Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma
Abstract
:1. Introduction
2. Hemodynamics in the Liver and HCC
2.1. Microvasculature of the Normal Liver
2.2. Hemodynamics in Hypervascular HCC
3. Limitation of TACE and Necessity of Curative TACE
3.1. Limitation of TACE
3.2. Necessity of Curative TACE
4. Rationale for Each TACE Technique
4.1. Rationale for Bland Embolization and DEB-TACE
4.2. Rationale for cTACE
4.3. Therapeutic Effects of Bland Embolization with Particles
4.4. Proper Use of Chemotherapeutics in TACE
4.5. Comparison of Therapeutic Effects between DEB-TACE and cTACE
4.6. Technical Advantages of Selective cTACE Compared with Non-Selective cTACE
5. Technical Tips for Performing Effective Superselective cTACE
5.1. Achievement of Marked Portal Vein Visualization with Iodized Oil During cTACE
5.2. Importance of the Order of Embolization of Each Tumor Feeder
5.3. Usefulness of Stepwise cTACE for Large HCCS
5.4. Usefulness of CT/CBCT and TACE Guidance Software
6. Concept of TACE Unsuitability
7. TACE Strategy According to the Number and Size of HCC
8. Further Directions
Author Contributions
Funding
Conflicts of Interest
References
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Author | Group/ | TACE | N | Bead | CR | PR | OR | P-Value | OS (%) | P-Value | |
---|---|---|---|---|---|---|---|---|---|---|---|
(Year) | Subgroup | Technique | Size (μm) | (%) | (%) | (%) | 1 y | 2 y | |||
Lammer Ref. [62] (2010) | Advanced disease * | DEB | 93 | mainly, 300–500 | 26.9 | 24.7 | 51.6 | 0.11 | |||
cTACE | 108 | 22.2 | 21.3 | 43.5 | |||||||
DEB | 63 | 52.4 | 0.038 | ||||||||
cTACE | 72 | 34.7 | |||||||||
Sacco Ref. [63] (2011) | DEB | 33 | 100–300 | 51.5 | 48.5 | 100 | 0.1 | 90 | 87 | 0.96 | |
cTACE | 34 | 70.6 | 29.4 | 100 | 90 | 84 | |||||
Golfieri Ref. [64] (2014) | DEB | 89 | 100–300 | 52.2 | 7.5 | 59.7 | 0.217 | 86 | 57 | 0.949 | |
cTACE | 88 | 58.1 | 12.2 | 70.3 | 84 | 55 | |||||
Ikeda Ref. [65] (2020) | DEB | 99 | 100–300 | 35.7 at 1 month | <0.0001 | ||||||
27.6 at 3 months | |||||||||||
cTACE | 101 | 84.2 at 1 month | <0.0001 | ||||||||
75.2 at 3 months |
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Miyayama, S. Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma. Appl. Sci. 2020, 10, 7337. https://doi.org/10.3390/app10207337
Miyayama S. Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma. Applied Sciences. 2020; 10(20):7337. https://doi.org/10.3390/app10207337
Chicago/Turabian StyleMiyayama, Shiro. 2020. "Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma" Applied Sciences 10, no. 20: 7337. https://doi.org/10.3390/app10207337
APA StyleMiyayama, S. (2020). Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma. Applied Sciences, 10(20), 7337. https://doi.org/10.3390/app10207337