Transcatheter arterial procedures in the treatment of patients with hepatocellular carcinoma: a review of literature.
BACKGROUND
Transcatheter arterial procedures (TAP) have been widely used to treat hepatocellular carcinoma (HCC) in several clinical settings (advanced and neoadjuvant), and contraindications and secondary effects have been clearly described. However, it is still unclear which patients should be selected for treatment, which procedures should be used, in particular whether or not to add an antiblastic agent to embolization, and if the treatment provides a survival advantage in patient with HCC.


METHODS
We conducted a Medline search for all study reports published until May 2002. Data from randomised studies were evaluated in detail.


RESULTS
Data on the use of TAP for the treatment of unresectable HCC mainly come from retrospective studies that are difficult to compare because of the lack of standardized procedures. Some prognostic systems have been proposed in order to improve the selection of the patients that can benefit from treatment. While the effects in terms of tumour response are clearly documented, the results in terms of survival are still unclear.


CONCLUSIONS
The real impact of TAP on survival remains to be determined in all clinical settings. The very few published prospective randomised trials are underpowered and cannot provide any definitive conclusions. Thus, there is an urgent need for prospective controlled trials in order assess the impact of TAP on survival and to compare different procedures.
De Maio
Ermelinda
E
Medical oncology B, National Cancer Institute of Naples, Via M. Semmola, 80131, Naples, Italy.
Fiore
Francesco
F
Daniele
Bruno
B
D'Angelo
Roberto
R
Perrone
Francesco
F
Barletta
Emiddio
E
Iaffaioli
Rosario Vincenzo
RV
Pignata
Sandro
S
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004621:Embolization, Therapeutic; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents