| Theme |
Treatment Strategy for Advanced Hepatocellular Carcinoma |
| Title |
Transcatheter Arterial Chemoembolization (TACE) for Advanced Hepatocellular Carcinoma : Indication and Outcomes |
| Author |
Shiro Miyayama |
Departments of Diagnostic Radiology, Fukuiken Saiseikai Hospital |
| Author |
Taku Sanada |
Departments of Internal Medicine, Fukuiken Saiseikai Hospital |
| Author |
Kazuo Notsumata |
Departments of Internal Medicine, Fukuiken Saiseikai Hospital |
| Author |
Teruyuki Ueda |
Departments of Internal Medicine, Fukuiken Saiseikai Hospital |
| Author |
Hisato Matsuda |
Departments of Internal Medicine, Fukuiken Saiseikai Hospital |
| Author |
Hiroyuki Watanabe |
Departments of Internal Medicine, Fukuiken Saiseikai Hospital |
| [ Summary ] |
In Child‒Pugh class A patients with hepatocellular carcinoma (HCC) ≤7 cm and with fewer than four lesions, a good prognosis can be expected if they are treated with superselective transcatheter arterial chemoembolization (TACE). Superselective TACE can also produce excellent outcomes in patients with large tumors and fewer than three lesions ; however, TACE via the extrahepatic collaterals and stepwise TACE sessions are frequently required. TACE is indicated for patients with a tumor thrombus in the second or third portal branch and is also indicated for selected patients with tumor thrombus in the first portal branch or the main portal trunk. TACE for tumor thrombus in the hepatic vein and inferior vena cava is one of the effective therapeutic options；however, it has a risk of pulmonary embolism. TACE is also effective for bile duct tumor thrombus. However, all intraductal tumor thrombi are dropped into the common bile duct after superselective TACE, and endoscopic removal of necrotic tumor casts is required. TACE is also indicated for patients with extrahepatic metastases whose intrahepatic tumors are thought likely to become the main cause of death. Administration of antiangiogenic agents may also make it possible to expand the indications of TACE for HCC patients with extrahepatic lesions. |