Conventional vs drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma

Abstract

Transarterial chemoembolization (TACE) is the current standard of therapy for patients with intermediate-stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer classification. The concept of conventional TACE (cTACE) is the selective obstruction of tumor-feeding artery by injection of chemotherapeutic agents, leading to ischemic necrosis of the target tumor via cytotoxic and ischemic effects. Drug-eluting beads (DEBs) have been imposed as novel drug-delivering agents for TACE, which allows for higher concentrations of drugs within the target tumor and lower systemic concentrations compared with cTACE. Despite the theoretical advantages of DEB-TACE, it is still controversial in clinical practice as to whether DEB-TACE is superior to cTACE in regard to overall survival and treatment response. In this review article, we summarize the clinical efficacy and safety of DEB-TACE for patients with intermediate or advanced stage HCC in comparison with cTACE.

Keywords: Drug-eluting beads transarterial chemoembolization; Hepatocellular carcinoma; Transarterial chemoembolization.

Figure 1

Action mechanism of drug-eluting bead-transarterial chemoembolization in hepatocellular carcinoma. Sustained release of chemotherapeutic agents from microbeads of uniform size, which embolize supplying vessels more distally, enables local concentration of cytotoxic agents to be higher within tumor.