title: Re-evaluating transarterial chemoembolization for the treatment of hepatocellular carcinoma: Consensus recommendations and review by an International Expert Panel.
abstract: Patients with unresectable hepatocellular carcinoma (HCC) usually receive transarterial chemoembolization (TACE) or systemic therapies with intermediate and advanced-stage disease. However, intermediate-stage HCC patients often have unsatisfactory clinical outcomes with repeated TACE and there is considerable uncertainty surrounding the criteria for repeating or stopping TACE treatment. In July 2012, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was re-convened in Shanghai in an attempt to provide a consensus on the practice of TACE, particularly in regard to evaluating TACE 'failure'. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies for intermediate HCC. This review summarizes the evidence discussed at the meeting and provides expert recommendations regarding the use of TACE for unresectable intermediate-stage HCC. A key consensus of the Expert Panel was that the current definitions of TACE failure are not useful in differentiating between situations where TACE is no longer effective in controlling disease locally vs. systemically. By redefining these concepts, it may be possible to provide a clearer indication of when TACE should be repeated and more importantly, when TACE should be discontinued.
authors.affiliation: Department of Oncology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ann Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Deepak
authors.initials: D
authors.lastname: Amarapurkar
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Khean L
authors.initials: KL
authors.lastname: Goh
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.forename: Rheun-Chuan
authors.initials: RC
authors.lastname: Lee
authors.forename: Laurentius A
authors.initials: LA
authors.lastname: Lesmana
authors.forename: Ho Yeong
authors.initials: HY
authors.lastname: Lim
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Ronnie T
authors.initials: RT
authors.lastname: Poon
authors.forename: Chee-Kiat
authors.initials: CK
authors.lastname: Tan
authors.forename: Tawesak
authors.initials: T
authors.lastname: Tanwandee
authors.forename: Gaojun
authors.initials: G
authors.lastname: Teng
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods / Q000592:standards*; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods / Q000592:standards*; D008113:Liver Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
keywords: TACE; combination therapy; hepatocellular carcinoma; sorafenib