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Semin intervent Radiol 2023; 40(06): 505-510
DOI: 10.1055/s-0043-1777715
Review Article

Chemoembolization Plus Ablation: Current Status

Farnaz Dadrass
1   Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Hospital, New York, New York
,
Pascal Acree
2   Department of Radiology and Imaging, Medical College of Georgia School of Medicine, Medical College of Georgia at Augusta University, Athens, Georgia
,
Edward Kim
1   Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Hospital, New York, New York
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Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. The treatment landscape for HCC has evolved significantly over the past decade, with several modalities available to treat various stages of disease. The Barcelona Clinic Liver Cancer (BCLC) system provides a foundation for treatment guidance. However, given the complex nature of HCC, a more nuanced approach is often required, especially for lesions sized between 3 and 5 cm. This review aims to analyze the available treatments for early-stage HCC lesions between 3 and 5 cm, with a focus on the therapeutic potential and efficacy of transarterial chemoembolization (TACE)–ablation. Additional therapies including TACE, ablation, transarterial radioembolization, and surgical resection are also reviewed and compared with TACE–ablation. TACE–ablation is a viable therapeutic option for early-stage HCC lesions between 3 and 5 cm. Surgical resection remains the gold standard. Although recent studies suggest radiation segmentectomy may be a curative approach for this patient population, further studies are needed to compare the relative efficacies between TACE–ablation and radiation segmentectomy.

Keywords

hepatocellular carcinoma - TACE–ablation - interventional oncology - interventional radiology - chemoembolization - ablation


Publication History

Article published online:
24 January 2024

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
    Google Scholar
  • 2 Kim YY, Kim MJ, Kim EH, Roh YH, An C. Hepatocellular carcinoma versus other hepatic malignancy in cirrhosis: performance of LI-RADS version 2018. Radiology 2019; 291 (01) 72-80
    CrossrefPubMedGoogle Scholar
  • 3 Vogel A, Meyer T, Sapisochin G, Salem R, Saborowski A. Hepatocellular carcinoma. Lancet 2022; 400 (10360): 1345-1362
    CrossrefPubMedGoogle Scholar
  • 4 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (03) 329-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Richani M, Kolly P, Knoepfli M. et al. Treatment allocation in hepatocellular carcinoma: assessment of the BCLC algorithm. Ann Hepatol 2016; 15 (01) 82-90
    CrossrefPubMedGoogle Scholar
  • 6 Reig M, Forner A, Rimola J. et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022; 76 (03) 681-693
    CrossrefPubMedGoogle Scholar
  • 7 Mazzaferro V, Regalia E, Doci R. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334 (11) 693-699
    CrossrefPubMedGoogle Scholar
  • 8 Jonas S, Bechstein WO, Steinmüller T. et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 2001; 33 (05) 1080-1086
    CrossrefPubMedGoogle Scholar
  • 9 Lewandowski RJ, Gabr A, Abouchaleh N. et al. Radiation segmentectomy: potential curative therapy for early hepatocellular carcinoma. Radiology 2018; 287 (03) 1050-1058
    CrossrefPubMedGoogle Scholar
  • 10 Chang YJ, Chung KP, Chang YJ, Chen LJ. Long-term survival of patients undergoing liver resection for very large hepatocellular carcinomas. Br J Surg 2016; 103 (11) 1513-1520
    CrossrefPubMedGoogle Scholar
  • 11 Jaeck D, Bachellier P, Oussoultzoglou E, Weber JC, Wolf P. Surgical resection of hepatocellular carcinoma. Post-operative outcome and long-term results in Europe: an overview. Liver Transpl 2004; 10 (2, Suppl 1): S58-S63
    CrossrefPubMedGoogle Scholar
  • 12 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226 (02) 441-451
    CrossrefPubMedGoogle Scholar
  • 13 Kwong AJ, Ghaziani TT, Yao F, Sze D, Mannalithara A, Mehta N. National trends and waitlist outcomes of locoregional therapy among liver transplant candidates with hepatocellular carcinoma in the United States. Clin Gastroenterol Hepatol 2022; 20 (05) 1142-1150.e4
    CrossrefPubMedGoogle Scholar
  • 14 Salem R, Johnson GE, Kim E. et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology 2021; 74 (05) 2342-2352
    CrossrefPubMedGoogle Scholar
  • 15 Kim E, Sher A, Abboud G. et al. Radiation segmentectomy for curative intent of unresectable very early to early stage hepatocellular carcinoma (RASER): a single-centre, single-arm study. Lancet Gastroenterol Hepatol 2022; 7 (09) 843-850
    CrossrefPubMedGoogle Scholar
  • 16 Yin XY, Xie XY, Lu MD. et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 2009; 115 (09) 1914-1923
    CrossrefPubMedGoogle Scholar
  • 17 Lee DH, Lee JM, Lee JY. et al. Radiofrequency ablation of hepatocellular carcinoma as first-line treatment: long-term results and prognostic factors in 162 patients with cirrhosis. Radiology 2014; 270 (03) 900-909
    CrossrefPubMedGoogle Scholar
  • 18 Lu DS, Yu NC, Raman SS. et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005; 234 (03) 954-960
    CrossrefPubMedGoogle Scholar
  • 19 Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 2010; 195 (03) 758-765
    CrossrefPubMedGoogle Scholar
  • 20 Liu Y, Zheng Y, Li S, Li B, Zhang Y, Yuan Y. Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 2013; 68 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 21 Golfieri R, Giampalma E, Renzulli M. et al; Precision Italia Study Group. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 2014; 111 (02) 255-264
    CrossrefPubMedGoogle Scholar
  • 22 Dhondt E, Lambert B, Hermie L. et al. 90Y radioembolization versus drug-eluting bead chemoembolization for unresectable hepatocellular carcinoma: results from the TRACE phase II randomized controlled trial. Radiology 2022; 303 (03) 699-710
    CrossrefPubMedGoogle Scholar
  • 23 Salem R, Gordon AC, Mouli S. et al. Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 2016; 151 (06) 1155-1163.e2
    CrossrefPubMedGoogle Scholar
  • 24 Chang Y, Jeong SW, Young Jang J, Jae Kim Y. Recent updates of transarterial chemoembolization in hepatocellular carcinoma. Int J Mol Sci 2020; 21 (21) 8165
    CrossrefPubMedGoogle Scholar
  • 25 Kudo M, Matsui O, Izumi N. et al; Liver Cancer Study Group of Japan. Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update. Oncology 2014; 87 (Suppl. 01) 22-31
    CrossrefPubMedGoogle Scholar
  • 26 Peng ZW, Zhang YJ, Liang HH, Lin XJ, Guo RP, Chen MS. Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial. Radiology 2012; 262 (02) 689-700
    CrossrefPubMedGoogle Scholar
  • 27 Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?. Radiology 2009; 252 (03) 905-913
    CrossrefPubMedGoogle Scholar
  • 28 Hoffmann R, Rempp H, Syha R. et al. Transarterial chemoembolization using drug eluting beads and subsequent percutaneous MR-guided radiofrequency ablation in the therapy of intermediate sized hepatocellular carcinoma. Eur J Radiol 2014; 83 (10) 1793-1798
    CrossrefPubMedGoogle Scholar
  • 29 Min JH, Lee MW, Cha DI. et al. Radiofrequency ablation combined with chemoembolization for intermediate-sized (3-5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 2013; 14 (02) 248-258
    CrossrefPubMedGoogle Scholar
  • 30 Lewis S, Dawson L, Barry A, Stanescu T, Mohamad I, Hosni A. Stereotactic body radiation therapy for hepatocellular carcinoma: from infancy to ongoing maturity. JHEP Rep Innov Hepatol 2022; 4 (08) 100498
    CrossrefPubMedGoogle Scholar
  • 31 Kim N, Cheng J, Jung I. et al. Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol 2020; 73 (01) 121-129
    CrossrefPubMedGoogle Scholar
  • 32 Groeschl RT, Gamblin TC, Turaga KK. Ablation for hepatocellular carcinoma: validating the 3-cm breakpoint. Ann Surg Oncol 2013; 20 (11) 3591-3595
    CrossrefPubMedGoogle Scholar
  • 33 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
    CrossrefPubMedGoogle Scholar
  • 34 Yan L, Ren Y, Qian K. et al. Sequential transarterial chemoembolization and early radiofrequency ablation improves clinical outcomes for early-intermediate hepatocellular carcinoma in a 10-year single-center comparative study. BMC Gastroenterol 2021; 21 (01) 182
    CrossrefPubMedGoogle Scholar
  • 35 Lu Z, Wen F, Guo Q, Liang H, Mao X, Sun H. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials. Eur J Gastroenterol Hepatol 2013; 25 (02) 187-194
    CrossrefPubMedGoogle Scholar
  • 36 Lee HJ, Kim JW, Hur YH. et al. Conventional chemoembolization plus radiofrequency ablation versus surgical resection for single, medium-sized hepatocellular carcinoma: propensity-score matching analysis. J Vasc Interv Radiol 2019; 30 (03) 284-292.e1
    CrossrefPubMedGoogle Scholar
  • 37 Peng Z, Wei M, Chen S. et al. Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol 2018; 28 (08) 3522-3531
    CrossrefPubMedGoogle Scholar
  • 38 Saviano A, Iezzi R, Giuliante F. et al; HepatoCATT Study Group. Liver resection versus radiofrequency ablation plus transcatheter arterial chemoembolization in cirrhotic patients with solitary large hepatocellular carcinoma. J Vasc Interv Radiol 2017; 28 (11) 1512-1519
    CrossrefPubMedGoogle Scholar
  • 39 Dan Y, Meng W, Li W, Chen Z, Lyu Y, Yu T. Transarterial chemoembolization combined with radiofrequency ablation versus hepatectomy for hepatocellular carcinoma: a meta-analysis. Front Surg 2022; 9: 948355
    CrossrefPubMedGoogle Scholar
  • 40 Fidelman N, Johanson C, Kohi MP. et al. Prospective Phase II trial of drug-eluting bead chemoembolization for liver transplant candidates with hepatocellular carcinoma and marginal hepatic reserve. J Hepatocell Carcinoma 2019; 6: 93-103
    CrossrefPubMedGoogle Scholar
  • 41 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
    CrossrefPubMedGoogle Scholar
  • 42 Montazeri SA, De la Garza-Ramos C, Lewis AR. et al. Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors. Eur J Nucl Med Mol Imaging 2022; 49 (11) 3892-3897
    CrossrefPubMedGoogle Scholar
  • 43 Biederman DM, Titano JJ, Bishay VL. et al. Radiation segmentectomy versus TACE combined with microwave ablation for unresectable solitary hepatocellular carcinoma up to 3 cm: a propensity score matching study. Radiology 2017; 283 (03) 895-905
    CrossrefPubMedGoogle Scholar