Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition

Multi-session transarterial chemoembolization(TACE)is usually needed for the treatment of intermediate-stage hepatocellular carcinoma(HCC),but it may not always have a positive influence on prognosis due to high heterogeneity of HCC.To avoid ineffective repeated TACE,the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors.The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data.To date,only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness,although the concept has been introduced and applied in many TACE-related clinical trials.This review focuses on some of the issues related to different versions of TACE failure/refractoriness,the rationality of related definitions,and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence.A suggestion to re-define TAEC failure/refractoriness is also put forward.