Transarterial chemoembolization （TACE） is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis i...Transarterial chemoembolization （TACE） is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma （HCC） patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients＇ life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival （OS） with TACE was similar to that with hepatic resection and radiofrequency ablation. Mthough being used for decades, Lipiodol~ （Lipiodol~ Ultra Fluid~, Guerbet, France） remains important as a tumor-seeking and radio-opaque clrug delivery vector in intervendonal oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead （DEB） is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem~ （CeloNova Biosciences Inc., USA）, DC-Beads~ （BTG, UK） and HepaSphere~ （BioSphere Medical, Inc., USA）. Transarterial radioembolization （TARE） technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres~ （Sirtex Medical Limited, Australia） and TheraSphere~ （BTG, UK）. This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical evaluation. The key clinical trials of transcatheter arterial therapy for liver cancer are summarized.展开更多
Importance:Transarterial chemoembolization(TACE)has been associated with a wide range of practice variations for hepatocellular carcinoma(HCC)between the East and the West.This considerable ambiguity may lead to the h...Importance:Transarterial chemoembolization(TACE)has been associated with a wide range of practice variations for hepatocellular carcinoma(HCC)between the East and the West.This considerable ambiguity may lead to the heterogeneous quality in treatment and have a negative impact on the role of TACE in the overall multidisciplinary HCC treatment system.Objective:It may be a good start to establish a guideline worldwide to have this consensus from experts who represent east and west,although it does not cover all aspects of TACE.Evidence Review:An international expert panel on TACE is convened to cluster the expert’s opinions and summary a standard consensus.This panel committee consist of leading physicians in TACE on HCC from USA,France,Japan,Singapore,Korea,China,and so on.The first-round face-to-face consensus meeting was held during in Nanjing,China in October 2019.The second-round conference for revision of the consensus was held during the Annual Meeting of Chinese College of Interventionalists in August 2020 by a hybrid format of a Webinar and roundtable meeting.After several on-line revisions,the final manuscript was approved by all members of the panel in June 2021.Findings:The consensus statements were organized into the following categories:patients’selection,performing the procedure,TACE outcomes,repeat TACE,TACE failure/refractory,and TACE-based combination treatments.Conclusions and Relevance for Reviews:More and more evidences have showed the better outcomes with strategy of combined TACE with other local therapies such as ablations.The most-recently developing strategy of combined TACE with PD-1/PD-L1 plus tyrosine kinase inhibitor(TKI)agents has shined a light to the HCC patients,especially to those with high risk of tumor recurrence after treatment or TACE failure/refractory.展开更多
文摘Transarterial chemoembolization （TACE） is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma （HCC） patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients＇ life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival （OS） with TACE was similar to that with hepatic resection and radiofrequency ablation. Mthough being used for decades, Lipiodol~ （Lipiodol~ Ultra Fluid~, Guerbet, France） remains important as a tumor-seeking and radio-opaque clrug delivery vector in intervendonal oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead （DEB） is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem~ （CeloNova Biosciences Inc., USA）, DC-Beads~ （BTG, UK） and HepaSphere~ （BioSphere Medical, Inc., USA）. Transarterial radioembolization （TARE） technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres~ （Sirtex Medical Limited, Australia） and TheraSphere~ （BTG, UK）. This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical evaluation. The key clinical trials of transcatheter arterial therapy for liver cancer are summarized.
基金The study was supported by Jiangsu Provincial Special Program of Medical Science(BE2019750)National Natural Science Foundation of China(81827805)and National Key Research and Development Program(2018YFA0704100,2018YFA0704104).
文摘Importance:Transarterial chemoembolization(TACE)has been associated with a wide range of practice variations for hepatocellular carcinoma(HCC)between the East and the West.This considerable ambiguity may lead to the heterogeneous quality in treatment and have a negative impact on the role of TACE in the overall multidisciplinary HCC treatment system.Objective:It may be a good start to establish a guideline worldwide to have this consensus from experts who represent east and west,although it does not cover all aspects of TACE.Evidence Review:An international expert panel on TACE is convened to cluster the expert’s opinions and summary a standard consensus.This panel committee consist of leading physicians in TACE on HCC from USA,France,Japan,Singapore,Korea,China,and so on.The first-round face-to-face consensus meeting was held during in Nanjing,China in October 2019.The second-round conference for revision of the consensus was held during the Annual Meeting of Chinese College of Interventionalists in August 2020 by a hybrid format of a Webinar and roundtable meeting.After several on-line revisions,the final manuscript was approved by all members of the panel in June 2021.Findings:The consensus statements were organized into the following categories:patients’selection,performing the procedure,TACE outcomes,repeat TACE,TACE failure/refractory,and TACE-based combination treatments.Conclusions and Relevance for Reviews:More and more evidences have showed the better outcomes with strategy of combined TACE with other local therapies such as ablations.The most-recently developing strategy of combined TACE with PD-1/PD-L1 plus tyrosine kinase inhibitor(TKI)agents has shined a light to the HCC patients,especially to those with high risk of tumor recurrence after treatment or TACE failure/refractory.
