem R, Kennedy A, Coldwell D, Wasan H. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol 2011; 34 (04) 422-431
- 59 Biederman DM, Titano JJ, Tabori NE. , et al. Outcomes of radioembolization in the treatment of hepatocellular carcinoma with portal vein invasion: resin versus glass microspheres. J Vasc Interv Radiol 2016; 27 (06) 812-821.e2