title: Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update.
abstract: In the 2010 version of the Japan Society of Hepatology (JSH) consensus-based treatment algorithm for the management of hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) failure/refractoriness was defined assuming the use of superselective lipiodol TACE, which has been widely used worldwide and particularly in Japan, and areas with lipiodol deposition were considered to be necrotic. However, this concept is not well accepted internationally. Furthermore, following the approval of microspheres, an embolic material that does not use lipiodol, in February 2014 in Japan, the phrase 'lipiodol deposition' needed to be changed to 'necrotic lesion or viable lesion'. Accordingly, the respective section in the JSH guidelines was revised to define TACE failure as an insufficient response after ≥2 consecutive TACE procedures that is evident on response evaluation computed tomography or magnetic resonance imaging after 1-3 months, even after chemotherapeutic agents have been changed and/or the feeding artery has been reanalyzed. In addition, the appearance of a higher number of lesions in the liver than that recorded at the previous TACE procedure (other than the nodule being treated) was added to the definition of TACE failure/refractoriness. Following the discussion of other issues concerning the continuous elevation of tumor markers, vascular invasion, and extrahepatic spread, descriptions similar to those in the previous version were approved. The revision of these TACE failure definitions was approved by over 85% of HCC experts.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Namiki
authors.initials: N
authors.lastname: Izumi
authors.forename: Masumi
authors.initials: M
authors.lastname: Kadoya
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Ueshima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Ogasawara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Minami
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D004998:Ethiodized Oil; D019538:Health Care Surveys; D006499:Hepatic Artery; D006801:Humans; D007564:Japan; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D000077157:Sorafenib; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D010671:Phenylurea Compounds; D009536:Niacinamide; D004998:Ethiodized Oil; D000077157:Sorafenib